Athens by Sound

Architecture is not only that which is built. Architecture is made up of different aspects, both material and immaterial. The atmosphere, the sounds, the smells, the possibility of interaction between human bodies: these all constitute characteristics of space, characteristics that are assuming an increasing importance within architectural research worldwide. Within this field of thought about “Architecture Beyond Building”, we focus on one particular non-material spatial phenomenon that lies ‘beyond the built’: sound. We have created, thus, an interactive sonic map of Athens, which presents, in an unexpected way, fragments of the atmosphere of the city. What would a non-visual map look like? What would it feel like if you wandered within a forest of headphones, playing sounds from different places in Athens? How would it feel if you found yourself in a ‘map’ that only appeared when you walked in it? What would it be like if the map only appeared when you invited one more person to be with you? The Greek pavilion addresses these questions through an atmospheric interactive ‘game’, presenting fragments of sounds and visual sequences of Athens. The visitor recreates the space around him through his own presence and movement. The map appears only where he walks, and/or when he invites one more person to sit next to him. The bodies of the visitors react with one another and with the space itself, creating a dynamic, changing field. This walk in the pavilion takes you “out there”, through invisible Athens. The pavilion brings forth the aspects of architecture that are ‘beyond the material’: the ‘beyond the built’, the almost unreachable, elusive aspects of space, such as sound, non-visual senses, atmosphere. It challenges, thus, the limits of architecture, the limits of what can be mapped and re-located and what cannot. An edited collection by A. Karandinou, C. Achtypi, S. Giamarelos, including texts by: Ιntothepill, Katie Lloyd Thomas, Martin Parker, Panayiotis Tournikiotis, Mark Wigley, Dorian Wiszniewski, Leslie Kavanaugh, Stephen Cairns, Jonathan Hill, Vassilis Ganiatsas, Anastasios Kotsiopoulos, Constance Classen, Stavros Stavrides, Ole Bouman, William Mitchell, Richard Coyne, Neil Spiller, Kas Oosterhuis, Nora Schueler, Zissis Kotionis, Stelarc, Andreas Angelidakis, Aristide Antonas, Slavoj Žižek, Nikolaos Laskaris, Argyris Rokas, Andreas Kourkoulas, John Peponis, Yorgos Ioannou, Yorgos Tzirtzilakis, Konstantinos Vita, Dionyssis Kapsalis, United Visual Artists, Platon Rivellis, and Dimitris Filippidis. Contributors to the Greek National Participation to the 11th International Architecture Exhibition La Biennale di Venezia "Out there. Architecture beyond building" (2008) Organised by: Hellenic Ministry of Culture [yppo.gr] General Directorate of Modern Culture Directorate of Visual Arts Department for the Promotion of Contemporary Art Curators: Anastasia Karandinou Christina Achtypi Stylianos Giamarelos Video works by Intothepill net [intothepill.net] Artists: Yiannis Grigoriadis Yiannis Isidorou Lina Theodorou Sound Recording / Sound Design Dimitris Miyakis [movement.gr] Vangelis Lympouridis Exhibition Graphics / Catalogue Design Company [company-london.com] Design and Implementation of interactive environment 2monochannels [2monochannels.com] Audiovisual and interactive systems design / acoustic design / construction supervision Iraklis Lampropoulos Giorgos Lampropoulos Software programming Vassilis Boukis Electronic subsystem design Michail Kritsotakis Electrical Design Giorgos Satolias Interconnection of interactive elements Vangelis Lympouridis [inter-axions.com] Dimitris Miyakis Light design L+DG lighting architects [lightingdg.com] Thomas Gravanis Christina Frangeti Construction Gavrilos Michalis [gavrilos.gr] Digital printing Polichromo [polichromo.com] Translations Rachel Howard Nikos Masourides Catalogue photographs Intothepill – Internet video platform Catalogue published by futura publications Marketing communication Chryssa Vrouzi Communication associate Katerina Stamidi Photographer Cathy Cunliffe [cathycunliffeΑΤgmail.com] For their financial and material support for the Greek participation at the 11th International Exhibition of Architecture, La Biennale di Venezia, we express our deepest thanks to the sponsors: Alexander S. Onassis Public Benefit Foundation [onassis.gr] Akzonobel [akzonobel.com] Carteco - Architectural Materials & Design [carteco.gr] L+DG Lighting Architects [lightingdg.com] Plaisio [plaisio.gr] Polichromo Advertising Applications [polichromo.com] iGuzzini illuminazione [iguzzini.com] Diathlasis Architectural Lighting [diathlasis.gr

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Étude comparée de quatre indicateurs qualifiant le champ visuel d'un piéton en milieu urbain: Partitionnement de l'espace ouvert urbain et représentation de la prévisibilité d'un environnement urbain

International audienceAccording to the permeability theory, the spatial configuration, and more precisely, the presence of occlusions in our surroundings may invite us to explore our environment. This article aims to analyze, in a systematic and reproducible way, the predictability of our visual environment. To assess this property for every observing point, we remind three indicators relative to the boundary predictability (entropy), to the weight of the visible mass (drift), and to the occlusions ratio (occlusivity). We introduce a fourth indicator weighting each visual discontinuity (anticipation). An aggregation operated thanks to the open space convex partition emphasizes characterisable patterns, towards an application for urban planning.Pour la théorie de la perméabilité, la configuration des lieux, et plus précisément la présence d'occlusions dans notre environnement visuel, peuvent nous inciter à son exploration. L'étude présentée dans cet article a pour but d'analyser de manière systématique et reproductible la prévisibilité de l'environnement urbain immédiat d'un piéton. Pour évaluer cette propriété du champ visuel en tout point, nous rappelons trois indicateurs permettant de quantifier la prévisibilité de la forme ambiante (entropie), le poids des masses visuelles (excentricité) et la part d'occlusions (occlusivité) avant d'en proposer un quatrième relativisant le poids de chaque occlusion (l'anticipation). L'agrégation opérée par un partitionnement convexe de l'espace ouvert facilite l'émergence de motifs géométriques caractérisables pour une meilleure compréhension des potentialités de l'espace urbain

Denver and Marshall scores successfully predict susceptibility to multiple independent infections in trauma patients.

Trauma patients are at risk of repeated hospital-acquired infections, however predictive scores aiming to identify susceptibility to such infections are lacking. The objective of this study was to investigate whether commonly employed disease-severity scores can successfully predict susceptibility to multiple independent infectious episodes (MIIEs) among trauma patients. A secondary analysis of data derived from the prospective, longitudinal study "Inflammation and the Host Response to Injury" ("Glue Grant") was performed. 1,665 trauma patients, older than 16, were included. Patients who died within seven days from the time of injury were excluded. Five commonly used disease-severity scores [Denver, Marshall, Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury Severity Score (ISS), and New Injury Severity Score (NISS)] were examined as independent predictors of susceptibility to MIIEs. The latter was defined as two or more independent infectious episodes during the index hospital stay. Multivariable logistic regression was used for the statistical analysis. 22.58% of the population was found to be susceptible to MIIEs. Denver and Marshall scores were highly predictive of the MIIE status. For every 1-unit increase in the Denver or the Marshall score, there was a respective 15% (Odds Ratio:1.15; 95% CI: 1.07-1.24; p < 0.001) or 16% (Odds Ratio:1.16; 95% CI: 1.09-1.24; p < 0.001) increase in the odds of MIIE occurrence. APACHE II, ISS, and NISS were not independent predictors of susceptibility to MIIEs. In conclusion, the Denver and Marshall scores can reliably predict which trauma patients are prone to MIIEs, prior to any clinical sign of infection. Early identification of these individuals would potentially allow the implementation of rapid, personalized, preventative measures, thus improving patient outcomes and reducing healthcare costs

The Role of Computed Tomography in the Diagnosis of Necrotizing Soft Tissue Infections

The exact role of IV contrast-enhanced computed tomography (CT) in the diagnosis of necrotizing soft tissue infections (NSTIs) has not yet been established. We aimed to explore the role of CT in patients with clinical suspicion of NSTI and assess its sensitivity and specificity for NSTI.The medical records of patients admitted between 2009 and 2016, who received IV contrast-enhanced CT to rule out NSTI, were reviewed. CT was considered positive in case of: (a) gas in soft tissues, (b) multiple fluid collections, (c) absence or heterogeneity of tissue enhancement by the IV contrast, and (d) significant inflammatory changes under the fascia. NSTI was confirmed only by the presence of necrotic tissue during surgical exploration. NSTI was considered absent if surgical exploration failed to identify necrosis, or if the patient was successfully treated non-operatively.Of the 184 patients, 17 had a positive CT and hence underwent surgical exploration with NSTI being confirmed in 13 of them (76%). Of the 167 patients that had a negative CT, 38 (23%) underwent surgical exploration due to the high clinical suspicion for NSTI and were all found to have non-necrotizing infections; the remaining 129 (77%) were managed non-operatively with successful resolution of symptoms. The sensitivity of CT in identifying NSTI was 100%, the specificity 98%, the positive predictive value 76%, and the negative predictive value 100%.A negative IV contrast-enhanced CT scan can reliably rule out the need for surgical intervention in patients with initial suspicion of NSTI

The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study

An intraoperative adverse event (iAE) is often directly attributable to the surgeon's technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as the surgeons' attitude about iAE reporting. We conducted a web-based cross-sectional survey of all surgeons at 3 major teaching hospitals of the same university. The 29-item questionnaire was developed using a systematic closed and open approach focused on assessing the surgeons' personal account of iAE incidence, emotional response to iAEs, available support systems, and perspective about the barriers to iAE reporting. The response rate was 44.8% (n = 126). Mean age of respondents was 49 years, 77% were male, and 83% performed >150 procedures/year. During the last year, 32% recalled 1 iAE, 39% recalled 2 to 5 iAEs, and 9% recalled >6 iAEs. The emotional toll of iAEs was significant, with 84% of respondents reporting a combination of anxiety (66%), guilt (60%), sadness (52%), shame/embarrassment (42%), and anger (29%). Colleagues constituted the most helpful support system (42%) rather than friends or family; a few surgeons needed psychological therapy/counseling. As for reporting, 26% preferred not to see their individual iAE rates, and 38% wanted it reported in comparison with their aggregate colleagues' rate. The most common barriers to reporting iAEs were fear of litigation (50%), lack of a standardized reporting system (49%), and absence of a clear iAE definition (48%). Intraoperative AEs occur often, have a significant negative impact on surgeons' well-being, and barriers to transparency are fear of litigation and absence of a well-defined reporting system. Efforts should be made to support surgeons and standardize reporting when iAEs occur

Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients

BACKGROUND: Bile spillage (BS) occurs frequently during laparoscopic cholecystectomy, yet its impact on postoperative outcomes remains unknown. We hypothesized that BS increases the risk of surgical site infections (SSI) after laparoscopic cholecystectomy. STUDY DESIGN: Patients older than 18, who were admitted to an academic hospital for a laparoscopic (or laparoscopic converted to open) cholecystectomy, from May 2010 to March 2017, were prospectively included. Open cholecystectomies were excluded. Patients were assessed clinically during hospitalization and 2 to 4 weeks after discharge. We compared those who had BS during the operation with those who did not. Our primary endpoint was the rate of SSI. Stepwise logistic regression was used to identify independent predictors of SSI. RESULTS: Of 1,001 patients, 49.9% underwent laparoscopic cholecystectomy for acute cholecystitis, 20.9% for symptomatic cholelithiasis or biliary colic, 12.8% for gallstone pancreatitis, and 16.4% for other indications. Bile was spilled intraoperatively in 591 patients (59.0%), with hydrops noted in 10.5% and empyema in 14.6% of them. In 202 (20.2%) patients, BS was accompanied by stone spillage. Patients with BS were older (median age of 52 vs 42, p 2 were independent predictors of SSI (odds ratios: 2.29, 2.46, and 2.1 respectively, p < 0.05). CONCLUSIONS: Bile spillage is associated with SSI, and surgeons should take extra caution to avoid it during laparoscopic cholecystectomy. (C) 2018 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved