Milano Metropoli Development Agency

The retrofitting of existing reinforced concrete structures is of paramount importance due to aging structures, changes in design codes, and the need to enhance resilience against seismic events. This paper addresses this critical issue by presenting the results of an experimental campaign focused on evaluating the shear performance of old-to-new concrete interface, considering the application of a thin (5 cm) concrete overlay. Both monotonic and cyclic shear tests were conducted to assess the behavior under static and seismic loading conditions. Mechanical anchors were installed into the existing concrete as connectors. The study investigates the influence of different concrete types, i.e. normal-weight and lightweight concrete, used for the overlay. The experimentally obtained shear strength values were compared with predictions derived from established design codes and guidelines: Eurocode 2 (old and new versions) and EOTA TR066. The aim of the comparison was to understand if the available codes are able to predict the experimental behavior when using an overlay with limited thickness and a lightweight concrete. TR066 results conservative but able to predict the failure mode, while the new Eurocode 2 gives the best prediction of resistance, although it does not cover very short embedment depth and seismic action. Lastly, the evaluation of the reduction coefficient α seis is made to account the behavior of the connectors under seismic action.

The rapid digitalization of work and daily life has introduced a wide range of online threats, from common hazards such as malware and phishing to emerging challenges posed by artificial intelligence (AI). While technical aspects of cybersecurity have received extensive attention, less is known about how individuals perceive digital risks and how these perceptions shape protective behaviors. Building on the psychometric paradigm, this study investigated the perception of seven digital threats among a sample of 300 Italian workers employed in IT and non-IT sectors. Participants rated each hazard on dread and unknown risk dimensions and reported their cybersecurity expertise. Optimism bias and proactive awareness were also detected. Cluster analyses revealed four profiles based on different levels of dread and unknown risk ratings. The four profiles also differed in reported levels of expertise, optimism bias, and proactive awareness. Notably, AI was perceived as the least familiar and most uncertain hazard across groups, underscoring its salience in shaping digital risk perceptions. These findings highlight the heterogeneity of digital risk perception and suggest that tailored communication and training strategies, rather than one-size-fits-all approaches, are essential to fostering safer online practices.

N/A

Work-related traumatic upper arm amputations still represent a significant issue, with prevalence estimates of 11.6/100,000 in Europe. These injuries significantly affect patients’ quality of life by causing loss of function with reduced autonomy, social and emotional consequences. We present the case of a 24-year-old man who suffered from a complete amputation of his left forearm due to a workplace accident involving a cast iron press. After clinical stabilization, a multidisciplinary team composed of plastic, orthopedic, and vascular surgeons performed a preoperative evaluation and subsequent successful replantation surgery. In our case, despite the mechanism of amputation, a prompt multidisciplinary evaluation, the minimal ischemia time, the bone-sparing reduction and fixation, muscle debridement, and doppler ultrasound assessment of the reimplanted limb skin flap vascularization achieved an optimal long term functional outcome further enhanced by postoperative rehabilitation, guided by an individualized program. Two years post-replantation, the patient regained sensitivity on all fingers with complete hand and forearm intrinsic muscle activity, enabling a return to work within one year. While upper limb replantation poses significant challenges, our case underscores the potential for favorable outcomes with multidisciplinary collaboration and postoperative comprehensive rehabilitation strategies.

Tinnitus is a frequent symptom, and is present in 10-15% of people who suffer from chronic tinnitus, defined as heard every day for at least 6 months. Among these, 1-2% develop a strong emotive reaction, anxiety, and depression, leading to poor quality of life. to evaluate the comorbidities in tinnitus sufferers. In our retrospective study, we collected data on 1156 subjects with tinnitus present for at least 3 months, including age, audiometric exam, THI questionnaire, vascular disorders, fluctuations, causal factors, lifetime psychiatric disorders, and the presence of migraine. A linear regression model was used to assess the independent role of these variables on the THI total score representing tinnitus annoyance. A lifetime history of psychiatric disorders and migraine were predictive for the development of a disabling tinnitus. Among comorbidities a history of previous psychiatric disorders was predictive for developing tinnitus. Moreover, no correlation has been found between hearing level and THI total score. Our data are not inconsistent with the hypothesis that psychological disorders and a particular personality trait may be the main causal factors for tinnitus annoyance.

Abstract Many robotic platforms are currently available for urologic surgery, each with its technical characteristics. It can be hypothesised that these characteristics might affect postoperative nursing, as they affect several aspects of surgery. They could, therefore, impact the surgical outcomes and wound characteristics, involving aspects of postoperative care such as mobilization, nutrition and length of stay. Although data are available on surgical technique aspects and intraoperative nursing, studies have yet to offer insights and considerations about the potential effect of having different robotic platforms on postoperative nursing care. We aimed to verify whether the technical features of the available robots could impact postoperative nursing. We conducted an integrative review on PubMed, CINAHL and Scopus, using Medical Subject Headings (MeSH) and free‐text terms; wildcards and boolean operators were also used. Studies of any design were included. Fifteen papers were retrieved; the key themes emerging from the literature regard trocar setup, technical characteristics of the robots (e.g. single or multiple ports), pneumoperitoneum and Trendelenburg degree. According to the literature, none of these characteristics produce differences in postoperative nursing. The fundamental concepts of postoperative care in surgical inpatients stay the same no matter the robotic platform used. Having competing platforms able to ensure reduced complications without impacting postoperative nursing allows health care facilities to adopt the newest technologies without the need for differentiated nursing protocols. This is an advantage in times of global nursing shortage as it avoids the need for additional platform‐based nursing training.

Background: In vitamin B12 deficiency, bone marrow suppression is common and can potentially affect all cell lines, but megaloblastic anemia is the most frequent. The causes of vitamin B12 deficiency are numerous, such as decreased ileal absorption, decreased intrinsic factor that is necessary for a correct absorption of this vitamin, inadequate intake, and prolonged medication use. Laboratory medicine has become a fundamental discipline in the diagnostic process and in medical care. The issue of appropriateness plays an increasing role in laboratory medicine, and in this regard, the concept of appropriateness in laboratory medicine has evolved in years. Case Description: An adult male presented to the emergency department of our hospital for marked asthenia for about a week, with a weight loss of approximately six kilograms in the last month and repeated episodes of nausea and vomiting. On admission, blood analysis showed severe anemia, with a hemoglobin of 39 g/L (3.9 g/dL), leukopenia (1.88×103/µL) and thrombocytopenia (26×103/µL). The suspicion of a possible acute hematological disease has raised. A bone marrow aspirate is performed, and the microscopic evaluation showed a hypercellular marrow with erythropoietic hyperplasia, with megaloblasts instead of normoblasts without evidence of acute hematological neoplasms. This picture is typical in case of severe deficit of vitamin B12. The final diagnosis was made of pernicious anemia and vitamin B12 supplementation was started. Note that in the following days, the patient has also claimed to be a strict vegetarian. Conclusions: This case report is a very good example of inappropriateness in laboratory medicine for the failure to request the appropriate test for the right patient at the right time, specifically the measurement.

BackgroundCritically ill patients are exposed to several physical and emotional stressors, needing analgesic and sedative drugs to tolerate invasive procedures and the harsh intensive care unit (ICU) environment. However, this pharmacological therapy presents several side effects: guidelines suggest using a light sedation target, keeping critically ill patients calm, conscious, and cooperative. Personalized music therapy (MT) can reduce stress and anxiety, decreasing the need for drugs. The aim of the current investigation is to compare different approaches for MT in the ICU: a personalized approach, with music selected by patients/families and listened through headphones, or a generalized approach, with ambient music chosen by a music therapist and transmitted through speakers. Primary outcome: number of days “free from neuroactive drugs” in the first 28 days after ICU admission. Secondary outcomes: total amount of neuroactive drugs (midazolam, propofol, morphine, fentanyl, haloperidol), stress during ICU stay (sleep at night, anxiety and agitation, use of physical restraints, stressors evaluated at discharge), the feasibility of generalized MT (interruptions requested by staff members and patients/families).MethodsRandomized, controlled trial with three groups of critically ill adults: a control group, without MT; a personalized MT group, with music for at least 2 h per day; a generalized MT group, with music for 12.5 h/day, subdivided into fifteen 50-min periods.DiscussionOne hundred fifty-three patients are expected to be enrolled. This publication presents the rationale and the study methods, particularly the strategies used to build the generalized MT playlist. From a preliminary analysis, generalized MT seems feasible in the ICU and is positively received by staff members, critically ill patients, and families.Trial registrationClinicalTrials.gov Identifier: NCT03280329. September 12, 2017.

The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. Italian general intensive care unit. Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm2 (interquartile range, 7.8-14.9 cm2). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3-199.2 ms]; versus 65.5 ms [interquartile range, 59.5-76.2 ms]; P<0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.