Anomaly pre-localization in distribution–transmission mains by pump trip: preliminary field tests in the Milan pipe system

In this paper, the reliability of transients due to pump trip as a powerful tool for the pre-localization of anomalies in real pipe systems is tested. The examined pipe system is part of the one supplying the city of Milan, Italy and is managed by Metropolitana Milanese SpA (MM). The characteristics of such a system can be considered as intermediate between those of classical transmission mains and distribution systems because of its several branches. A Lagrangian model simulating pressure wave propagation is used to evaluate the pipe pressure wave speed – associated with a genetic algorithm – and to locate possible anomalies – associated with wavelet analysis. The results of the diagnosis of the pipe system are corroborated by repairs executed by MM in the area where possible anomalies have been pre-localized

A multi-parameter field monitoring system to investigate the dynamics of large earth slides–earth flows in the Northern Apennines, Italy

Large earth slides and rocks lides evolving into earth flows are quite widespread in the Northern Italian Apennines. Despite being simply referred to as landslides, many of them are, in fact, large complexes of landslides. They evolved through multiple and/or successive movements, undergoing partial and/or total reactivations. The reactivation of pre-existing landslide bodies is the prevalent mechanism for the known landslide events, as the historical records and the technical reports indicate. Landslide reactivation is, indeed, a relevant topic from the perspective of risk assessment and mitigation. A multi-parameter monitoring system was installed on a large complex of landslides that underwent partial or total reactivations after heavy rainfall events, causing damages to buildings and infrastructures. Two clusters of automatic piezometers—each coupled with an inclinometer—and a time-lapse resistivity deployment were the core of the monitoring system. A weather station, collecting data from subsurface thermometers, and a water content probe completed the system. After the construction of a new geological model of the slope, this study aimed at understanding the possible mechanisms leading to the reactivation of the landslide. This goal was achieved by gaining insights into the process of rainfall infiltration into the landslide deposits, by determining the groundwater flow and evaluating the landslide displacements. The monitoring system captured the processes that took place in the landslide bodies and the bedrock in response to a rainfall event in early February 2017, which followed a dry period of eight months. The recorded data provided indications on the variation of the hydraulic head in the groundwater within the landslide and the bedrock, particularly at the sliding surfaces. The electrical conductivity of the groundwater and the resistivity of the terrain varied across the failure surfaces. In particular, a sudden increase in the electrical conductivity was related to the locations of the main sliding surfaces. The joint analysis of time-lapse resistivity, hydraulic heads, and groundwater electrical conductivity helped identify the locations of weaker levels within the landslide masses, which were confirmed by data from inclinometers. This study improved the knowledge of the hydrogeological behaviour of a complex of landslides in heterogeneous low-permeability media. Moreover, the obtained results contributed to the understanding of the role played by different portions of the landslide complex in the evolution of the movement

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidit

Ionic liquids at electrified interfaces

Until recently, “room-temperature” (<100–150 °C) liquid-state electrochemistry was mostly electrochemistry of diluted electrolytes(1)–(4) where dissolved salt ions were surrounded by a considerable amount of solvent molecules. Highly concentrated liquid electrolytes were mostly considered in the narrow (albeit important) niche of high-temperature electrochemistry of molten inorganic salts(5-9) and in the even narrower niche of “first-generation” room temperature ionic liquids, RTILs (such as chloro-aluminates and alkylammonium nitrates).(10-14) The situation has changed dramatically in the 2000s after the discovery of new moisture- and temperature-stable RTILs.(15, 16) These days, the “later generation” RTILs attracted wide attention within the electrochemical community.(17-31) Indeed, RTILs, as a class of compounds, possess a unique combination of properties (high charge density, electrochemical stability, low/negligible volatility, tunable polarity, etc.) that make them very attractive substances from fundamental and application points of view.(32-38) Most importantly, they can mix with each other in “cocktails” of one’s choice to acquire the desired properties (e.g., wider temperature range of the liquid phase(39, 40)) and can serve as almost “universal” solvents.(37, 41, 42) It is worth noting here one of the advantages of RTILs as compared to their high-temperature molten salt (HTMS)(43) “sister-systems”.(44) In RTILs the dissolved molecules are not imbedded in a harsh high temperature environment which could be destructive for many classes of fragile (organic) molecules

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Advantages of innovative automatic inclinometers applied to landslides monitoring for early warning activities

Geotechnical monitoring is one of the most important activities aimed to study and understand the evolution of a landslide. Traditionally, surveys have been performed by using different devices specifically developed to measure a parameter of interest. Inclinometers are some of the most commonly used and well-known tools, designed to monitor slope displacements at different depths. These instruments present a series of features typical of the so-called “traditional” approach, including the need for an operator on-site to perform all the passages required to obtain monitoring data, and a sampling rate typically ranging from some day to weeks depending of several factors, including site accessibility and operator’s availability. While these characteristics do not affect the tool’s ability to perform as a survey system, they represent a relevant limitation to their application for early warning purposes. In fact, in a context where it is essential to acquire timely information on the evolution of a critical event, it should be required to provide a monitoring system able to provide a continuous description of the ongoing phenomenon. In particular, features like automatic data acquisition, high sampling frequency and remote control of the on-site instrumentation are typical of monitoring systems designed for early warning applications. The need for tools able to meet these requirements has led to several upgrades of classical inclinometers, resulting into the development of new contact-based tools. These innovative systems include the possibility to integrate different devices typologies (e.g. inclinometers, piezometers and thermometers) creating a single, multi-parametric array of sensors. The exploited technologies allow for the implementation of automatic procedures for data sampling, elaboration and visualization, which can greatly contribute to the design of alert systems for instability phenomena. In particular, larger datasets achievable by these tools are suitable for a more reliable application of failure forecasting models, which are a key component in the development of early warning activities. In order to provide an example of the importance of these considerations, a case study is presented where both traditional and innovative inclinometers were installed on-site. While the monitoring plan was intended as a geotechnical survey activity, the innovative system allowed to identify a series of critical events which interested the monitored area. Thanks to the innovative procedures implemented, it was possible to obtain a good representation of the final collapse of the landslide, which irreversibly damaged all the traditional inclinometer casings and, ultimately, broke the automatic array. Nonetheless, the dataset recorded before the system failure allowed the application of forecasting models, which correctly predicted the landslide collapse several hours before its occurrence