Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Artificial Intelligence-Based Voice Assessment of Patients with Parkinson's Disease Off and On Treatment: Machine vs. Deep-Learning Comparison

: Parkinson's Disease (PD) is one of the most common non-curable neurodegenerative diseases. Diagnosis is achieved clinically on the basis of different symptoms with considerable delays from the onset of neurodegenerative processes in the central nervous system. In this study, we investigated early and full-blown PD patients based on the analysis of their voice characteristics with the aid of the most commonly employed machine learning (ML) techniques. A custom dataset was made with hi-fi quality recordings of vocal tasks gathered from Italian healthy control subjects and PD patients, divided into early diagnosed, off-medication patients on the one hand, and mid-advanced patients treated with L-Dopa on the other. Following the current state-of-the-art, several ML pipelines were compared usingdifferent feature selection and classification algorithms, and deep learning was also explored with a custom CNN architecture. Results show how feature-based ML and deep learning achieve comparable results in terms of classification, with KNN, SVM and naïve Bayes classifiers performing similarly, with a slight edge for KNN. Much more evident is the predominance of CFS as the best feature selector. The selected features act as relevant vocal biomarkers capable of differentiating healthy subjects, early untreated PD patients and mid-advanced L-Dopa treated patients

Comparing recist and Choi\u2019s criteria to evaluate radiological response to chemotherapy in patients with advanced pancreatic cancer

Background: Assessment of response after chemotherapy (CTH) for pancreatic cancer (PC) is currently based on RECIST criteria. In 2007 Choi et al. published a new classification system.The purpose of this study was to evaluate the accuracy of these classification systems for radiological response to CTH in patients with advanced PC. Methods: From 2006 to 2012, 66 untreated patients with advanced PC underwent palliative CTH. Fourty (60 %) had a locally advanced PC and 26 (40%) a metastatic disease. All patients were treated with a GEM-based CTH or FOLFIRINOX. We assessed radiological response after three months of first-line therapy applying both RECIST criteria, which evaluate differences in CT size, and Choi\u2019s criteria, which consider changes both in size and in density at CT. We evaluated the accuracy in restaging, comparing the class of response with overall survival (OS). OS was calculated with Kaplan-Meier method. The accuracy in restaging was assessed through log rank test and multivariate analysis with Cox Regression. Results: At restaging, using RECIST criteria, we registered 7 (10.6 %) patients with partial response (PR), 32 (48.5 %) with stable disease (SD), and 27 (40.9 %) with disease progression (PD). Instead Choi\u2019s criteria assessed 19 PR (28.8 %), 12 SD (18.2%) and 35 PD (53.0%). Comparing each classification with OS, we observed that patients with different prognosis were better stratified with Choi\u2019s criteria. Using RECIST criteria we found a borderline significant difference in OS between patients with PR (13.47 months), SD (13.67 months) and PD (9.97 months) (p=0.05). Instead we found a significant statistical difference in OS using Choi\u2019s criteria between patient with PR (14 months), SD (16.37 months), PD (9.7 months; p=0.004). Multivariate analysis showed a statistically significant difference in OS between Disease Control Rate (DCR, PR+SD) and PD patients (14.47 vs. 9.67 months, p=0.02), only using Choi\u2019s criteria. Conclusions: In our experience, Choi\u2019s criteria seem to better assess radiological response of CTH in PC patients than RECIST criteria. Due to the small number of patients, larger prospective studies are needed

Barbed suture and gastrointestinal surgery. A retrospective analysis

Although minimally invasive surgery is recognized as the gold standard of many surgical procedures, laparoscopic suturing is still considered as the most difficult skill in laparoscopic surgery

Minimally invasive pilonidal sinus treatment: A narrative review

The management of chronic pilonidal disease remains controversial, but recently, new minimal invasive approaches have been proposed. Whereas in the conventional surgical treatment an elliptical wedge of skin and subcutaneous tissue is created to remove the sinus and its lateral tracks, the basis for our new treatment is to create a minimal elliptical wedge of the subcutaneous tissue, including all the inflamed tissue and debris while leaving the overlying skin intact

Soggettività e situazioni tributarie

Il Volume "Soggettività e situazioni tributarie" raccoglie gli atti del Convegno omonimo tenutosi a Catania, presso il Dipartimento di Giurisprudenza dell'Università, nei giorni 25 e 26 novembre 2022. Convegno e Volume esprimono, entrambi, una prima precisa volontà dell'Associazione Italiana dei Professori e Studiosi di Diritto Tributario di muoversi nella formazione dei "Giovani" e di darne testimonianza. Con questo spirito si dà anche inizio ad una Collana di studi. Il titolo si deve all'idea di voler trattare di temi basilari della materia, in alcune loro possibili declinazioni, problematiche ed attuali, allo scopo di avviare un non facile confronto che nella prospettiva del diritto pubblico rivisiti studi, che nascono nel diritto privato e quivi trovano il loro maggior sviluppo, e che si avvantaggi della particolarità e della (forse) maggiore vivacità del diritto tributario: risaltano, infatti, le diverse flessioni della soggettività come anche (alcune peculiarità del)le situazioni delle potestà e degli interessi. Lungi dal perseguire idee di completezza il Volume, come già il Convegno, ha voluto valorizzare, meglio finalizzandolo, un dibattito tra professori e giovani studiosi - in questo caso su temi che si riconducono all'area dei principi della materia in una auspicata più ampia trattazione della stessa che nel tempo e con lo stesso spirito ne tocchi le diverse aree - che è avvenuto in più riprese e in diversi contesti. La speranza è quella di aver reso un buon servizio e di essere emulati

CoCoNet: towards coast to coast networks of marine protected areas (from the shore to the high and deep sea), coupled with sea-based wind energy potential

This volume contains the main results of the EC FP7 “The Ocean of Tomorrow” Project CoCoNet, divided in two sections: 1) a set of guidelines to design networks of Marine Protected Areas in the Mediterranean and the Black Seas; 2) a smart wind chart that will allow evaluating the possibility of installing Offshore Wind Farms in both seas. The concept of Cells of Ecosystem Functioning, based on connectivity, is introduced to define natural units of management and conservation. The definition of Good Environmental Status, as defined in the Marine Strategy Framework Directive, is fully embraced to set the objectives of the project, by adopting a holistic approach that integrates a full set of disciplines, ranging from physics to bio-ecology, economics, engineering and many sub-disciplines. The CoCoNet Consortium involved scientist sfrom 22 states, based in Africa, Asia, and Europe, contributing to build a coherent scientific community

CoCoNet: Towards coast to coast networks of marine protected areas (From the shore to the high and deep sea), coupled with sea-based wind energy potential

This volume contains the main results of the EC FP7 "The Ocean of Tomorrow" Project CoCoNet, divided in two sections: 1) a set of guidelines to design networks of Marine Protected Areas in the Mediterranean and the Black Seas; 2) a smart wind chart that will allow evaluating the possibility of installing Offshore Wind Farms in both seas. The concept of Cells of Ecosystem Functioning, based on connectivity, is introduced to define natural units of management and conservation. The definition of Good Environmental Status, as defined in the Marine Strategy Framework Directive, is fully embraced to set the objectives of the project, by adopting a holistic approach that integrates a full set of disciplines, ranging from physics to bio-ecology, economics, engineering and many sub-disciplines. The CoCoNet Consortium involved scientist sfrom 22 states, based in Africa, Asia, and Europe, contributing to build a coherent scientific community