Modellazione numerica di una porzione dell'acquifero della Piana orientale di Lucca: oscillazioni piezometriche recenti e scenari previsionali

La presente Tesi vuole studiare le fluttuazioni della falda idrica della parte nord-orientale della Pianura di Lucca e ipotizzare possibili scenari sulla sua evoluzione, al fine di prevenire o porre soluzione ad eventuali problematiche future. Questo lavoro è stato svolto contestualmente alla Tesi della Dott.sa Del Sordo Alice dal titolo “Modellazione numerica di una porzione dell’acquifero della Pianura orientale di Lucca: implementazione, calibrazione e determinazione dei parametri sensibili del modello”, la quale ha descritto le metodologie di implementazione e calibrazione del modello numerico e determinato i parametri sensibili che influenzano maggiormente le oscillazioni della falda idrica nell’area di studio. La Piana di Lucca è da sempre molto sfruttata dal punto di vista idrico, in quanto è sede di un importante acquifero dal quale attingono numerosi pozzi ad uso idropotabile, industriale ed agricolo. L’emungimento spinto ha prodotto nel tempo fenomeni di subsidenza e localmente l’aperture di cavità nel terreno. Le principali fasi del lavoro posso essere così riassunte: - censimento di una serie di punti di misura, sia di acque superficiali che sotterranee; - raccolta di sondaggi stratigrafici, di parametri idraulici dell’acquifero e realizzazione dei modelli geologici ed idrogeologici concettuali; - esecuzione di 11 campagne piezometriche (dicembre 2007-ottobre 2008) su 97 punti d’acqua e realizzazione di carte piezometriche mensili; - acquisizione di dati termo-pluviometrici ed elaborazione di due grafici di correlazione tra piogge e variazioni piezometriche; - realizzazione di scenari previsionali. I principali risultati raggiunti possono essere così riassunti: - l’acquifero della Pianura di Lucca si sviluppa in un livello di ghiaie e sabbie con una lente di argille e sabbie argilloso-limose, al cui tetto sono presenti coperture costituite da limi sabbiosi, limi argillosi e argille con torbe, mentre al letto si trovano argille e argille-sabbiose del ciclo lacustre di Lucca-Montecarlo-Vinci; - le carte piezometriche hanno evidenziato la presenza di due minimi chiusi nell’area del Padule di Porcari e dell’abitato di Porcari. Il confronto con le carte piezometriche pregresse hanno evidenziato che dal 1975 al 2008 la superficie piezometrica si è abbassata di circa 3 e 6 m rispettivamente a nord e a sud dell’abitato di Paganico; - l’implementazione dei 5 scenari previsionali ha messo in evidenza che il quantitativo attuale dei prelievi difficilmente può essere sostenuto ancora per molto tempo

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis : results of the SPRi.MACC study

Peer reviewe

Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.1

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition).

The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition).

The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients

WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe

WHO global research priorities for antimicrobial resistance in human health

The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR