Minimally invasive surgical management of Boerhaave's syndrome: A narrative literature review

Treatment of Boerhaave's syndrome is controversial. Formal thoracotomy and laparotomy were considered the gold standard treatment in the past. However, these approaches are associated with significant surgical trauma, stress, and postoperative pain. Recently published studies reported the application of minimally invasive surgery in the setting of such esophageal emergency. However, the application of minimally invasive surgery in the setting of Boerhaave's syndrome is debated and evidence is puzzled. The aim of this study was to summarize the current knowledge on minimally invasive treatment of Boerhaave's syndrome. PubMed, EMBASE, and Web of Science databases were consulted. All articles that described the management of Boerhaave's syndrome in the setting of minimally invasive surgery (thoracoscopy or laparoscopy) were included. Sixteen studies and forty-eight patients were included. The age of the patient population ranged from 37 to 81 years old and 74% were males. The time shift period from symptoms onset to surgical treatment ranged from 5 to 240 hours with 10 patients (20.8%) having surgery more than 24 hours from symptoms onset. Vomiting (100%), chest/epigastric pain (88%), and dyspnea (62%) were the most commonly reported symptoms. The perforation size ranged from 6 to 30 mm with 96% of patients suffering from distal esophageal tear. Video-assisted thoracoscopy (VATS) was the most commonly reported surgical approach (75%), followed by laparoscopy (16.7%), and combined thoraco-laparoscopy (6.2%). In case of VATS, a left approach was adopted in 91% of patients with selective lung ventilation. Primary suture was the most commonly performed surgical procedure (60%) with interrupted single or duallayer repair. Surgical debridement (25%), primary repair reinforced with gastric or omental patch (8%), esophageal repair over T-tube (6%), and endoscopic stenting combined with laparoscopic debridement (2%) were also reported. The postoperative morbidity was 64.5% with pneumonia (42%), pleural empyema (26%), and leak (19%) being the most commonly reported complications. The overall mortality was 8.3%. Boerhaave's syndrome is a rare entity. Minimally invasive surgical treatment seems promising, feasible, and safe in selected patients with early presentation and stable vital signs managed in referral centers. In the management algorithm of Boerhaave's syndrome, a definitive indication to adopt minimally invasive surgery is lacking and its potential role mandates further analysis

Ocean liming effects on dissolved organic matter dynamics

Ocean liming has gained attention as a potential solution to mitigate climate change by actively removing carbon dioxide (CO2) from the atmosphere. The addition of hydrated lime to oceanic surface water leads to an increase in alkalinity, which in turn promotes the uptake and sequestration of atmospheric CO2.Despite the potential of this technique, its effects on the marine ecosystem are still far from understood, and there is currently no information on the potential impacts on the concentration and quality of dissolved organic matter (DOM), which is one of the largest, most complex and yet least understood mixtures of organic molecules on Earth.The aim of this study is to provide the first experimental evidence about the potential effects of hydrated lime addition on DOM dynamics in the oceans by assessing changes in its concentration and optical properties (absorption and fluorescence).To investigate the effects of liming on DOM pools with different concentrations and quality, seawater was collected from two contrasting environments: the oligotrophic Mediterranean Sea, known for its dissolved organic carbon (DOC) concentration comparable to that observed in the oceans, and the eutrophic Baltic Sea, characterized by high DOM concentration mostly of terrestrial origin. Hydrated lime was added to both waters to reach pH values of 9 and 10.Our findings reveal that the addition of hydrated lime has a noticeable effect on DOM dynamics in both the Mediterranean Sea and Baltic Sea, determining a reduction in DOC concentration and a change in the optical properties (absorption and fluorescence) of DOM. These effects, detectable at pH 9, become significant at pH 10 and are more pronounced in the Mediterranean Sea than in the Baltic Sea. These potential short-term effects should be considered within the context of the physicochemical properties of seawater and the seasonal variability

Defining organizational contributions to sustaining an ageing workforce:a bibliometric review

The ageing of populations worldwide has implications for workforces in developed countries, and labour shortages have increasingly become a political concern. Governments in developed countries have responded by increasing the retirement age as a strategy for overcoming the fall in labour supply. Using bibliometric techniques, we reviewed 122 articles published between 1990 and 2018 to examine the effectiveness of the strategy in addressing the labour shortages and, in particular, to identify the factors that contribute positively to maintaining worker participation within an ageing workforce at an organizational level. The results identified five organizational factors that support continued participation: health, institutions, human resource management, human capital and technology tools. Employers will increasingly need to develop “age-friendly” workplaces and practices if they are to recruit and retain older workers.</p

Balancing picking and outbound loading efficiency in an SBS/RS through a digital twin

Warehouses are essential elements of almost every Supply Chain and have a significant impact on its performance. However, existing research on warehouse operations mainly aims at maximizing operational performance, neglecting their effect on downstream nodes. In this paper, we propose the use of a digital twin (DT) to support warehouse managers to identify the picking policy that most effectively balances picking and outbound loading efficiencies in an SBS/RS, with the aim of providing both a cost-effective and timely delivery to the subsequent nodes. The problem is set referring to a real case study of the logistics hub of a tire distributor company. The DT was built and validated based on real data from plant sensors and information systems. Afterwards, the DT was used to define three picking strategies that differently impact on both picking and outbound loading efficiency. The DT was then employed on a daily basis and fed with real orders, machine and rack availability to replicate stocking and picking operations and to directly communicate the recommended picking strategy to the warehouse PLC. Several demand scenarios have been considered to extend managerial inferences. Results show that the DT is a valuable tool to support the balancing of picking and outbound loading performance

Multi-objective planning method for renewable energy communities with economic, environmental and social goals

In this paper we propose an innovative multi-objective methodology to optimally size and operate an Energy Community under social, environmental, and economic considerations, where both user preferences demand side management have been incorporated to manage flexibility that can be provided by appliances and Electric Vehicles using a Mixed-Integer Linear Programming model. The problem is efficiently decomposed using the A-AUGMECON2 technique that has confirmed its efficiency for an Italian case study. Results show that Renewable Energy Communities enable significant savings even beyond 10%–20% while keeping adequate level of user satisfaction, especially when grid prices are high. Demand response and demand side management confirmed to play a relevant role to achieve higher self sufficiency, economic, and social goals, in agreement to the energy transition targets

Design of Energy Communities and Data-Sharing: Format and Open Data

Governments are promoting energy community (EC) policies to encourage joint investment and the operation of shared energy assets by citizens, industries, and public authorities, with the aim of promoting economic, social, and environmental benefits. However, ECs require appropriate planning and energy management strategies, which require data that are rarely clean and well-structured. Data providers rarely adhere to a common format for data sharing, which hinders the development of ECs. As the number of ECs is expected to grow significantly, this poses significant issues for stakeholders to quickly and efficiently develop projects. To address this issue, in this paper we propose a literature-based analysis and classification to derive the major data needs for EC planning, as well as a template format for data sharing. Our literature review on ECs successfully identifies the main data required to properly describe this system and its components. Their classification further clarifies that data structures shall account for tabular-like data of various types and flexible dimentionality, or cardinality. A public release of an open dataset for a case study in Pisa, Italy is also provided, supported by realistic or real data for testing the sizing and operation of ECs. The results suggest that data standard practices are needed, and this paper can lay the foundation for their standardization for ECs to fast-forward their deployment as support policy and technical decision-making

Enhancing operations management through smart sensors: measuring and improving well-being, interaction and performance of logistics workers

Purpose: The purpose of the research is to conduct an exploratory investigation of the material handling activities of an Italian logistics hub. Wearable sensors and other smart tools were used for collecting human and environmental features during working activities. These factors were correlated with workers' performance and well-being. Design/methodology/approach: Human and environmental factors play an important role in operations management activities since they significantly influence employees' performance, well-being and safety. Surprisingly, empirical studies about the impact of such aspects on logistics operations are still very limited. Trying to fill this gap, the research empirically explores human and environmental factors affecting the performance of logistics workers exploiting smart tools. Findings: Results suggest that human attitudes, interactions, emotions and environmental conditions remarkably influence workers' performance and well-being, however, showing different relationships depending on individual characteristics of each worker. Practical implications: The authors' research opens up new avenues for profiling employees and adopting an individualized human resource management, providing managers with an operational system capable to potentially check and improve workers' well-being and performance. Originality/value: The originality of the study comes from the in-depth exploration of human and environmental factors using body-worn sensors during work activities, by recording individual, collaborative and environmental data in real-time. To the best of the authors' knowledge, the current paper is the first time that such a detailed analysis has been carried out in real-world logistics operations