Emergency surgery and Limitation of therapeutic effort in relation to neurologic deterioration in elderly patients – a survey of European surgeons

Background. In emergency surgery, a very heterogeneous approach is required in the decision making process, especially when considering the patient’s postoperative quality of life as well as medical, ethical, and legal factors. In some cases, the presence of an Advance Directive (AD) form may potentially help resolve the surgeon’s dilemma. Objectives. The primary objective of this survey was to investigate the opinions of surgeons across a representative cross-section of European countries regarding the decision making process using a specific case scenario so as to identify similarities and differences in practice. A secondary objective was to identify the possibility of establishing a more uniform approach and best practice. Method. A survey was conducted of surgeons from a range of European countries. Questionnaires were designed to obtain an overview of decision making in relation to the Limitation of Therapeutic Effort (LTE) using a specific case study and the level of awareness and practical use of ADs. Surveys were distributed via email to the members of the ESTES (European Society for Trauma and Emergency Surgery) and AEC (Association of Spanish surgeons), with voluntary, anonymous participation. Conclusions. Clear and additional support in the form of legal and ethical guidance with clinical protocols for surgical practice in such case scenarios is necessary. Wider use of ADs, together with education about their role and support for patients and relatives, would benefit the type of patient described in our scenario. A multidisciplinary team should play a more active role in decision making in order to avoid surgical procedures that are potentially futile. The concepts of LTE and Quality of life need a broader understanding among surgeons as well as more consistent application

The Role of Non-Verbal Interaction in a Short-Term Psychotherapy: Preliminary Analysis and Assessment of Paralinguistic Aspects

Analysis at a paralinguistic level of communication, already conceptualized within the multiple code theory, would appear to be very important in order to fully describe the quality of the patient-therapist relationship. In this study the therapeutic process and microprocess are analyzed taking into consideration a specific paraverbal aspect (speech rate) present in patient and therapist's communication. More specifically, in this paper we aim to investigate the relationship between the speech rate of both patient and therapist with the linguistic aspects of their referential process as obtained by the IDAAP dictionaries, relating to three sessions belonging to different phases of the psychotherapy. The results show that there are many significant correlations between the considered values. These findings are interpreted as an expression of the alignment between patient and therapist which can be linked to the outcome of the psychotherapy.</p

"Un interessante caso di spasma da torsione": sapere medico e documentario sperimentale nel Guf di Perugia

Over the backdrop of a reflection on the almost absolute centrality of documentary practice in the complex jumble of experimental Cineguf productions between 1934 and 1943, the essay examines the only remaining neuropathological documentary produced within a Cineguf: “Un interessante caso di spasma da torsione” (1937, by Mario Bencivenga). Shot in the Santa Margherita Psychiatric Hospital in Perugia, the film documents a young girl in the grip of a series of dramatic spasms, due to a case of dystonia. This documentary is an exceptional testimony to the vitality and richness of the scientific documentary debate in the Cineguf and to the convergence of experimental and substandard film practices and scientific research. Studying it therefore reveals traces of a complex etiological debate, between neurology and psychoanalysis, where dystonia becomes the terrain for an epistemological clash that leaves traces in the film

ERICA: A multiparametric toxicological risk index for the assessment of environmental healthiness

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Comparison between Conventional and Non-Conventional Computer Methods to Define Antiknock Properties of Fuel Mixtures

Research Octane Number (RON) is one of the primary indicators for the determination of the resistance of gasoline fuels to autoignition. This parameter is usually determined with a test procedure involving a standardized engine that requires expensive hardware and time-consuming tests. In this work, a set of different methods with which to determine the RON of gasoline fuel surrogates is presented, considering only computer simulations, which allows to reduce both cost and time for the evaluation. A palette of 11 chemical species has been chosen as the basis for the surrogates’ database, which will be investigated in the work, allowing the representation of the complex chemical formulation of fuels in an easier way. A simplified zero-dimensional engine model of the standard variable compression ratio is used to provide pressure and temperature, then employed to calculate RON. This is done first by means of existing methods, and then by introducing new processes concerning a simplified chemical reactor built on kinetic schemes. Finally, these different methodologies are tested against a molar weighted sum of RONs of each chemical specie, allowing to have a criterion for comparison and evaluating their real prediction capabilities

Nerve Sheath Myxoma of the Tongue

Nerve sheath myxoma (NSM) of the oral mucosa is aslow-growing, benign, often asymptomatic submucosal mass. Wereport on a case of classical NSM of the tongue, with diagnostic andtherapeutic approach to the case.Many NSM arise within the endoneurium of a peripheral nerve. It isa rare condition with no apparent differences between sexes in itsprealence. It can occur at any age..</p

A Novel Study and Meta-Analysis of the Genetic Variation of the Serotonin Transporter Promoter in the Italian Population Do Not Support a Large Effect on Alzheimer's Disease Risk

Alzheimer's disease (AD) is a neurodegenerative disorder whose clinical onset is mainly characterized by memory loss. During AD progression, behavioral and psychological symptoms of dementia (BPSD) frequently occur. In this paper we evaluated the association between AD and the short/long (S/L) functional polymorphism of the promoter region of the 5-hydroxytryptamine (5-HT) transporter gene (SLC6A4). The S-allele shows a 2-fold reduced transcriptional rate, causing an imbalance in 5-HT intracellular availability that might in turn trigger behavioral and cognitive alterations. We also genotyped the SLC6A4 promoter functional variant rs25531 (A → G). By comparing the genotypic and allelic frequencies in an Italian population of 235 AD and 207 controls, we found an association between 5-HTTLPR and AD (odds ratio for the L-allele versus the S-allele: 0.74, associated P value = .03), while no difference was found for the rs25531. A meta-analysis of studies in Italy assessing 5-HTTLPR and AD risk gave an estimation of odds ratio for the L-allele versus the S-allele of 0.85 (associated P value = .08). Overall, our findings are not supportive of a large genetic effect of the explored polymorphisms on AD risk

Supporting Early-Safety Analysis of IoT Systems by Exploiting Testing Techniques

IoT systems complexity and susceptibility to failures pose significant challenges in ensuring their reliable operation Failures can be internally generated or caused by external factors impacting both the systems correctness and its surrounding environment To investigate these complexities various modeling approaches have been proposed to raise the level of abstraction facilitating automation and analysis FailureLogic Analysis FLA is a technique that helps predict potential failure scenarios by defining how a components failure logic behaves and spreads throughout the system However manually specifying FLA rules can be arduous and errorprone leading to incomplete or inaccurate specifications In this paper we propose adopting testing methodologies to improve the completeness and correctness of these rules How failures may propagate within an IoT system can be observed by systematically injecting failures while running test cases to collect evidence useful to add complete and refine FLA rule

Vigilancia del cáncer colorrectal en la provincia de Córdoba mediante prevención y detección temprana: resultados de una prueba piloto

INTRODUCCIÓN: El cáncer colorrectal (CCR) es la segunda causa de mortalidad por cáncer en Argentina. Su diagnóstico tardío reduce sustancialmente las posibilidades de sobrevida. El objetivo fue describir el estudio de implementación de prevención del CCR realizado en el departamento cordobés de Pocho y analizar factores de riesgo y vulnerabilidad según condiciones de riesgo promedio (RP) o elevado (RE). MÉTODOS: Se incluyó a 265 adultos de 50-75 años residentes en Pocho. Se diseñó un dispositivo de intervención territorial; se construyeron y analizaron indicadores de cobertura, salud, referencia y contrarreferencia. RESULTADOS: Hubo 19,6% de participantes con RE y 80,4% con RP. La cobertura por invitación fue de 36,6% de la población objetivo, con una tasa de aceptación del 84,2%, una positividad del test de sangre oculta en materia fecal inmunoquímico (TSOMFi) del 19,3% y un índice de cumplimiento de videocolonoscopia del 81,8%. El consumo inadecuado de frutas, verduras y carnes asadas fue mayor en el grupo de RP (p≤0,05); 17,4% había consumido al menos un cigarrillo en los últimos 30 días; 77,6% había realizado al menos 30 minutos diarios de actividad física; 52% reportó al menos una vez presión elevada, 21,7% glucemia elevada y 21,8% colesterol elevado; 29,5% presentó obesidad. DISCUSIÓN: La adherencia al test y al circuito de atención fue alta. Se sentaron las bases para el escalamiento provincial de la estrategia preventiva del CCR mediante tamizaje con TSOMFi