Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

RESTAURI ROMANTICI ALL'OMBRA DEL CAMPANILE

Il saggio ripercorre la storia dei restauro alla basilica di San'Abbondio a Como con una cronologia degli interventi e un'ipotesi sullo stato di consistenza dell'edificio prima dei restaur

L'INGEGNER TATTI PROGETTAVA E SAN CARPOFORO CROLLAVA

L'articolo ripercorre la storia dei restauri alla basilica comasca di San Carpoforo

Porphyrin thin films coated quartz crystal microbalances prepared by electropolymerization technique

Quartz crystal microbalances (QMB) have been coated by thin films of different metal complexes of protoporphyrin IX dimethyl ester (M-PPIX), deposited by electropolymerization technique. The structure of these films has been characterized by scanning tunnelling microscopy (STM). The sensory behaviour of the obtained QMB have been studied in the presence of four volatile organic compounds (VOC)

Effects of different levels of variability and pressure support ventilation on lung function in patients with mild-moderate acute respiratory distress syndrome

Background: Variable pressure support ventilation (vPSV) is an assisted ventilation mode that varies the level of pressure support on a breath-by-breath basis to restore the physiological variability of breathing activity. We aimed to compare the effects of vPSV at different levels of variability and pressure support (ΔPS) in patients with acute respiratory distress syndrome (ARDS). Methods: This study was a crossover randomized clinical trial. We included patients with mild to moderate ARDS already ventilated in conventional pressure support ventilation (PSV). The study consisted of two blocks of interventions, and variability during vPSV was set as the coefficient of variation of the ΔPS level. In the first block, the effects of three levels of variability were tested at constant ΔPS: 0% (PSV0%, conventional PSV), 15% (vPSV15%), and 30% (vPSV30%). In the second block, two levels of variability (0% and variability set to achieve ±5 cmH2O variability) were tested at two ΔPS levels (baseline ΔPS and ΔPS reduced by 5 cmH2O from baseline). The following four ventilation strategies were tested in the second block: PSV with baseline ΔPS and 0% variability (PSVBL) or ±5 cmH2O variability (vPSVBL), PSV with ΔPS reduced by 5 cmH2O and 0% variability (PSV−5) or ±5 cmH2O variability (vPSV−5). Outcomes included gas exchange, respiratory mechanics, and patient-ventilator asynchronies. Results: The study enrolled 20 patients. In the first block of interventions, oxygenation and respiratory mechanics parameters did not differ between vPSV15% and vPSV30% compared with PSV0%. The variability of tidal volume (VT) was higher with vPSV15% and vPSV30% compared with PSV0%. The incidence of asynchronies and the variability of transpulmonary pressure (PL) were higher with vPSV30% compared with PSV0%. In the second block of interventions, different levels of pressure support with and without variability did not change oxygenation. The variability of VT and PL was higher with vPSV−5 compared with PSV−5, but not with vPSVBL compared with PSVBL. Conclusion: In patients with mild-moderate ARDS, the addition of variability did not improve oxygenation at different pressure support levels. Moreover, high variability levels were associated with worse patient-ventilator synchrony. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT01683669

Potencial de propagação de cultivares de marmeleiro por estaquia Potencial of propagation of cultivars of quince for cuttings

Devido à escassez de trabalhos com o enraizamento de estacas de marmeleiro, realizou-se o presente trabalho com o objetivo de verificar o potencial de enraizamento de estacas de cultivares de marmeleiro. Utilizaram-se estacas lenhosas e lisas coletadas de plantas de marmeleiro 'Radiolo', 'Mendoza Inta-37', 'Much Prolife', 'Pineapple', 'Smyrna', 'De Patras', 'Provencia', 'Van Deman', 'Provance', 'Meliforme', 'Portugal' (Cydonia oblonga) e 'Japonês' (Chaenomelis sinensis L.), sendo estas padronizadas com 20 cm de comprimento. As estacas foram enterradas até a metade do comprimento em canteiro de terra e coberto por tela sombrite 50%, sendo umedecidas diariamente através de regas manuais. Após 75 dias, coletaram-se os seguintes dados biométricos: porcentagem de estacas enraizadas e brotadas, número de folhas e brotos, comprimento da maior raiz, comprimento médio das brotações e número de raízes emitidas por estaca. As cultivares Pineapple, De Patras, Provencia e Mendoza Inta-37 apresentaram maior potencialidade de propagação via estaquia.<br>Due to the shortage of works with the quince cutting, the present work was developed with the objective to verify the rooting potential of quince cultivars cutting. Hardwoody cuttings of quince were collected from 'Radiolo', 'Mendoza Inta-37', 'Much Prolife', 'Pineapple', 'Smyrna', 'De Patras', 'Provencia', 'Van Deman', 'Provance', 'Meliforme', 'Portugal' (Cydonia oblonga) and 'Japonês' (Chaenomelis sinensis L.), being these samples standardized with 20 cm of length. Soon after, half of the length of the cutting was put in a substrate constituted by soil and covered by sombrite 50%, being daily humidified by water. After 75 days, were evaluated the percentage of rooting and sprouting, number of leaves and sprouts, length of the largest root and sprouting and number of roots emitted by cutting. The cultivars Pineapple, De Patras, Provencia and Mendoza Inta-37 presented larger potentiality of propagation of cutting