A Straightforward Framework for Road Network Screening to Lombardy Region (Italy)

It is not possible to deal with sustainable mobility without considering road safety as a key element: Target 3.6 of the Sustainable Development Goals aims at halving the number of road deaths by 2030. To do so, further effort and effective tools are required for road authorities, to implement improvement measures and enhance road safety for all. Road network screening (RNS) is the first step of the whole Road Infrastructure Safety Management (RISM) System process. It is applied to a wide scale to assess the safety performance of the whole road network and identify the worst performing roads (or sites). The literature is quite rich with RNS models and methods, which have greatly improved, recently. Moreover, although many national frameworks on road safety have been issued over time, some barriers remain, specifically related to data quality, such as accurate crash location, which is mainly used to integrate crash data with other databases. In addition, most of these frameworks adopted partial indexes to identify black spots and presented results using fixed maps for visualization. This paper fills these gaps by the proposal of a straightforward operational framework to perform RNS, based on a simple and flexible rationale to integrate raw crash, traffic, and road data. Specifically, the framework: (i) manages crash location data, without relying on plane or geographical coordinates, which are missing or inaccurate and still are a crucial issue in many European countries such as Italy; (ii) adopts an adjusted accident cost rate index that integrates frequency and severity of crashes as well as a measurement of exposure; (iii) introduces variable maps that show the results at different jurisdiction levels. A relevant case study demonstrates the usefulness of this framework using 30,000+ crash data of the whole non-urban road network of the Lombardy Region (Northern Italy). Road authorities could adopt this framework to perform an accurate safety screening on the overall regional road network. Moreover, this framework could be implemented in a road traffic safety managerial system to better prioritise safety interventions within a tight budget and help achieve sustainable development targets

Measuring Safety Performance in the extra-urban Road Network of Lombardy Region (Italy)

Road Network Screening (RNS) is a process to evaluate the safety performance of the whole road network and identify worst performing roads. Currently, literature provides many models and methods for RNS. Moreover, several frameworks of RNS were issued at the European National Level over time. However, even if sophisticated models and methods could be preferable for their computational accuracy, they may be far from the capabilities of practitioners. In addition, other issues such as availability of operative attributes and data quality and processing persist. For instance, accurate crash location, which is crucial for detailed analyses of high crash rates at some locations, is still an issue: many road administrations pointed out that coordinates miss or are inaccurate in many cases. Within this context, this paper proposes a straightforward operational framework to evaluate safety performance for RNS, using a flexible rationale that integrates crash, traffic, and road data, respectively. More precisely, this framework: (a) handles crash location data without using spatial coordinates; (b) computes the crash rate index at different administrative levels; (c) shows results by Geographic Information System (GIS) maps. This framework is applied to the whole extra-urban road network of the Lombardy Region (Northern Italy) using 30.000+ crash data provided by the Regional Institute for Lombardy Policy Support (PoliS). Road authorities could adopt this framework to perform an accurate safety screening on the road network aimed at rational planning of safety interventions

Kinematic performance of micro-mobility vehicles during braking: experimental analysis and comparison between e-kick scooters and bikes

According to the Italian legislation, e-kick scooters and bikes are considered a single category of vehicles and can travel on the same infrastructures with the same rules; however, their kinematic behavior is very different. The adoption of a bike as a vehicle for covering short distances i.e., within 5 km is widely known both at the kinematic level and for its use by users. Conversely, e-kick scooters are "unknown" vehicles both for their kinematic characteristics and for their use by users. A handful of studies have shown how the behavior of e-kick scooters and bikes is very different; however, there are not many studies that analyze the different kinematic behavior of e-kick scooters and bikes. This study presents an experimental analysis that evaluates braking behavior by comparing e-kick scooters and traditional bikes according to several vehicle speeds. These analyzes help build a probabilistic mathematical model for estimating the stopping space of e-kick scooters and bikes. The availability of this model is crucial for the design of safe intersections between cycle paths and roads intended for motor vehicle traffic. Moreover, this model may reveal insights that could challenge the recent European regulations that equated e-kick scooters as bikes

A comparative cycling path selection for sustainable tourism in Franciacorta. An integrated AHP-ELECTRE method

Cycle tourism is a form of sustainable itinerant tourism expanding in Italy and the rest of the world, with prospects for growth in coming years. Europe and North America have already developed a wide range of cycling infrastructures tied to tourism experiences. Benefits induced are generally recognised: first, it is a sustainable solution that increases local economics while conserving the environment; second, it guarantees advantages on social connections, amusement, and physical and mental health. However, it requires an adequate network to enjoy destinations as historical and landscape peculiarities. Currently, literature provides some methods for planning itineraries dedicated to cycle tourism. Despite that, there is less attention on how evaluating existing or already planned tourist itineraries. This study covers this gap, by applying an integrated method to assess bicycle connections for tourism experiences within municipalities. Since this evaluation may contain many conflicting criteria (e.g., preferences of public administrator, technical and economic viability) and possible alternatives, this study frames the method as a multi-criteria decision-making problem (MCDM). Specifically, at first, the Analytical Hierarchy Process (AHP) is adopted to calculate weights for each criterium; next, the ELimination Et Choix Traduisant la REalitè (ELECTRE) method is applied to provide a (possible) priority ranking of cycling tourist paths among alternatives, by computing indices of discordance and concordance between pairs of alternatives. The framework is applied to the Franciacorta area (North-East Italy), a national and international tourist relevance territory encompassing 22 municipalities. This study may be useful for public administrators to rationalise and prioritise cycling routes

The implications for patients undergoing splenectomy: postsurgery risk management

Fabrizio Romano, Mattia Garancini, Arianna Libera Ciravegna, Fabio Uggeri, Luca Degrate, Matteo Maternini, Franco UggeriDepartment of General Surgery (Chirurgia I), San Gerardo Hospital, University of Milan-Bicocca, Monza, ItalyAbstract: Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkin's disease. Most patients undergoing therapeutic splenectomy are chronically ill with significant splenomegaly. This scenario can be associated with a high risk of postoperative morbidity and mortality due to the prolonged course of disease for patients with myelofibrosis; their susceptibility to infection, thrombosis, and hemorrhage; and the severe enlargement of their spleens. We have reviewed the main papers published about postoperative complications after splenectomy, analyzing the risk factors, prevention measures, and respective treatments. Great care must be taken in the management of patients presenting malignant diseases, splenomegaly, and hemostasis disorder. Moreover, despite the faster discharge that new surgical techniques now allow, close attention should be paid to symptoms reported by patients, in order to avoid potentially life-threatening complications such as portal vein thrombosis, pancreas injuries, and overwhelming postsplenectomy infection.Keywords: hematologic disease, complications, postoperative, laparoscopi

Mega-Events: Assessing Road Safety through an Operating Framework. An Application for the Milano–Cortina 2026 Winter Olympic Games †

To meet the United Nations and European Union goals of reducing road crash fatalities and injuries, it is also relevant to address the negative externalities due to mega-events on the road network and the local communities, to assess the safety of the road network involved, and to implement appropriate measures for different road environments. Despite their relevance, the literature often overlooks social costs and risks associated with mega-events. This study presents an operating framework for rapidly assessing the safety of the Milano–Cortina 2026—“Via Olimpica” road—which will host a significant proportion of the traffic during the Winter Olympic Games in 2026. The framework proposes a simplified Road Infrastructure Safety Management (RISM) to address the unique challenges posed by the limited time available for screening and implementation by local authorities. The framework integrates four data sources and follows a seven-step procedure. It provides recommendations for improving road safety by identifying critical road sections and blackspots. Road authorities, practitioners, and public administrations may all benefit from the framework, as it makes it easier to prioritise safety improvements within time constraints

Macroscopic Models for Pedestrian Flows

International audienceIn this paper we present macroscopic models for pedestrian flows that recently appeared in the literature. The first one was proposed by Colombo, Rosini, 2005. In a 1D setting, this model properly describes the movements of pedestrians, the onset of panic and the dynamics of a panicking crowd. Furthermore, its assumptions were experimentally confirmed by an empirical study of a crowd crush, see Helbing, Johansson, Al-Abideen, 2007. Then, we consider a 2D model that aims at describing similar phenomena while taking care of more complex geometries. Numerical integrations show that some realistic features are capture

Non cross-linked equine collagen (Salvecoll-E gel) for treatment of complex ano-rectal fistula

Summary: Background: Fistula-in-ano is one of the most commonly presenting anorectal diseases. Sphincter sparing treatment options should be considered in patients with complex fistulas. Salvecoll-E gel is a native collagen deantigenated and purified, non-cross-linked equine dermal extract, with an amino acid composition identical to human collagen. Methods: The multicentric trial study was a prospective, single-arm observational clinical study with the objective to assess the efficacy of Salvecoll-E gel for anal fistula repair in 70 patients. All patients had undergone preliminary surgical treatment consisting of positioning of a draining loosing seton that was maintained for a period of 4–6 weeks. After seton removal, a gentle debridement and washing of the fistula track was performed. The scar tissue was removed from the internal orifice. Internal opening was covered by a side-to side mucosal suture. Salvecoll-E was injected through the external opening into the fistula track, the external opening it has been opened. Results: Twelve months after surgery, 55 patients demonstrated a clinically healed fistula (78,5%), 15 patients have a recurrence (21,5%). Most of the recurrences were observed in the first 6 months of treatment (13/15, 86.6%). We don't observe any worsening in CCF score. The results obtained at 1 year certainly seem satisfactory and in line with the best results published in literature using mini-invasive techniques. Conclusion: Salvecoll-E gel is a promising non-invasive technique for conservative treatment of anal fistulas, it's well tolerated by the patients and, in case of recurrence, reinjection or all other known techniques are feasible. Keywords: Complex ano-rectal fistula, Non cutting technique, Mini-invasive treatmen

Omental infarction in the postpartum period: a case report and a review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women.</p> <p>Case presentation</p> <p>This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery.</p> <p>Conclusion</p> <p>Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.</p

Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study.

Introduction: Elective surgery for inguinal hernia is affected by very low mortality « 1 per 10000 operation); in contrast, when surgery is carried out for complicated inguinal hernia, risks of postoperative complication are higher. TAPP is a world-wide accepted surgical practice in the treatment of elective bilateral or recurrent inguinal hernia, above all in young patients. Few exploratory studies were published on laparoscopic approach in the treatment of urgent complicated inguinal hernia. Aim of this study was to analyze feasibility (operative time, conversion rate), safety (postoperative morbidity, length of hospital stay) and quality of life (acute and chronic pain, return to work) of trans-abdominal pre-peritoneal laparoscopic hernia repair in acute incarcerated inguinal hernia. Rationale of laparoscopic trans-abdominal approach is the easier hernia reduction under vision and a better exploration of the abdominal cavity. Methods: from September 2012 to September 2013, 15 consecutive patients admitted in emergency at the Division of General Surgery of University "Sapienza", Polo Pontino, for acute incarcerated inguinal hernia were submitted to TAPP using 3 trocars (1 of 10 mm and 2 of 5mm) and polyester prosthesis fixed by fibrin glue. Exclusion criteria for laparoscopic approach were age III, previous abdominal surgery, signs of strangulated hernia. All of them were evaluated for operative time, conversion rate, postoperative morbidity, organ resection or other surgery required. All patients were scored for pain by Visual Analogic Scale (VAS) during postoperative in hospital stay at 7 days, 1,6 and 12 months after surgery. Results: median follow-up was 16 months and 12 as minimum. In all cases reduction of hernia was always possible and none conversion to open surgery was recorded, median operative time was 89 minutes (55-137 as range), omental resection was carried out in one patient (6,6%), no other organ resections needed, whereas contralateral hernia was diagnosed and repaired at the same time in 4 patients (26,6%). No major complications were observed, median blood loss was 100 ml, minor morbidity was contained to 18% represented by fever and wound infection of surgical umbilical scar. Median in hospital stay was 1,5 days with 1-5 days as range. Postoperative median acute pain, measured by visual analogic scale (VAS), was 2 (range:0-4), none patient referred any pain during follow-up. Median time of return to work was 6,5 days, ranged between 3 to 15 days. Patients' compliance to treatment and to follow-up was complete as well their satisfaction. Conclusions: In centres skilled for laparoscopy in emergency, TAPP could be considered a feasible and safe technique. In well-selected patients (especially if emolled in controlled clinical trial) TAPP could represent an alternative surgical approach for complicated incarcerated inguinal hernia to conventional open surgery even in urgency. The main advantages of laparoscopic approach are the ability to perform surgical hernia reduction under vision, a better exploration and evaluation of abdominal cavity and diagnosis and treatment of eventual contralateral defect of wall, otherwise often missed. Finally, the good control of acute and chronic pain, faster return to normal activity and work, better aesthetic results contributed to total satisfaction and compliance of the patients