6 research outputs found
Efficiency assessment of existing pumping/hydraulic network systems to mitigate flooding in low-lying coastal regions under different scenarios of sea level rise. The Mazzocchio area study case
No full textRising of the sea level and/or heavy rainfall intensification significantly enhance the risk of flooding in low-lying coastal reclamation areas. Therefore, there is a necessity to assess whether channel hydraulic networks and pumping systems are still efficient and reliable in managing risks of flooding in such areas in the future. This study addresses these issues for the pumping system of the Mazzocchio area, which is the most depressed area within the Pontina plain, a large reclamation region in the south of Lazio (Italy). For this area, in order to assess climate change impact, a novel methodological approach is proposed, based on the development of a simulation–optimization model, which combines a multiobjective evolutionary algorithm and a hydraulic model. For assigned extreme rainfall events and sea levels, the model calculates sets of Pareto optimal solutions which are obtained by defining two optimality criteria: (a) to minimize the flooding surface in the considered area; (b) to minimize the pumping power necessary to mitigate the flooding. The application shows that the carrying capacity of the hydraulic network downstream of the pumping system is insufficient to cope with future sea level rise and intensification of rainfall
JEDI (jugular entrapment, dilated ventricles, intracranial hypertension) syndrome: a new clinical entity? A case report
No full textPatients with idiopathic intracranial hypertension are frequently obese women with normal/slit ventricles. Patients with high-pressure hydrocephalus, instead, present enlarged ventricles. We describe a 63-year-old woman with signs and symptoms of intracranial hypertension. Brain MRI revealed hydrocephalus. Venous Doppler ultrasound showed external compression of the omohyoid muscles on the internal jugular veins. During jugular vein decompression, intracranial pressure dropped from 18 to 6 mmHg. Patient is asymptomatic at 2-year follow-up, with decreased brain ventricles. These findings could represent a novel form of high-pressure hydrocephalus that can be successfully treated without a CSF shunt. We called this syndrome JEDI (jugular entrapment dilated ventricles intracranial hypertension)
Flood Risk Management Model to Identify Optimal Defence Policies in Coastal Areas Under Climate Change Uncertainties: Pontina Plain Case Study
No full textCoastal areas are highly vulnerable to flooding, due to hydrological extreme events such heavy rainfalls and/or storm surges which are supposed to be increasing in the next future due to the emission in atmosphere of anthropogenic greenhouse gases. In this study, in order to assess the future hydraulic risk in coastal regions, as well as, to identify optimal defense/adaptation policies, a risk analysis model is developed to calculate the present day and future flood risk, accounting for climate change uncertainties and mitigation measures. Such model juxtaposes a number of coupled/nested models as: a) a stacking daily rainfall downscaling model which combines simulations from multiple predictive models, as Random Forest, extreme gradient boosting and Non-homogeneous Hidden Markov Model (NHMM) (Cioffi et al. 2018); b) a Bivariate Point Process model (BPPM) (Zheng et al., 2014) that calculates Joint probability density function between extreme daily rainfall amount and daily extreme storm tide depth; c) a simulation-optimization model - in which multi-objective GA optimization model (Deb et al., 2002) and 2D hydraulic model are combined (Cioffi et al. 2018) - calculates sets of Pareto optimal solutions which are obtained by defining two optimality criteria consisting in: minimizing both the cost of the flood defense infrastructure system and the flooding hydraulic risk. ; d) a mathematical decision model which is aimed to identify the best policies of mitigation of hydraulic risk and the timing, taking into account the uncertainties in hydrological extreme event predictions. The risk analysis model is applied to the study case of Mazzocchio area which is the most depressed area (about 10000 ha) within the Pontinia Plain, a large reclamation region in the south of Lazio (Italy), particularly vulnerable to extreme events - as extreme rainfall amount and sea level rise due to storm surge at the sea outfall of the river- which in the past caused the crisis of hydraulic network system with flooding of large areas and collapse of levees. XXI Century projections of daily rainfall amount and sea level for the RCP 8.5-IPCC scenarios were performed using ensemble of 35 GCM simulations (CESM1 CAM5 BGC 20C + RCP8.5 Large Ensemble) (Kay et al., 2015)
Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc: A Clinical, Radiological, Two-center Study
No full textStudy Design. This is a prospective two-center study. Objective. The aim of this study was to assess the safety and efficacy of treating patients with lumbar foraminal disc herniations via a microscopic transpars approach, with a clinical and radiological follow-up evaluation. Summary of Background Data. Purely foraminal lumbar disc herniations comprise about 5% of all lumbar herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Methods. From January 2012 to January 2015, 47 patients were prospectively recruited. Patients were followed-up as outpatients at 1 week after discharge, then at 1, 6, and 12 months. A clinical multiparametric evaluation of patients including numeric rating scale (NRS), drugs intake, Macnab criteria, and working days lost was used. Postoperative dynamic x-rays (flexion, extension) were performed in all cases 12 months after surgery. Results. No surgery-related complications occurred. Among the 35 patients who were not retired at the time of the study, 29 patients returned to work and to normal daily activities within 60 days after surgery. Pain evaluation at discharge showed a significant improvement of NRS score, from 8.93 to 1.45 at 12 months. Root palsy significantly improved in all cases already at 1-month follow-up. Drugs intake analysis showed that at 6-month follow-up, no patients used steroids, or opioids, 17 patients used non-steroidal anti-inflammatory drugs when needed, and 29 patients (61.7%) used no drugs for pain relief. No significant variations occurred at 12-month-follow-up. At 12-month follow-up, excellent or good outcome (following Macnab criteria) was achieved in 36 (76.6%) and 8 (17%) patients, respectively. There were no cases of spinal instability at 12-month radiological evaluation. No recurrence occurred at follow-up. Conclusion. Transpars microscopic approach is effective and safe for the treatment of FLDH, but larger studies are needed
Functional Outcome after odontoid fractures in the elderly
No full textWhile several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement. A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients. Patients treated with anterior screw fixation had a good functional outcome in 92.6% of cases. This percentage seemed to decrease in octogenarians. Less information was available for patients treated with posterior approaches; it would seem that up to a half of such patients experienced pain and limitations in activities of daily living after surgery. Patients treated with a halo device had a functional outcome that was worse (or at least no better) than that of patients treated with surgery, with absence of limitations in activities of daily living in 77.3% of patients. Patients treated with a collar had a good functional outcome in the majority of cases, with absence of limitations in activities of daily living in 89% of patients. More studies are needed for evaluation of functional outcome, especially in patients treated with a collar, a halo device or a posterior approach
A Flood Risk Management Model to Identify Optimal Defence Policies in Coastal Areas Considering Uncertainties in Climate Projections
No full textCoastal areas are particularly vulnerable to flooding from heavy rainfall, sea storm surge, or a combination of the two. Recent studies project higher intensity and frequency of heavy rains, and progressive sea level rise continuing over the next decades. Pre-emptive and optimal flood defense policies that adaptively address climate change are needed. However, future climate projections have significant uncertainty due to multiple factors: (a) future CO2 emission scenarios; (b) uncertainties in climate modelling; (c) discount factor changes due to market fluctuations; (d) uncertain migration and population growth dynamics. Here, a methodology is proposed to identify the optimal design and timing of flood defense structures in which uncertainties in 21st century climate projections are explicitly considered probabilistically. A multi-objective optimization model is developed to minimize both the cost of the flood defence infrastructure system and the flooding hydraulic risk expressed by Expected Annual Damage (EAD). The decision variables of the multi-objective optimization problem are the size of defence system and the timing of implementation. The model accounts for the joint probability density functions of extreme rainfall, storm surge and sea level rise, as well as the damages, which are determined dynamically by the defence system state considering the probability and consequences of system failure, using a water depth–damage curve related to the land use (Corine Land Cover); water depth due to flooding are calculated by hydraulic model. A new dominant sorting genetic algorithm (NSGAII) is used to solve the multi-objective problem optimization. A case study is presented for the Pontina Plain (Lazio Italy), a coastal region, originally a swamp reclaimed about a hundred years ago, that is rich in urban centers and farms. A set of optimal adaptation policies, quantifying size and timing of flood defence constructions for different climate scenarios and belonging to the Pareto curve obtained by the NSGAII are identified for such a case study to mitigate the risk of flooding and to aid decision makers
