Perceptions of online surgical-focused learning amongst surgeons during the COVID pandemic: A scoping review 2020-22.

INTRODUCTION: During the COVID pandemic many centres adopted e-learning as a tool to adhere to social distancing recommendations while continuing to provide ongoing postgraduate medical education. We aimed to complete this scoping review in order to map experience and perceptions amongst surgeons and surgical trainees to remote learning during the COVID pandemic. METHODS: Using Arksey and O'Malley's five step model for conducting a scoping review, a systematic search strategy was undertaken across three online databases SCOPUS, MEDLINE and Web of Science. Only original articles in English in the field of postgraduate education in surgery were included. RESULTS: 44 studies were selected for review. Of these 44, 21 were studies of perception of a newly developed e-learning tool/platform. 17 were surveys of surgeon's attitudes towards e-learning during the COVID pandemic. The remaining 6 studies were studies of knowledge or skills acquired through new e-learning, which included a survey of experience. The United States was the most common country of origin with General Surgery the most represented surgical speciality. Response rates across all three study subgroups were on average >60%. Surgeon's experience of e-learning was reported in only positive terms in 86% (n = 38/44) of studies. CONCLUSIONS: This paper is informative in that it focuses specifically on surgeons' perceptions of a e-learning tools used in addition to skills or knowledge gained. Positive e-learning experience reported in these studies may lead to more blended learning curriculums being developed, deployed and evaluated going forward.

Multidimensional analysis for the correlation of physico-chemical attributes to osteoblastogenesis in TiNbZrSnTa alloys.

Data-enabled approaches that complement experimental testing offer new capabilities to investigate the interplay between chemical, physical and mechanical attributes of alloys and elucidate their effect on biological behaviours. Reported here, instead of physical causation, statistical correlations were used to study the factors responsible for the adhesion, proliferation and maturation of pre-osteoblasts MC3T3-E1 cultured on Titanium alloys. Eight alloys with varying wt% of Niobium, Zirconium, Tin and Tantalum (Ti- (2-22 wt%)Nb- (5-20 wt%)Zr- (0-18 wt%)Sn- (0-14 wt%)Ta) were designed to achieve exemplars of allotropes (incl., metastable-ß, ß + α', α″). Following confirmation of their compositions (ICP, EDX) and their crystal structure (XRD, SEM), their compressive bulk properties were measured and their surface features characterised (XPS, SFE). Because these alloys are intended for the manufacture of implantable orthopaedic devices, the correlation focuses on the effect of surface properties on cellular behaviour. Physico-chemical attributes were paired to biological performance, and these highlight the positive interdependencies between oxide composition and proliferation (esp. Ti4+), and maturation (esp. Zr4+). The correlation reveals the negative effect of oxide thickness, esp. TiOx and TaOx on osteoblastogenesis. This study also shows that the characterisation of the chemical state and elemental electronic structure of the alloys' surface is more predictive than physical properties, namely SFE and roughness.

Notified occupational mental disorders: associations with health and income.

BACKGROUND: Studies indicate that workers' compensation claim processes may affect patients' health negatively. However, few studies focus on patients with mental health claims, and the claim process varies between countries. AIMS: The aims of this study were to examine whether being notified to the Danish Labour Market Insurance with an occupational mental health condition was associated with changes in visits to the general practitioner (GP), use of medicine and annual income. METHODS: Study participants were 965 patients with a mental disorder examined at a department of occupational medicine. Of these, 669 patients were notified with an occupational mental disorder, 296 were not. Health-related outcomes, including GP visits and prescriptions of psychotropic drugs, were estimated at baseline during the year of medical examination, while annual income was estimated a year before the examination. The follow-up was the year after the year of examination for all outcomes. Outcomes were collected from the Danish National Bureau of Statistics. Analyses were conducted using Poisson regression and conditional logistic regression. RESULTS: All measured outcomes decreased from baseline to follow-up in both groups. These changes were not significantly different depending on notification status at baseline. CONCLUSIONS: This study suggests that being notified with an occupational mental disorder does not significantly affect health-related outcomes. A significant decrease in annual income over time was seen in both groups, the notified and the unnotified group, highlighting the importance of providing support to all employees with a mental disorder.

In-silico design and experimental validation of TiNbTaZrMoSn to assess accuracy of mechanical and biocompatibility predictive models.

Numerical design of TiNbTaZrMoSn alloy preceded its manufacture and mechanical, physico-chemical and in vitro characterisation. The specifications of the alloy required a multi-objective optimisation including lower modulus of elasticity than c.p.Ti, high strength, stabilised ß crystal structure with a low martensitic start temperature, a narrow solidification range and high biocompatibility. The results reveal that there was a good match between the bulk mechanical properties exhibited by the alloy experimentally and those predicted. Regarding surface properties, independent of roughness effects, the oxide thickness and surface zeta-potential, measured in biologically relevant electrolytes and at physiological pH, arose as important factors in osteoblastic activity (i.e., cell proliferation, measured via DNA, protein and metabolite content, and differentiation, via ALP levels), but not in cell adhesion and viability. The thinner oxide layer and lower absolute value of surface zeta-potential on the TiNbTaZrMoSn alloy explain its lesser osteogenic properties (i.e., inhibition of ALP activity) compared to the c.p. Ti. This study demonstrates that the numerical models to predict microstructure and bulk mechanical properties of ß-Ti alloys are robust, but that the prediction of cellular bioactivity lags behind and still requires parameterisation to account for features such as oxide layer composition and thickness, electro-chemical properties and surface charge, and topography to optimise cell response in silico before committing to the costly manufacture and deployment of these alloys in regenerative medicine.

The impact of multimodal pore size considered independently from porosity on mechanical performance and osteogenic behaviour of titanium scaffolds.

Titanium porous scaffolds comprising multimodal pore ranges (i.e., uni-, bi-, tri-modal and random) were studied to evaluate the effect of pore size on osteoblastogenesis. The scaffolds were manufactured using spaceholder-powder metallurgy, and porosity and pore size were kept independent. Their mechanical and physical properties (i.e., stiffness, strength, total and open porosity) were determined. In a first step, unimodal porous samples were tested with a mouse osteoblastic clonal cell line to ascertain pore size and porosity effects on cellular behaviour. Their proliferation (via cell number and total protein content), differentiation (via ALP enzyme levels) and maturation potency (with gene markers (Runx2, osteocalcin) and cytoplasmatic calcium) were investigated. In a second step informed by the previous results, multimodal scaffolds were shortlisted according to a set of criteria that included stiffness similar to that of cortical or trabecular bone, high strength and high open porosity. Their bioactivity performance was then studied to assess the benefits of mixing different pore ranges. The study concludes that pre-osteoblasts cultivated in unimodal microstructures with a pore range 106-212 µm of 36% total (actual) porosity and 300-500 µm of 55% total (actual) porosity achieved the largest extent of maturation. Bimodal microstructures comprising small (106-212 µm) and large (300-500 µm) pore ranges, distinctively distributed within the volume, and 40% (actual) porosity outperformed others, including multimodal (i.e. three or more pore ranges) and non-porous samples. They displayed a synergistic effect over the unimodal distributions. This should be a consideration in the design of scaffolds for implantation and bioengineering applications.

Establishing premises for inter-professional collaborative practice in school: inclusion, difference and influence.

PURPOSE: To ascertain stakeholders' agreement and disagreement about inter-professional collaboration (IPC) when supporting the child with a developmental language disorder (DLD) in school. MATERIALS AND METHODS: Two rounds of an online Delphi survey were undertaken with a purposive sample of 26 participants (researchers, practitioners and parents). Topics were informed by the views of children engaged in an earlier phase of the research. Agreement was set at an inter-quartile range of 1, with level of agreement measured using a five-point semantic differential scale. Qualitative data were examined using content analysis. RESULTS: There was strong agreement across the stakeholder groups about the child-led goals of IPC. Stakeholders also agreed that DLD is best viewed as a learning difference rather than a disorder. We identified ambivalence across the groups about the right of the child with DLD to have influence in decision-making about supports in school. CONCLUSIONS: We propose that IPC should be viewed as a means of ensuring the inclusion of the child in school. A shift in focus from remediating perceived deficits of the child, to affecting change in classroom practice, is also indicated. The need to reinforce the unconditional right of the child to have influence in decisions about supports is highlighted. Implications for IPC when meeting the needs of children with a developmental disability in school are outlined.IMPLICATIONS FOR REHABILITATIONThe goal of inter-professional collaboration should be to ensure the inclusion of the child with a developmental disability in school.Interventions delivered in school should focus on changing practice in the classroom, rather than on the child's perceived deficits.The child with a developmental disability should be given influence in collaborative decision-making to ensure supports are relevant and responsive to their needs.

Addition of Sn to TiNb alloys to improve mechanical performance and surface properties conducive to enhanced cell activity.

Titanium (Ti) alloys with Niobium (Nb) and Tin (Sn) were prepared in order to conduct a systematic study on the bulk and surface properties of as-cast c.p.Ti, binary Ti-40Nb and Ti-10Sn, and ternary Ti-10Nb-5Sn (at.%) to ascertain whether Sn content can be used as an enhancer for cell activity. From a metallurgy viewpoint, a range of binary and ternary alloys displaying distinctive Ti phases (i.e. ß, α', α") were achieved at room temperature. Their surface (oxide thickness and composition, roughness, contact angle) and bulk (compressive stiffness, strength, elongation, microhardness, electrical resistance) features were characterised. The same surface roughness was imparted on all the alloys, therefore substrate-cell interactions were evaluated independently from this variable. The physico-mechanical properties of the ternary alloy presented the highest strength to stiffness ratio and thereby proved the most suitable for load-bearing orthopaedic applications. From a cellular response viewpoint, their cytotoxicity, ability to adsorb proteins, to support cell growth and to promote proliferation were studied. Metabolic activity using a mouse model was monitored for a period of 12 days to elucidate the mechanism behind an enhanced proliferation rate observed in the Sn-containing alloys. It was hypothesised that the complex passivating surface oxide layer and the bulk inhomogeneity with two dominant Ti phases were responsible for this phenomenon.

Engaging multiple stakeholders to improve speech and language therapy services in schools: an appreciative inquiry-based study.

BACKGROUND: Effective collaboration between speech and language therapists (SLTs) and teachers is essential in meeting the needs of children with developmental language disorders in school, but it is difficult to achieve. Currently, many children receive inadequate speech and language therapy services and/or support in school. The aim of this study was to engage key stakeholders (SLTs, teachers, parents and children with DLD) in the co-design of their ideal speech and language therapy service and support in school. The study was undertaken in order to inform the development of a conceptual model to guide collaborative practice when working with this population. METHODS: A qualitative study involving a diverse range of key stakeholders and using appreciative inquiry. This is a method which enables those involved to construct their 'ideal' about a topic of interest. Recruitment was carried out using purposive sampling. We conducted focus groups with practitioners (SLTs and teachers) and parents as well as semi-structured interviews with children who have DLD using 'draw and tell' techniques. A total of five focus groups and nine interviews were conducted with participants (n = 27). RESULTS: The children described their ideal supports as those which enabled them to connect, contribute and achieve. They describe ways in which environmental barriers in school needed to be addressed to allow them to do so. The professionals primarily described ways in which the language skills of the child could be improved. Both parents and practitioner groups described the importance of strengthening networks between service providers and service users. They also highlighted the need to promote a collaborative culture if stakeholders are to work effectively together across sectors. CONCLUSIONS: There were differences in perspectives about the ways in which speech and language therapy services and supports could be improved, demonstrating the importance of engaging a diverse group of stakeholders. Of note were the unique insights the children brought about the barriers they faced as a result of their difficulties. Based on our findings we propose that children should be given influence in decisions about the supports that they receive in school. Implications for policy, research and practice are discussed.

The effect of pore size and porosity on mechanical properties and biological response of porous titanium scaffolds.

The effect of pore size and porosity on elastic modulus, strength, cell attachment and cell proliferation was studied for Ti porous scaffolds manufactured via powder metallurgy and sintering. Porous scaffolds were prepared in two ranges of porosities so that their mechanical properties could mimic those of cortical and trabecular bone respectively. Space-holder engineered pore size distributions were carefully determined to study the impact that small changes in pore size may have on mechanical and biological behaviour. The Young's moduli and compressive strengths were correlated with the relative porosity. Linear, power and exponential regressions were studied to confirm the predictability in the characterisation of the manufactured scaffolds and therefore establish them as a design tool for customisation of devices to suit patients' needs. The correlations were stronger for the linear and the power law regressions and poor for the exponential regressions. The optimal pore microarchitecture (i.e. pore size and porosity) for scaffolds to be used in bone grafting for cortical bone was set to <212µm with volumetric porosity values of 27-37%, and for trabecular tissues to 300-500µm with volumetric porosity values of 54-58%. The pore size range 212-300µm with volumetric porosity values of 38-56% was reported as the least favourable to cell proliferation in the longitudinal study of 12days of incubation.

Using an integrated approach to the assessment of the psychosocial work environment: the case of a major hospital in northern Italy.

BACKGROUND: In 2010, Italian regulatory guidelines have been issued consisting of a stepwise procedure for the assessment and management of work-related stress. However, research that empirically examines whether this procedure proves effective in accurately identifying critical psychosocial factors and informing risk management is scarce. OBJECTIVES: To examine the differential sensitivity of two approaches to risk assessment, the first based on objective instruments only, the second consisting of an integrated approach combining different methods and theoretical perspectives. METHODS: We examined a sample of 306 healthcare employees in a large-size hospital in northern Italy, using a series of tools, both quantitative (an observational checklist and the HSE-IT and MOHQ questionnaires) and qualitative (Focus Groups). Through instrument-specific reference values, we then compared risk profiles between different homogeneous groups within the institution. RESULTS: The psychosocial work environment resulted to be far more positive when adopting the first compared to the second approach to risk assessment. The latter approach was also more sensitive in detecting between-groups differences in risk profiles. Furthermore, the Focus Groups returned a more context-specific picture of the psychosocial work environment. Finally, going beyond the emphasis on negative working conditions inherent in the other quantitative instruments, the MOHQ allowed for also identifying health-promoting factors in need for improvement. CONCLUSIONS: Although more research is needed to confirm our findings, the present study suggests that using an integrated approach to assess the psychosocial work environment may be the most effective way to accurately identify risk factors and support the management process.

Context specificity in the assessment of psychosocial risk at work: an empirical study on Italian call centre workers.

BACKGROUND: Following EU requirements, in recent years standard procedures for the assessment of work-related stress have been developed in Italy. However, while such standardization has facilitated the spread and use of these procedures, it has brought a lack of specificity in risk assessment. OBJECTIVES: To exemplify a method for the assessment of work-related stress that was developed by the University of Milan to allow the definition of risk profiles tailored to the different organizational settings. METHODS: We examined risk factors for work-related stress in call centre operators employed by two separate Italian companies. At an early stage of the assessment procedure, we conducted a wide series of consultation and training activities that allowed the identification of context-specific risk factors and homogeneous groups, which fuelled the preparation of both the "objective" and the "subjective" evaluation instruments. RESULTS: Results obtained by means of the standardized "Effort-Reward Imbalance Questionnaire" and "Job Content Questionnaire", interpreted in the light of consultations with key organizational figures and individual interviews with employees, have allowed the detection of different risk profiles and priorities for intervention at both the group and the organizational levels. CONCLUSIONS: Findings demonstrated the existence of both common and specific risk factors in the two companies, which would have remained undetected with the exclusive use of standardized approaches.

[Burnout: survey of the literature]. / Burnout ieri e oggi: stato delle conoscenze.

BACKGROUND: Past clinical research has provided varied and sometimes diverging descriptions of burnout. OBJECTIVES: As burnout is still prevalent in today's workplaces, actions are required mainly at the primary but also at the secondary and tertiary levels of prevention. METHODS: In this literature review, the concept of burnout is reread through the lens of positive psychology and the most established theoretical models in the field. RESULTS: A common view is seemingly emerging that characterizes burnout as a condition of alienation, loss of motivation and low autonomy resulting from an unbridgeable gap in the personal and/or organizational resources that one has to invest in building a stimulating and rewarding professional career, full of significant relationships that give meaningfulness to one's life project. CONCLUSIONS: Establishing clinical criteria for burnout, as it is the case in some European countries, couldfacilitate the identification of the syndrome and the estimation of its prevalence in Italian work organizations.

Strain dependent protection conferred by Lactobacillus spp. administered orally with a Salmonella Typhimurium vaccine in a murine challenge model.

Consumption of Lactobacillus spp. has been shown to enhance immune responses in mice. This study examined the immuno-adjuvant capacity of two strains: Lactobacillus acidophilus L10 and Lactobacillus fermentum PC2, in the induction of protective humoral immunity in a Salmonella Typhimurium vaccine challenge model. Briefly, BALB/c mice were divided into four groups. Three groups of mice received S. Typhimurium vaccine (10(8) colony forming units (CFU) per dose) on days 0 and 14. In addition to the vaccine, five doses (10(8) CFU per dose) of either L. acidophilus L10 or L. fermentum PC2 were also administered to a group. All mice were challenged with viable S. Typhimurium on day 28. On day 10 post challenge, the study was terminated and microbial and immunological parameters were assessed. Mice dosed with L. fermentum PC2 in addition to the vaccine had a significantly enhanced S. Typhimurium humoral response. The mice in this group had high levels of lactobacilli in the feces and in association with the Peyer's patches, no detectable levels of either lactobacilli or S. Typhimurium in the spleen, and no detectable weight loss. Mice given L. acidophilus L10 with the vaccine were unable to exhibit elevated S. Typhimurium specific humoral responses. However, there was no detectable S. Typhimurium in the spleens of this group. Interestingly, translocation of lactobacilli into the spleen was observed as well as a slight weight loss was noted in mice that received the L. acidophilus L10 with the vaccine. This study shows that, the L. fermentum PC2 had a greater capacity than the L. acidophilus L10 to act as an oral adjuvant in a S. Typhimurium oral vaccine program and afforded greater protection against a live S. Typhimurium challenge.

[Job Demands-Resources, exhaustion and work engagement in a long-term care institution]. / Modello Job Demands-Resources, esaurimento psico-fisico e coinvolgimento lavorativo nel personale di una casa di cura per lungodegenti.

In this study, we aimed at testing the main hypotheses of the Job Demands-Resources model (JD-R) in a sample of employees (n = 205, mainly healthcare workers) of a long-term care institution located in Northern Italy. Hierarchical linear regression analyses show that almost all job demands considered were significantly associated with higher general psycho-physical exhaustion (beta ranging from 0.14 to 0.29), whereas more unfavourable scores in all job resources were associated with lower work engagement (from -0.27 to -0.51). However, also significant cross-over associations were observed, mainly between job resources and exhaustion, with effect sizes comparable with those found for the relationships between job demands and exhaustion. Hence, our study only partially supports the JD-R model. Implications of results for work-related stress management are finally discussed.

[Work-related stress in nursery school educators in the Venice and Marghera districts]. / Rischio stress tra il personale degli asili nido/scuole dell'infanzia della Municipalità di Venezia e Marghera.

BACKGROUND: Based on an investigation on organizational well-being in the Municipality of Venice (2009), we examined 110 public nursery school and preschool teachers working in the Venice and Marghera districts. OBJECTIVES: The aim of this study was to develop and implement a procedure for work-related stress assessment and management in Municipality of Venice, in the light of Law 81/2008. METHODS: Occupational stress and its impact on teachers' well-being and health were assessed by means of self-administered questionnaires and semi-structured interviews. Descriptive analyses were conducted to compare teachers' data with those concerning employees operating in other services in the Venice and Marghera districts. RESULTS: According to the results, while nursery school and preschool teachers work with considerable commitment, vigor, dedication and involvement, problems were observed related to: assignment of administrative tasks without appropriate support from the district offices; difficult access to support services; shortage of temporary teachers and auxiliary personnel and, limited to some facilities, lack of adequate physical space devoted to teaching activities. Such adverse conditions result in an increase in vigilance levels required to ensure children's safety. Personnel also suffer from a lack of career prospects, with scarce opportunities for contact with other facilities in the area and inadequate involvement in the decisional processes at Municipality level. CONCLUSIONS: Improving such adverse conditions could solve the current marginalization of public nursery school and preschool teachers and encourage mutual exchange of information, which would in turn favour more appropriate methods of managing each single facility.

[Role of "gender" and "age" factors in the assessment of psychosocial risk and in prevention interventions of hospital personnel]. / Ruolo dei fattori "genere" ed "età" nella valutazione del rischio psicosociale e negli interventi di prevenzione del personale ospedaliero.

Gender, age and psychosocial risks. The paper reports research experience on nurses with special reference to "gender" and "age". Parameters such as "affectivity" and "work-family conflict" indicate the insufficiency of policies and actions to limit staff shortage and safeguard health till retirement age.

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

OBJECTIVES: To describe how in-depth analysis of adverse events can reveal underlying causes. METHODS: Triggers for adverse events were developed using the hospital's computerised medical record (naloxone for opiate-related oversedation and administration of a glucose bolus while on insulin for insulin-related hypoglycaemia). Triggers were identified daily. Based on information from the medical record and interviews, a subject expert determined if an adverse drug event had occurred and then conducted a real-time analysis to identify event characteristics. Expert groups, consisting of frontline staff and specialist physicians, examined event characteristics and determined the apparent cause. RESULTS: 30 insulin-related hypoglycaemia events and 34 opiate-related oversedation events were identified by the triggers over 16 and 21 months, respectively. In the opinion of the experts, patients receiving continuous-infusion insulin and those receiving dextrose only via parenteral nutrition were at increased risk for insulin-related hypoglycaemia. Lack of standardisation in insulin-dosing decisions and variation regarding when and how much to adjust insulin doses in response to changing glucose levels were identified as common causes of the adverse events. Opiate-related oversedation events often occurred within 48 h of surgery. Variation in pain management in the operating room and post-anaesthesia care unit was identified by the experts as potential causes. Variations in practice, multiple services writing orders, multidrug regimens and variations in interpretation of patient assessments were also noted as potential contributing causes. CONCLUSIONS: Identification of adverse drug events through an automated trigger system, supplemented by in-depth analysis, can help identify targets for intervention and improvement.

[The instruments for subjective assessment of work-related stress]. / Gli strumenti per la valutazione soggettiva del rischio stress lavoro-correlato.

The instruments for subjective assessment of work-related stress are aimed to evaluate individual perceptions of aspects that are crucial in the causal process linking psychosocial exposure to harmful physical and psychological health effects. Subjective assessment is most commonly performed by means of self-administered questionnaires, non least for their ability to hold down financial and economic costs of both field studies and data analyses. A common problem is that, for the major part of these questionnaires, no Italian validated (or accept) versions exist. Among available questionnaires, those that have been applied to a higher number of subjects in Italy are the Job Content Questionnaire, the Effort/Reward Imbalance Questionnaire, the Occupational Stress Indicator and the Multidimensional Questionnaire of Organizational Health. In this contribution, the main characteristics of the above-mentioned instruments are depicted. Finally, important aspects relating to the usage of self-administered questionnaires are emphasized, mainly when field evaluations are undertaken in specific work contexts.