Energy based vessel sealing devices in thyroid surgery: A systematic review to clarify the relationship with recurrent laryngeal nerve injuries

Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future

A comprehensive framework tool for performance assessment of NBS for hydro-meteorological risk management

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Quantifying the effects of nature-based solutions in reducing risks from hydrometeorological hazards: Examples from Europe

The combination of climate change and social and ecological factors will increase risks societies face from hydrometeorological hazards (HMH). Reducing these risks is typically achieved through the deployment of engineered (or grey) infrastructure but increasingly, nature-based so-lutions (NBS) are being considered. Most risk assessment frameworks do not allow capturing well the role NBS can play in addressing all components of risk, i.e., the hazard characteristics and the exposure and vulnerability of social-ecological systems. Recently, the Vulnerability and Risk as-sessment framework developed to allow the assessment of risks in the context of NBS implemen-tation (VR-NBS framework) was proposed. Here, we carry out the first implementation of this framework using five case study areas in Europe which are exposed to various HMH. Our results show that we can demonstrate the effect NBS have in terms of risk reduction and that this can be achieved by using a flexible library of indicators that allows to capture the specificities of each case study hazard, social and ecological circumstances. The approach appears to be more effec-tive for larger case study areas, but further testing is required in a broader variety of contexts

Earth observation for sustainable urban planning in developing countries: needs, trends, and future directions

Abstract: Cities are constantly changing and authorities face immense challenges in obtaining accurate and timely data to effectively manage urban areas. This is particularly problematic in the developing world where municipal records are often unavailable or not updated. Spaceborne earth observation (EO) has great potential for providing up-to-date spatial information about urban areas. This article reviews the application of EO for supporting urban planning. In particular, the article overviews case studies where EO was used to derive products and indicators required by urban planners. The review concludes that EO has sufficiently matured in recent years but that a shift from the current focus on purely science-driven EO applications to the provision of useful information for day-to-day decision-making and urban sustainability monitoring is clearly needed

Evaluating the Impact of Nature-Based Solutions: A Handbook for Practitioners

The Handbook aims to provide decision-makers with a comprehensive NBS impact assessment framework, and a robust set of indicators and methodologies to assess impacts of nature-based solutions across 12 societal challenge areas: Climate Resilience; Water Management; Natural and Climate Hazards; Green Space Management; Biodiversity; Air Quality; Place Regeneration; Knowledge and Social Capacity Building for Sustainable Urban Transformation; Participatory Planning and Governance; Social Justice and Social Cohesion; Health and Well-being; New Economic Opportunities and Green Jobs. Indicators have been developed collaboratively by representatives of 17 individual EU-funded NBS projects and collaborating institutions such as the EEA and JRC, as part of the European Taskforce for NBS Impact Assessment, with the four-fold objective of: serving as a reference for relevant EU policies and activities; orient urban practitioners in developing robust impact evaluation frameworks for nature-based solutions at different scales; expand upon the pioneering work of the EKLIPSE framework by providing a comprehensive set of indicators and methodologies; and build the European evidence base regarding NBS impacts. They reflect the state of the art in current scientific research on impacts of nature-based solutions and valid and standardized methods of assessment, as well as the state of play in urban implementation of evaluation frameworks

Water management

No abstract available