Impact of COVID-19 pandemic on general surgery training program: An Italian experience

The outbreak of COVID-19 infection in Italy started in late February with a rapid and dramatic spread. The hospitals in the most hit regions of Northern Italy started modifying their working schedule and, on the March 9, 2020, the Government approved the lock-down of the whole Country in order to minimize the further spread of the infection and to optimize health-care resources. This drastic measure transformed all hospitals activities, including suspension of all non-urgent outpatient visits and postponable sur- geries. The aim of this paper is to evaluate how this new organiza- tion affected the role of residents in their last year of training at a General Surgery Department in a tertiary center of North-East Italy (Trieste)

Facilitative effects of learner-directed codeswitching : Evidence from Chinese learners of English

This study examines the interaction between learner-oriented codeswitching (CS) practices and the degree to which intermediate Chinese L2 learners of English engage in classroom interaction. The guiding questions are whether the teacher's CS use facilitates classroom interaction at moderate L2 proficiency, and if so, at which specific stages of the lesson, and to what extent. A systematic comparison of two classroom types was carried out in the same Chinese secondary school, with English-only instruction versus with English–Chinese CS. A combination of quantitative and qualitative analyses was based on class observations (two classes per type) and subsequent teacher interviews. CS behaviour was analysed in relation to the particular teaching focus of the task at hand. Interviews included a stimulated recall technique using selected CS extracts to enrich insights from the teachers' perspective. The results showed a higher student response frequency as well as a longer mean utterance length in CS classes. Overall, codeswitches were systematically distributed across lesson stages and were closely related to changes in the teaching focus. These findings call for an optimal use of CS in instructed environments so as to maximise its benefits via a sensitive adjustment to specific pedagogic aims

What makes you not a Buddhist? : a preliminary mapping of values

This study sets out to establish which Buddhist values contrasted with or were shared by adolescents from a non-Buddhist population. A survey of attitude toward a variety of Buddhist values was fielded in a sample of 352 non-Buddhist schoolchildren aged between 13 and 15 in London. Buddhist values where attitudes were least positive concerned the worth of being a monk/nun or meditating, offering candles & incense on the Buddhist shrine, friendship on Sangha Day, avoiding drinking alcohol, seeing the world as empty or impermanent and Nirvana as the ultimate peace. Buddhist values most closely shared by non-Buddhists concerned the Law of Karma, calming the mind, respecting those deserving of respect, subjectivity of happiness, welfare work, looking after parents in old age and compassion to cuddly animals. Further significant differences of attitude toward Buddhism were found in partial correlations with the independent variables of sex, age and religious affiliation. Correlation patterns paralleled those previously described in theistic religions. Findings are applied to spiritual, moral, social and cultural development and for the teaching of religious to pupils of no faith adherence. The study recommends that quantitative psychometrics employed to conceptualize Buddhist values by discriminant validity in this study could be extended usefully to other aspects of the study of Buddhism, particularly in quest of validity in the conceptualization of Buddhist identity within specifically Buddhist populations

Human cases of West Nile Virus infection in north-eastern Italy, 15 June to 15 November 2010.

In 2010, for the third consecutive year, human cases of West Nile virus (WNV) infection, including three confirmed cases of neuroinvasive disease and three confirmed cases of West Nile fever, were identified in north-eastern Italy. While in 2008 and 2009 all human cases of WNV disease were recorded in the south of the Veneto region, cases of WNV disease in 2010 additionally occurred in two relatively small northern areas of Veneto, located outside those with WNV circulation in the previous years. WNV IgG antibody prevalence in blood donors resident in Veneto was estimated as ranging from 3.2 per 1,000 in areas not affected by cases of WNV disease to 33.3 per 1,000 in a highly affected area of the Rovigo province. No further autochthonous human cases of WNV disease were notified in Italy in 2010. The recurrence of human cases of WNV infection for the third consecutive year strongly suggests WNV has become endemic in north-eastern Italy

Tick-borne encephalitis in north-east Italy: a 14-year retrospective study, January 2000 to December 2013

Italy is considered at low incidence of tick-borne encephalitis (TBE), and the occurrence of human cases of TBE appears to be geographically restricted to the north east of the country. However, most information to date derives from case series, with no systematic data collection. To estimate incidence rates (IR) and spatial distribution of TBE cases, we conducted a retrospective study in north-eastern Italy. Data were collected through the infectious disease units and public health districts of three regions (Friuli Venezia Giulia, Trentino Alto Adige and Veneto) between 2000 and 2013. Overall, 367 cases were identified (IR: 0.38/100,000). The cases' median age was 56 years and 257 (70%) were male. Central nervous system involvement was reported in 307 cases (84%). Annual fluctuations in case numbers occurred, with peaks in 2006 and in 2013, when 44 and 42 cases were respectively observed. A strong seasonality effect was noted, with the highest number of cases in July. In terms of geographical location, three main endemic foci with high TBE IR (> 10/100,000) were identified in three provinces, namely Belluno (Veneto region), Udine (Friuli Venezia Giulia) and Trento (Trentino Alto-Adige). When investigating the whole study area in terms of altitude, the IR between 400 and 600\u2009m was greater (2.41/100,000) than at other altitudes (p< 0.01). In conclusion, the incidence of TBE in Italy is relatively low, even considering only the three known affected regions. However, three endemic foci at high risk were identified. In these areas, where the risk of TBEV infection is likely high, more active offer of TBE vaccination could be considere

Evidence for insertional codemixing: mixed compounds and French nominal groups in Brussels Dutch

In this paper we analyse mixed compounds, such as legume+winkel ‘vegetable shop, greengrocery’ and winter+paletot ‘winter coat’ which contain a French and a Dutch element, and French nominal groups, such as carte d’identité ‘identity card’, and journal parlé ‘radio news’, which bilingual speakers from Brussels frequently insert into Brussels Dutch utterances. Using Muysken’s (2000) typology of bilingual speech, we claim that the mixed compounds and the nominal groups display the characteristics of insertional code-mixing. In addition, some evidence for the existence of a continuum between borrowing and code-switching can be obtained from these examples. As the multimorphemic units that are inserted into Dutch are neither single words, nor full constituents, their status in the lexicon raises interesting issues for researchers interested in the interface between syntax and the lexicon (see also Backus 2003). We try to argue that nominal groups such as carte d’identité and journal parlé are probably best seen as lexical templates or constructional idioms (Booij, 2002b). The insertion of French constructional idioms in Brussels Dutch represents an innovation in the lexical patterns that are available to speakers of this language, which is highly relevant for theories of language change

Predictors of choice of initial antifungal treatment in intraabdominal candidiasis

Intraabdominal candidiasis (IAC) is the second most frequent form of invasive candidiasis, and is associated with high mortality rates. This study aims to identify current practices in initial antifungal treatment (IAT) in a real-world scenario and to define the predictors of the choice of echinocandins or azoles in IAC episodes. Secondary analysis was performed of a multinational retrospective cohort at 13 teaching hospitals in four countries (Italy, Greece, Spain and Brazil), over a 3-year period (2011\u20132013). IAC was identified in 481 patients, 323 of whom received antifungal therapy (classified as the treatment group). After excluding 13 patients given amphotericin B, the treatment group was further divided into the echinocandin group (209 patients; 64.7%) and the azole group (101 patients; 32.3%). Median APACHE II scores were significantly higher in the echinocandin group (p 0.013), but IAT did not differ significantly with regard to the Candida species involved. Logistic multivariate stepwise regression analysis, adjusted for centre effect, identified septic shock (adjusted OR (aOR) 1.54), APACHE II > 15 (aOR 1.16) and presence in surgical ward at diagnosis (aOR 1.16) as the top three independent variables associated with an empirical echinocandin regimen. No differences in 30-day mortality were observed between groups. Echinocandin regimen was the first choice for IAT in patients with IAC. No statistical differences in mortality were observed between regimens, but echinocandins were administered to patients with more severe disease. Some disagreements were identified between current clinical guidelines and prescription of antifungals for IAC at the bedside, so further educational measures are required to optimize therapies

Differentiated transplant derived airway epithelial cell cytokine secretion is not regulated by cyclosporine

<p>Abstract</p> <p>Background</p> <p>While lung transplantation is an increasingly utilized therapy for advanced lung diseases, chronic rejection in the form of Bronchiolitis Obliterans Syndrome (BOS) continues to result in significant allograft dysfunction and patient mortality. Despite correlation of clinical events with eventual development of BOS, the causative pathophysiology remains unknown. Airway epithelial cells within the region of inflammation and fibrosis associated with BOS may have a participatory role.</p> <p>Methods</p> <p>Transplant derived airway epithelial cells differentiated in air liquid interface culture were treated with IL-1β and/or cyclosporine, after which secretion of cytokines and growth factor and gene expression for markers of epithelial to mesenchymal transition were analyzed.</p> <p>Results</p> <p>Secretion of IL-6, IL-8, and TNF-α, but not TGF-β1, was increased by IL-1β stimulation. In contrast to previous studies using epithelial cells grown in submersion culture, treatment of differentiated cells in ALI culture with cyclosporine did not elicit cytokine or growth factor secretion, and did not alter IL-6, IL-8, or TNF-α production in response to IL-1β treatment. Neither IL-1β nor cyclosporine elicited expression of markers of the epithelial to mesenchymal transition E-cadherin, EDN-fibronectin, and α-smooth muscle actin.</p> <p>Conclusion</p> <p>Transplant derived differentiated airway epithelial cell IL-6, IL-8, and TNF-α secretion is not regulated by cyclosporine <it>in vitro</it>; these cells thus may participate in local inflammatory responses in the setting of immunosuppression. Further, treatment with IL-1β did not elicit gene expression of markers of epithelial to mesenchymal transition. These data present a model of differentiated airway epithelial cells that may be useful in understanding epithelial participation in airway inflammation and allograft rejection in lung transplantation.</p