1,721,112 research outputs found
Correction to: Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
No full textBackground
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Stereotactic Radiosurgery for Hypothalamic Hamartomas
No full textHypothalamic hamartomas (HH) are developmental malformations growing within the hypothalamus and the third ventricle with patterns similar to benign tumors. HH are often associated with mild-to-severe drug-refractory epilepsy. The spectrum of the epileptic disorders induced by HH is very wide, but the natural history of disease is often characterized by severe seizures leading to mental retardation and possibly death in severely affected infants. Stereotactic radiosurgery (SRS) provides excellent seizure outcomes without the risks of neurological complications inherently associated with microsurgical resection. Early radiosurgical intervention leading to seizure control and excellent long-term psychosocial outcomes has been recently described. We summarize evidence regarding the role of SRS for HH and the appropriate timing for treatment delivery, even though further studies are expected
Image-Guided Stereotactic Radiosurgery for Spinal PathologyTumors of the Central Nervous System, Volume 12
No full textRadiosurgery is the delivery, in a single or a few fractions, of a concentrated dose of radiation to diseased tissue with a steep dose fall-off outside the treatment volume. Traditionally, radiosurgery is delivered to intracranial targets using a rigid frame to immobilize the target and provide external reference points for target localization. The development of image-guided radiosurgery has allowed the principles of radiosurgery to be applied to the treatment of extracranial pathologies including spinal lesions. Image guidance is the use of imaging to locate the tumor before and during a treatment session and redirect the radiation source or reposition the patient based on these measurements. In this manner dose delivery accuracy comparable to frame-based radiosurgery can be achieved. Furthermore, frameless stereotactic radiosurgery allows treatments to be delivered in more than one fraction, which has the potential to reduce toxicity to healthy tissue and organs at risk such as the spinal cord, an organ that is among the most sensitive to radiation.
Spinal radiosurgery has resulted in excellent rates of tumor control with a relatively low risk of radiation-induced myelopathy. Here we review currently available image-guided stereotactic radiosurgery devices that can be used to treat the spine, summarize clinical data showing the efficacy of these systems, and discuss dose and volume limits to avoid radiation toxicity induced by spinal radiosurgery for malignant and benign pathologies
Trigeminal Neuralgia
No full textTrigeminal Neuralgia (TN) is the most common cranio-facial pain syndrome, with an incidence of up to 5 in 100,000. Long-term medical treatment is commonly required, with up to 10% of cases suffering adverse drug-related events. In 1951, Lars Leksell pioneered the application of stereotactic irradiation for the treatment of TN, which may now achieve up to 90% pain control at 1 year and 60% at 2 years. Pain control can remain excellent in 26% of treated patients at 10 years.
Radiosurgical treatment targets either the nerve’s emergence (the root entry zone) or the retrogasserian portion of the nerve. Use of the former has a greater likelihood for long-term pain control, but may lead to higher doses to the brainstem. Targeting the latter may reduce the risk of complications, but requires a higher maximum dose to obtain optimal results. Generally speaking, radiosurgical treatment achieves better results in patients receiving high doses of radiations ranging from 70 to 90 Gy. It is also recommended that the length of nerve treated is between 4 and 6 mm.
Hypoesthesia and facial numbness are frequently observed after high-dose trigeminal irradiation. Mild hypoesthesia is acceptable and is considered by many an efficacy endpoint of the procedure. Bothersome facial numbness is relatively rare. Sensitive trigeminal disturbances and paresthesia after treatment have been reported to range 6%–54% and 0%–17%, respectively. The prescribed dose and brainstem-delivered dose are correlated with the subsequent rate of sensitive trigeminal disturbances.
CyberKnife frameless non-isocentric radiosurgery is an emerging and thoroughly non-invasive treatment for TN that can potentially deliver homogeneous irradiation to an extended length of the trigeminal nerve. This feature makes CyberKnife radiosurgery essentially different from isocenter-based Gamma Knife treatment. By contrast, targeting an extended segment of the trigeminal nerve with Gamma Knife requires placement of a second isocenter and generates hot and cold spots along the nerve. Thus, CyberKnife can administer variable doses to discreet lengths of nerve in order to improve pain control and reduce complication rates. Currently, clinical results reported in the literature are comparable to those offered by the Gamma Knife
Alfredo Conti: O grande senhor do patrimônio: Reconhecimento da Cátedra UNESCO de Turismo Cultural por sua trajetória impecável
Full text linkOur first meeting with Alfredo Conti was in 2008, possibly in August. A few months earlier, at the beginning of May, we had been visited in Buenos Aires by Bernard Morucci, a professor at the Sorbonne University and coordinator of the global network of UNESCO Chairs on Culture, Tourism, and Development, to deliver a seminar organized by our newly established UNESCO Chair.
Morucci, a global advocate for the importance and value of heritage in tourism, encouraged us to create a postgraduate program to provide specialized training for professionals with this focus in Argentina and the region.
A year earlier, in March 2007, within the impressive setting of Villa Ocampo, then UNESCO Director-General Koïchiro Matsuura had signed the act establishing the UNESCO Chair of Cultural Tourism in Argentina, alongside the heads of the two institutions that, since then, have continuously brought it to life: the National University of Tres de Febrero and the Friends Association of the National Museumof Fine Arts.With the mission of strengthening, through education and awareness, a virtuous alliance between heritage and tourism, this Chair was launched, pioneering its field in Latin America. Nuestro primer encuentro con Alfredo Conti fue en 2008. Posiblemente en agosto. Unos meses antes, a comienzos de mayo, nos había visitado en Buenos Aires Bernard Morucci, profesor de la Universidad de la Sorbona y coordinador de la red mundial de Cátedras Unesco de Cultura, Turismo y Desarrollo, para dictar un seminario organizado por nuestra flamante Cátedra Unesco. Morucci, un inspirador a nivel mundial de la importancia y valor del patrimonio para el turismo nos exhortó a crear un Posgrado para la formación especializada de profesionales con este enfoque en Argentina y la región.
Un año antes, en marzo de 2007, con el imponente marco de Villa Ocampo, el entonces director general de la Unesco, Koïchiro Matsuura, había firmado el acta de creación en Argentina de la Cátedra Unesco de Turismo Cultural, junto con los titulares de las dos instituciones que, desde entonces y en forma ininterrumpida, le dan vida: la Universidad Nacional de Tres de Febrero y la Asociación Amigos del Museo Nacional de Bellas Artes.
Con la misión de consolidar, a través de la formación y sensibilización, una alianza virtuosa entre patrimonio y turismo, se lanzó a andar esta Cátedra, pionera en su especialidad en América latina. Nosso primeiro encontro com Alfredo Conti foi em 2008, possivelmente em agosto. Alguns meses antes, no início de maio, recebemos em Buenos Aires a visita de Bernard Morucci, professor da Universidade de Sorbonne e coordenador da rede mundial de Cátedras UNESCO de Cultura, Turismo e Desenvolvimento, para ministrar um seminário organizado por nossa recém-criada Cátedra UNESCO.Morucci, um inspirador de nível mundial sobre a importância e o valor do patrimônio para o turismo, nos incentivou a criar um curso de pós-graduação para a formação especializada de profissionais com esse enfoque na Argentina e na região. Um ano antes, em março de 2007, no impressionante cenário de Villa Ocampo, o então diretor-geral da UNESCO, Koïchiro Matsuura, havia assinado o ato de criação da Cátedra UNESCO de Turismo Cultural na Argentina, junto com os representantes das duas instituições que, desde então, e de forma ininterrupta, a mantêm viva: a Universidade Nacional de Tres de Febrero e a Associação Amigos do Museu Nacional de Belas Artes.
Com a missão de consolidar, por meio da formação e sensibilização, uma aliança virtuosa entre patrimônio e turismo, essa Cátedra foi lançada, sendo pioneira em sua especialidade na América Latina.
Alfredo Conti: The great master of heritage: Recognition by the UNESCO Chair of Cultural Tourism for his impeccable career
Full text linkNuestro primer encuentro con Alfredo Conti fue en 2008. Posiblemente en agosto. Unos meses antes, a comienzos de mayo, nos había visitado en Buenos Aires Bernard Morucci, profesor de la Universidad de la Sorbona y coordinador de la red mundial de Cátedras Unesco de Cultura, Turismo y Desarrollo, para dictar un seminario organizado por nuestra flamante Cátedra Unesco. Morucci, un inspirador a nivel mundial de la importancia y valor del patrimonio para el turismo nos exhortó a crear un Posgrado para la formación especializada de profesionales con este enfoque en Argentina y la región. Un año antes, en marzo de 2007, con el imponente marco de Villa Ocampo, el entonces director general de la Unesco, Koïchiro Matsuura, había firmado el acta de creación en Argentina de la Cátedra Unesco de Turismo Cultural, junto con los titulares de las dos instituciones que, desde entonces y en forma ininterrumpida, le dan vida: la Universidad Nacional de Tres de Febrero y la Asociación Amigos del Museo Nacional de Bellas Artes.Con la misión de consolidar, a través de la formación y sensibilización, una alianza virtuosa entre patrimonio y turismo, se lanzó a andar esta Cátedra, pionera en su especialidad en América latina.Nosso primeiro encontro com Alfredo Conti foi em 2008, possivelmente em agosto. Alguns meses antes, no início de maio, recebemos em Buenos Aires a visita de Bernard Morucci, professor da Universidade de Sorbonne e coordenador da rede mundial de Cátedras UNESCO de Cultura, Turismo e Desenvolvimento, para ministrar um seminário organizado por nossa recém-criada Cátedra UNESCO.Morucci, um inspirador de nível mundial sobre a importância e o valor do patrimônio para o turismo, nos incentivou a criar um curso de pós-graduação para a formação especializada de profissionais com esse enfoque na Argentina e na região. Um ano antes, em março de 2007, no impressionante cenário de Villa Ocampo, o então diretor-geral da UNESCO, Koïchiro Matsuura, havia assinado o ato de criação da Cátedra UNESCO de Turismo Cultural na Argentina, junto com os representantes das duas instituições que, desde então, e de forma ininterrupta, a mantêm viva: a Universidade Nacional de Tres de Febrero e a Associação Amigos do Museu Nacional de Belas Artes.Com a missão de consolidar, por meio da formação e sensibilização, uma aliança virtuosa entre patrimônio e turismo, essa Cátedra foi lançada, sendo pioneira em sua especialidade na América Latina.Our first meeting with Alfredo Conti was in 2008, possibly in August. A few months earlier, at the beginning of May, we had been visited in Buenos Aires by Bernard Morucci, a professor at the Sorbonne University and coordinator of the global network of UNESCO Chairs on Culture, Tourism, and Development, to deliver a seminar organized by our newly established UNESCO Chair.Morucci, a global advocate for the importance and value of heritage in tourism, encouraged us to create a postgraduate program to provide specialized training for professionals with this focus in Argentina and the region.A year earlier, in March 2007, within the impressive setting of Villa Ocampo, then UNESCO Director-General Koïchiro Matsuura had signed the act establishing the UNESCO Chair of Cultural Tourism in Argentina, alongside the heads of the two institutions that, since then, have continuously brought it to life: the National University of Tres de Febrero and the Friends Association of the National Museumof Fine Arts.With the mission of strengthening, through education and awareness, a virtuous alliance between heritage and tourism, this Chair was launched, pioneering its field in Latin America.Instituto de Investigaciones en Turism
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Conversaciones con... Jukka Jokilehto. 2 Año 2 (2016) enero-diciembre. Conversasiones
No full text- Editorial por Valerie Magar Meurs. - Heritage values and valuation por Jukka Jokilehto. - Valores patrimoniales y valoración por Jukka Jokilehto. - El patrimonio como representación del “nosotros”. El caso de Argentina por Alfredo Conti. - Revisiting the evaluation of heritage objects por Silvio Mendes Zanchetti. - Reconsiderando la evaluación de los bienes culturales por Silvio Mendes Zanchetti. - El valor del patrimonio arquitectónico. Más allá de Alois Riegl, con el permiso de Jokilehto por Albert Casals Balengué, José Luis González Moreno-Navarro y Mariona Genís Vinyals. - Valores patrimoniales, la perspectiva del actor social: la historia de Manuel y su barrio patrimonial por Bernardita Ladrón de Guevara. - Bibliografía de Jukka Jokilehto
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