Conceptual Design of the Steam Generators for the EU DEMO WCLL Reactor

In the framework of the EUROfusion Horizon Europe Programme, ENEA and its linked third parties are in charge of the conceptual design of the steam generators belonging to EU DEMO WCLL Breeding Blanket Primary Heat Transfer Systems (BB PHTSs). In particular, in 2021, design activities and supporting numerical simulations were carried out in order to achieve a feasible and robust preliminary concept design of the Once Through Steam Generators (OTSGs), selected as reference technology for the DEMO Balance of Plant at the end of the Horizon 2020 Programme. The design of these components is very challenging. In fact, the steam generators have to deliver the thermal power removed from the two principal blanket subsystems, i.e., the First Wall (FW) and the Breeding Zone (BZ), to the Power Conversion System (PCS) for its conversion into electricity, operating under plasma pulsed regime and staying in dwell period at a very low power level (decay power). Consequently, the OTSG stability and control represent a key point for these systems' operability and the success of a DEMO BoP configuration with direct coupling between the BB PHTS and the PCS. In this paper, the authors reported and critically discussed the FW and BZ steam generators' thermal-hydraulic and mechanical design, the developed 3D CAD models, as well as the main results of the stability analyses and the control strategy to be adopted

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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

Lo scheduling di un mix di prodotti: il caso di un'azienda metalmeccanica

RIASSUNTO: Automazione della pianificazione della produzione tramite un software di scheduling: definizioni e applicazione. A partire da una classificazione dell’architettura delle linee produttive, viene proposto un caso applicativo per mostrare le potenzialità degli algoritmi di simulazione delle sequenze di operazioni su un determinato parco macchine. SUMMARY: Production planning automation by a scheduling software. Overview of the architecture of production lines, case study and potential of simulation algorithms for the sequence of operations on a given set of machines

Metodologia MA.MU. (metodo MAieutico MUltisensoriale) e attività di laboratorio del tecnico di radiologia

Purpose This work is focused on an educational project regarding the ability to learn radiological techniques based on the application of the Maieutico Multisensoriale® method. It is so called because the experimental design has been structured to give scientific foundation to a pedagogical technique based on sensory stimuli, according to a maieutic teaching method - multisensorial (from now on referred as Ma.Mu.). The authors intend to show how this approach supports and encourages the learning of professional skills in radiological techniques. The results of laboratory activities based on this new approach were compared, the one based on lessons rich in sensory stimuli and the one based on a classical approach, usually devoid of such stimuli. In this text, when reference is made to a "traditional" teaching method or based on simple "frontal teaching", it will imply the "classical" teaching method, in which the source of knowledge resides in the teacher and in his ability to convey the contents and to stimulate the interest of the learners. The Ma.Mu.® method The process of building learning, only apparently intuitive, is subjected to deconstruction, and it shows an important role of neuro-linguistic programming (NLP): it could be then implied that the construction of effective learning is also based on skills learned subconsciously. In this context, maieutic techniques of the Ma.Mu.® method can facilitate their migration to a conscious level. The trial has been carried where tuition of RT/Radiographers (TSRM in Italian) is implemented, adapting the more specific aspects of the didactics to be carried out, and maintaining the validity of its more qualifying aspects also in other formative fields, with the intent of: Demonstrate the validity of a didactic-formative approach based on visual, tactile, auditory stimuli; Demonstrate how a maieutic method, integrated with a multisensory approach, contributes to the increment of abilities and technical-operational skills in radiological techniques. Method The Ma.Mu.® method was developed as a tool for teachers, involved in the training of aspiring RT . It has been experimented over 8 months, from January to September 2019, involving all the students attending the first year of the Degree course in RT (28), and randomly subdividing them into a group "A", called "experimental", and a group "B", called "non experimental". Special laboratories have been designed to compare the traditional or classic method, in which the learning of radiological techniques is based entirely on frontal lessons, with an innovative method of learning that can be defined as maieutic because of its ability to create in the learner an imprinting about the quality of the radiological and multisensorial image. The purposes is to train and enhance the sensory skills of students to the advantage of a better development of their professional technical skills. Conclusions The Ma.Mu.® method. has proved a valid guide in the transmission of the concept of image quality and technical-practical activities to students, who should be prepared following the suggestions provided by this, identifying the "sensory" of the student among the cognitive requirements indispensable to the daily work activity. Touch, hearing and sight can be usefully trained and enhanced regardless of the individual prevailing representational system: the acquisition of consciousness of one’s body as an instrument of knowledge is therefore an important aid and complement for the acquisition of curricular knowledge. The Ma.Mu.® method is an educational support in the training of the trainees and the professional workers, and appears to be a useful support to teachers and tutors as an alternative to the mere experiential approach.Scopo Questo lavoro presenta un progetto di un metodo didattico per l’apprendimento delle tecniche radiologiche basato sull’applicazione del metodo Maieutico Multisensoriale® (d’ora in avanti anche metodo Ma.Mu.), così denominato perché il disegno sperimentale è stato strutturato per dare fondamento scientifico ad una tecnica pedagogica basata su stimoli sensoriali, in accordo ad un metodo didattico maieutico – multisensoriale. Gli autori intendono mostrare come questo metodo supporti ed incentivi la formazione delle capacità professionali nelle tecniche radiologiche, confrontando i risultati di attività di laboratorio basate su questo nuovo approccio che si fonda su lezioni ricche di stimoli sensoriali, con quelle di un approccio classico, applicato con metodi tradizionali, che di tali stimoli è solitamente privo. Nel corso del testo, quando si farà riferimento ad un metodo didattico "tradizionale" o basato sulla semplice "didattica frontale", si intenderà dunque il metodo di insegnamento "classico", nel quale la fonte del sapere risiede nel docente e nella sua capacità di farsi comprendere nel trasmettere i contenuti e di stimolare l'interesse dei discenti. Il metodo Ma.Mu.® trae fondamento dall’attribuire maggiore importanza agli aspetti legati alla conoscenza intuitiva degli studenti-tirocinanti, aspetto dal ruolo marginale o comunque non preponderante sia nei sistemi sanitari sia nella didattica dei relativi corsi di laurea. Il processo di costruzione dell’apprendimento, solo apparentemente intuitivo, sottoposto a decostruzione, mostra un importante ruolo della programmazione neuro-linguistica (PNL), suggerendo che la costruzione di un efficace apprendimento debba fondarsi anche su abilità apprese passate alla competenza inconscia. In tale contesto, le tecniche maieutiche del Metodo Ma.Mu.® possono agevolare la loro migrazione ad un livello consapevole. La sperimentazione è stata condotta nei luoghi della formazione dei TSRM ma, adattando gli aspetti più specifici della didattica, può svolgersi e mantenere validità dei suoi aspetti più qualificanti anche in altri ambiti formativi con l’intento di: dimostrare la validità di un’impostazione didattico-formativa basata su stimoli visivi, tattili, uditivi; dimostrare come un metodo maieutico, integrato con un’impostazione multisensoriale, contribuisca all’incremento delle competenze e delle capacità tecnico-operative nelle tecniche radiologiche. Metodo Il metodo Ma.Mu. è nato come strumento per i docenti coinvolti nella formazione degli aspiranti TSRM. È stato sperimentato nell’arco di 8 mesi, dal gennaio al settembre 2019, coinvolgendo l’insieme dei 28 studenti del primo anno di corso di Laurea in TRMIR. E suddividendoli in modo casuale in un gruppo “A”, detto “sperimentale”, e in un gruppo “B” detto “non sperimentale”. Appositi laboratori sono stati strutturati per confrontare il metodo tradizionale o classico, in cui l’apprendimento delle tecniche radiologiche è basato totalmente su lezioni frontali e solo da esse mutuato, con un innovativo metodo di apprendimento definibile maieutico per la sua capacità di creare nel discente un imprinting circa la qualità dell’immagine radiologica e multisensoriale, perché capace di allenare e potenziare le capacità sensoriali degli studenti a tutto vantaggio di un migliore sviluppo delle loro capacità tecnico professionali. Conclusioni Il metodo Ma.Mu. si è dimostrato una valida guida per la trasmissione agli studenti del concetto di qualità di un’immagine e le attività tecnico-pratiche, predisposte in accordo ai suggerimenti da esso forniti, hanno individuato la “sensorialità” dello studente tra i requisiti cognitivi indispensabili all’attività lavorativa quotidiana; tatto, udito e vista possono essere utilmente allenati e potenziati a prescindere dall’individuale sistema rappresentazionale prevalente: l’acquisizione della consapevolezza del proprio corpo come strumento di conoscenza è dunque un importante ausilio e complemento all’acquisizione delle conoscenze curricolari. Il metodo Ma.Mu. è un sostegno educativo nella formazione del tirocinante e del professionista, e appare rivelarsi un supporto utile ai docenti ed ai tutor, alternativo al mero approccio esperienza

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results