Students’ satisfaction and teaching efficiency of university offer

This study analyses the factors affecting students’ satisfaction with university experience, focusing on the aspects characterising the teaching efficiency of educational offer. For this purpose, organisation of teaching activities, available information, teaching materials, and other facilities offered to students to make their learning experience more successful, are considered as indicators of teaching efficiency. Our interest in this topic is justified by the importance that students’ satisfaction assumes, not only as indicator of the quality of educational services but also for its relationship with overall life satisfaction and subjective well-being. A structural equation model with latent variables is estimated by using survey and administrative data of the University of Pisa. Main findings seem to show that teaching efficiency has a positive effect on satisfaction and suggest that whenever it is inadequate, or at least, considered as such, students are less satisfied for their university experience. The effects of other factors on students’ satisfaction such as studies organisation, social capital and internship experience are also discussed

ANESTHESIA FOR ABDOMINAL AORTIC RECONSTRUCTION

Anesthesia for abdominal aortic reconstruction can present some of the most difficult patient management problems likely to be encountered by the anesthesiologist. Although the stresses imposed upon the patient by aortic cross-clamping and unclamping are often well tolerated, the hemodynamic perturbations that result at times can be severe. 14 Management of these hemodynamic derangements is further complicated by the fact that a high percentage of patients presenting for abdominal aortic reconstruction also present with a host of coexisting illnesses. Pulmonary disease, diabetes mellitus, renal insufficiency, and cerebrovascular disease may all, at one time or another, contribute to the difficulty in anesthetic management of patients undergoing abdominal aortic reconstruction and lead to perioperative complications; however, the greatest contributor to perioperative morbidity and mortality is concomitant cardiovascular disease. 9 Vascular disease encompasses a wide variety of pathologies, including cerebrovascular disease, thoracic aortic disease, abdominal aortic disease, and cardiovascular and peripheral vascular diseases. The focus of this article, however, is on the anesthetic management of patients undergoing abdominal aortic reconstruction, with particular attention to those patients with concomitant coronary artery disease (CAD) and valvular heart disease

The Efficacy and Safety of a Pharmacologic Protocol for Maintaining Coronary Artery Bypass Patients at a Higher Mean Arterial Pressure during Cardiopulmonary Bypass

A recent randomized trial of higher versus lower mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) showed that higher MAP on CPB was associated with a lower incidence of overall cardiac and neurologic morbidity and mortality in coronary artery bypass graft surgery (CABG) patients. Cardiopulmonary bypass MAP was controlled pharmacologically while CPB flow was held constant for any given period. The objective of the present study was to assess the efficacy and safety of this pharmacologic protocol. Two hundred forty-eight patients participated in the study; the mean age was 65.8 ± 9.4 years, 20% were women, and the mean preoperative ejection fraction was 48%. The low-flow conrrected CPB MAP attained for the low and high MAP groups was 56.7 ± 5.0 mmHg and 77.7 ± 7.1 mmHg, respectively (p = 0.0001). Major cardiac and neurologic outcomes, postoperative blood loss, renal dysfunction, intensive care unit (ICU) stay, and duration of intubation were not found to be significantly associated with any drug in the pharmacologic protocol. These findings support that the pharmacologic protocol used to maintain CABG patients at higher MAP on CPB is both efficacious and safe

Severity of Aortic Atheromatous Disease Diagnosed by Transesophageal Echocardiography Predicts Stroke and Other Outcomes Associated with Coronary Artery Surgery: A Prospective Study

Advanced atheromatous disease of the thoracic aorta identified by transesophageal echocardiography (TEE) is a major risk factor for perioperative stroke.This study investigated whether varying degrees of atherosclerosis of the descending aorta, as assessed by TEE, are an independent predictor of cardiac and neurologic outcome in patients undergoing coronary artery bypass grafting (CABG). Intraoperative TEE of the descending aorta was performed on 189 of 248 patients participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100 mm Hg) mean arterial pressure during cardiopulmonary bypass for elective CABG. Aortic atheromatous disease was graded from I to V in order of increasing severity by observers blinded to outcome. Measured outcomes were death, stroke, and major cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE examinations had perioperative strokes by 1 wk. At 1 wk, no strokes had occurred in the 123 patients with atheroma Grades I or II, while the 1-wk stroke rate was 5.5% (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively (Fisherʼs exact test, P = 0.00001). For 6-mo outcome, advancing aortic atheroma grade was a univariate predictor of stroke (P = 0.00001) and death (P = 0.03). By 6 mo there were one additional stroke, three additional deaths, and one additional major cardiac event. Atheromatous disease of the descending aorta was a strong predictor of stroke and death after CABG. TEE determination of atheroma grade is a critical element in the management of patients undergoing CABG surgery.(Anesth Analg 1996;83:701-8

The Porcupine Abyssal Plain fixed-point sustained observatory (PAP-SO): variations and trends from the Northeast Atlantic fixed-point time-series

The Porcupine Abyssal Plain sustained observatory (PAP-SO) in the Northeast Atlantic (49°N 16.5°W; 4800 m) is the longest running open-ocean multidisciplinary observatory in the oceans around Europe. The site has produced high-resolution datasets integrating environmental and ecologically relevant variables from the surface to the seabed for >20 years. Since 2002, a full-depth mooring has been in place with autonomous sensors measuring temperature, salinity, chlorophyll-a fluorescence, nitrate, and pCO2. These complement ongoing mesopelagic and seabed observations on downward particle flux and benthic ecosystem structure and function. With national and European funding, the observatory infrastructure has been advanced steadily, with the latest development in 2010 involving collaboration between the UK's Meteorological Office and Natural Environment Research Council. This resulted in the first simultaneous atmospheric and ocean datasets at the site. All PAP-SO datasets are open access in near real time through websites and as quality-controlled datasets for a range of remote users using ftp sites and uploaded daily to MyOcean and the global telecommunications system for use in modelling activities. The combined datasets capture short-term variation (daily–seasonal), longer term trends (climate-driven), and episodic events (e.g. spring-bloom events), and the data contribute to the Europe-wide move towards good environmental status of our seas, driven by the EU's Marine Strategy Framework Directive (http://ec.europa.eu/environment/water/marine)

Identification and Management of Overweight and Obesity by Internal Medicine Residents

BACKGROUND: Obesity is a major cause of morbidity and mortality in the United States. OBJECTIVE: To assess how frequently Internal Medicine residents identify and manage overweight and obese patients and to determine patient characteristics associated with identification and management of overweight compared with obesity. DESIGN: A cross-sectional medical record review. PATIENTS: Four hundred and twenty-four overweight or obese primary care patients from 2 Internal Medicine resident clinics in Connecticut. MEASUREMENTS: Measurements included the frequency with which obese and overweight patients were identified as such by their resident physicians, patient demographics, and co-morbid illnesses, as well as use of management strategies for excess weight. RESULTS: In this population of obese and overweight patients, obese patients were identified and treated more often compared with overweight patients (76/246%, 30.9% vs 12/178%, 7.3% for identification, P=.001, and 59/246%, 24.0% vs 11/178%, 6.2% for treatment, P=.001). Overall, only 70/424 (17%) of patients received any form of management. Only higher body mass index (BMI) (BMI≥30 kg/m(2)compared with BMI 25–29.9 kg/m(2)) was independently associated with identification of overweight or obesity (odds ratio 7.51%, 95% confidence interval [CI] 3.76 to 15.02) or with any management for excess weight (odds ratio 4.79%, 95% CI 2.44 to 9.42). CONCLUSIONS: Our results suggest that Internal Medicine residents markedly underrecognize and undertreat overweight and obesity