Compensation effect between deaths from Covid-19 and crashes: The Italian case

Abstract Emergencies such as the Covid-19 pandemic pose several decision-making issues, while clear evidence of successful strategies are still unavailable, different policies may be identified. However, in such emergencies, the preservation of public health, by firstly reducing human loss of life may be prioritized and then restrictive measures are implemented. The trade-off between damage due to the threat and the decrease in damage due to the lockdown is largely unexplored. Here we show that there is a degree of compensation between damage from epidemic deaths and from traffic deaths, especially in the case of immediate restrictive measures imposed by governments. Based on the Italian case, we found that damage from loss of human Capital and health care costs could have been fully compensated if the lockdown had been imposed ten days earlier. Considering only one Italian region (Puglia), where the epidemic was delayed and then restrictions were timely, damage due to loss of human Capital was largely compensated in the real scenario. However, damage due to loss of welfare could not have been fully compensated for, since Covid-19 deaths largely outnumber traffic deaths in the simulated epidemic period and loss of welfare damage is scarcely dependent on the age-at-death. From a broader perspective, societies seem to react to external threats as a whole organism, thus tending to restore the original equilibrium. Governmental decisions could accelerate this process. However, in the case of similar threats, some wounds cannot be compensated for, such as the incalculable damage due to loss of welfare

The deviation angle for one-lane roundabouts: A general mathematical formulation and application

Abstract Properly designed roundabouts may lead to safety improvements based on both reducing approaching speeds and controlling traffic. Measurements of deflection of vehicle trajectories are commonly used to estimate roundabout speed control. One of these measurements is the deviation angle, which is mentioned in both the Italian and Swiss road standards and, in specific conditions, can be more effective than other methods. This article presents a general mathematical formulation for linking several geometric parameters with the deviation angle in different rural and urban one-lane roundabout configurations, which is currently missing in the literature. For urban roundabouts, refuge islands for pedestrians and cyclists were considered. Based on the proposed formulation, a sensitivity analysis of the influential geometric parameters was conducted. Results suggest that an insufficient deflection of trajectories (deviation angle less than 45°) is always present for roundabouts with inscribed circle diameter less than 25 m; for urban roundabouts with refuge islands for pedestrians and cyclists having inscribed circle diameter less than 34 m and orthogonal legs; and for roundabouts with angles between opposite legs smaller than 140°. The main parameters which are responsible for a decrease in the deviation angle are: a decrease in the inscribed circle diameter; a decrease in the angle between opposite legs; and an increase in the width of the circulatory lane. Some optimized procedures for roundabout design, the generalized application of the deviation angle method and alternative speed control measures in cases of small deviation angles are discussed

A cohesive-zone model for steel beams strengthened with pre-stressed laminates

We analyse the problem of a simply supported steel beam subjected to uniformly distributed load, strengthened with a pre-stressed fibre-reinforced polymer (FRP) laminate. According to the assumed application technology, the laminate is first put into tension, then bonded to the beam lower surface, and finally fixed at both its ends by suitable connections. The beam and laminate are modelled according to classical beam theory. The adhesive is modelled as a cohesive interface with a piecewise linear constitutive law defined over three intervals (elastic response, softening response, debonding). The model is described by a set of differential equations with suitable boundary conditions. An analytical solution to the problem is determined, including explicit expressions for the internal forces and interfacial stresses. For illustration, an IPE 600 steel beam strengthened with a Sika® Carbodur® FRP laminate is considered. First, the elastic limit state load of the unstrengthened beam is determined. Then, the loads corresponding to the elastic limit states in the steel beam, adhesive, and laminate for the strengthened beam are calculated. As a result, the increased elastic limit state load of the strengthened beam is obtained

Investigating the Deviation Angle Method for Ensuring Deflection at One-Lane Rural Roundabouts

Roundabouts developed as a road intersection design option has resulted in a series of nonuniform design guidance criteria in Europe, as well as in the United States and other Countries. In addition to different design specifications about the geometry of the elements constituting a roundabout (width and lanes of the circulatory roadway, entry and exit legs, splitter island), the methods for guaranteeing that vehicle paths deflect through the roundabout are also different. These methods ensure proper travel speeds between conflicting traffic flows. Currently, the main parameters used by standards to control the deflection are the deflection radius, the entry path radius, and the deviation angle. After a comparison between International deflection methods for roundabouts, this study checks the geometric requirements of the deviation angle for more than 7.000 hypothetical one-lane rural roundabouts. The Computer-Aided Design (CAD) drawing of the roundabouts takes into account the range of variability of their main geometric parameters, according to the Italian Standard. Subsequently, a number of the considered roundabouts checked with both the entry path radius and the German methods. Some results showing the greater effectiveness of the less popular deviation angle method are discussed. The main aims of this paper are:1) to promote the deviation angle method, which is only used in Switzerland and Italy;2) to improve standards, as regards the applicability and validity of the deflection angle method;3) to help practitioners to know in advance the outcome of the deflection checks at the beginning of the iterative design process, once the boundary conditions are known

Geometric Design Issues and Safety Analysis of Two-way Rural Road Tunnels

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Integrated American-European protocol for safety interventions on existing two-lane rural roads

Abstract Purpose The main purpose was to integrate two strategies for road safety analyses (qualitative: audits, inspections; and quantitative: accident predictions) and develop a possible protocol for the safety interventions on existing two-lane rural road segments. Those road sections do not typically belong to the TEN-network, to which the 2008/96/EC Directive is mainly oriented. Hence, they could lack of methods for designing safety-based interventions. The main research questions were:Which possible problems can arise from the application of this protocol to real cases?Which data are practically needed?Which possible solutions can be provided for the highlighted problems? Methods The integrated protocol, including: 1) the HSM predictive method, 2) the EU Regulations, 3) the local road design standards, 4) some research developments; is applied to real two-lane rural road segments requiring safety-based interventions. Its application is divided in the typical road safety analysis stages. Results A wide list of possible problems was highlighted and addressed: 1) lack of data, 2) difficult comparison with current road standards in order to identify safety problems, 3) lack of methods for evaluating the skidding risk along the layout, 4) setting speed limits, 5) need for optimizing the selection of countermeasures based on their aims and their timely application, in different recurrent situations, 6) availability and comparison of predictive methods. Conclusions Based on the problems and solutions discussed, main advantages (1) the systematic approach, 2) the quantitative assessment of benefits, 3) the possible transferability) and disadvantages (difficulties in overcoming the lack of data and calibrated accident prediction models) of the method were remarked

Validation of Geant4 nuclear reaction models for hadrontherapy and preliminary results with SMF and BLOB

Reliable nuclear fragmentation models are of utmost importance in hadrontherapy, where Monte Carlo (MC) simulations are used to compute the input parameters of the treatment planning software, to validate the deposited dose calculation, to evaluate the biological effectiveness of the radiation, to correlate the bþ emitters production in the patient body with the delivered dose, and to allow a non- invasive treatment verification. Despite of its large use, the models implemented in Geant4 have shown severe limitations in reproducing the measured secondaries yields in ions interaction below 100 MeV/A, in term of production rates, angular and energy distributions [1–3]. We will present a benchmark of the Geant4 models with double-differential cross sec- tion and angular distributions of the secondary fragments produced in the 12C fragmentation at 62 MeV/A on thin carbon target, such a benchmark includes the recently implemented model INCL++ [4,5]. Moreover, we will present the preliminary results, obtained in simulating the same interaction, with SMF [6] and BLOB [7]. Both, SMF and BLOB are semiclassical one-body approaches to solve the Boltzmann-Langevin equation. They include an identical treatment of the mean-field propagation, on the basis of the same effective interaction, but they differ in the way fluctuations are included. In particular, while SMF employs a Uehling-Uhlenbeck collision term and introduces fluctuations as projected on the density space, BLOB introduces fluctuations in full phase space through a modified collision term where nucleon-nucleon correlations are explicitly involved. Both of them, SMF and BLOB, have been developed to sim- ulate the heavy ion interactions in the Fermi-energy regime. We will show their capabilities in describing 12C fragmentation foreseen their implementation in Geant4

safety of edoxaban 30 mg in elderly patients with severe renal impairment

Patients with atrial fibrillation (AF) and advanced chronic kidney disease (CKD) are at high risk of adverse events and are complicated to manage. There is little evidence on the effects of non-vitamin K oral anticoagulants in patients with severe CKD. Preliminary data in patients taking edoxaban whose creatinine clearance fell below 30 mL/min showed a low risk of stroke and major bleeding. The aim of our study is to test the safety of edoxaban 30 mg/day in patients with severe renal impairment with an estimated glomerular filtration rate (eGFR) of 15–29 mL/min. We analyzed retrospective data from 46 patients who had documented AF with severe renal impairment (eGFR between 15 and 29 mL/min). The follow-up, characterized by clinical examination and blood analysis, was performed at 3, 6, and 12 months. The main endpoint was the incidence of major bleedings or clinically relevant non-major (CRNM) bleedings or thromboembolic events. At the time of the data collection, the average follow-up was 9.13 ± 3.0 months. There were no major bleedings, strokes, systemic embolisms, or cardiovascular deaths reported: one non-cardiac death and five minor hemorrhages occurred. No differences related to the severity of CKD were observed in the left ventricular ejection fraction at echocardiography and in the thrombotic and hemorrhagic risk profile. In this explorative study analyzing patients with severe CKD treated with edoxaban 30 mg once daily, no major bleeding or thrombotic events were observed. Some minor bleedings were observed. While additional studies are necessary to confirm the results of this exploratory study, edoxaban 30 mg once daily appears to be safe in patients with severe CKD

clinical conundrums in antithrombotic therapy management a delphi consensus panel

Abstract Background Anticoagulants are recommended for the prevention of stroke/systemic embolism for most patients with atrial fibrillation (AF) and for the treatment of patients with venous thromboembolism (VTE). Regulatory-driven randomized trials, however, typically exclude extreme patient scenarios involving, for instance, severe bleeding, ischaemic risk, frailty or renal impairment, despite their common occurrence in clinical practice. Uncertainty in the management of such cases leads to a high degree of variability in therapeutic approaches. Consensus conferences or panels may provide insights and help bridge the gaps that separate clinical guidelines from real-world practice. In the present study, a description of challenging AF and VTE patients was submitted to a large panel of experts to investigate areas of common or divergent management. Method A modified-Delphi method was used to obtain consensus among 178 Italian AF and VTE specialists. A questionnaire was sent on the appropriateness of anticoagulant therapy in AF and VTE cases, including CHA 2 DS 2 -VASc=1, comorbid coronary artery disease, frailty, advanced age, risk of falling, prior haemorrhagic stroke, and low- or intermediate-risk pulmonary embolism. Strategies to improve guideline adherence were also investigated. Results All participants completed the questionnaire. Consensus was reached on many, but not all cases, leaving uncertainty on some debated topics (conundrums) where decisions are unsupported by clinical studies or driven by controversial results. Conclusions The indications emerging from this large panel of experts may help guide the management of challenging AF or VTE cases. Studies are needed addressing treatment options in those cases for whom no consensus was reached