Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Seamen on Land? A Preliminary Analysis of Medieval Ship Graffiti on Cyprus

This article reports on the results of a research project entitled ‘KARAVOI. The Ship Graffiti on the Medieval Monuments of Cyprus: Mapping, Documentation and Digitisation’, during which 233 ship graffiti were recorded in 44 different monuments on the island, dating from the 15th to the 20th centuries. Innovative recording techniques have been used to mitigate the effects of the subjective or partial recording of graffiti lines on tracing paper. Apart from the study of ship graffiti as iconographic sources, particular emphasis has been given to their geographical and social context through a comprehensive analysis of the graffiti types and their spatial distribution in the monuments as well as the monuments location on the island

Authentic Learning to Better Prepare for Preservation Work

Cultural heritage preservation has developed from an insular vocation into a field of innovative scientific methodologies characterized by a holistic approach combining a range of scientific fields. Unfortunately, preservation education has not been able to keep pace with all these developments. In this paper authentic learning is analyzed as a possible educational scenario to help improve preservation education to connect to the state of affairs at the preservation workplace. The purpose is to sketch an educational framework based on knowledge and experiences with authentic learning in other engineering fields as a primer for the design and implementation of ‘authentic learning for preservation’. From the analysis it becomes clear that authentic learning can support the selection of valuable unknown experiences and support the design and development of ‘authentic learning for preservation’ experiments to help closing the gap between preservation education and cultural heritage practice. The authentic learning model as presented here clearly supplies a framework to consider in this endeavor. As such the paper can be helpful in the discussion about the usefulness and feasibility of this approach.</p