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Background: Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. Objective: To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. Design, setting, and participants: The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. Outcome measurements and statistical analysis: Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. Results and limitations: The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. Conclusions: The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. Patient summary: We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk. © 2022 European Association of Urology

[Excerpt] Urologists are increasingly aware of new surgical concepts including natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) [1–5]. In 2008, the Urology LESS and NOTES Working Group was formed under the auspices of the Endourological Society. In addition to having a stated goal of increasing awareness about LESS and NOTES, the working group also wanted to define nomenclature, guide scientific evaluation, and provide opportunities for safe clinical implementation [6]. In 2010, the European Society of Urotechnology similarly formed a working group dedicated to LESS and NOTES. In this paper, we report progress on the stated goals and make new recommendations for the future of LESS and NOTES in urology. To date, progress has been made with all stated goals. Nomenclature for LESS and NOTES has been clearly defined [7,8]. In addition, most urologists are now aware of the concepts of LESS and NOTES [1,3,4,8]. Society in general is also interested and largely supportive of the LESS and NOTES concepts [9,10]. Although savvy patients may be interested in LESS and NOTES procedures, we are always obligated to place the needs of the patient first when determining surgical approach. It may sound very appealing to the patient to have no visible surgical scars, but the same patient is less interested in the so-called scarless approach if the risk of complications or morbidity is significantly increased [9–11]. As such, the development of these nascent approaches should be methodical and the recommendations based on objective data. [...]

Ciencia del suelo, orden de suelo, suborden de suelo, unidad y subunidad.

Los levantamientos formales de suelos son costosos y tardados, por lo que es necesario encontrar métodos alternativos para realizarlos. Los sensores remotos se pueden emplear para identificar y delimitar algunas propiedades de los suelos, ya que algunas de ellas tienen una reflectancia característica, como contenido de arcilla, humedad, rugosidad, densidad aparente, color y materia orgánica. Dos de estas propiedades, porcentaje de arcilla y densidad aparente, definen a un Vertisol y las demás están relacionadas con éste, lo cual sugiere que estudiarlas en conjunto puede generar un patrón espectral que ayude a delimitarlo en una imagen de satélite. Los objetivos fueron: 1) identificar y clasificar los Vertisoles y determinar su mineralogía; 2) relacionar las propiedades típicas de los suelos con la reflectancia espectral de las imágenes Landsat TM; y 3) delimitar a los Vertisoles con base en sus propiedades típicas a través de procedimientos de percepción remota. El estudio se llevó a cabo en Guanajuato, México. La zona de estudio comprendió 30 000 ha. Se utilizó una imagen de satélite Landsat TM del 29 de abril de 2002. Los suelos se clasificaron como: Chromic Haplusterts, Typic Haplusterts yMollic Ustifluvents. Las propiedades que presentaron una mayor precisión y se relacionan con la reflectancia espectral fueron el porcentaje de arcilla y la densidad aparente; sin embargo, los Vertisoles no presentan un patrón espectral único, por lo que no se pueden delimitar cartográficamente con imágenes de satélite.

In the current demand-driven European office markets, attracting new tenants is difficult. To limit vacancy rates, asset managers are shifting focus towards also trying to retain current tenants through relationship marketing and customer intimacy strategies. The service profit chain endorses this shift, pointing out that a satisfied tenant is a loyal tenant who is less inclined to move. So growing research attention is paid to factors that keep a tenant satisfied. Originating from the behavioural location decision theory from the 1960s, tenants have been proven to base location decisions (like moving) both on objective and subjective aspects; in later studies these aspects are called (objective and subjective) push- and pull factors. Recently keep factors have been mentioned as a third category of factors, but little research has been devoted to them so far. This first exploratory research gives more insight in keep factors of office tenants and their relation to push and pull factors, satisfaction and loyalty.Data have been gathered by holding structured interviews with 38 companies in 2 multi-tenant office buildings. Statistical analyses of these data showed that while more than half of the push and pull factors positively correlate with each other (especially the ones mentioned often), keep factors are mostly a significantly different category. Both keep factors and push/pull factors correlate with satisfaction. A tenant is pushed/pulled away most if a building is not up to date (maintenance, quality of fittings). Flexibility and being close to (the facilities of) the inner city are the main keep factors that bring about a satisfied tenant. Representativeness of both the building and its surroundings are mentioned fairly often as keep factor and as push/pull factor for both buildings, implying that for some factors satisfaction is based on subjective judgements of this factor and thus might be susceptible to customer intimacy management activities. The results imply that (facility) management activities for keeping the building up to date are most important to make sure a tenant is not pushed/pulled away to another location. To actually stimulate him to stay is harder. Flexibility and the distance to the inner city are mainly fixed during the design of a building, and not easily changed after completion. These factors should thus receive ample attention when adding an office to a real estate portfolio, because it will make vacancy management easier during the entire utilisation period.

The deterioration of small-scale shopping centres is an increasing problem in Dutch neighbourhoods. Because of consumers’ increased mobility and the decreased potential amount of spending within the catchments area, these small-scale shopping facilities are hardly exploitable. A clear vision on the future development is currently missing. Existing methods for measuring shopping centre vitality are based on the analysis of site qualities, like accessibility, and of financial-economic aspects like turnover, floor-productivity and costs. These methods focus on the possibility to continue the current retail function. Especially when checking the financial economic aspects, unfortunately most of the small centres would fail the test. Subsequently none of the methods offer a solution for the vacant or deteriorated real estate. Because of the value of the real estate and the function for the neighbourhood, this is a frustrating outcome while it would be too extreme to dismantle each centre that functions badly. In this paper we introduce a methodology by which alternative directions of development can be worked out, by making a site- as well as a situation-analysis. This alternative approach takes the absolute and the relative location into account and gives insight into the potential of the location and the real estate. The outcome is a set of solutions for redevelopment and brings along a whole package of facilities and services, both profit as non-profit, site- or situation oriented. This approach increases the range of solutions and decreases the chances for disinvestments.

Introducción: en Colombia la mayoría de los partos son institucionales; sin embargo, la morbimortalidad materna y perinatal es alta. Los resultados de la atención materna están determinados en parte por la adecuada atención de las complicaciones. Dado que la morbimortalidad materna es evitable en una importante proporción de casos, es relevante determinar el impacto que tienen los eventos adversos (EA) intra-hospitalarios sobre ella. No tener datos sobre éstos, limita su análisis. El propósito del presente trabajo es describir los resultados del tamizaje de los eventos adversos en la atención materna y su relación con la morbimortalidad materna en una institución de tercer nivel y centro de referencia de la atención materno perinatal en Bogotá. Materiales y métodos: estudio prospectivo de vigilancia epidemiológica, en pacientes gestantes que ingresaron al Instituto Materno Infantil (IMI) durante el período comprendido entre noviembre del 2002 y octubre del 2003. Se incluyeron pacientes con alteraciones del embarazo o en trabajo de parto. Se excluyeron quienes tuvieron parto en otra institución. Se describen las frecuencias de los eventos adversos y los factores asociados. Se realizó un análisis univariado para establecer la asociación con variables de tipo clínico u hospitalario por medio de la prueba t de student o la prueba Ji2, con un nivel de confianza del 95%. Resultados: se incluyeron 2.530 mujeres. La incidencia de eventos adversos durante la hospitalización fue de 12,02%. Tuvieron mayor riesgo de presentar eventos adversos las pacientes con menor edad gestacional, morbilidad materna de base a su ingreso (RR 1,63 IC95% 1,06 - 2,53) y disfunción orgánica al ingreso (RR 3,2 IC95% 2,53 - 4,07). Las pacientes sometidas a cesárea tuvieron un RR de 1,81 (IC95% 1,4 - 2,41) de presentar eventos adversos, en comparación con las de parto vaginal. En el grupo de pacientes con eventos adversos la estancia fue significativamente mayor (mediana 4 días, 0 - 30 versus mediana 2 días, 0 - 30). Conclusiones: los eventos adversos se encuentran asociados a la morbilidad materna y están relacionados con factores maternos y hospitalarios. Introduction: most births in Colombia are institutional; however, maternal and perinatal morbidity-mortality is high. The results of maternal attention are partly determined by suitable attention regarding complications. Given that maternal morbidity-mortality is avoidable in an important number of cases, determining intra-hospital adverse events (AE) impact on it would seem to be extremely pertinent. Not having apposite data limits its analysis. The present work is aimed at describing AE screening frequency, in maternal attention and their relationship with maternal morbidity-mortality in a third level institution and perinatal maternal attention referral centre in Bogotá. Materials and methods: prospective epidemiological surveillance study, in pregnant mothers being admitted to the Instituto Materno Infantil (IMI) from November 2002 to October 2003. Patients having alterations in their pregnancy or during giving birth were included. Women were excluded who gave birth in another institution. The frequency of adverse events and associated factors are described. Single-variable analysis was carried out for establishing association with clinical or hospital variables using Student’s t-test or Ji2 test having 95% confidence interval. Results: 2,530 women were included. There was 12.02% incidence of adverse events during hospitalization. Patients had a greater risk of presenting adverse events if their gestation was less advanced, were suffering maternal morbidity on being admitted (1.63 RR; 1.06-2.53 95% CI) and organic dysfunction on being admitted (3.2 RR; 2.53-4.07 95% CI). Patients who underwent caesarean section had (1.81 RR; 1.4-2.41 95% IC) of presenting adverse events, compared to those giving birth vaginally. Hospital stay was significantly greater in the group of patients presenting adverse events: 4 days (0 - 30) versus 2.00 days (0 -30). Conclusions: adverse events are associated with maternal morbidity and are related to maternal and hospital factors.

Osteosarcoma is a rare cancer, which metastasizes to the lung in up to 80% of cases. Thrombin is involved in metastasis and is present in the lungs of patients with pulmonary metastases (PM). To identify its role in PM and osteosarcoma, we measured thrombin levels in the bronchoalveolar lavage fluid (BALF) of 15 patients. BALF was collected at different stages of the disease and correlated with the diagnosis of PM. We also assessed fibrinogen overexpression in the tumors. We found that 11/15 (73%) patients with high thrombin levels in the lungs developed PM within the first 12 months from primary surgery. The median thrombin concentration in the BALF of these patients increased up to 8×10-9 M (range, 3×10-9M-15×10-9M), which represents a more than 100-fold increase compared to patients without PM (p