Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial

Objective: To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background: GEARS–Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods: In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results: The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P &lt; 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions: Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment. </jats:sec

Postfordismo e trasformazione urbana.Casi di recupero dei vuoti industriali e indicazioni per le politiche nel territorio torinese

Il volume sulle aree dismesse e la trasformazione urbana promosso dalla Direzione Competitività della Regione Piemonte e dall'ente strumentale di ricerca economica e sociale, IRES Piemonte, racchiude contributi su esperienze di recupero dei vuoti urbani industriali e casi rilevanti della trasformazione urbana che hanno interessato Torino e la sua area metropolitana.- Prefazione #7- Introduzione #9- 1. Le ristrutturazioni industriali e il territorio: crisi, declino,metamorfosi? #33- 2. Scoprire i vuoti industriali: analisi e riflessioni a partire da censimenti e mappature di aree industriali dismesse a Torino #51- 3. Le aree dismesse nella riqualificazione e nella rigenerazione urbana a Torino (1990-2015) #113- 4. La trasformazione urbana tra grandi interventi e architetture “ordinarie”. #147- 5. Due esperienze di rigenerazione urbana sul territorio torinese:il Comitato Parco Dora sulla Spina 3 e il Comitato Urban in Barriera di Milano, a Torino #169- 6. Da cittadella industriale a Spina 3: una riconversione incompiuta #193- 7. Ex Diatto - Ex Westinghouse, due casi emblematici per le politiche di rivitalizzazione delle aree industriali torinesi #211- 8. Mirafiori. Dalla componentistica allo yogurt: storia di un progetto di re-industrializzazione #229- 9. Area OSI OVEST-NORD: Toolbox Coworking! #247- 10. Abilitare il territorio metropolitano alla rigenerazione e ad un nuovo sviluppo. Il caso di None, dall'industria subita all'industria inseguita #275- 11. Le ex-Acciaierie Mandelli di Collegno: la storia di una fabbrica,l'attualità del dibattito urbanistico. #301- 12. I programmi territoriali quale motore di rigenerazione urbana e di politiche di contenimento del consumo di suolo nel comune di Settimo Torinese #323- 13. La Regione Piemonte e la sfida del contenimento del consumo di suolo e del riutilizzo delle aree dismesse #353- 14. Torino, la nascita della città postindustriale: quale bilancio? #365- 15. Valutare i rischi della riqualificazione urbanistica e ambientale delle aree industriali dismesse #381- 16. Le aree industriali dismesse e il loro impatto sulla salute: il ruolo dei cittadini e delle amministrazioni locali nell'identificazione dei problemi e delle possibili soluzioni. #405- 17. I giovani e la città che cambia. Nuovi passi e nuovi sguardi sulle tracce di un passato industriale #427- Elenco degli autori e delle autrici #44

Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum TimeCourse

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established.Areas covered: This review summarizes the main epidemiologic, pathophysiological, and clinical risk factors of CV disease associated with IJDs. Less common aspects on early diagnosis and risk stratification of the CV disease in these conditions are also discussed. In Europe, the most commonly used risk algorithm in patients with IJDs is the modified SCORE index based on the revised recommendations proposed by the EULAR task force in 2017.Expert opinion: Early identification of IJD patients at high risk of CV disease is essential. It should include the use of complementary noninvasive imaging techniques. A multidisciplinary approach aimed to improve heart-healthy habits, including strict control of classic CV risk factors is crucial. Adequate management of the underlying IJD is also of main importance since the reduction of disease activity decreases the risk of CV events. Non-steroidal anti-inflammatory drugs may have a lesser harmful effect in IJD than in the general population, due to their anti-inflammatory effects along with other potential beneficial effects.This research was partially funded by FOREUM—Foundation for Research in Rheumatolog

Exploration of psychometric properties of the Italian version of the Core Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE).

There is an increasing need of outcome measures for young people suitable to evaluate treatments and routine settings. However, measures must show suitable psychometric characteristics for such use. This is the first psychometric evaluation of the Italian version of the Core Young Person Clinical Outcomes in Routine Evaluation (YP-CORE). Data are reported for a clinical sample, aged 11-17 (n=175) and non-clinical sample, aged 11-17 (n=206). Analyses included acceptability, confirmatory factor analysis, internal reliability, influence of gender and age on cutoff scores and reliable change. The YP-CORE acceptability was good, with a very high completion rate (98.7% fully completed). Internal consistency was good: the overall Cronbach’s alpha value (α) equal to 0.75 (95% confidence interval=0.69-0.80). The measure was sensitive to change (Cohen dz=1.35). The Italian version of the YP-CORE showed acceptable psychometric properties is suitable for use in services for young people as a change/outcome measure

Comitato Scientifico dell'Associazione Italiana per lo Studio e le Applicazioni delle Microalghe (AISAM)

Il Comitato Scientifico viene interpellato dal Comitato Direttivo dell'Associazione per fornire pareri o redigere documenti a destinazione nazionale e internazionale, al fine di favorire un approccio alle microalghe e cianobatteri corretto e scientificamente basato da parte di soggetti pubblici e privati, istituzioni, enti regolatori etc

Outcomes of Salvage Robotic-assisted Radical Prostatectomy in the last decade: systematic review and perspectives of referral centers.

ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques

Positive Surgical Margins After Anterior Robot-assisted Radical Prostatectomy: Assessing the Learning Curve in a Multi-institutional Collaboration

Background: The learning curve for robot-assisted radical prostatectomy (RARP) remains controversial, with prior studies showing that, in contrast with evidence on open and laparoscopic radical prostatectomy, biochemical recurrence rates of experienced versus inexperienced surgeons did not differ. Objective: To characterize the learning curve for positive surgical margins (PSMs) after RARP. Design, setting, and participants: We analyzed the data of 13 090 patients with prostate cancer undergoing RARP by one of 74 surgeons from ten institutions in Europe and North America between 2003 and 2022. Outcome measurements and statistical analysis: Multivariable models were used to assess the association between surgeon experience at the time of each patient's operation and PSMs after surgery, with adjustment for preoperative prostate-specific antigen level, grade, stage, and year of surgery. Surgeon experience was coded as the number of robotic radical prostatectomies done by the surgeon before the index patient's operation. Results and limitations: Overall, 2838 (22%) men had PSMs on final pathology. After adjusting for case mix, we found a significant, nonlinear association between surgical experience and probability of PSMs after surgery, with a lower risk of PSMs for greater surgeon experience (p < 0.0001). The probabilities of PSMs for a patient treated by a surgeon with ten, 250, 500, and 2000 prior robotic procedures were 26%, 21%, 18%, and 14%, respectively (absolute risk difference between ten and 2000 procedures: 11%; 95% confidence interval: 9%, 14%). Similar results were found after stratifying patients according to extracapsular extension at final pathology. Results were also unaltered after excluding surgeons who had moved between institutions. Conclusions: While we characterized the learning curve for PSMs after RARP, the relative contribution of surgical learning to the achievement of optimal outcomes remains controversial. Future investigations should focus on what experienced surgeons do to avoid positive margins and should explore the relationship between learning, margin rate, and biochemical recurrence. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors may shed light on where to focus future efforts in surgical education. Patient summary: In patients receiving robotic radical prostatectomy for prostate cancer, we characterized the learning curve for positive margins. The risk of surgical margins decreased progressively with increasing experience, and plateaued around the 500th procedure. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors has implications for surgeons and patients, and it may shed light on where to focus future efforts in surgical education