Thermal mapping as a valuable tool for road weather forecast and winter road maintenance: an example from the Italian Alps

During the winter period ice is likely to form on roads, making pavement surfaces slippery and increasing accident risk. Road surface temperature (RST) is one of the most important parameters in ice formation. The LIFE+ “CLEANROADS” project aims to forecast RSTs in advance in order to support road maintenance services in the timely and effective preparation of preventive anti-icing measures. This support is provided through a novel MDSS (Maintenance Decision Support System). The final goal of the project is to quantitatively demonstrate that the implemented MDSS is capable to minimize the consumption of chemical anti-icing reagents (e.g. sodium chloride) and the associated environmental (water and air) impact while maintaining the current high levels of road safety. In the CLEAN-ROADS system RSTs have been forecast by applying the numerical model METRo (Model of the Environment and Temperature of Roads) to a network of RWIS (Road Weather Information System) stations installed on a test route in the Adige Valley (Italy). This forecast is however local and does not take into account typical peculiarities along road network, such as the presence of road sections that are particularly prone to ice formation. Thermal mapping, i.e. the acquisition of mobile RST measurements through infrared thermometry, permits to (i) identify and map those sections, and (ii) extend the forecast from a RWIS station to adjacent areas. The processing of thermal mapping signals is however challenging because of random variations in the road surface emissivity. To overcome this we have acquired several thermal mapping traces along the test route during winter seasons 2014-2015 and 2015-2016. We have then defined a “characteristic” thermal fingerprint as a function of all its historical thermal mapping signals, and used it to spatialize local METRo forecasts. Preliminary results suggest the high potential of such a technique for winter road applications

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Long-term morphological response of tide dominated estuaries

Most estuaries of the world are influenced by tides. The tidal action is a fundamental mechanism for mixing river and estuarine waters, resuspending and transporting sediments and creating bedforms. The planform of tide-dominated estuaries is characterized by a funnel-shaped geometry with a high width-to-depth ratio. The width of the estuarine section tends to decrease rapidly upstream, following an exponential law and the bottom slopes are generally non-significant. In this thesis the long-term morphological evolution of tide-dominated estuaries is investigated through a relatively simple one-dimensional numerical model. When a reflective barrier condition is assigned at the landward boundary, the morphological evolution of an initially horizontal tidal channel is characterized by the formation of a sediment wave that migrates slowly landward until it leads to the emergence of a beach. The bottom profile reaches a dynamical equilibrium configuration which has been defined as the condition in which the tidally averaged sediment flux vanishes or, alternatively, the bottom elevation attains a constant value. For relatively short and weakly convergent estuaries, the beach is formed at the landward end of the channel, due to the reflective barrier chosen as boundary condition, and the equilibrium length coincides with the distance of such boundary from the mouth. When the above distance exceeds a threshold value, which decreases for increasing values of the degree of convergence of the channel, the beach forms within an internal section of the estuary and the final equilibrium length is much shorter and mainly governed by the convergence length. The final equilibrium length of the channel is found to depend mainly on two parameters, namely the physical length of the channel and the degree of convergence. Moreover, if a condition of vanishing sediment flux from the outer sea during the flood phase is imposed, a larger scour in the seaward part of the estuary is observed, though the overall longitudinal bottom profile does not differ much from that corresponding to a sediment influx equal to the equilibrium transport capacity at the mouth. This fixed banks model is not able to explain this typical funnel shape; furthermore, the bottom slopes obtained with this models are quite large if compared with the mild slopes of real tidedominated estuaries. For these reasons, the problem has been analysed to understand the reason why tidal channels are convergent and to define the conditions under which the exponential law for width variation, which is so often observed in nature, is reproduced. The long-term evolution of the channel cross-section is investigated allowing the width to vary with time. The one-dimensional model is expanded by considering a simple way to take the banks erosion into account. A strongly simplified approach is adopted, whereby only the effects related to flow and sediment transport processes within the tidal channel are retained and further ingredients, like the control exerted by tidal flats or the direct effect of sea currents in the outer part of the estuary, are discarded. The lateral erosion is taken into account and computed as a function of bed shear stress, provided it exceeds a threshold value within the cross section. The effect of different initial and boundary conditions on the widening process of the channel is tested, along with the role of the incoming river discharge. Another problem, which is somehow analogous to that of the cross-section evolution, is tackled: a part of a tidal flat dissected by a series of parallel channels is considered and the response of the system induced by a modification of the depth of the channels is studied. In particular, the aim is to assess whether the increase of the depth of one channel, starting from an equilibrium configuration, causes deposition in the others inducing their closure. The evaluation of the morphological effect of a depth variation in one of channel upon the other channels is quite a relevant task, because the stability of salt marshes and lagoons is intrinsically related to the stability of the hydrodynamic functionality of the channels. A result of this analysis is the determination of a characteristic distance between the channels to have mutual influence. It is found that this distance scales with the root of the longitudinal length of the flat; thus, a scaledependent spacing is expected in tidal networks

Small Bowel Metastatic Melanoma: An Emblematic "Coal-Black" Appearance at Videocapsule Endoscopy

A 80-year-old woman underwent vulvar melanoma resection and segmental lung resection for pulmonary metastasis. Immunotherapy with Nivolumab was performed. One year later, the patient was admitted for gastrointestinal (GI) recurrent bleeding and severe anemia. Esophagoastroduodenoscopy and colonoscopy did not show any abnormality, while videocapsule endoscopy (VCE) revealed an irregular and exophytic whitish area with a "coal-black" central depression. Small bowel resection was performed and histological examination revealed S100 protein strongly positive melanoma metastasis. The patient died six months later from disease progression. A "coal-black" appearance of intestinal metastatic melanoma has been described only twice before this report. In one case the patient had been treated by immunotherapy with interferon A and dendritic cell-based vaccination. In our patient, it is presumable that the picture we observed was a consequence of Nivolumab treatment inducing the disappearance of melanocytes in the area surrounding the metastasis with the onset of the central coal-black lesion encircled by whitish tissue. This picture should be emblematic of intestinal metastatic melanoma in subjects treated with immunotherapy showing occult/obscure bleeding

A contribution to the evolution of the BAT concept in the steelmaking sector

The sector of steelmaking, in the European Union, is considered today one of the major potential contributors to the atmospheric release and consequent deposition of dioxin. The emissions of a plant depend on many factors: characteristics of the input, process, prevention and removal of dioxin from the gaseous stream. The local impact depends also on the different emission path, namely diffused emissions, secondary emissions and conveyed gases, as each stream can be related to a different way of dilution into the atmosphere. Moreover, the local impact is also related to the meteorological conditions. The high variability of parameters that can affect the local impact from a plant can be analyzed through the deployment of deposimeters, in order to understand the human exposure in the surroundings. The present paper refers to an Italian case-study where deposition was measured using deposimeters placed in sites identified by means of the results of a dispersion model. The role of particulate matter emissions was studied also with an optical particle counter. The obtained values are discussed taking into account seasonality and operation of the plant. Some considerations on the potential evolution of this industrial sector beyond the present concept of best available technology are included too

A contribution to the evolution of the BAT concept in the steelmaking sector

The sector of steelmaking, in the European Union, is considered today one of the major potential contributors to the atmospheric release and consequent deposition of dioxin. The emissions of a plant depend on many factors: characteristics of the input, process, prevention and removal of dioxin from the gaseous stream. The local impact depends also on the different emission path, namely diffused emissions, secondary emissions and conveyed gases, as each stream can be related to a different way of dilution into the atmosphere. Moreover, the local impact is also related to the meteorological conditions. The high variability of parameters that can affect the local impact from a plant can be analyzed through the deployment of deposimeters, in order to understand the human exposure in the surroundings. The present paper refers to an Italian case-study where deposition was measured using deposimeters placed in sites identified by means of the results of a dispersion model. The role of particulate matter emissions was studied also with an optical particle counter. The obtained values are discussed taking into account seasonality and operation of the plant. Some considerations on the potential evolution of this industrial sector beyond the present concept of best available technology are included too