Simplified approach to integrate seismic retrofitting prioritization with social cost evaluation: A case study in central Italy

In the last three decades, bridge stock seismic retrofitting prioritization has become one of the cult topics for scientific discussions in the bridge management strategies. More recent methods are focusing on the evaluation of the generalized failure cost, of a specific bridge derived from direct and indirect costs induced to the users/residents of the area exposed to the seismic hazard as a consequence of bridge collapse. However, when these approaches have to be applied to large transport networks, appear still very complex and computa-tional demanding, and therefore simplified methods to evaluate the impact in terms of social cost related to the reduced efficiency of a transportation network due to potential bridge failure, are required.In this work, a simplified method for seismic retrofitting prioritization on a bridge stock is proposed, which is based on a "blended" approach considering specific fragility curves according to several bridge features and condition state, seismic inputs and generalized failure costs related to the transportation network. The effectiveness of the method has been showed on a case study of a local bridge stock placed in central Italy and the obtained results have been compared with those provided by more refined transport simulation models, on one hand, and by more traditional prioritization approaches, on the other. It is highlighted that this method can be very useful for transportation network managers with in a limited budget scenario, in case of lack of information about possible earthquake -induced impacts on a transportation network efficiency.(c) 2022 Periodical Offices of Chang'an University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The importance of monitoring cerebral oxygenation in non brain injured patients

Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. While there are many neuromonitoring modalities utilized in brain injured patients, the majority of those are either invasive such as intracranial pressure monitoring, require special skill such as transcranial Doppler ultrasonography, or intermittent such as pupillometry and therefore unable to provide continuous monitoring. Cerebral oximetry using Near infrared Spectroscopy, is a simple non invasive continuous measure of cerebral oxygenation that has been shown to be useful in preventing cerebral hypoxemia both within the intensive care unit and the perioperative settings. At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population

Pig, F1 (wild boar x pig) and wild boar meat quality

Sixteen carcasses of wild boars, pigs, hybrids F1 (wild boar x pig) and reared wild boar have been examined to study the meat quality and the fatty acid composition. Four carcasses came from hunted wild boars and twelve from animals reared in outdoor pens till nine months of age. The meat produced by the hunted wild animals, although not marketable, offers the best quality and nutritional characteristics. The use of hybrids reared in outdoor pens can approximate or equalize the hunted wild boars meat traits. Reared wild boar meat has, in the complex, better compositional characters than hybrids and domestic groups, but acidic quality of fat is not particularly useful for human feeding

Perioperative Hypothermia (33°C) Does Not Increase theOccurrence of Cardiovascular Events in PatientsUndergoing Cerebral Aneurysm SurgeryFindings from the Intraoperative Hypothermia for AneurysmSurgery Trial

The IHAST Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia or normothermia. Cardiovascular events were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. Conclusion: In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events

Time-dependent cyclic behavior of reinforced concrete bridge columns under chlorides-induced corrosion and rebars buckling

This study presents the results of a refined numerical investigation meant at understanding the time-dependent cyclic behavior of reinforced concrete (RC) bridge columns under chlorides-induced corrosion. The chloride ingress in the cross-section of the bridge column is simulated, taking into account the effects of temperature, humidity, aging, and corrosion-induced cover cracking. Once the partial differential equations governing such multiphysics problem are solved through the finite-element method, the loss of reinforcement steel bars cross-section is calculated based on the estimated corrosion current density. The nonlinear cyclic response of the RC bridge column under corrosion is, thus, determined by discretizing its cross-sections into several unidirectional fibers. In particular, the nonlinear modeling of the corroded longitudinal rebars exploits a novel proposal for the estimation of the ultimate strain in tension and also accounts for buckling under compression. A parametric numerical study is finally conducted for a real case study to unfold the role of corrosion pattern and buckling mode of the longitudinal rebars on the time variation of capacity and ductility of RC bridge columns

Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from "TBI Section" of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the "TBI Section" of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TBI management is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence

Long-term physical impairments in survivors of COVID-19-associated ARDS compared with classic ARDS: A two-center study

Purpose: This work aimed to compare physical impairment in survivors of classic ARDS compared with COVID-19-associated ARDS (CARDS) survivors. Material and methods: This is a prospective observational cohort study on 248 patients with CARDS and compared them with a historical cohort of 48 patients with classic ARDS. Physical performance was evaluated at 6 and 12 months after ICU discharge, using the Medical Research Council Scale (MRCss), 6-min walk test (6MWT), handgrip dynamometry (HGD), and fatigue severity score (FSS). We also assessed activities of daily living (ADLs) using the Barthel index. Results: At 6 months, patients with classic ARDS had lower HGD (estimated difference [ED]: 11.71 kg, p < 0.001; ED 31.9% of predicted value, p < 0.001), 6MWT distance (ED: 89.11 m, p < 0.001; ED 12.96% of predicted value, p = 0.032), and more frequent significant fatigue (OR 0.35, p = 0.046). At 12 months, patients with classic ARDS had lower HGD (ED: 9.08 kg, p = 0.0014; ED 25.9% of predicted value, p < 0.001) and no difference in terms of 6MWT and fatigue. At 12 months, patients with classic ARDS improved their MRCss (ED 2.50, p = 0.006) and HGD (ED: 4.13 kg, p = 0.002; ED 9.45% of predicted value, p = 0.005), while those with CARDS did not. Most patients in both groups regained independence in ADLs at 6 months. COVID-19 diagnosis was a significant independent predictor of better HGD (p < 0.0001) and 6MWT performance (p = 0.001), and lower prevalence of fatigue (p = 0.018). Conclusions: Both classic ARDS and CARDS survivors experienced long-term impairments in physical functioning, confirming that post-intensive care syndrome remains a major legacy of critical illness. Surprisingly, however, persisting disability was more common in survivors of classic ARDS than in CARDS survivors. In fact, muscle strength measured with HGD was reduced in survivors of classic ARDS compared to CARDS patients at both 6 and 12 months. The 6MWT was reduced and fatigue was more common in classic ARDS compared to CARDS at 6 months but differences were no longer significant at 12 months. Most patients in both groups regained independent function in ADLs at 6 months

Electrophysiological neuromuscular alterations and severe fatigue predict long-term muscle weakness in survivors of COVID-19 acute respiratory distress syndrome

IntroductionLong-term weakness is common in survivors of COVID-19-associated acute respiratory distress syndrome (CARDS). We longitudinally assessed the predictors of muscle weakness in patients evaluated 6 and 12 months after intensive care unit discharge with in-person visits.MethodsMuscle strength was measured by isometric maximal voluntary contraction (MVC) of the tibialis anterior muscle. Candidate predictors of muscle weakness were follow-up time, sex, age, mechanical ventilation duration, use of steroids in the intensive care unit, the compound muscle action potential of the tibialis anterior muscle (CMAP-TA-S100), a 6-min walk test, severe fatigue, depression and anxiety, post-traumatic stress disorder, cognitive assessment, and body mass index. We also compared the clinical tools currently available for the evaluation of muscle strength (handgrip strength and Medical Research Council sum score) and electrical neuromuscular function (simplified peroneal nerve test [PENT]) with more objective and robust measures of force (MVC) and electrophysiological evaluation of the neuromuscular function of the tibialis anterior muscle (CMAP-TA-S100) for their essential role in ankle control.ResultsMVC improved at 12 months compared with 6 months. CMAP-TA-S100 (P = 0.016) and the presence of severe fatigue (P = 0.036) were independent predictors of MVC. MVC was strongly associated with handgrip strength, whereas CMAP-TA-S100 was strongly associated with PENT.DiscussionElectrical neuromuscular abnormalities and severe fatigue are independently associated with reduced MVC and can be used to predict the risk of long-term muscle weakness in CARDS survivors