Flood damage risk assessment optimizing a flood mitigation system

Flood risk management plan for potentially damaged areas is a main requirement from the European Directive 2007/60. Therefore, assessment and evaluation of the potential flood damages in quantitative terms need to be defined in mapped flood risk areas. Quantitative evaluation should be in agreement with the required cost-benefit analysis as a rational decision-making tool optimizing the flood mitigation system. In the first part of the paper, analyses are reported, based on recent flood events that had taken place in the Europe, in order to obtain depth-damage functions to apply in the Sardinia region (Italy). Flood damage functions are not still available for every European country and the paper analysed previous studies to define depth-damage functions for this region. The paper focuses then on the validation of the proposed depth-damage functions. The available flood data and reported damages of the massive storm happened in South-Est Sardinia the 22nd of October 2008 are analysed. Data analysis allows to compute the total economic losses for different land uses conditions and to compare with the evaluated ones. In the last part of the paper, expected damages evaluated using depth-damages functions are used for the Coghinas river lowlands valley. The regional Water District Authority defining the flood risk management plan considers this river basin as a pilot area. Applying hydraulic models to floodplain river flow allows evaluation of the expected flood damages using the depth-damage functions. Moreover, the procedure allows developing the cost-benefit analysis in order to justify different design scenarios and gives a rational decision-making tool optimizing the flood mitigation syste

Sustainable Cultural Heritage Planning and Management of Overtourism in Art Cities: Lessons from Atlas World Heritage

In recent years, there has been an increase in international tourist arrivals worldwide. In this respect, Art Cities are among the most favorable tourist destinations, as they exhibit masterpieces of art and architecture in a cultural environment. However, the so-called phenomenon of overtourism has emerged as a significant threat to the residents’ quality of life, and, consequently, the sustainability of Art Cites. This research aims to develop a management toolkit that assists site managers to control tourism flows in Art Cities and World Heritage Sites and promotes the residents’ quality of life. The research methodology was developed within the framework of the Atlas Project in 2019. In this project, five European Art Cities, including Florence, Edinburgh, Bordeaux, Porto, and Santiago de Compostela, discussed their common management challenges through the shared learning method. After developing selection criteria, the Atlas’ partners suggested a total of nine strategies as best practices for managing overtourism in Art Cities in multiple sections of accommodation policies, monitoring tactics, and promotional offerings. The Atlas project was conducted before the outbreak of the COVID-19 virus pandemic. Based on the current data, it is somehow uncertain when and how tourism activities will return to normal. The analysis of the Atlas findings also highlights some neglected dimensions in the current strategies in terms of environmental concerns, climate change impacts, crisis management, and cultural development plans, which require further research to boost the heritage planning process

Surgical evolution in the treatment of mandibular condyle fractures

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application

Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

Background: During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods: We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results: Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion: The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures

Assessment of evolutionary algorithms for optimal operating rules design in real Water Resource Systems

Two evolutionary algorithms (EAs) are assessed in this paper to design optimal operating rules (ORs) for Water Resource Systems (WRS). The assessment is established through a parameter analysis of both algorithms in a theoretical case, and the methodology described in this paper is applied to a complex, real case. These two applications allow us to analyse an algorithm's properties and performance by defining ORs, how an algorithm's termination/convergence criteria affect the results and the importance of decision-makers participating in the optimisation process. The former analysis reflects the need for correctly defining the important algorithm parameters to ensure an optimal result and how the greater number of termination conditions makes the algorithm an efficient tool for obtaining optimal ORs in less time. Finally, in the complex real case application, we discuss the participation value of decision-makers toward correctly defining the objectives and making decisions in the post-process. (C) 2014 Elsevier Ltd. All rights reserved.[EN]The authors wish to thank the University of Cagliari (Sardinia) and the Basin Agency of Sardinia for the data provided in the development of this study, as well as the Autonomous Region of Sardinia for funding the research project CRP 2_716. Thanks are also due to the Spanish Ministry of Science and Innovation (Comision Interministerial de Ciencia y Tecnologia, CICYT) for funding the projects NUTEGES (VI Plan Nacional de I+D-Ei 2008-2011, CGL2012-34978) and SCARCE (program Consolider-Ingenio 2010, project CSD2009-00065). The authors also thank the European Commission (Directorate-General for Research and Innovation) for funding the projects DROUGHT-R&SPI (program FP7-ENV-2011, project 282769), SIRIUS (FP7-SPACE-2010-1, project 262902), LIFE ALBUFERA project (LIFE12 ENV/ES/000685) and WAMCD project (EC-DG Environment No. 07.0329/2013/671291/SUB/ENV.C.1).Lerma Elvira, N.; Paredes Arquiola, J.; Andreu Álvarez, J.; Solera Solera, A.; Sechi, GM. (2015). Assessment of evolutionary algorithms for optimal operating rules design in real Water Resource Systems. Environmental Modelling and Software. 69:425-436. https://doi.org/10.1016/j.envsoft.2014.09.024S4254366

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys