Robot-assisted pancreaticoduodenectomy. Safety and feasibility

Background: The availability of robotic assistance could make laparoscopic pancreaticoduo- denectomy safely feasible. We herein provide a systematic review on laparoscopic robot-assisted pancreaticoduodenectomy (RAPD). Methods: Literature search was conducted on multiple databases considering articles published in English up to October 31, 2014, reporting on ten or more patients. Results: A total of 262 articles were identified. Excluding duplicates (n=172), studies not matching inclusion criteria (n=77), and studies not suitable for other reasons (n=6), a total of seven studies reporting on 312 RAPDs were eventually reviewed. These studies were either retrospective cohort studies (n=4) or case-matched studies (n=3). No randomized controlled trial was identified. Most patients undergoing RAPD were diagnosed with malignant tumors (224/312; 71.8%). RAPD was feasible in most patients. Conversion to open surgery was reported in 9.2% of the patients. A hybrid RAPD technique, employing standard laparoscopy or open surgery through a mini-incision, was adopted in most patients (178/312; 57.0%). Overall, there were six postoperative deaths at 30 days (6/312; 1.9%), including one intraoperative death caused by portal vein injury, while 137 out of 260 patients with complete information developed postoperative complications (52.7%). The mean length of hospital stay ranged from 10–29 days. Postoperative pancreatic fistula (POPF) occurred in 66 patients (66/312; 21.1%). Grade C POPF was reported in eight patients (8/312; 2.5%). The costs of RAPD were assessed in two studies, demonstrating additional costs ranging from 4,000–5,000 US dollars to 6,193 Euro. The mean number of examined lymph nodes and the rate of positive surgical margins indicate that RAPD could be an appropriate oncologic operation. Conclusion: RAPD is safely feasible. These results were obtained in selected patients and in specialized centers. RAPD should not be implemented in the occasional patient by surgeons without advanced laparoscopic skills and formal training in robotic surgery

La formazione dell'insegnante competente

2010 - 2011I rapidi cambiamenti che hanno investito la società negli ultimi decenni hanno coinvolto anche il corpo insegnante in servizio e i futuri maestri a cui sono richieste, già nell’ambito della formazione iniziale, sempre maggiori competenze. Già da tempo il personale docente ha dovuto modificare il suo modo d’insegnare per adeguarsi al passaggio da una scuola della conoscenza a una scuola della competenza. Quindi non più la semplice trasmissione di nozioni dal docente al discente ma una formazione che stimoli attraverso la scoperta, il lavoro di gruppo, l’ausilio delle nuove tecnologia, l’acquisizione di competenze. Questo nuovo ruolo dell’insegnante richiede una formazione specifica orientata all’acquisizione di tecniche e strategie didattiche adatte a relazionarsi con studenti sempre più eterogenei, che in particolar modo nella scuola primaria presentano marcate differenze culturali, di capacità, d’interessi e di valori. Studenti che si approcciano alla scuola con modalità totalmente differenti gli uni dagli altri. Gli insegnanti quindi si trovano di fronte ad una scuola di massa che deve rispondere ad una pluralità d’esigenze. Nodo cruciale è la formazione dei docenti che deve iniziare con un adeguato percorso universitario e continuare lungo tutto il corso di vita, al fine di acquisire in primis le competenze di base da arricchire costantemente con un patrimonio di conoscenze, pratiche, tecniche e modelli d’azioni in costante evoluzione grazie alla ricerca. In realtà, la formazione degli insegnanti è un percorso che continua lungo tutto il tragitto personale e professionale in quanto nuove competenze devono essere sviluppate costantemente per far fronte alle sfide che il mondo della scuola pone quotidianamente innanzi. Questo richiede una formazione iniziale di qualità e un successivo percorso che permetta di essere costantemente aggiornati.The rapid changes of last decades have deeply affected our society and as well as the in-service and future teachers to whom are required already in the initial training specific competences. For-back the teaching staff has had to change their way to teach in order to adapt to the transition from a school of knowledge to a school of competence. Therefore, not more a mere transmission of notions by a teacher to a learner but a training that sharpens the acquisition of skills through the discovery, the teamwork and the use of new technologies. This new role of the teacher requires a specific training oriented to the acquisition of techniques and teaching strategies suited to interact with students always more heterogeneous who in particular in Primary School show marked cultural differences, skills, interests and values. Students who approaches to the school in a completely different manner from each other. Because of these differences teachers find themselves to face with a mass education that must respond to a variety of needs. In order to achieve these results teachers have to make use of tools offered by the autonomy of didactics, research, and development. The training of teachers becomes a crucial issue, because it has to start with an appropriate degree course and continue throughout the whole life, in order to acquire the first basic skills which later need to be constantly enriched with a heritage of knowledge, practices, techniques and models of 'actions constantly changing thanks to the research. [a cura dell'autore]X n.s

L’insegnante competente e le competenze dell’insegnante

Il corso di laurea in Scienze per la Formazione Primaria nasce come corso deputato alla preparazione di una categoria di professionisti ben definita, con l’obiettivo di fornire una preparazione teoricopratica necessaria per lavorare come insegnanti nella scuola dell’infanzia e nella scuola primaria. Per tale professione nonsono necessarie esclusivamente conoscenze dichiarative, contestuali o procedurali, occorre, invece, che uno studente, un futuro docente, sia capace di mobilitare i suoi saperi per organizzare risposte efficaci a problemi complessi e rilevanti. Pertanto è necessario che durante il percorso universitario lo studente acquisisca specifiche competenze. La ricerca è andata ad indagare se e in che misura gli studenti, al termine del loro percorso formativo, ritengono di aver acquisito le competenze fondanti di questa professione

Politica di coesione 2014-2020.<br/> Il sistema di governance per la gestione dei fondi della Regione Sardegna

This dissertation aims to study and analyze how the new 2014-2014 ESIF regulations (European Structural &amp; Investment Funds), particularly ERDF (European Regional Development Funds) and ESF (European Social Funds), impact the governance system in the Autonomous Region of Sardinia (ARS) with regard to the management of EU resources for cohesion policy. Moreover, it investigates how the latter has responded to the EU's push towards reinforcing the administrative efficacy of actors responsible for managing European funds. More specifically, this work examines whether and how the Regional administration has changed in an effort to meet current needs for the simplification, consistency and transparency of fund management required by the new regulations; what difficulties were encountered in the process; what systems of coordination and interchange among involved parties (regional, national and European) were set in place; what measures were taken to meet the EU's demands for reinforcing administrative management; finally, what strengths and critical issues are evidenced in the new Regional organization

The Crystal Fortress: the world of children witnessing domestic violence in the words of health and welfare professionals

Witnessing Domestic Violence (WDV) is defined by The Child Welfare Information Gateway as a psychological violence that has dramatic consequences on the psychophysical health of children. In order to contribute to the taking charge of Domestic Violence (DV) and according to researchers who show the role of fatherhood in ending the phenomenon, ViDaCS project puts fathers in their children's shoes by making them witness a scene of strong family conflict through the virtual reality. In order to structure the scene of DV, 16 Neapolitan health professionals dealing with children WDV were selected through a theoretical intentional sampling and interviewed. Narrative focused interviews were carried out, transcribed verbatim and analyzed through the Grounded Theory Methodology, using the ATLAS.ti 8 software. 319 codes were assigned to the texts, then grouped in 10 categories and 4 macro-categories. The “Cristal Fortress” emerged as the core category, summarizing the world of the children WDV in the voice of Neapolitan professionals; a world where family that would protect like a fortress, is made fragile by the “inexplicable and senseless violence”. The analysis also allowed to investigate the experiences and suggestions of the participants with respect to the network of services. In fact, the core category also reflected a network that should protect like a fortress, but which is made fragile by the difficulty of communication among the services. It revealed the importance of offering children a solid space in which to be protected, and it helped to think about useful guidelines for services dealing with WDV

Drawingvoice 2.0: classroom joint designing and Facebook interactions to develop reflexivity and awareness

Drawingvoice 2.0 is an instructional method of collaborative pencil and paper drawing to use in the school classroom, followed by Facebook interaction on the drawing produced in class. It is based on a participatory and meta reflective approach, explicitly aimed at deconstructing, negotiating, and reconstructing the meaning that students attribute to themselves regarding their professional expectations and educational pathways. In particular, the collaborative pencil and paper drawing allows for the student’s emotional symbolisation processes underlying their educational pathway. Drawingvoice 2.0 induces a multidimensional cognitive and meta-cognitive process further supported by the following interaction on Facebook. Therefore, the World Wide Web is the added resource for sharing and deepening the classmates’ discussion. Finally, Drawingvoice 2.0 supported structural group interaction and was an important supportive and instructional method to bring about transformational and developmental training practices. As the main result, in our experience, psychology students increased their reflectivity about their strengths and threats in being psychologists within their cultural contexts and potential positive resources underlying their choice. Drawingvoice 2.0 thus enhanced their self-awareness about the lights and shadows of their training and future professional career.info:eu-repo/semantics/publishedVersio

Ending Intimate Partner Violence (IPV) and Locating Men at Stake: An Ecological Approach

Interventions for ending intimate partner violence (IPV) have not usually provided integrated approaches. Legal and social policies have the duty to protect, assist and empower women and to bring offenders to justice. Men have mainly been considered in their role as perpetrators to be subjected to judicial measures, while child witnesses of violence have not been viewed as a direct target for services. Currently, there is a need for an integrated and holistic theoretical and operational model to understand IPV as gender-based violence and to intervene with the goal of ending the fragmentation of existing measures. The EU project ViDaCS—Violent Dads in Child Shoes—which worked towards the deconstruction and reconstruction of violence’s effects on child witnesses, has given us the opportunity to collect the opinions of social workers and child witnesses regarding violence. Therefore, the article describes measures to deal with IPV, proposing functional connections among different services and specific preventative initiatives. Subsequently, this study will examine intimate partner violence and provide special consideration to interventions at the individual, relational, organizational and community levels. The final goal will be to present a short set of guidelines that take into account the four levels considered by operationalizing the aforementioned ecological principles

A Hospital Medical Record Quality Scoring Tool (MeReQ): Development, Validation, and Results of a Pilot Study

Hospital medical records are valuable and cost-effective documents for assessing the quality of healthcare provided to patients by a healthcare facility during hospitalization. However, there is a lack of internationally validated tools that measure the quality of the whole hospital medical record in terms of both form and content. In this study, we developed and validated a tool, named MeReQ (medical record quality) tool, which quantifies the quality of the hospital medical record and enables statistical modeling using the data obtained. The tool was applied to evaluate a sample of hospital individual patient medical records from a secondary referral hospital and to identify the departments that require quality improvement interventions and the effects of improvement actions already implemented

Pyrosequencing analysis of fungal assemblages from geographically distant, disparate soils reveals spatial patterning and a core mycobiome

Identifying a soil core microbiome is crucial to appreciate the established microbial consortium, which is not usually subjected to change and, hence, possibly resistant/resilient to disturbances and a varying soil context. Fungi are a major part of soil biodiversity, yet the mechanisms driving their large-scale ecological ranges and distribution are poorly understood. The degree of fungal community overlap among 16 soil samples from distinct ecosystems and distant geographic localities (truffle grounds, a Mediterranean agro-silvo-pastoral system, serpentine substrates and a contaminated industrial area) was assessed by examining the distribution of fungal ITS1 and ITS2 sequences in a dataset of 454 libraries. ITS1 and ITS2 sequences were assigned to 1,660 and 1,393 Operational Taxonomic Units (OTUs; as defined by 97% sequence similarity), respectively. Fungal beta-diversity was found to be spatially autocorrelated. At the level of individual OTUs, eight ITS1 and seven ITS2 OTUs were found in all soil sample groups. These ubiquitous taxa comprised generalist fungi with oligotrophic and chitinolytic abilities, suggesting that a stable core of fungi across the complex soil fungal assemblages is either endowed with the capacity of sustained development in the nutrient-poor soil conditions or with the ability to exploit organic resources (such as chitin) universally distributed in soils