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This article proposes an integrated assessment methodology aimed at supporting decision-makers in design energy production scenarios to power a low emissions traffic fleet. The Multidimensional Air Quality (MAQ) system is used to define and solve a decision problem that selects a set of energy production scenarios minimizing costs, impacts on air quality, and greenhouse gases (GHGs) emissions. This study focuses on the road transport sector, that is responsible for 25% of European GHGs emissions and 39% of NOₓ emission, a precursor of both NO₂ and PM₁₀ concentrations. The electrification of the light vehicle fleet and the use of biomethane to power heavy vehicles are analyzed, estimating the electricity demand increase, exploring different energy production mixes, and assessing the impacts on air quality, costs, and GHGs according to the fuels/sources used to satisfy the energy demand. A case study over Lombardy region, in Northern Italy, is proposed.

In this work, a data-driven approach for the identification of a piece-wise linear model for nitrogen oxide daily concentration simulation is presented and applied. The model has been identified by using daily measured concentrations, meteorological variables, and emission levels estimated starting from the results contained in suitable emission databases. We propose an innovative methodology that jointly optimizes clustering and parameter identification. The procedure has been applied considering data from the Milan (Italy) metropolitan area. The methodology has been compared with two state-of-the-art approaches based on a two-step, cluster-based algorithm and on Hammerstein–Wiener models. The results show how, in the presented application, the devised approach ensures better performance with respect to the two literature methods, both in terms of statistical indexes (correlation, normalized mean absolute error) and in terms of problem-specific metrics (hit ratio, false alarm). For this reason, the approach can be considered suitable to be used in the definition of optimal emission control strategies.

The aim of this study was to analyze the hearing outcomes and quality of life in a series of 52 patients affected by conductive or mixed hearing loss and treated with Bonebridge52 of 71 patients implanted with BonebridgeThe liminal tone audiometry (free field) pure tone average for air conduction after 6 months with the implant was 35.12 dB, obtaining a mean gain of 31.83 dB. With BonebridgeThe hearing outcomes and the subjective benefits reported by patients obtained in our study are similar to those published in the literature. Bonebridge

ObjectiveTo describe our management of implantable hearing device extrusion in cases of previous cervicofacial surgery.MethodsA review was conducted of a retrospectively acquired database of surgical procedures for implantable hearing devices performed at our department between January 2011 and December 2019. Cases of device extrusion and previous cervicofacial surgery are included. Medical and surgical management is discussed.ResultsFour cases of implant extrusion following cervicofacial surgery were identified: one involving a Bonebridge system and three involving cochlear implants. In all cases, antibiotic treatment was administered and surgical debridement performed. The same Bonebridge system was implanted in the middle fossa. The three cochlear implants were removed, and new devices were implanted in a more posterior region.ConclusionPrevious cervicofacial surgery is a risk factor for hearing implant extrusion. The middle fossa approach is the best option for the Bonebridge system. Regarding the cochlear implant, it is always suitable to place it in a more posterior area. An inferiorly based fascio-muscular flap may be a good option to reduce the risk of extrusion.

The control of critical pollutant events has become one of the most relevant problems that the Local Authorities need to manage, in order to limit population exposure to high pollutant levels. The problem of the selection of suitable short terms plans allowing to maintain the pollutant concentrations under a certain threshold is particularly difficult due to the strong nonlinearity and due to the high number of parameters (sometimes not manageable, as in the case of meteorological conditions) that can affect the concentrations at a certain time. In order to help Local Authorities in taking these decision, suitable Integrated assessment Models (IAMs) have to be formalized and implemented. In this work, the formalization and implementation of an IAM for the selecting of short-term actions is presented. The system is based on a forecasting phase and on a receding horizon approach for the selection of suitable emission control actions. The system has been applied with encouraging results to the management of PM10 levels over a domain including the metropolitan area of the city of Brescia in Lombardy.

Forecasting has always been at the forefront of decision making and planning. The uncertainty that surrounds the future is both exciting and challenging, with individuals and organisations seeking to minimise risks and maximise utilities. The large number of forecasting applications calls for a diverse set of forecasting methods to tackle real-life challenges. This article provides a non-systematic review of the theory and the practice of forecasting. We provide an overview of a wide range of theoretical, state-of-the-art models, methods, principles, and approaches to prepare, produce, organise, and evaluate forecasts. We then demonstrate how such theoretical concepts are applied in a variety of real-life contexts. We do not claim that this review is an exhaustive list of methods and applications. However, we wish that our encyclopedic presentation will offer a point of reference for the rich work that has been undertaken over the last decades, with some key insights for the future of forecasting theory and practice. Given its encyclopedic nature, the intended mode of reading is non-linear. We offer cross-references to allow the readers to navigate through the various topics. We complement the theoretical concepts and applications covered by large lists of free or open-source software implementations and publicly-available databases. Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)001 Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ)307403/2019-0 CA19130 ECO2017-87245-R SBPLY/19/180501/000151 info:eu-repo/semantics/publishedVersion

SARS-CoV-2 virus (COVID-19) pandemic has impacted several countries, with also some differences at local levels. When lockdown restrictions were imposed, the concentrations of some air pollutants were reduced, as reported in some other cities in the world. This was often considered a positive by-product of the pandemic. However, often literature reporting the connection of air quality (AQ) and lockdown, suffers of limited and incomplete data analysis, not considering, for example, some confounding factors. This work presents a methodology, and the results of its application, to assess the impact of pandemic restrictions on AQ (in particular nitrogen oxides, NO

In this work, a virtual sensor for PM10 concentration monitoring is presented. The sensor is based on wavenet models and uses daily mean NO2 concentration and meteorological variables (wind speed and rainfall) as input. The methodology has been applied to the reconstruction of PM10 levels measured from 14 monitoring stations in Lombardy region (Italy). This region, usually affected by high levels of PM10, is a challenging benchmarking area for the implemented sensors. Neverthless, the performances are good with relatively low bias and high correlation.

BackgroundThe indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.MethodA prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.ResultsTwenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).ConclusionThe combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

RESUMEN Un síndrome caracterizado por dolor cervical y un apófisis estiloides alargado fue descrito por primera vez por Watt Eagle en 1937. Aunque el síndrome de Eagle en su variante vascular es raro y no es reconocido como causa clara de disección carotídea, en los últimos años ha sido reportado un incremento del número de casos de disección carotídea causada por una apófisis estiloides alargada. Paciente de 56 años que acudió al servicio de urgencias por paresia facial izquierda aguda y habla confusa. Presentaba dolor cervical de dos días de evolución, relacionado con un ataque de tos. Se activó el código ictus y la tomografía computarizada (TC) mostró isquemia del lóbulo temporal derecho y disección bilateral de la arteria carótida interna. La angio-TC de los troncos supraaórticos con reconstrucción tridimensional, identificó una apófisis estiloides alargado en ambos lados. El paciente fue sometido a una angioplastía con colocación de dos stents. Debido al alto riesgo de padecer nuevo ictus, se decidió realizar tratamiento quirúrgico. Para el lado derecho se realizó un abordaje transoral y en el izquierdo un abordaje abierto. La apófisis estiloides alargado es una causa importante de disección carotídea y de las complicaciones cerebrovasculares relacionadas.

Advances in oncological head and neck surgery evidenced in the last decades have been linked to the progression in the reconstruction capacity of the defects resulting from resection of advanced tumors, allowing the improvement of both esthetic and functional results, as well as decrease the rate of postoperative complications in rescue surgery. To understand the situation of head and neck reconstruction across the country. a questionnaire about the current state of head and neck reconstructive surgery in Spain in otorhinolaryngology and head and neck surgery departments was distributed via email. Eighty (25.5%) of 313 ENT departments in Spain carry out some type of reconstruction in oncological surgery of the head and neck. Forty-four (55%) departments use regional pedicled flaps as a single reconstruction strategy, while 36 (45%) departments also employed the use of microvascular free flaps. Fifty-six (70%) departments perform 10 or less regional pedicled flaps per year, while 21 (29.6%) perform 10 or more flaps per year, with an average of 9.91 ± 11.73 flaps/year (min. 2, max. 40). Seven (8.75%) departments perform 10 or more free flaps a year, while the other 29 (36.25%) perform 10 or less, with an average of 4.96 ± 5.1 free flaps microvascular year (min. 2, max 20). In our country, head and neck cancer surgeries are performed in a tertiary level hospital and patients benefit from the reconstruction of post-surgical defects, through the use of regional pedicled or microvascular free flaps.

BackgroundThe transmastoid pre-sigmoid approach is always the preferred choice for implantation of the Bonebridge active bone conduction system in patients with a normal anatomy. When an anatomical variant exists or a previous surgery has been performed, a retrosigmoid approach or middle fossa approach can be performed.MethodsThe preferred surgical technique for a middle fossa approach is described. A 14 mm drill head (Neuro Drill) was used to create the bed at the squamous portion of the temporal bone. Surgical time and complication rate were analysed.ResultsThe surgical time was shorter than 30 minutes in all cases, and only 14 seconds were needed to create a 14 mm bone bed. No complications were observed during the follow-up period (6–45 months).ConclusionUse of the Neuro Drill for the middle fossa approach is an easy technique. It significantly decreases the surgical time, without increasing the complication rate.

Resumen Objetivo El implante activo de conduccion osea transcutaneo Bonebridge® esta indicado en pacientes con hipoacusia conductiva/mixta bilateral o en casos de hipoacusia neurosensorial unilateral, mostrando resultados auditivos similares a otros dispositivos percutaneos de conduccion osea pero con menor tasa de complicaciones. El objetivo del siguiente trabajo ha sido analizar los resultados auditivos en una serie de 26 pacientes con hipoacusia conductiva/mixta tratados con Bonebridge®. Metodos Veintiseis de un total de 30 pacientes implantados con Bonebridge® entre octubre 2012 y mayo 2017 fueron incluidos en el estudio. Se compararon los umbrales de via aerea a las frecuencias 500, 1.000, 2.000, 3.000 y 4.000 Hz, umbral de reconocimiento verbal 50% y el porcentaje de aciertos a 50 dB sin y con el implante. Resultados El umbral tonal medio en campo libre con el dispositivo en funcionamiento fue de 34,91 dB, obteniendo unas ganancias medias de 33,46 dB. La SRT 50% media con el implante fue de 34,33 dB mientras que sin el nadie alcanzaba el 50% de aciertos a una intensidad de hasta 50 dB. Con respecto al porcentaje de aciertos a 50 dB, mejoro desde un 11% sin implante a un 85% con el mismo. Entre las complicaciones solo se observo un caso de extrusion del dispositivo en una paciente con antecedentes de 2 ritidoplastias previas. Conclusiones Los resultados audiologicos obtenidos en nuestro estudio son similares a los publicados en la literatura. Bonebridge® representa una excelente alternativa en el tratamiento de la hipoacusia conductiva/mixta, pero con una tasa menor de complicaciones.

Objective The active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyse the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. Methods 26 of 30 patients implanted with Bonebridge® between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000 Hz, the SRT 50% and the percentage of correct answers at an intensity of 50 dB with and without the implant. Results “Pure tone average” with the implant was 34.91 dB showing an average gain of 33.46 dB. Average SRT 50% with the implant was 34.33 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50 dB. The percentage of correct answers at 50 dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies. Conclusions The hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications.

Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 129:1001-1004, 2019.

Amanita muscaria is considered to be one of the most remarkable and beautiful mushrooms. It has a red or orange cap covered with small white plaques and its distinctive appearance makes accidental and severe intoxication very rare. Its consumption is sometimes used as a means of suicide or it can be consumed for its psychedelic effects, and in some cases, it can be mistaken for edible species. In this paper, we will discuss a patient who fell into a coma after accidental Amanita muscaria poisoning. Rapid identification of the mushroom allowed the regression of symptoms and discharge from the hospital on the fourth day after consumption. Learning points Amanita muscaria is one of the most remarkable mushrooms for its distinctive appearance, but sometimes it can be mistaken for edible species.Amanita muscaria is a highly poisonous mushroom; the primary effects usually involve the central nervous system, and in severe poisoning, symptoms may manifest with coma and in rare cases lead to death.The rapid and correct identification of this mushroom is important for optimal risk assessment and in order to prescribe the best therapy.

This paper highlights advantages and drawbacks due to the use of portable and low-cost devices for aerosol sampling, showing their performances during an aerosol monitoring campaign with the parallel use of the gravimetric sampling reference method and a cascade impactor. A specific monitoring campaign was held running all instruments in parallel in indoor, confined, and outdoor environments characterized by local emission sources or particulate matter background concentrations. PM2.5 concentrations were used to compare data emerging from the different instruments adopted. Significant underestimation of PM2.5 emerged when comparing data coming from optical sensors with those estimated by the cascade impactor, whose data resulted in being coherent with gravimetric determination, integrated over the same sampling time. A cause–effect relationship between PM2.5 concentrations and specific emission sources was found when observing the daily patterns of all the real-time sampling devices. It emerged that optical devices are useful for detecting concentration trends, the presence of peak values, or changes in the background value, even if with limited accuracy and precision. The comparison with particle size distributions obtained by the cascade impactor data allowed us to define which particle sizes are not detected by different optical devices, evidencing a low representativeness of optical low-cost sensors for health exposure measurements. The correlations among the specific particle size fractions detected by the cascade impactor and their specific emission sources were particularly high for car emissions in a semi-confined garage area.