Accounting for environmental and fishery management factors when standardizing CPUE data from a scientific survey: A case study for Nephrops norvegicus in the Pomo Pits area (Central Adriatic Sea).

Abundance and distribution of commercial marine resources are influenced by environmental variables, which together with fishery patterns may also influence their catchability. However, Catch Per Unit Effort (CPUE) can be standardized in order to remove most of the variability not directly attributable to fish abundance. In the present study, Generalized Additive Models (GAMs) were used to investigate the effect of some environmental and fishery covariates on the spatial distribution and abundance of the Norway lobster Nephrops norvegicus within the Pomo/Jabuka Pits (Central Adriatic Sea) and to include those that resulted significant in a standardization process. N. norvegicus is a commercially important demersal crustacean, altering its catchability over the 24-h cycle and seasons according to its burrowing behavior. A historically exploited fishing ground for this species, since 2015 subject to specific fisheries management measures, is represented by the meso-Adriatic depressions, which are also characterized by particular oceanographic conditions. Both the species behaviour and the features of this study area influence the dynamics of the population offering a challenging case study for a standardization modelling approach. Environmental and catch data were obtained during scientific trawl surveys properly designed to catch N. norvegicus, thus improving the quality of the model input data. Standardization of CPUE from 2 surveys from 2012 to 2019 was conducted building two GAMs for both biomass and density indices. Bathymetry, fishing pressure, dissolved oxygen and salinity proved to be significant drivers influencing catch distribution. After cross validations, the tuned models were then used to predict new indices for the study area and the two survey series by means of informed spatial grids, composed by constant surface cells, to each of which are associated average values of environmental parameters and specific levels of fishing pressure, depending on the management measures in place. The predictions can be used to better describe the structure and the spatio-temporal distribution of the population providing valuable information to evaluate the status of such an important marine resource.

Preliminary results on the occurrence and anatomical distribution of microplastics in wild populations of Nephrops norvegicus from the Adriatic Sea.

This study reports the shapes, dimensional classes, types and counts of microplastics (MPs) found in 23 individuals of N. norvegicus collected from two wild populations of the Adriatic Sea (Mediterranean basin). The focus was on three different anatomical compartments (gut, hepatopancreas and tail), which were analysed separately. MPs were found in all the investigated individuals with an average of about 17 MPs/individual. Fragments were predominant over fibers with a ratio of about 3:1. The majority of MPs were in the dimensional range 50-100 µm. The predominant polymers were polyester, polyamide 6, polyvinyl chloride and polyethylene, which together constitute about 61% of all the MPs found. Fragments were more concentrated in the hepatopancreas, with no significant difference between gut and tail, while fibers were more concentrated in the gut than in the tail with hepatopancreas somehow in between. The dimensional class of the MPs influences their anatomical distribution. There were no statistical differences among individuals from the two sampling sites. Sex of the individual did not influence the level of retained MPs, while length had a very marginal effect. The information reported here contributes to understanding of the possible risks linked to human consumption of different tissues from contaminated Norway lobsters.

The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients.

OBJECTIVES: To evaluate the feasibility and safety of the MIRUS system (Pall International, Sarl, Fribourg, Switzerland) for sedation with sevoflurane for postsurgical ICU patients and to evaluate atmospheric pollution during sedation. DESIGN: Prospective interventional study. SETTING: Surgical ICU. February 2016 to December 2016. PATIENTS: Postsurgical patients requiring ICU admission, mechanical ventilation, and sedation. INTERVENTIONS: Sevoflurane was administered with the MIRUS system targeted to a Richmond Agitation Sedation Scale from -3 to -5 by adaptation of minimum alveolar concentration. MEASUREMENTS AND MAIN RESULTS: Data collected included Richmond Agitation Sedation Scale, minimum alveolar concentration, inspired and expired sevoflurane fraction, wake-up times, duration of sedation, sevoflurane consumption, respiratory and hemodynamic data, Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment, and laboratory data and biomarkers of organ injury. Atmospheric pollution was monitored at different sites: before sevoflurane delivery (baseline) and during sedation with the probe 15 cm up to the MIRUS system (S1) and 15 cm from the filter-Reflector group (S2). Sixty-two patients were enrolled in the study. No technical failure occurred. Median Richmond Agitation Sedation Scale was -4.5 (interquartile range, -5 to -3.6) with sevoflurane delivered at a median minimum alveolar concentration of 0.45% (interquartile range, 0.4-0.53) yielding a mean inspiratory and expiratory concentrations of 0.79% (SD, 0.24) and 0.76% (SD, 0.18), respectively. Median awakening time was 4 minutes (2.2-5 min). Median duration of sevoflurane administration was 3.33 hours (2.33-5.75 hr), range 1-19 hours with a mean consumption of 7.89 mL/hr (SD, 2.99). Hemodynamics remained stable over the study period, and no laboratory data indicated liver or kidney injury or dysfunction. Median sevoflurane room air concentration was 0.10 parts per million (interquartile range, 0.07-0.15), 0.17 parts per million (interquartile range, 0.14-0.27), and 0.15 parts per million (interquartile range, 0.07-0.19) at baseline, S1, and S2, respectively. CONCLUSIONS: The MIRUS system is a promising and safe alternative for short-term sedation with sevoflurane of ICU patients. Atmospheric pollution is largely below the recommended thresholds (< 5 parts per million). Studies extended to more heterogeneous population of patients undergoing longer duration of sedation are needed to confirm these observations.

Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery.

OBJECTIVES: The following study proposes and tests an integrated methodology involving Health Technology Assessment (HTA) and Failure Modes, Effects and Criticality Analysis (FMECA) for the assessment of specific aspects related to robotic surgery involving safety, process and technology. METHODS: The integrated methodology consists of the application of specific techniques coming from the HTA joined to the aid of the most typical models from reliability engineering such as FMEA/FMECA. The study has also included in-site data collection and interviews to medical personnel. RESULTS: The total number of robotic procedures included in the analysis was 44: 28 for urology and 16 for general surgery. The main outcomes refer to the comparative evaluation between robotic, laparoscopic and open surgery. Risk analysis and mitigation interventions come from FMECA application. CONCLUSIONS: The small sample size available for the study represents an important bias, especially for the clinical outcomes reliability. Despite this, the study seems to confirm the better trend for robotics' surgical times with comparison to the open technique as well as confirming the robotics' clinical benefits in urology. More complex situation is observed for general surgery, where robotics' clinical benefits directly measured are the lowest blood transfusion rate.

In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team.

OBJECTIVES: Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. METHODS: In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. RESULTS: In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). CONCLUSIONS: Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.

Development of a web based monitoring system for safety and activity analysis in operating theatres.

BACKGROUND: The management and the monitoring of the operating rooms on the part of the general management have the objective of optimizing their use and maximizing the internal safety. The expenses owed to their safe use represent, besides reimbursements coming from the surgical activity, important factors for the analysis of the medical facility. OBJECTIVE: Given that it is not possible to reduce the safety, it is necessary to develop supporting systems with the aim to enhance and optimize the use of the rooms. METHODS: The developed analysis model of the operating rooms in this study is based on the specific performance indicators and allows the effective monitoring of both the parameters that influence the safety (environmental, microbiological parameters) and those that influence the efficiency of the usage (employment rate, delays, necessary formalities, etc.). This allows you to have a systematic dashboard on hand for all of the OTs and, thus, organize the intervention schedules and more appropriate improvements. RESULTS: A monitoring dashboard has been achieved, accessible from any platform and any device, capable of aggregating hospital information. The undertaken organizational modifications, through the use of the dashboard, have allowed for an average annual savings of 29.52 minutes per intervention and increase the use of the ORs of 5%. The increment of the employment rate and the optimization of the operating room have allowed for savings of around $299,88 for every intervention carried out in 2013, corresponding to an annual savings of $343,362,60. CONCLUSIONS: Integration dashboards, as the one proposed in this study as a prototype, represent a governance model of economically sustainable healthcare systems capable of guiding the hospital management in the choices and in the implementation of the most efficient organizational modifications.

Sindrome Oculoglandular de Parinaud: Presentación de un caso / Parinaud´s oculoglandular síndrome A case report

Presentamos el caso de un adolescente de 14 años que consultó por adenopatías en región preauricular izquierda.En el interrogatorio dirigido surgió el contacto con gatos, registrándose el antecedente de una conjuntivitis homolateral, por lo cual se planteo el Síndrome de Parinaud por enfermedad por arañazo de gato entre diagnósticos diferenciales

Sindrome oculoglandular de Parinaud: presentación de un caso / Parinaud´s oculoglandular síndrome: a case report

Presentamos el caso de un adolescente de 14 años que consultó por adenopatías en región preauricular izquierda.En el interrogatorio dirigido surgió el contacto con gatos, registrándose el antecedente de una conjuntivitis homolateral, por lo cual se planteo el Síndrome de Parinaud por enfermedad por arañazo de gato entre diagnósticos diferenciales.

Prevalencia del tabaquismo pasivo en pediatría / Prevalence of exposure to environmental tabacco smoke of children pediatric pasive soking prevalence

Estudiar la prevalencia de la exposición al humo del tabaco ambiental (HTA) de los niños asistidos durante el invierno del año 2007.Evaluar si la exposición al HTA se relaciona con determinada evolución en los pacientes internados por patología respiratoria

Prevalencia del tabaquismo pasivo en pediatría / Prevalence of exposure to environmental tabacco smoke of children pediatric pasive soking prevalence

Estudiar la prevalencia de la exposición al humo del tabaco ambiental (HTA) de los niños asistidos durante el invierno del año 2007. Evaluar si la exposición al HTA se relaciona con determinada evolución en los pacientes internados por patología respiratoria.

AMON: a wearable multiparameter medical monitoring and alert system.

This paper describes an advanced care and alert portable telemedical monitor (AMON), a wearable medical monitoring and alert system targeting high-risk cardiac/respiratory patients. The system includes continuous collection and evaluation of multiple vital signs, intelligent multiparameter medical emergency detection, and a cellular connection to a medical center. By integrating the whole system in an unobtrusive, wrist-worn enclosure and applying aggressive low-power design techniques, continuous long-term monitoring can be performed without interfering with the patients' everyday activities and without restricting their mobility. In the first two and a half years of this EU IST sponsored project, the AMON consortium has designed, implemented, and tested the described wrist-worn device, a communication link, and a comprehensive medical center software package. The performance of the system has been validated by a medical study with a set of 33 subjects. The paper describes the main concepts behind the AMON system and presents details of the individual subsystems and solutions as well as the results of the medical validation.