Noise maps and action plans represent the main tools in the fight against citizens' exposure to noise, especially that produced by road traffic. The present and the future in smart traffic control is ...represented by Intelligent Transportation Systems (ITS), which however have not yet been sufficiently studied as possible noise-mitigation tools. However, ITS dedicated to traffic control rely on models and input data that are like those required for road traffic noise mapping. The present work developed an instrumentation based on low-cost cameras and a vehicle recognition and counting methodology using modern machine learning techniques, compliant with the requirements of the CNOSSOS-EU noise assessment model. The instrumentation and methodology could be integrated with existing ITS for traffic control in order to design an integrated method, which could also provide updated data over time for noise maps and action plans. The test was carried out as a follow up of the L.I.S.T. Port project, where an ITS was installed for road traffic management in the Italian port city of Piombino. The acoustic efficacy of the installation is evaluated by looking at the difference in the acoustic impact on the population before and after the ITS installation by means of the distribution of noise exposure, the evaluation of G
and G
, and the calculation of the number of highly annoyed and sleep-disturbed citizens. Finally, it is shown how the ITS system represents a valid solution to be integrated with targeted and more specific sound mitigation, such as the laying of low-emission asphalts.
The knowledge of the acoustic impedance of a material allows for the calculation of its acoustic absorption. Impedance can also be linked to structural and physical proprieties of materials. However, ...while the impedance of pavement samples in laboratory conditions can usually be measured with high accuracy using devices such as the impedance tube, complete in-situ evaluation results are less accurate than the laboratory results and is so time consuming that a full scale implementation of in-situ evaluations is practically impossible. Such a system could provide information on the homogeneity and the correct laying of an installation, which is proven to be directly linked to its acoustic emission properties. The present work studies the development of a measurement instrument which can be fastened through holding elements to a moving laboratory (i.e., a vehicle). This device overcomes the issues that afflict traditional in-situ measurements, such as the impossibility to perform a continuous spatial characterization of a given pavement in order to yield a direct evaluation of the surface's quality. The instrumentation has been uncoupled from the vehicle's frame with a system including a Proportional Integral Derivative (PID) controller, studied to maintain the system at a fixed distance from the ground and to reduce damping. The stabilization of this device and the measurement system itself are evaluated and compared to the traditional one.
To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C).
Retrospective data review of a case series of children meeting the ...published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management.
We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90;
= .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82;
< .0001) increased risk per day reduction respectively.
In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.
•Mapping road traffic noise is fundamental for preventing health effects on citizens.•Noise models need to react to social changes and future scenarios.•CNOSSOS-EU coefficients for electric vehicles ...have been calculated starting from Controlled Pass-By measurements in urban scenarios.•The obtained results, with uncertainties, are compared to scientific literature.
Road traffic noise mapping is a fundamental step in the prevention and mitigation of citizens' exposure to noise, which is the cause of well-known and widespread health issues. The most current noise simulation models are not yet ready to adapt to the present and future scenarios of sustainable mobility, manifested by the increasing of electric vehicles. To improve the accuracy of the simulated noise level results, the European CNOSSOS-EU model uses different calculation coefficients for the sound power for each car category. However, for electric vehicles (EVs), such coefficients have not been defined yet, and it is deliberately left open in the decree pending studies dedicated to their definition. In order to fill this gap, the present study defines the CNOSSOS-EU coefficients for calculating the sound power of EVs starting from the Controlled Pass-By measurements in a real case scenario. The analysis performed with four different EVs, considering two different pair of tyres and two different pavements such as reference (RP) and crumb rubber (CRP). A peculiarity of the work is that measurements were deliberately carried out in urban roads since they represent the case where the road traffic noise maps will be used the most to investigate citizens’ exposure to noise. However, this real case scenario implied measurement difficulties which required a specific adaptation of the data analysis procedure. The results are compared with similar studies thus defining values that can be taken as a reference in road noise simulations. Results are the coefficients for the open category (category 5) of CNOSSOS-EU for both RP and CRP, but also a methodology applicable into urban area under real conditions that could act as a basis for other future studies aimed at broadening its applicability and statistical value.
PAHs are largely spread in the aquatic environment, and the drawbacks of conventional remediation techniques as well as the expenditures for alternative disposal of polluted sediments lead to seek ...more effective, environmentally-friendly and sustainable approaches. Therefore, the present review shows a critical overview of the literature evaluated with VOSviewer, focusing on the problem of PAH-contaminated marine sediments and the knowledge of available remediation processes to shed light on what research and technology lack. This review supplies specific information about the key factors affecting biological, physical-chemical and thermal remediation techniques, and carefully examines the drawbacks associated with their employment for remediating PAH-polluted marine sediments by showing adequate alternatives. The technologies thoroughly discussed here are biostimulation, bioaugmentation, sediment washing, carbonaceous adsorbent addition and thermal desorption. The environmental and economic impacts associated with the application of the mentioned remediation technologies have been also taken into account. Finally, this review examines new research directions by showing future recommendations.
Display omitted
•The main remediation techniques employed for PAH-contaminated sediments are reviewed.•Bioaugmentation and biostimulation represent a booster for bioremediation techniques.•Sediment washing is affected by the extracting agent, solid-to-liquid ratio and time.•The use of carbonaceous adsorbent in sediments is limited by sorbent recovery issues.•Thermal desorption-remediated sediments can alter plants and microbial communities.
Minimally invasive resection of gastrointestinal stromal tumors (GIST) results in faster recovery and similar oncological safety when compared to conventional approach 1–3. The new robotic Single ...Port platform (Da Vinci SP) could help decreasing invasiveness while overcoming technical limitations of previous single incision surgical approaches 4.
A 69-year-old male was treated for a 3 cm non-ulcerated GIST in the anterior wall of the proximal gastric body.
A robotic partial gastric resection was performed. The Da Vinci SP platform, which hosts three multi jointed, wristed instruments and a 3D HD articulating scope was used. The camera and instruments were introduced in the abdominal cavity through a 25 mm multichannel port. The lesion was identified in the lesser curvature at the level of the body, approximately 3 cm above the incisura. The gastric wall was resected en-bloc with the tumor using a combination of monopolar hook and bipolar forceps. The lesion was lifted using the third robotic arm and was not manipulated during the dissection. The gastric defect was closed with two running sutures of polydioxanone 3/0. Operative time was 82 minutes. Postoperative course was uneventful, and the patient was discharged home on postoperative day 2 with adequate pain control. Histopathology analysis found a 2.3 × 2 cm low grade GIST.
Robotic SP partial gastrectomy is safe and feasible in patients with gastric GIST. The robotic SP approach might help expanding the indications of previous single incision techniques.
•The single port robotic platform allows to perform surgery through a 2.5 cm incision.•This technology eliminates technical constraints of previous single incision laparoscopic techniques.•Robotic single port partial gastrectomy provides fast recovery and excellent cosmesis.
Background
The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and ...might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP).
Methods
A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain.
Results
MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1 min,
p
= 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6 min,
p
< 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%,
p
= 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6 months for MP-TAPP and 13.3 months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups.
Conclusion
Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform.
Graphical abstract
Background Robotic surgery is gaining popularity for digestive surgery; however, its use for liver surgery is reported scarcely. This article reviews a surgeon's experience with the use of robotic ...surgery for liver resections. Methods From March 2002 to March 2009, 70 robotic liver resections were performed at 2 different centers by a single surgeon. The surgical procedure and postoperative outcome data were reviewed retrospectively. Results Malignant tumors were indications for resections in 42 (60%) patients, whereas benign tumors were indications in 28 (40%) patients. The median age was 60 years (range, 21–84) and 57% of patients were female. Major liver resections (≥3 liver segments) were performed in 27 (38.5%) patients. There were 4 conversions to open surgery (5.7%). The median operative time for a major resection was 313 min (range, 220–480) and 198 min (range, 90–459) for minor resection. The median blood loss was 150 mL (range, 20–1,800) for minor resection and 300 mL (range, 100–2,000) for major resection. The mortality rate was 0%, and the overall rate of complications was 21%. Major morbidity occurred in 4 patients in the major hepatectomies group (14.8%) and in 4 patients in the minor hepatectomies group (9.3%). All complications were managed conservatively and none required reoperation. Conclusion This preliminary experience shows that robotic surgery can be used safely for liver resections with a limited conversion rate, blood loss, and postoperative morbidity. Robotics offers a new technical option for minimally invasive liver surgery.
One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its ...wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution.
Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs.
Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique.
Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.
Background
Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported ...by Gagner and Pomp (Surg Endosc 8:408–410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique.
Methods
We took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical “tips and tricks” to facilitate the learning curve and assist with the teaching/evaluation process.
Results
17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform.
Conclusions
Standardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the ‘gold standard’ is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.
PDF
