345 research outputs found
Educare al mare, una nuova frontiera per la geografia italiana?
No full textNell’ultimo decennio la comunità scientifica ha incrementato l’interesse per il mare sviluppando concetti quali: la cittadinanza oceanica e l’ocean literacy (alfabetizzazione al mare). Più recentemente l’ interesse mass mediatico su tali tematiche si è soffermato sull’inquinamento e il disastro “plastica” negli oceani. L’Italia, stato immerso nel Mediterraneo, dovrebbe ricoprire un ruolo in prima fila nella salvaguardia e nell’educazione ambientale marina. Tuttavia, la scuola, principale agenzia educativa nazionale, si mostra ancora poco attiva rispetto a questi temi. Gli autori riflettono nel seguente contributo sulla centralità del prendersi cura del mare come condizione sine qua non per instaurare un rapporto affettivo e trasformare uno spazio in un luogo. In questa prospettiva presentano un gruppo di ricerca italiano GREAM (Gruppo di ricerca per l’educazione ambientale marina) che si occupa di analizzare e formare sull’importanza del mare in un momento storico particolarmente critico per questo delicato ambiente, mettendo in luce il ruolo chiave dell’azione educativaDuring the last decade the scientific community has increasingly paid attention to the sea developing concepts such as oceanic citizenship and ocean literacy. More recently, the mass media has become more and more interested in similar issues denouncing sea pollution and the oceanic "plastic" disaster. Italy, surrounded by the Mediterranean sea, may play a leading role in marine environmental protection and education. However, the main national educational agency, the school, is still not very active with respect to sea issues. The authors reflect in the following article on the importance of caring for the sea as a sine qua non condition to establish an emotional relationship and transform the idea of the sea from a space into a place. In this perspective, we present an Italian research group GREAM (Research Group for Marine Environmental Education) which deals with analyzing and shaping the importance of the sea in a particularly critical historical moment for this fragile environment, highlighting the key role of educational actio
Comment on "prognostic Factors of Survival after Neoadjuvant Treatment and Resection for Initially Unresectable Pancreatic Cancer": What Is Good for the Surgeon Is Just as Good for the Patient?
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Perioperative nutritional management of elderly patients
No full textThe nutritional status of patients undergoing surgery is very relevant as it represents a modifiable risk factor for postoperative outcomes. Malnutrition is frequent among elderly patients, which often carry other overlapping conditions such as comorbidities and poor functional status. For this reason, it is very important to screen patients preoperatively for nutritional and functional status and tailor perioperative strategies accordingly. Malnourished patients can be identified through simple screening tools that include questions focused on BMI, weight loss, and dietary intake. Surgery may also be delayed to implement a nutritional intervention to potentially reduce postoperative morbidity. Preoperative nutritional interventions to enhance patient nutritional status aim at meeting an adequate protein target by improving diet or adding high-protein oral nutritional supplements, since proteins are the most used substrate in surgical stress situations. If the oral route is not effective, nutritional interventions include enteral feeding and parenteral nutrition. During surgery, the nutritional support needed for postoperative recovery should be anticipated, and effective strategies include positioning of a naso-enteric feeding tube, a needle catheter jejunostomy, or a central venous line. Postoperatively, oral or enteral feeding can be initiated early to reach enough calorie and protein intake, which is essential to promote anabolism and functional recovery. Using the gut to feed the patients is extremely important in order to preserve the immune response and the intestinal barrier. However, parenteral nutrition should also be considered early after surgery if it is difficult to reach the nutritional targets via the enteral route. Elderly patients undergoing emergency surgery represent a specific group of patients at very high risk for postoperative poor outcomes and prolonged recovery. Nutritional support and follow-up should then continue throughout hospital stay, but also after discharge in an outpatient setting
Islas. Le Maldive: pratiche, miti ed immaginari del paradiso terreste
No full textIsole, paesaggio, immaginario, Maldiv
Il telaio di Dolores
No full textMy dissertation clarifies the psychological importance of words and language in Dolores Prato's works Giù la piazza non c'è nessuno and Le ore. An analysis of these works helps to demonstrate the decisive impact that language had on Prato's perception of her childhood. Fortunately, this analysis was made lucid by the "unfortunate" editorial cuts that Natalia Ginzburg made in Giù la piazza non c'è nessuno as published in 1980.
For both editorial conviction and personal ideas on what literature is, Ginzburg decided to reduce the original manuscript by two thirds and in the process eliminated most of the linguistic richness of the author's original manuscript. This reduction clearly demonstrates Ginzburg's benightedness of the psychological involvement that Prato's childhood language had in her impulse to start writing in the first place.
Prato's negation of her childhood language, and later recuperation of that language in the original manuscript resulted in Prato rediscovering her identity, i.e., the identity of her childhood. In fact, to recuperate her childhood Prato reconciled herself with her past and in the process regained the language of Treia, the small village where she spent the first ten years of her life. The prohibition of the Treia dialect at Prato's local boarding school and the editorial cuts made by Natalia Ginzburg were both done for reasons of linguistic prestige. Therefore, Prato's boarding school linguistic proscriptions as well as these editorial interdictions represent "violent acts" against the maintenance, recuperation and rediscovery of that childhood identity.
Ultimately, given the history of publishing houses at the time the book was published, without Natalia Ginzburg's editorial cuts the book would have never come out. Therefore, while we can debate the type of cuts that were made, what we cannot debate is that without Ginzburg's drastic reduction of Prato's book it never would have come to light.Ph.D.Includes bibliographical references (p. 218-225)
A prognostic score to predict major complications after pancreaticoduodenectomy
No full text"OBJECTIVE:. . To develop and validate a simple prognostic score to predict major postoperative complications after pancreaticoduodenectomy (PD).. BACKGROUND:. . PD still carries a high rate of severe postoperative complications. No specific score is currently available to stratify the patient's risk of major morbidity.. METHODS:. . Between 2002 and 2010, preoperative, intraoperative, and outcome data from 700 consecutive patients undergoing PD in our institution were prospectively collected in an electronic database. Major complications were defined as levels III to V of Clavien-Dindo classification. On the basis of a multivariate regression model, the score was developed using a random two-thirds of the population (n = 469) and was validated on the remaining 231 patients.. RESULTS:. . Major complication rate was 16.7% (117/700). Significant predictors included in the scoring system were: pancreas texture, pancreatic duct diameter, operative blood loss, and ASA score. The mean risk of developing major postoperative complications was 7% in patients with score 0 to 3, 13% in patients with score 4 to 7, 23% in patients with score 8 to 11, and 36% in patients with score 12 to 15. In the validation population, the predicted risk of major complications was 15.2% versus a 16.9% observed risk (C-statistic index = 0.743).. CONCLUSION:. . This new score may accurately predict a patient's postoperative outcome. Early identification of high-risk patients could help the surgeon to adopt intraoperative and postoperative strategies tailored on individual basis
Gender and Age as Preoperative Predictors of Early Disease Progression in Patients Undergoing Surgery for Pancreatic Neuroendocrine Tumors with Liver Metastases
No full textBackground: Pancreatic neuroendocrine tumor liver metastases (PanNET LMs) are traditionally classified into three types based on their distribution. Surgery is generally considered for patients with type I/II LMs, while those with type III LMs are typically regarded as unresectable; however, type III LMs encompass a wide range of clinical scenarios, some of which may allow surgical resection. Objective: The aim of this study was to identify preoperative predictors of early progression following surgery (≤6 months) in patients with PanNETs and LMs. Methods: Consecutive patients with PanNETs and LMs who underwent surgery at San Raffaele Hospital (2010-2023) were included. Results: After a median follow-up of 56 months, 18/54 patients (34%) experienced early disease progression. Female gender was identified as a protective factor (hazard ratio [HR] 0.373, p = 0.049), while age ≥ 70 years emerged as a significant risk factor (HR 2.744, p = 0.042) for early postoperative progression. When overall disease progression was considered as an outcome, female gender was confirmed as protective (HR 0.426, p = 0.010), while type III LMs significantly increased the risk of progression (HR 2.500, p = 0.012). In the subgroup of patients with type III LMs (n = 37), female gender was confirmed as the only predictor of longer progression-free survival (HR 0.332, p = 0.006). Conclusions: This study highlights the potential role of surgery for patients with resectable or potentially resectable PanNETs and LMs. For patients with type III LMs, the role of surgery remains controversial. Nevertheless, surgery may still be an option in selected cases, particularly in younger patients and females, as part of a multidisciplinary treatment strategy
Civilian Airway Trauma: A Single-Institution Experience
No full textBackground: Injuries to the airway in the neck and thorax are uncommon, but may be potentially life threatening. The objective of this study is to determine the clinical characteristics and outcomes for patients with airway injury. Methods: From 1974 to 2014, a prospectively entered trauma database at a Level 1 trauma center was accessed to identify patients with injuries to the larynx, cervical trachea, or thoracic airway. Hospital charts were reviewed to obtain data on demographics, presentation, injury management, in-hospital and long-term morbidity and in-hospital mortality. Multivariate logistic regression was used to estimate predictors of mortality and long-term vocal cord morbidity. Data are expressed as N (%). Results: One hundred and twenty patients were included (median injury severity score: 19 [interquartile range: 10–27]). There were 65 (54 %) blunt and 55 (46 %) penetrating injuries, with 90 (75 %) suffering multiple injuries. Sixteen (13 %) patients died from associated injuries (7: in ER; 9: after admission). Injuries were located in the cervical airway [101 (84 %)], thoracic airway [21 (18 %)], or both [2 (2 %)]. Eighty-six (72 %) patients were managed surgically. Predictors of in-hospital mortality included hemodynamic instability (OR 6.54, 95 % CI 1.11–37.14), GCS < 8 upon presentation (OR 4.35, 95 % CI 3.24–5.41), and head trauma (OR 4.10, 95 % CI 1.91–6.30). Fracture of cricoid or thyroid cartilages was a strong predictor of long-term vocal cord injury (OR 3.93, 95 % CI 1.25–12.59). Conclusions: Airway trauma remains a major challenge for early diagnosis, airway control, and management of both acute life-threatening injury and long-term morbidity
Islas. Le Maldive: pratiche, miti ed immaginari del paradiso terreste
No full textIsole, paesaggio, immaginario, Maldiv
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