THE PATIENT IN THE OPERATING ROOM: CONSIDERATION AT SEVEN YEARS FROM WORLD HEALTH ORGANIZATION GUIDELINES PUBLICATION.

Modern surgery is burdened by a huge amount of patient to be treated and an increasingly complex number of procedures which request planned action and shared behaviours, aimed to prevent perioperative accidents and favour good surgical outcomes. Surgical and anaesthetic safety has improved significantly in last few decades. However, the operating room environment continues to have significant safety risks for patients as well as the health care providers who work there. Adverse events may result from problems in practice, products, procedures or systems. The worldwide incidence of surgical site infection, one of the most important and frequent post-operative complication, ranges from 3% to 16%, with a mortality rate ranging from 0.4% to 0.8%; in these studies, about 50% of cases were considered preventable (1-9). Patients safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care. Just as public health interventions and educational projects have dramatically improved maternal and neonatal survival, analogous efforts might improve surgical safety and quality of care (10). According to these objectives, the World Health Organization (WHO) has published and diffused the international “Guidelines for Safe Surgery” (11). The guidelines have the clear proposal to 61ameliorate the safety of surgical interventions; they define and promote recommendation and safety standards suitable for the different Countries and operative settings, suggesting a new deal in managing pre-operative, intra-operative and post-operative processes. On the base of these recommendations, the WHO has also developed a checklist for the safety in the operating room, in order to prevent avoidable adverse events, thus minimizing unnecessary loss of life and serious complications. The results raised from a multicentre study carried out in eight different Countries, demonstrating the effectiveness of the WHO checklist in terms of better patient safety, reduction of deaths and post-operative complications (12). The objectives of this international effort are resumable as follow: 1. the patient must be correctly positioned on the surgical bed and prepared; 2. the surgery team must operate on the correct patient at the correct site; 3. blood loss and risk for surgical site infection must be minimized; 4. inadvertent retention of instruments and sponges in surgical site must be prevented; 5. during surgery, anaesthesiologists must prevent harm from the administration of anaesthetics, while protecting the patient from pain; 6. anaesthesiologists must manage patient’s airways and respiratory function, in order to avoid life-threatening complications; 7. the team should consider patient’s allergies or intolerances in order to prevent an allergic or adverse drug reaction; 8. at the end of intervention, the surgical team must secure and accurately identify all surgical specimens, while the anaesthesiologists will guarantee a correct patient awakening; 9. all the members of the team will effectively communicate and exchange critical information for the safe conduct of the operation; 10. post-operative thromboembolism must be prevented adopting the right measures; 11. each member of the team is responsible for his own clinical documentation; 12. hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results. On March 2013, the American Agency for Health Research and Quality (AHRQ) published the Making Health Care Safer II report, which confirmed the effectiveness of WHO checklist and considered it as one of the 10 strongest recommended practices health care organizations should immediately apply to improve patient safety (13). After the first launch of the WHO checklist, the American Veteran Health Administration observed a constant reduction of patient mortality (0.5/1000 surgeries/4 months); in Holland, compliance to the new guidelines raised from 12% of the first 4 months to the 60%, observed at the end of the second year after publication. This means that «The checklist only works if you use it» (14). The checklist does not reduces itself patient complications, but only the application of all the provided items could help to do so. The checklist should be understood not merely as a list of items to be checked off, but as an instrument for the improvement of communication, teamwork, and safety culture in the operating room, and it should be accordingly implemented. To reach the expected results it needs time, the time to let surgical team to learn and involve (gradually) all the interested units of a determined hospital or the hospitals of a specific geographic area. Agreeing with Bosk and colleagues (15), using an electronic recording format within the standard mandatory strategy facilitates apparent compliance and the use of the safety checklist as a tick box exercise. It seems that the main trick to improving safety is a strategy leading to positive attitudes on the part of the health professionals involved, involving a far more complex adaptive process than merely mandating the use of a checklist

Single-ion anisotropy and magnetic field response in the spin-ice materials Ho2Ti2 O7 and Dy2Ti2 O7

Motivated by its role as a central pillar of current theories of dynamics of spin ice in and out of equilibrium, we study the single-ion dynamics of the magnetic rare earth ions in their local environments, subject to the effective fields set up by the magnetic moments they interact with. This effective field has a transverse component with respect to the local easy-axis of the crystal electric field, which can induce quantum tunnelling. We go beyond the projective spin-1/2 picture and use instead the full crystal-field Hamiltonian. We find that the Kramers vs non-Kramers nature, as well as the symmetries of the crystal-field Hamiltonian, result in different perturbative behaviour at small fields ($\lesssim 1$ T), with transverse field effects being more pronounced in Ho$_{2}$Ti$_{2}$O$_{7}$ than in Dy$_{2}$Ti$_{2}$O$_{7}$. Remarkably, the energy splitting range we find is consistent with time scales extracted from experiments. We also present a study of the static magnetic response which highlights the anisotropy of the system in the form of an off-diagonal $g$ tensor and we investigate the effects of thermal fluctuations in the temperature regime of relevance to experiments. We show that there is a narrow yet accessible window of experimental parameters where the anisotropic response can be observed.EPSRC, STFC, HEFCE, SEPnetThis is the author accepted manuscript. The final version is available from the American Physical Society via http://dx.doi.org/10.1103/PhysRevB.92.15512

2016 WHO GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION: A NEW STEP TO IMPROVE PATIENT'S SAFETY BEFORE, DURING AND AFTER SURGERY

Surgical site infection (SSI) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during and after surgery. No international guidelines are available and incosistencies in the interpretations of evidence and recommendations of national guidelines have been identified. Given the burden of SSI worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for thew prevention of SSI. The guidelines take into account the balance between benefits and harms, the evidence quality, costs and resource use implications, and patgients values andf preferences. on the basis of systematic literature reviews and expert consensus, we present 23 recommendations on preoperative, intraoperative and postoperative preventive measures. The WHO recommendations were developed with a global perspective and they take into account the balance between benefitgs and harms, the evidence quality level, cost and resource use implications, and patient values and preferences

Why do dogs (Canis familiaris) select the empty container in an observational learning task?

Many argue that dogs show unique susceptibility to human communicative signals that make them suitable for being engaged in complex co-operation with humans. It has also been revealed that socially provided information is particularly effective in influencing the behaviour of dogs even when the human’s action demonstration conveys inefficient or mistaken solution of task. It is unclear, however, how the communicative nature of the demonstration context and the presence of the human demonstrator affect the dogs’ object-choice behaviour in observational learning situations. In order to unfold the effects of these factors, 76 adult pet dogs could observe a communicative or a non-communicative demonstration in which the human retrieved a tennis ball from under an opaque container while manipulating another distant and obviously empty (transparent) one. Subjects were then allowed to choose either in the presence of the demonstrator or after she left the room. Results showed a significant main effect of the demonstration context (presence or absence of the human’s communicative signals), and we also found some evidence for the response-modifying effect of the presence of the human demonstrator during the dogs’ choice. That is, dogs predominantly chose the baited container, but if the demonstration context was communicative and the human was present during the dogs’ choice, subjects’ tendency to select the baited container has been reduced. In agreement with the studies showing sensitivity to human’s communicative signals in dogs, these findings point to a special form of social influence in observational learning situations when it comes to learning about causally opaque and less efficient (compared to what comes natural to the dog) action demonstrations

Quantum Discord in a spin-1/2 transverse XY Chain Following a Quench

We report a study on the zero-temperature quantum discord as a measure of two-spin correlation of a transverse XY spin chain following a quench across a quantum critical point and investigate the behavior of mutual information, classical correlations and hence of discord in the final state as a function of the rate of quenching. We show that though discord vanishes in the limit of very slow as well as very fast quenching, it exhibits a peak for an intermediate value of the quenching rate. We show that though discord and also the mutual information exhibit a similar behavior with respect to the quenching rate to that of concurrence or negativity following an identical quenching, there are quantitative differences. Our studies indicate that like concurrence, discord also exhibits a power law scaling with the rate of quenching in the limit of slow quenching though it may not be expressible in a closed power law form. We also explore the behavior of discord on quenching linearly across a quantum multicritical point (MCP) and observe a scaling similar to that of the defect density.Comment: 6 pages, 5 figure

DISMICROBISM IN INFLAMMATORY BOWEL DISESE AND COLORECTAL CANCER: CHANGES IN RESPONSE OF COLOCYTES

Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. the CRC has been increasing in recent years and its mortality rates are very high. Multiple biological and biochemical factors are responsible for the onset nad progression of this pathology. moreover, it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the production of colonic healt. the gut microflora, or microbiota, has an extensive diversity both quantitatively and qualitatively. in utero, the intestine of the mammalian fetus is sterile. Al birth, the intestinal microbiota in acquired by ingestion maternal anal or vaginal organisms, ultimately developing into a stable community, with marked variations in microbial composition between individuals. the development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora (dysbiosis). the healthy human gut arbours about 10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract. The intestinal microbiota plays a fundamental role in helath and the progeression of diseases such as IBD and CRC. in Healthy subjects, the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature, competition between different bacterial strains, peristalsis and drugs can influence the intestinal microenvironment. the microbiota exerts diverse physiological functions to include; growth inhibition of pathogenic microrganisms, synthesis of compounds useful for the trophysm of colonic mucosa, regulation of the intestinal lymphoid tissue and synthesis of amino acids. furthermopre, mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity. changes in the microbiota composition are mainly influenced by diet and age, as well as genetic factors. Increasing evidence indicates that dysbiosis favors the production of genotoxins and metabolities associated with carcinogeneasis and induces dysregulation of the immune response wich promotes and sustains inflammation in IBD leading to carcinogenesis. a disequilibrium in gut microflora composition leads to the specific activation of gut associated lymphoid tissue. the associated chronic inflammatory process associated increases the risk of developing CRC. Ulcerative colitis and Crohn's diasease are the two major IBDs characterized by an early onset and extraintestinal manifestations, such as rheumatoid arthtritis. the pathogenesis of both diseases is complex and not yet fully known. however, it is widely accepted that an inappropriate immune response to microbial flora can play a pivotal role in IBD pathogenesis

EFFICACY OF ARGENTUM-QUARTZ SOLUTION IN THE TREATMENT OF PERIANAL FISTULAS: A PRELIMINARY STUDY

Objective: Nowadays, an optional and effective medical surgery remains the gold standard for perianal fistulas. Hereby we reported preliminary rsults in favor of using Argentum-Quartz solution for both primary and recurrent perianal fisrtulas. Methods: Three patients with intersphimncter and extrasphinteric fistulas were enrolled. Argentum-Quartz solution was administrated twice a week for sa period of 4 weeks, followed by a pause of 8 days and then another 4 weeks of treatment, totally 16 administrations. After treatment, all patients were monitored for 4-months follow-up. Results: Complete closures of 2 extrasphinteric fistulas and a partial closure with absence of inflammation and superative phenomena in the intraspinteric fistula were both manifested. Conclusions: Selective treatment of perianal fistulas with argentum-quartz solution is safe and effective. and may represent a reliable alternative

Critical Point Estimation and Long-Range Behavior in the One-Dimensional XY Model Using Thermal Quantum and Total Correlations

We investigate the thermal quantum and total correlations in the anisotropic XY spin chain in transverse field. While we adopt concurrence and geometric quantum discord to measure quantum correlations, we use measurement-induced nonlocality and an alternative quantity defined in terms of Wigner-Yanase information to quantify total correlations. We show that the ability of these measures to estimate the critical point at finite temperature strongly depend on the anisotropy parameter of the Hamiltonian. We also identify a correlation measure which detects the factorized ground state in this model. Furthermore, we study the effect of temperature on long-range correlations.Comment: 7 pages, 6 figure

Body-part-specific Representations of Semantic Noun Categories.

Word meaning processing in the brain involves ventrolateral temporal cortex, but a semantic contribution of the dorsal stream, especially frontocentral sensorimotor areas, has been controversial. We here examine brain activation during passive reading of object-related nouns from different semantic categories, notably animal, food, and tool words, matched for a range of psycholinguistic features. Results show ventral stream activation in temporal cortex along with category-specific activation patterns in both ventral and dorsal streams, including sensorimotor systems and adjacent pFC. Precentral activation reflected action-related semantic features of the word categories. Cortical regions implicated in mouth and face movements were sparked by food words, and hand area activation was seen for tool words, consistent with the actions implicated by the objects the words are used to speak about. Furthermore, tool words specifically activated the right cerebellum, and food words activated the left orbito-frontal and fusiform areas. We discuss our results in the context of category-specific semantic deficits in the processing of words and concepts, along with previous neuroimaging research, and conclude that specific dorsal and ventral areas in frontocentral and temporal cortex index visual and affective–emotional semantic attributes of object-related nouns and action-related affordances of their referent objects

Quantum Correlation in One-dimensional Extend Quantum Compass Model

We study the correlations in the one-dimensional extended quantum compass model in a transverse magnetic field. By exactly solving the Hamiltonian, we find that the quantum correlation of the ground state of one-dimensional quantum compass model is vanishing. We show that quantum discord can not only locate the quantum critical points, but also discern the orders of phase transitions. Furthermore, entanglement quantified by concurrence is also compared.Comment: 8 pages, 14 figures, to appear in Eur. Phys. J.