19 research outputs found
Secondary Traumatic Stress and Child Welfare
No full textAlthough secondary traumatic stress (STS) has garnered some attention in related human service fields, it has only recently begun to be investigated in child welfare. In this article I offer a detailed description of the problem of secondary traumatic stress (STS) in child welfare. The focus of this article is on child welfare in the United States; however the ideas and principles may cut across international systems of child protection. First I provide a background to justify a need for a continuing dialogue regarding STS and its impact on workers. I then provide a comprehensive review of the literature including both the current state of research and emerging theory regarding STS. Also, I offer a rationale for more research regarding the impact of STS on child welfare workers. The current state of the existing STS literature provides indicators of future needs, however still is filled with mainly gaps and silences. Note. Wrongly, on the original pdf the name \u27Jeannette Rankin Hall\u27 was mentioned as that of a co-author; the paper was only written by James C. Caringi. The second name is removed from the revised version
Modern approach to hepatocellular carcinoma treatment
No full textHepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, necessitating innovative treatment strategies. Surgical resection and liver transplantation continue to be the gold standards for early stage HCC; however, advances in imaging and minimally invasive techniques have improved patient selection and outcomes. Additionally, the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC. This review highlights the efficacy of agents such as tyrosine kinase inhibitors, alongside emerging options like immune checkpoint inhibitors, which have shown promise in clinical trials. Furthermore, the role of locoregional therapies, including ablation in the setting of combined treatment, transarterial chemoembolization and transarterial radioembolization with flow catheters, cone-beam computed tomography and 4D navigation guidance, is examined in the context of bridging therapies for patients awaiting surgical intervention. The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes. Future directions for HCC treatment are discussed, including the potential of novel biomarkers in prognosis and treatment response. This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates
A Complex Partnership to Optimize and Stabilize the Public Child Welfare Workforce
No full textThis article introduces a complex partnership developed in a Northeastern state. Its aim is to optimize and stabilize the public child welfare workforce and thereby improve outcomes for clients as well as results for country and borough agencies. To achieve this aim, this partnership has implemented a comprehensive, multi‐faceted strategy. Intermediaries play pivotal roles in this partnership system. Originating with a focus on social work education, this partnership quickly focused on research. Participatory workforce research aimed at understanding turnover led to a hybrid, complex intervention involving team‐driven articipatory action research and learning in local agencies. These design teams, facilitated by social workers, connect professional development and organizational development to retention planning and ultimately, to workforce optimization initiatives. (Author abstract
Robotic Liver Resection for Breast Cancer Metastasis: A Multicenter Case Series and Literature Review
No full textBackground: Breast cancer is a widespread disease and, when metastatic, has a bleak prognosis. The surgical approach for BCLM has had a limited role, but robotic surgery could find an important place. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections performed in nine European hospital centers from 2011 to 2023. Of the entire series, 35 were performed for BCLM in five European hospital centers. Results: The post-operative complication rate was 11.44%, but no severe complications occurred. The mean hospital stay was 4.65 days. One patient (2.85%) was readmitted to the hospital within 90 days after discharge and died due to heart failure, with a 90-day mortality of 2.85%. Conclusions: Robotic liver resection for BCLM is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve
Step-by-Step Description of Standardized Technique for Robotic Pancreatoduodenectomy
No full textRobotic pancreaticoduodenectomy (RPD) has emerged as a viable alternative to open and laparoscopic approaches, offering potential advantages in precision and dexterity. However, its complexity and lack of standardization remain as barriers to widespread adoption. We present a step-by-step surgical approach to RPD, emphasizing key technical strategies to enhance safety, efficiency, and reproducibility. Our technique is structured into defined surgical steps, facilitating learning curve optimization and intraoperative consistency. Key refinements include an optimized trocar placement, the strategic suspension of vascular structures, and specific reconstructive techniques to reduce the operative time and improve surgical ergonomics. These improvements may contribute to a reduction in perioperative morbidity and procedural standardization. Standardizing RPD through defined surgical steps and structured learning pathways may improve its feasibility, safety, and broader adoption. Further studies are needed to validate these strategies in high-volume centers
Hot Topics in the Surgical Treatment of Intrahepatic Cholangiocarcinoma: A Narrative Review of Current Managements
No full textIntrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with a poor prognosis. Negative-margin resection is presently the only potentially curative treatment option. Emerging trends with direct applicability to surgical strategy include margin thickness, lymphadenectomy, optimization of future liver remnant (FLR), minimally invasive techniques, incorporation of systemic therapy, and reconsideration of liver transplantation. This review emphasizes areas of consensus and ongoing debate. Margins ≥5–10 mm are associated with improved results, but biology generally takes precedence over prognosis. Regional lymphadenectomy enhances staging accuracy, although its therapeutic benefit remains unsettled. PVE is standard for FLR enlargement, LVD provides faster hypertrophy, and ALPPS remains reserved for highly selective cases. Minimally invasive and robotic hepatectomy share oncologic results in skilled institutions. Systemic therapies, including immunotherapy and biomarker-directed targeted therapy, are increasingly being incorporated perioperatively. Liver transplant may be of potential value in early-stage disease or on strict indications after neoadjuvant treatment. The modern surgical management of iCCA encompasses a blend of oncologic considerations, FLR optimization, minimally invasive surgery, and systemic therapy according to tumor biology. Multidisciplinary planning and participation in clinical trials are necessary to align surgical innovation with advancements in molecular and systemic treatments, ultimately leading to improved long-term outcomes
Robotic Liver Resection for Hepatocellular Carcinoma: A Multicenter Case Series
No full textBackground: Liver resection is the standard treatment for resectable hepatocellular carcinoma (HCC). The advent of robotic surgery has extended its application in liver surgery, reducing post-operative complications without compromising oncological safety. This study is a retrospective series with the aim of analyzing the preoperative patient’s and tumor’s characteristics and evaluating intraoperative and post-operative data in terms of hospital stay, complications, and oncological radicality. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections (RLRs) performed in nine European hospital centers from 2011 to 2023. Of the entire series, 343 liver resections were performed for HCC. Results: A total of 247 patients (72.3%) had mono-focal lesions. Major hepatectomies and anatomical resections have been perfomed in 87% and 55% of patients, respectively. All 17 conversions (4.95%) were to the open approach. The operative mean time was 239.56 min and the estimated blood loss was 229.45 mL. The overall post-operative complication rate was 22.74%, but severe complications occurred in 4.08% of patients and one of them (0.29%) was reoperated on. The mean hospital stay was 5.82 days with a mean ICU stay of 0.9 days. Twenty-six resections (7.6%) were R1 parenchymal. Forty-six patients (4.08%) were readmitted to the hospital within 90 days after discharge and seventy-eight patients (22.74%) had disease recurrence. Total deaths included 36 (10.5%) patients with a 90-day mortality of 0.9%. Conclusions: Robotic liver resection for HCC is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve
Devices for minimally invasive liver parenchyma transection: the SICE (Italian Society of Endoscopic Surgery) Italian and International survey
No full textBackgroundsMinimally Invasive Liver Surgery (MILS), encompassing laparoscopic (L-MILS) and robotic (R-MILS) approaches, has revolutionized liver surgery, offering reduced morbidity, shorter hospital stays, and improved outcomes while maintaining oncological efficacy. Despite the widespread use of L-MILS, parenchyma liver transection techniques and devices remain debated. This study investigates the adoption of transection devices (TDs) in MILS among 86 hospitals, focusing on surgical practices, device utilization, and outcomes.MethodsThe Italian Society of Endoscopic Surgery (SICE) endorsed a cross-sectional internet-based survey targeting general and Hepato-Pancreato-Biliary surgeons.ResultsResponses from 86 centers revealed that 77% of institutions is available a robotic platform, with an adoption rate of 87.50% in high-volume centers. L-MILS remains the predominant technique for liver resections, also in case of major hepatectomies, although R-MILS is increasingly utilized. For minor L-MILS, more than 50% of respondents use ultrasonic shears and electrosurgical pencil and advanced bipolar devices, while about 40% of surgeons adopt Cavitronic Ultrasonic Surgical Aspirator (CUSA) in major resections. R-MILS procedures predominantly used Maryland bipolar forceps and vessel sealers, with hybrid techniques (30%) integrating laparoscopic devices (e.g., CUSA) to address robotic device limitations.ConclusionThe minimally invasive approach to liver parenchymal transection is a key component of this surgical procedure. For major hepatectomies, the CUSA device remains the most effective tool, whereas ultrasonic shears, electrosurgical pencil, and advanced bipolar devices are more suited for minor resections. Despite limited access to specialized instruments, R-MILS achieves favorable outcomes in liver transection by employing the crash-clamp technique or hybrid strategies
Quadrupole Anisotropy in Dihadron Azimuthal Correlations in Central d plus Au Collisions at root s(NN)=200 GeV
No full textThe PHENIX collaboration at the Relativistic Heavy Ion Collider (RHIC) reports measurements of azimuthal dihadron correlations near midrapidity in d + Au collisions at root s(NN) = 200 GeV. These measurements complement recent analyses by experiments at the Large Hadron Collider (LHC) involving central p + Pb collisions at root s(NN) = 5.02 TeV, which have indicated strong anisotropic long-range correlations in angular distributions of hadron pairs. The origin of these anisotropies is currently unknown. Various competing explanations include parton saturation and hydrodynamic flow. We observe qualitatively similar, but larger, anisotropies in d + Au collisions at RHIC compared to those seen in p + Pb collisions at the LHC. The larger extracted upsilon(2) values in d + Au are consistent with expectations from hydrodynamic calculations owing to the larger expected initial-state eccentricity compared with that from p + Pb collisions. When both are divided by an estimate of the initial-state eccentricity the scaled anisotropies follow a common trend with multiplicity that may extend to heavy ion data at RHIC and the LHC, where the anisotropies are widely thought to arise from hydrodynamic flow.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000327245900006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701Physics, MultidisciplinarySCI(E)EI98ARTICLE21null11
Centrality categorization Rp(d)+A in high-energy collisions
No full textHigh-energy proton- and deuteron-nucleus collisions provide an excellent tool for studying a wide array of physics effects, including modifications of parton distribution functions in nuclei, gluon saturation, and color neutralization and hadronization in a nuclear environment, among others. All of these effects are expected to have a significant dependence on the size of the nuclear target and the impact parameter of the collision, also known as the collision centrality. In this article, we detail a method for determining centrality classes in p(d) + A collisions via cuts on the multiplicity at backward rapidity (i.e., the nucleus-going direction) and for determining systematic uncertainties in this procedure. For d + Au collisions at root s(NN) = 200 GeV we find that the connection to geometry is confirmed by measuring the fraction of events in which a neutron from the deuteron does not interact with the nucleus. As an application, we consider the nuclear modification factors Rp(d)+A, for which there is a bias in the measured centrality-dependent yields owing to auto correlations between the process of interest and the backward-rapidity multiplicity. We determine the bias-correction factors within this framework. This method is further tested using the HIJING Monte Carlo generator. We find that for d + Au collisions at root s(NN) = 200 GeV, these bias corrections are small and vary by less than 5% (10%) up to p(T) = 10 (20) GeV/c. In contrast, for p + Pb collisions at v root s(NN) = 5.02 TeV we find that these bias factors are an order of magnitude larger and strongly pT dependent, likely attributable to the larger effect of multiparton interactions.Physics, NuclearSCI(E)[email protected]; [email protected]
