THE PATIENT IN THE OPERATING ROOM: CONSIDERATION AT SEVEN YEARS FROM WORLD HEALTH ORGANIZATION GUIDELINES PUBLICATION.

Modern surgery is burdened by a huge amount of patient to be treated and an increasingly complex number of procedures which request planned action and shared behaviours, aimed to prevent perioperative accidents and favour good surgical outcomes. Surgical and anaesthetic safety has improved significantly in last few decades. However, the operating room environment continues to have significant safety risks for patients as well as the health care providers who work there. Adverse events may result from problems in practice, products, procedures or systems. The worldwide incidence of surgical site infection, one of the most important and frequent post-operative complication, ranges from 3% to 16%, with a mortality rate ranging from 0.4% to 0.8%; in these studies, about 50% of cases were considered preventable (1-9). Patients safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care. Just as public health interventions and educational projects have dramatically improved maternal and neonatal survival, analogous efforts might improve surgical safety and quality of care (10). According to these objectives, the World Health Organization (WHO) has published and diffused the international “Guidelines for Safe Surgery” (11). The guidelines have the clear proposal to 61ameliorate the safety of surgical interventions; they define and promote recommendation and safety standards suitable for the different Countries and operative settings, suggesting a new deal in managing pre-operative, intra-operative and post-operative processes. On the base of these recommendations, the WHO has also developed a checklist for the safety in the operating room, in order to prevent avoidable adverse events, thus minimizing unnecessary loss of life and serious complications. The results raised from a multicentre study carried out in eight different Countries, demonstrating the effectiveness of the WHO checklist in terms of better patient safety, reduction of deaths and post-operative complications (12). The objectives of this international effort are resumable as follow: 1. the patient must be correctly positioned on the surgical bed and prepared; 2. the surgery team must operate on the correct patient at the correct site; 3. blood loss and risk for surgical site infection must be minimized; 4. inadvertent retention of instruments and sponges in surgical site must be prevented; 5. during surgery, anaesthesiologists must prevent harm from the administration of anaesthetics, while protecting the patient from pain; 6. anaesthesiologists must manage patient’s airways and respiratory function, in order to avoid life-threatening complications; 7. the team should consider patient’s allergies or intolerances in order to prevent an allergic or adverse drug reaction; 8. at the end of intervention, the surgical team must secure and accurately identify all surgical specimens, while the anaesthesiologists will guarantee a correct patient awakening; 9. all the members of the team will effectively communicate and exchange critical information for the safe conduct of the operation; 10. post-operative thromboembolism must be prevented adopting the right measures; 11. each member of the team is responsible for his own clinical documentation; 12. hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results. On March 2013, the American Agency for Health Research and Quality (AHRQ) published the Making Health Care Safer II report, which confirmed the effectiveness of WHO checklist and considered it as one of the 10 strongest recommended practices health care organizations should immediately apply to improve patient safety (13). After the first launch of the WHO checklist, the American Veteran Health Administration observed a constant reduction of patient mortality (0.5/1000 surgeries/4 months); in Holland, compliance to the new guidelines raised from 12% of the first 4 months to the 60%, observed at the end of the second year after publication. This means that «The checklist only works if you use it» (14). The checklist does not reduces itself patient complications, but only the application of all the provided items could help to do so. The checklist should be understood not merely as a list of items to be checked off, but as an instrument for the improvement of communication, teamwork, and safety culture in the operating room, and it should be accordingly implemented. To reach the expected results it needs time, the time to let surgical team to learn and involve (gradually) all the interested units of a determined hospital or the hospitals of a specific geographic area. Agreeing with Bosk and colleagues (15), using an electronic recording format within the standard mandatory strategy facilitates apparent compliance and the use of the safety checklist as a tick box exercise. It seems that the main trick to improving safety is a strategy leading to positive attitudes on the part of the health professionals involved, involving a far more complex adaptive process than merely mandating the use of a checklist

Single-ion anisotropy and magnetic field response in the spin-ice materials Ho2Ti2 O7 and Dy2Ti2 O7

Motivated by its role as a central pillar of current theories of dynamics of spin ice in and out of equilibrium, we study the single-ion dynamics of the magnetic rare earth ions in their local environments, subject to the effective fields set up by the magnetic moments they interact with. This effective field has a transverse component with respect to the local easy-axis of the crystal electric field, which can induce quantum tunnelling. We go beyond the projective spin-1/2 picture and use instead the full crystal-field Hamiltonian. We find that the Kramers vs non-Kramers nature, as well as the symmetries of the crystal-field Hamiltonian, result in different perturbative behaviour at small fields ($\lesssim 1$ T), with transverse field effects being more pronounced in Ho$_{2}$Ti$_{2}$O$_{7}$ than in Dy$_{2}$Ti$_{2}$O$_{7}$. Remarkably, the energy splitting range we find is consistent with time scales extracted from experiments. We also present a study of the static magnetic response which highlights the anisotropy of the system in the form of an off-diagonal $g$ tensor and we investigate the effects of thermal fluctuations in the temperature regime of relevance to experiments. We show that there is a narrow yet accessible window of experimental parameters where the anisotropic response can be observed.EPSRC, STFC, HEFCE, SEPnetThis is the author accepted manuscript. The final version is available from the American Physical Society via http://dx.doi.org/10.1103/PhysRevB.92.15512

Ground-state factorization and correlations with broken symmetry

We show how the phenomenon of factorization in a quantum many-body system is of collective nature. To this aim we study the quantum discord Q in the one-dimensional XY model in a transverse field. We analyze the behavior of Q at both the critical point and at the non-critical factorizing field. The factorization is found to be governed by an exponential scaling law for Q. We also address the thermal effects fanning out from the anomalies occurring at zero temperature. Close to the quantum phase transition, Q exhibits a finite-temperature crossover with universal scaling behavior, while the factorization phenomenon results in a non-trivial pattern of correlations present at low temperature. Copyright (C) EPLA, 2011 RI Rossini, Davide/A-8156-201

2016 WHO GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION: A NEW STEP TO IMPROVE PATIENT'S SAFETY BEFORE, DURING AND AFTER SURGERY

Surgical site infection (SSI) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during and after surgery. No international guidelines are available and incosistencies in the interpretations of evidence and recommendations of national guidelines have been identified. Given the burden of SSI worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for thew prevention of SSI. The guidelines take into account the balance between benefits and harms, the evidence quality, costs and resource use implications, and patgients values andf preferences. on the basis of systematic literature reviews and expert consensus, we present 23 recommendations on preoperative, intraoperative and postoperative preventive measures. The WHO recommendations were developed with a global perspective and they take into account the balance between benefitgs and harms, the evidence quality level, cost and resource use implications, and patient values and preferences

Theory of mind in animals : current and future directions

C.K. was supported by European Commission Marie Skłodowska‐Curie fellowship MENTALIZINGORIGINS and J.C. by European Research Council Synergy grant 609819 SOMICS.Theory of mind (ToM; a.k.a., mind-reading, mentalizing, mental-state attribution, and perspective-taking) is the ability to ascribe mental states, such as desires and beliefs, to others, and it is central to the unique forms of communication, cooperation, and culture that define our species. As a result, for 40 years, researchers have endeavored to determine whether ToM is itself unique to humans. Investigations in other species (e.g., apes, monkeys, corvids) are essential to understand the mechanistic underpinnings and evolutionary origins of this capacity across taxa, including humans. We review the literature on ToM in nonhuman animals, suggesting that some species share foundational social cognitive mechanisms with humans. We focus principally on innovations of the last decade and pressing directions for future work. Underexplored types of social cognition have been targeted, including ascription of mental states, such as desires and beliefs, that require simultaneously representing one's own and another's conflicting motives or views of the world. Ongoing efforts probe the motivational facets of ToM, how flexibly animals can recruit social cognitive skills across cooperative and competitive settings, and appropriate motivational contexts for comparative inquiry. Finally, novel methodological and empirical approaches have brought new species (e.g., lemurs, dogs) into the lab, implemented critical controls to elucidate underlying mechanisms, and contributed powerful new techniques (e.g., looking-time, eye-tracking) that open the door to unexplored approaches for studying animal minds. These innovations in cognition, motivation, and method promise fruitful progress in the years to come, in understanding the nature and origin of ToM in humans and other species.PostprintPeer reviewe

Brain correlates of action word memory revealed by fMRI

Understanding language semantically related to actions activates the motor cortex. This activation is sensitive to semantic information such as the body part used to perform the action (e.g. arm-/leg-related action words). Additionally, motor movements of the hands/feet can have a causal effect on memory maintenance of action words, suggesting that the involvement of motor systems extends to working memory. This study examined brain correlates of verbal memory load for action-related words using event-related fMRI. Seventeen participants saw either four identical or four different words from the same category (arm-/leg-related action words) then performed a nonmatching-to-sample task. Results show that verbal memory maintenance in the high-load condition produced greater activation in left premotor and supplementary motor cortex, along with posterior-parietal areas, indicating that verbal memory circuits for action-related words include the cortical action system. Somatotopic memory load effects of arm- and leg-related words were observed, but only at more anterior cortical regions than was found in earlier studies employing passive reading tasks. These findings support a neurocomputational model of distributed action-perception circuits (APCs), according to which language understanding is manifest as full ignition of APCs, whereas working memory is realized as reverberant activity receding to multimodal prefrontal and lateral temporal areas

Why do dogs (Canis familiaris) select the empty container in an observational learning task?

Many argue that dogs show unique susceptibility to human communicative signals that make them suitable for being engaged in complex co-operation with humans. It has also been revealed that socially provided information is particularly effective in influencing the behaviour of dogs even when the human’s action demonstration conveys inefficient or mistaken solution of task. It is unclear, however, how the communicative nature of the demonstration context and the presence of the human demonstrator affect the dogs’ object-choice behaviour in observational learning situations. In order to unfold the effects of these factors, 76 adult pet dogs could observe a communicative or a non-communicative demonstration in which the human retrieved a tennis ball from under an opaque container while manipulating another distant and obviously empty (transparent) one. Subjects were then allowed to choose either in the presence of the demonstrator or after she left the room. Results showed a significant main effect of the demonstration context (presence or absence of the human’s communicative signals), and we also found some evidence for the response-modifying effect of the presence of the human demonstrator during the dogs’ choice. That is, dogs predominantly chose the baited container, but if the demonstration context was communicative and the human was present during the dogs’ choice, subjects’ tendency to select the baited container has been reduced. In agreement with the studies showing sensitivity to human’s communicative signals in dogs, these findings point to a special form of social influence in observational learning situations when it comes to learning about causally opaque and less efficient (compared to what comes natural to the dog) action demonstrations

DISMICROBISM IN INFLAMMATORY BOWEL DISESE AND COLORECTAL CANCER: CHANGES IN RESPONSE OF COLOCYTES

Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. the CRC has been increasing in recent years and its mortality rates are very high. Multiple biological and biochemical factors are responsible for the onset nad progression of this pathology. moreover, it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the production of colonic healt. the gut microflora, or microbiota, has an extensive diversity both quantitatively and qualitatively. in utero, the intestine of the mammalian fetus is sterile. Al birth, the intestinal microbiota in acquired by ingestion maternal anal or vaginal organisms, ultimately developing into a stable community, with marked variations in microbial composition between individuals. the development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora (dysbiosis). the healthy human gut arbours about 10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract. The intestinal microbiota plays a fundamental role in helath and the progeression of diseases such as IBD and CRC. in Healthy subjects, the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature, competition between different bacterial strains, peristalsis and drugs can influence the intestinal microenvironment. the microbiota exerts diverse physiological functions to include; growth inhibition of pathogenic microrganisms, synthesis of compounds useful for the trophysm of colonic mucosa, regulation of the intestinal lymphoid tissue and synthesis of amino acids. furthermopre, mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity. changes in the microbiota composition are mainly influenced by diet and age, as well as genetic factors. Increasing evidence indicates that dysbiosis favors the production of genotoxins and metabolities associated with carcinogeneasis and induces dysregulation of the immune response wich promotes and sustains inflammation in IBD leading to carcinogenesis. a disequilibrium in gut microflora composition leads to the specific activation of gut associated lymphoid tissue. the associated chronic inflammatory process associated increases the risk of developing CRC. Ulcerative colitis and Crohn's diasease are the two major IBDs characterized by an early onset and extraintestinal manifestations, such as rheumatoid arthtritis. the pathogenesis of both diseases is complex and not yet fully known. however, it is widely accepted that an inappropriate immune response to microbial flora can play a pivotal role in IBD pathogenesis