A five-year survey for plastic surgery malpractice claims in Rome, Italy

(1) Introduction: Medical malpractice claims against both health institutions and physicians are a crucial topic in Italy, as well as in other countries, particularly regarding civil proceedings. Our study reports an analysis of all of the malpractice judgments concerning plastic surgery decided in the Civil Court of Rome between 2012 and 2016. (2) Methods: the database of the Observatory Project on Medical Responsibility (ORMe) was analyzed, which collects all of the judgments of the Civil Court of Rome, that is, the first instance district court. Therefore, neither the jurisprudence of the second level court nor that of the Supreme Court was taken into account. (3) Results: 144 judgments concerning plastic surgery were delivered in the five-year period of 2012–2016 (corresponding to 10.6% of total professional liability verdicts of the Civil Court of Rome in the same period). In 101/144 cases (70.14%), the claim was accepted. A total of €4,727,579.00 was paid in compensation for plastic surgery malpractice claims, with a range from a minimum amount of €1555.96 to a maximum amount of €1,425,155.00 and an average compensation of €46,807.71 per claim that was significantly lower compared to other surgical disciplines. (4) Conclusions: Our data confirm that the analyzed branch has a high litigation rate, with a prevalence of convictions for cosmetic procedures over reconstructive ones, both for malpractice and for violation of the informed consent. Plastic surgery is also confirmed among those branches in which the professionals are more frequently sued compared to health institutions

MEDIRAD project “implications of medical low-dose radiation exposure”: Enhancing the protection of patients and health professionals from exposure to low-dose medical radiation

The EC-funded project MEDIRAD addresses numerous low-dose exposure situations for patients and workers in the medical context, to further develop risk models and draw operational recommendations for improving radiation protection. The four-year project (2017–2021) relies on a 33-partner consortium from 14 European countries and is coordinated by the European Institute for Biomedical Imaging Research (EIBIR, AT). Prof. Elisabeth Cardis (ISGlobal, ES) and Prof. Guy Frija (Universit´e Paris Descartes, FR) are the scientific coordinator and the clinical coordinator, respectively. The MEDIRAD Project consists of six interdependent and complimentary Work Packages (WPs). WP1: project management and dissemination; WP2: dose evaluation and optimisation in medical imaging; WP3: impact of low-dose radiation exposure from I-131 radioiodine in thyroid cancer treatment; WP4: breast radiotherapy and secondary cardiovascular risks; WP5: possible health impact of paediatric scanning; WP6: bringing together medical and nuclear scientific communities for radiation protection purposes. The Italian National Institute of Health (ISS), thanks to its consolidated experience in the field of quality assurance in radiological sciences, will contribute to the latter issue coordinating a Working Group to develop recommendations on patient radiological protection, directed to the medical communities, considering the scientific outcomes of the MEDIRAD WPs and the stakeholders’comments

A Novel Approach for an Integrated Straw tube-Microstrip Detector

We report on a novel concept of silicon microstrips and straw tubes detector, where integration is accomplished by a straw module with straws not subjected to mechanical tension in a Rohacell $^{\circledR}$ lattice and carbon fiber reinforced plastic shell. Results on mechanical and test beam performances are reported on as well.Comment: Accepted by Transactions on Nuclear Science (2005). 11 pages, 9 figures, uses lnfprep.st

Towards understanding the thermal history of microstructural surface deformation when cutting a next generation powder metallurgy nickel-base superalloy

Despite the ongoing progress in metallurgical characterisation of machined surfaces, knowledge of the thermal conditions under which they originate during the workpiece-flank interaction is still lacking. When cutting advanced superalloys, little is known about temperature evolution in the machined part volume, where workpiece material interacts with the tool flank. In this work, the characteristics of the thermal field and the resulting surface metallurgy induced in a next generation nickel-base superalloy have been studied for cutting scenarios involving different combinations of thermo-mechanical boundary conditions. Analysis of the thermal field evolution in the workpiece subsurface has allowed the heating and cooling rates induced by cutting to be revealed, allowing description of two distinct types of thermal cycle, with a Heating-Peaking-Cooling (H–P–C) and a Heating-Quasi-isothermal Deformation-Cooling (HQC) structure depending on the process aggressiveness. Subsurface thermal history has been found to relate with the severity of the cutting-induced deformation, as it combines information on thermal field magnitude and on the process rates. Furthermore, thermal balance equations have been applied to study the rate of the heat generation in the machined subsurface due to its own plastic deformation while interacting with the tool flank. This has revealed that the highest rate of heat generation induced by plastic deformation occurred in thin surface layers at the beginning of the workpiece-flank contact, which has been associated to the conditions under which white layers (WLs) are generated. Energy balance analysis has furthermore indicated the development of a less severe and less impulsive deformation process at higher subsurface depths, which has been linked to the formation mechanism of material drag (MD) layers. In this way, the thermal history of machined surfaces has been related to their resulting metallurgical integrity, allowing in-depth understanding of the physical conditions developing when cutting next-generation superalloys

Can higher cutting speeds and temperatures improve the microstructural surface integrity of advanced Ni-base superalloys?

Future Ni-base superalloys are designed to deliver outstanding mechanical behaviour at high temperatures, which may translate in significant machining challenges. In this work, a paradigm is presented by which is proven how machining of these materials could benefit from increased cutting speeds and temperatures provided that they are able to promote shear localisation and thermal softening in the chip deformation zones, whilst retaining high-temperature strength within the machined surface. In this way, thermal control of chip formation leads to both lower cutting forces and energies, as well as enhanced surface integrity with lower levels of microstructural reconfiguration

Temperature-dependent shear localisation and microstructural evolution in machining of nickel-base superalloys

Understanding the microstructural evolution mechanisms in machining of advanced materials is essential to achieve excellent surface integrity levels within the manufacture of safety–critical components. However, as thermal and mechanical effects are coupled in conventional cutting operations, it is difficult to attribute their individual role on microstructural evolution and integrity. To investigate the temperature-dependency of microstructural evolution in cutting, a new experimental set-up has been developed to perform machining experiments under controlled temperatures. Results show that an onset in chip shear localisation with nanocrystalline grain refinement can be induced uniquely by an increase in cutting temperature under fixed cutting parameters, which microstructurally controls the transition from continuous to serrated chip formation. Increase in mechanical effects at HT leads to the formation of a continuous chip grain refinement layer, associated to a change in energy partition at the tool-workpiece interface. These small-scale behaviours are found to control the reduction in cutting forces and energy at higher temperatures, with a decrease of ∼ 25–30%. Nevertheless, despite the lower deformation energy, HT cutting induced larger amounts of microstructural deformation because of thermal softening effects, further disclosing the role of thermal effects on the interplay between shear localisation, microstructural evolution and surface integrity

Primary squamous cell carcinoma of major salivary gland: “Sapienza Head and Neck Unit” clinical recommendations

Primary squamous cell carcinoma of salivary gland (SCG) is an extremely rare type of malignant salivary gland tumor, which in turn results in scarcity of data available regarding both its treatment and associated genetic alterations. A retrospective analysis of 12 patients with primary SCG was conducted, along with analysis of the association between treatment, clinical/pathological characteristics, and outcomes. Most patients (8) were staged IVa, with the majority of them (10) having G3 fast growing cancer. Local and systemic recurrence were reported in only three out of nine parotid cases (0 out of 2 submandibular SCGs). In two out of eight patients local relapse occurred after integrated treatment, while recurrence occurred in two out of three patients undergoing exclusive surgery. Five patients eventually died. Treatment of resectable disease must be aggressive and multimodal, with achievement of loco-regional control in order to reduce rate of recurrence and improve outcomes. Metastatic disease would require a therapeutic strategy tailored to the molecular profile in order to improve the currently disappointing results

Measurement results and improvements on an open EPR system

Electron spin resonance (ESR) is a spectroscopic method that allows to measure stable radicals induced by ionizing radiation. The EPR measurements can help to estimate the dose absorbed by people exposed during a nuclear disaster, detecting the number of radicals induced in their mobile phones due to the exposition [1]. Using conventional closed microwave cavities, the phone display must be fragmented in order to be introduced inside the resonator, becoming no more usable. The aim of this work is to develop a system, compatible with the spectrometer Bruker Elexys E500, able to preserve the sample integrity. The system uses an X-band resonant metallic cavity with a slit, realized on one side, for the leak of the excitation magnetic field and a Helmotz coil pair. The resonator allows measuring a sample lodged outside the cavity, while the coils produce a 100 kHz modulated field that encodes the output signal at a particular frequency and increases the SNR

The Top-Implart Proton Linear Accelerator: Interim Characteristics of the 35 Mev Beam

In the framework of the Italian TOP-IMPLART project (Regione Lazio), ENEA-Frascati, ISS and IFO are developing and constructing the first proton linear accelerator based on an actively scanned beam for tumor radiotherapy with final energy of 150 MeV. An important feature of this accelerator is modularity: an exploitable beam can be delivered at any stage of its construction, which allows for immediate characterization and virtually continuous improvement of its performance. Currently, a sequence of 3 GHz accelerating modules combined with a commercial injector operating at 425 MHz delivers protons up to 35 MeV. Several dosimetry systems were used to obtain preliminary characteristics of the 35-MeV beam in terms of stability and homogeneity. Short-term stability and homogeneity better than 3% and 2.6%, respectively, were demonstrated; for stability an improvement with respect to the respective value obtained for the previous 27 MeV beam

Understanding the Reactivity of a Thin Li1.5Al0.5Ge1.5(PO4)3 Solid-State Electrolyte toward Metallic Lithium Anode

The thickness of solid-state electrolytes (SSEs) significantly affects the energy density and safety performance of all-solid-state lithium batteries. However, a sufficient understanding of the reactivity toward lithium metal of ultrathin SSEs (<100 µm) based on NASICON remains lacking. Herein, for the first time, a self-standing and ultrathin (70 µm) NASICON-type Li1.5Al0.5Ge1.5(PO4)3 (LAGP) electrolyte via a scalable solution process is developed, and X-ray photoelectron spectroscopy reveals that changes in LAGP at the metastable Li–LAGP interface during battery operation is temperature dependent. Severe germanium reduction and decrease in LAGP particle size are detected at the Li–LAGP interface at elevated temperature. Oriented plating of lithium metal on its preferred (110) face occurs during in situ X-ray diffraction cycling