Intestinal perforation after surgical treatment for incisional hernia. iatrogenic or idiopathic?

Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by 'rectus abdominis muscle plasty' and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed

Health challenges in refugee reception: dateline Europe 2016

The arrival of more than one million migrants, many of them refugees, has proved a major test for the European Union. Although international relief and monitoring agencies have been critical of makeshift camps in Calais and Eidomeni where infectious disease and overcrowding present major health risks, few have examined the nature of the official reception system and its impact on health delivery. Drawing upon research findings from an Economic and Social Research Council (ESRC) funded project, this article considers the physical and mental health of asylum-seekers in transit and analyses how the closure of borders has engendered health risks for populations in recognised reception centres in Sicily and in Greece. Data gathered by means of a survey administered in Greece (300) and in Sicily (400), and complemented by in-depth interviews with migrants (45) and key informants (50) including representatives of government offices, humanitarian and relief agencies, NGOs and activist organisations, are presented to offer an analysis of the reception systems in the two frontline states. We note that medical provision varies significantly from one centre to another and that centre managers play a critical role in the transmission of vital information. A key finding is that, given such disparity, the criteria used by the UNHCR to grade health services reception do not address the substantive issue that prevent refugees from accessing health services, even when provided on site. Health provision is not as recorded in UNHCR reporting but rather there are critical gaps between provision, awareness, and access for refugees in reception systems in Sicily and in Greece. This article concludes that there is a great need for more information campaigns to direct refugees to essential services

On the width and shape of the corotation region for low-mass planets

We study the coorbital flow for embedded, low mass planets. We provide a simple semi-analytic model for the corotation region, which is subsequently compared to high resolution numerical simulations. The model is used to derive an expression for the half-width of the horseshoe region, x_s, which in the limit of zero softening is given by x_s/r_p = 1.68(q/h)^(1/2), where q is the planet to central star mass ratio, h is the disc aspect ratio and r_p the orbital radius. This is in very good agreement with the same quantity measured from simulations. This result is used to show that horseshoe drag is about an order of magnitude larger than the linear corotation torque in the zero softening limit. Thus the horseshoe drag, the sign of which depends on the gradient of specific vorticity, is important for estimates of the total torque acting on the planet. We further show that phenomena, such as the Lindblad wakes, with a radial separation from corotation of ~ a pressure scale height H can affect x_s, even though for low-mass planets x_s << H. The effect is to distort streamlines and to reduce x_s through the action of a back pressure. This effect is reduced for smaller gravitational softening parameters and planets of higher mass, for which x_s becomes comparable to H.Comment: 15 pages, 11 figures, accepted for publication in MNRA

Neuroethical issues in cognitive enhancement: Modafinil as the example of a workplace drug?

The use of cognitive-enhancing drugs by healthy individuals has been a feature for much of recorded history. Cocaine and amphetamine are modern cases of drugs initially enthusiastically acclaimed for enhancing cognition and mood. Today, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as non-invasive brain stimulation, to maintain or improve work performance. Cognitive-enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups under what conditions and by what methods we would wish to improve and flourish

Dystonia: sparse synapses for D2 receptors in striatum of a DYT1 knock-out mouse model

Dystonia pathophysiology has been partly linked to downregulation and dysfunction of dopamine D2 receptors in striatum. We aimed to investigate the possible morpho-structural correlates of D2 receptor downregulation in the striatum of a DYT1 Tor1a mouse model. Adult control Tor1a+/+ and mutant Tor1a+/− mice were used. The brains were perfused and free-floating sections of basal ganglia were incubated with polyclonal anti-D2 antibody, followed by secondary immune-fluorescent antibody. Confocal microscopy was used to detect immune-fluorescent signals. The same primary antibody was used to evaluate D2 receptor expression by western blot. The D2 receptor immune-fluorescence appeared circumscribed in small disks (~0.3–0.5 μm diameter), likely representing D2 synapse aggregates, densely distributed in the striatum of Tor1a+/+ mice. In the Tor1a+/− mice the D2 aggregates were significantly smaller (μm2 2.4 ± SE 0.16, compared to μm2 6.73 ± SE 3.41 in Tor1a+/+) and sparse, with ~30% less number per microscopic field, value correspondent to the amount of reduced D2 expression in western blotting analysis. In DYT1 mutant mice the sparse and small D2 synapses in the striatum may be insufficient to “gate” the amount of presynaptic dopamine release diffusing in peri-synaptic space, and this consequently may result in a timing and spatially larger nonselective sphere of influence of dopamine action

Professional competences of pre-service teachers: from the F2F to the online learning programme

The COVID-19 pandemic has created significant challenges for the global higher education community: it has required faculty and students to respond to an unprecedented challenge and to shift suddenly from traditional face-to-face curriculum to distance learning formats through virtual classrooms. Some learning programmes, such as the TFA, had a strong theoretical-practical characterisation and were therefore delimited by regulations requiring full in-presence (F2F) and compulsory attendance. Due to the pandemic, the one-year teaching-learning programme for support teachers (TFA) followed the same path and was redesigned by universities for distance education. The re-design at the University of Macerata was based on pedagogical assumptions: technology was intended as a support to achieve learning outcomes. Our study aims to investigate perceptions of the theoretical and practical skills acquired from the F2F and the online format, considering a group of students enrolled for different school orders who followed both the current online programme and the previous years\u2019 F2F programm

Neuroethical issues in cognitive enhancement: Modafinil as the example of a workplace drug?

The use of cognitive-enhancing drugs by healthy individuals has been a feature for much of recorded history. Cocaine and amphetamine are modern cases of drugs initially enthusiastically acclaimed for enhancing cognition and mood. Today, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as non-invasive brain stimulation, to maintain or improve work performance. Cognitive-enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups under what conditions and by what methods we would wish to improve and flourish

LQ non-Gaussian Control with I/O packet losses

The paper concerns the Linear Quadratic non-Gaussian (LQnG) sub-optimal control problem when the input and output signals travel through an unreliable network, namely Gilbert-Elliot channels. In particular, the input/output packet losses are modeled by Bernoulli sequences, and we assume that the moments of the non-Gaussian noises up to the fourth order are known. By mean of a suitable rewriting of the system through an intermittent output injection term, and by considering an augmented system with the second-order Kronecker power of the measurements, a simple solution is provided by substituting the Kalman predictor with intermittent observations of the LQG control law with a quadratic optimal predictor. Numerical simulations show the effectiveness of the proposed method

Shaping gels and gels mixture to create helices

In cooking, food gels, such as agar-agar or alginate, are often prepared and presented in the form of spheres or spaghetti. While experimenting in our kitchen, we realized that it is quite difficult to make more advanced shapes. In this study, we sought to develop new methods to obtain more complex shapes. Our first challenge was to obtain helices. The best method we selected was to deposit the solutions before their gelation in a thread. The robustness of the method is tested by systematically changing the thread pitch, diameter, and depth. From the deformation under its own weight, we propose to deduce the mechanical characteristics of the helix. These values are compared to those obtained in the laboratory using indentation testing. Finally, we experimented with mixed gels obtained by combining agar-agar and alginate.Fil: D'angelo, María Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Física. Grupo de Medios Porosos; ArgentinaFil: Pauchard, L.. Centre National de la Recherche Scientifique; FranciaFil: Auradou, H.. Centre National de la Recherche Scientifique; FranciaFil: Darbois Texier, B.. Centre National de la Recherche Scientifique; Franci