at the second ballot, winning 63.9% of the votes in a run-off against the centre-right candidate, the incumbent mayor Gianni Alemanno. Among Marino's projects has been the closing of the Via dei Fori Imperiali and Piazza di Spagna to cars and opening to pedestrian and bicycle traffic only. Mayor Marino cited his experiences as a cyclist in Philadelphia as the foundation for his having learned to live without a car. On 18 October 2014, Marino registered the marriages of 16 same-sex couples who requested it to the Municipality, which followed similar acts by other Italian mayors. Same-sex marriages and civil unions were illegal in Italy at the time, and by registering the marriages, Mayor Marino hoped to force the hand of national legislators to clarify a deepening legal muddle around same-sex unions, particularly for Italians married abroad. Same-sex civil unions were eventually legalized in Italy in 2016. Upon his election, Marino found Rome on the verge of bankruptcy. In 2013, the city was in the red with a loss of $888 million. Its public transport system had a loss of $951 million. During his mandate, Marino balanced both budgets. In only 27 months, the administrative work conducted by Mayor Ignazio Marino, strengthening the City's operating performance, was recognized by all International Rating Agencies. In September 2015, FitchRatings revised the Italian City of Rome's Outlook to Stable from Negative for the first time. On 12 October 2015, Marino resigned amidst a fake accusation of expense scandal that had been made by the opposition parties of Five Star Movement (M5S) and Fratelli d'Italia, but on 29 October he retired the resignation. Nevertheless, on 30 October he was ousted from his position after 26 of the 48 members of the City Council resigned. He was replaced by Francesco Paolo Tronca, a government-appointed commissioner. On 7 October 2016, Rome court acquitted Marino over the allegations of embezzlement, fraud, and forgery that had been made by the opposition parties of M5S and Fratelli d'Italia and after which he had stepped down to prove his innocence. Return to Medicine and Surgery In 2016, Ignazio Marino returned to the USA where he is Professor of Surgery at the Thomas Jefferson University, School of Medicine, and Executive Vice President of Thomas Jefferson University and Jefferson Health in Philadelphia. Jefferson Health, the clinical arm of Thomas Jefferson University, is an 18-hospital health system, with more than 42,000 employees and