Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

A Neural-Network-Based Model for the Dynamic Simulation of the Tire/Suspension System While Traversing Road Irregularities

This paper deals with the simulation of the tire/suspension dynamics by using recurrent neural networks (RNNs). RNNs are derived from the multilayer feedforward neural networks, by adding feedback connections between output and input layers. The optimal network architecture derives from a parametric analysis based on the optimal tradeoff between network accuracy and size. The neural network can be trained with experimental data obtained in the laboratory from simulated road profiles (cleats). The results obtained from the neural network demonstrate good agreement with the experimental results over a wide range of operation conditions. The NN model can be effectively applied as a part of vehicle system model to accurately predict elastic bushings and tire dynamics behavior. Although the neural network model, as a black-box model, does not provide a good insight of the physical behavior of the tire/suspension system, it is a useful tool for assessing vehicle ride and noise, vibration, harshness (NVH) performance due to its good computational efficiency and accuracy

A smart wheel for improving the active safety of road vehicles

A new lightweight smart wheel has been designed and manufactured. The smart wheel is able to measure the three forces and the three moments acting at the wheel. The wheel is based on an original structural concept and it appears to be rather simple to be implemented in future automobiles. The paper presents the concept and the testing of such a device. The structural part is composed basically by three spokes whose deformations (depending on the forces applied to the wheel) are sensed by means of strain gauges. The strain gauges signals are filtered, amplified and digitally converted and finally wireless transmitted to a remote receiver which can be connected to the vehicle control unit. A particular joint structure, which do realize the physical link between the three spoke structure (wheel hub) and the wheel rim, is designed. The smart-wheel calibration phase is described in the paper. A comprehensive indoor and outdoor experimental phase has been completed, useful to compare the performance of the new sensor with respect to commercial measuring wheels. The performance of the smart wheel fits well the need of improving the active safety of road vehicles. In other terms, the information given by the wheel, allowing to sense the three forces and the three moments, should lead to considerable improvement of the ABS and ESP/VDC performance with respect to today control logics

Importance of uncertainties in non-linear simulation and testing for engineering design

Nowadays, mechanical industries operate in a highly competitive environment, therefore the process of developing a component from concept through detailed CAE and performance validation is optimized for reduced development time and increased product performance. In order to continuously improve the product design and performance, and reduce the costs and time to market, the design and performance engineering is shifted more and more towards virtual modelling and simulation processes from the expensive test-based design evaluations. A second evolution is the booming introduction of active and adaptive systems in mechanical structures, leading to a ‘mechatronics systems’ revolution to further push the product performance to higher levels, however at the expense of increased system complexity. Here, it is noted that the potential of structural dynamics test and analysis methods for addressing a structural dynamics design assessment or design optimization, depends largely on the confidence that one can have in the results. In this context, a key aspect is to be aware of the key sources of uncertainty in the designed product, and the impact thereof on the product performance. The product nowadays can often no longer be seen as a linear mechanical system, but rather as mechatronics systems and/or as a mechanical system with distinct nonlinear behaviour for certain performance criteria of interest. This paper reviews the main elements of test data and modal modelling uncertainty and assesses the impact of the uncertainty on some typical modelling problems. Some recent methods for uncertainty analysis in modelling are addressed. Examples include a vehicle bumper system analyzed for crashworthiness, the mechatronics system design challenge and structural analysis of vehicle and aeronautics structures. KEYWORDS: uncertainties, non-linearity, crash, mechatronics systemsstatus: publishe

Hyperfractionated radiotherapy in locally advanced nasopharyngeal cancer. An analysis of 43 consecutive patients

Background: Despite numerous randomized trials suggesting a benefit of unconventional fractionation in locally advanced head and neck cancer, the role of this approach in nasopharyngeal carcinoma is debatable. Based on the current clinical experience, the authors introduced hyperfractionated irradiation in the treatment of locally advanced head and neck cancer, including nasopharyngeal tumors. The preliminary results of this treatment approach in nasopharyngeal cancer patients are presented, with special focus on the pattern of failure and toxicity. Patients and methods: 43 patients with nasopharyngeal cancer (stage II-IV, TNM 1997) underwent hyperfractionated irradiation. In 34 cases, radiotherapy was preceded by a median of three cycles of cisplatin-based induction chemotherapy. Irradiation was delivered using a shrinking-field technique up to a total dose of 74.4 Gy in 62 fractions of 1.2 Gy twice daily (minimum 6-h interval)/5 days/week. Results: Acute toxicity of hyperfractionated radiotherapy was significant but tolerable. Mucositis proved the most common side effect (grade 3: 24 patients, grade 4: three patients). Severe late toxicity was not observed. 30 of 34 patients (88%) responded to induction chemotherapy. At 6 weeks after completion of radiotherapy, complete response was seen in 35 patients (81%), partial response in five (12%), stable disease in one, and progressive disease in two. After a median follow-up of 32 months, 18 patients (41%) developed progressive disease. Primary tumor progression was observed in three patients, and seven patients each showed regional lymph node progression and distant metastases. In one case both regional lymph node progression and distant metastases were diagnosed. The 2-year progression-free survival and overall survival rates were 58% and 84%, respectively. Conclusion: Hyperfractionated radiotherapy seems a feasible and active regimen in locally advanced nasopharyngeal carcinoma. Accompanying acute and late toxicity is acceptable and does not compromise delivery of the planned irradiation dose. This regimen is associated with a high local control rate; relatively high nodal and distant failure, however, call for further treatment modifications, e. g., optimization of irradiation technique and/or dose escalation as well as improved systemic therapies

Dicere laudes. Elogio, comunicazione, creazione del consenso. Atti del convegno internazionale, Cividale del Friuli, 23-25 settembre 2010

Un aspetto particolarmente interessante del modo con cui i protagonisti dei ceti intellettuali antichi cercano sostegno e protezione da parte del potere politico è il carattere "negoziale" della loro proposta: artisti e letterati, in quanto dotati degli strumenti capaci di rappresentare la realtà (e dunque di influenzarne la percezione), detengono di fatto essi stessi un potere che mettono in campo nei confronti dell'autorità politica