Abstract Background: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC (“PAL-LIFE group”). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world.

Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institución académica de la Santa Sede (Vaticano) cuyo objetivo es promover una visión católica de la ética biomédica. La PAV invitó a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estratégicas para el desarrollo global de CP (“Grupo PAL-LIFE”). Diseño: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidió a los participantes que identificasen los grupos de interés o instituciones claves para la promoción de CP y que propusieran, para cada uno de ellos, recomendaciones estratégicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones más importantes. En una última fase, al grupo de expertos se le solicitó la jerarquización por importancia de los grupos clave en una escala de 1 a 13. También se solicitaron sugerencias concretas para la implementación de las recomendaciones. Mediante análisis clúster se ordenaron los grupos de interés en dos niveles de importancia para el desarrollo de CP. Resultados: Trece recomendaciones fueron seleccionadas como las más importantes (una por cada grupo clave). Las recomendaciones para los grupos mejor puntuados fueron: (1) Responsables Políticos: garantizar el acceso universal a los CP; (2) Academia: ofrecer cursos obligatorios de CP en el pregrado; (3) Profesionales sanitarios: promover una certificación adecuada; (4) Hospitales e Instituciones sanitarias: asegurar el acceso a medicamentos de CP; y (5) Asociaciones de CP: ser promotoras eficaces y trabajar con los gobiernos en la implementación de las recomendaciones internacionales sobre CP. También se presentan recomendaciones para los ocho grupos clave restantes. Discusión: Este documento representa la posición oficial de la PAV en lo que respecta a estrategias de promoción para el desarrollo de los CP en el mundo.

In   organic   agriculture   fertilizers   are   permitted   in   organic   forms,   as defined   by   regulation.   Mineralization   of   organic   fertilizers   is   a   biological   decomposition   that   release   plants’   available   nutrients;;   hence   soil   microbial   communities are   vital   in   the   organic   cropping   systems.   Composting   microorganisms   can   work   for   the   farmer’s   benefit   recycling   agricultural   organic   wastes   into   materials   that   contribute   to   healthy   and   biologically   active   soil.   Composting   process   has   been   deeply  described  to  highlight  the  link  among  starting  mixture,  process  factors  and  final  resulting  compost.  Composting  and  crop  residues  incorporation  are  fundamental  to  recycle  resources  at  farm  level  to  improve  the  nutrients  use  efficiency  and  to decrease  the  off-­farm  input  needs.  In  the  organic  farming  a  balanced  combination  of compost  application  and  crop  residues  incorporation  increases  the  microbial  carbon use   efficiency,   which   regulates   the   soil   organic   matter   decomposition   and   nutrients  mineralization  resulting  both  to  increase  the  yield  and  to  decrease  the  negative impact  on  the  environment.

OBJECTIVE: To investigate the cognitive and physical workload experienced by each operating room team member for different types of urologic procedures.

METHODS: Surgeons, anesthesiologists, surgical fellows, bedside assistants, circulating nurses, and scrub nurses completed the National Aeronautics and Space Administration Task Load Index questionnaire for various urologic robot-assisted surgery procedures. A total of 338 questionnaires from 55 unique individuals were collected. Workload differences by role, type of procedure, and surgery duration were analyzed using analysis of variance for each of the 6 domains of the National Aeronautics and Space Administration Task Load Index. The effects of trainees' participation on their perceived workload and the workloads of the lead surgeon and bedside assistant were analyzed with correlation.

RESULTS: The role of the surgical team was significant for all the scales of workload, and there was a main effect type of surgery on temporal demand and frustration. Frustration was higher for prostatectomy in comparison to cystectomy for the trainee surgeon. On the other hand, it was lower for the anesthesiologist, bedside assistant, and the circulating nurse. There was no effect of procedural complexity on workload. Regardless of surgical complexity, the trainees performed approximately 40% of the procedure without significantly impacting their perceived workload.

CONCLUSION: This study provides an analysis of variations and contributors to workload parameters and serves as a platform to optimize team members' workload during robot-assisted surgery.

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After many years of information systems development, most private and public organizations are characterized by the presence of multiple information systems, possibly distributed and heterogeneous. Heterogeneity is generally related to representation languages, support technology, and evolution strategies. The result can be a deep disintegration of data and processes spread in several information systems. Methods and tools for the analysis and comparison of the existing information systems are required, to identify replication, overlapping, bad distribution of data and processes among the existing systems, to set the basis for reengineering activities. This paper proposes computer-based techniques for the analysis of multiple information systems. Following an inherently data-oriented approach, conceptual descriptions of processes are analyzed focusing on characteristics of data manipulated and exchanged and on operations performed by processes. The proposed techniques rely on similarity criteria and metrics and on a semantic dictionary, where the knowledge on process data and operations is properly organized. Process descriptions are analyzed for the aspects related to information and operation similarity, to evaluate semantic correspondences between processes and identify activity replication and overlapping, as well as for the aspects related to interaction/cooperation, to evaluate the degree of coupling between processes and identify the type and the nature of exchanged information flows. Experimental results of applying the analysis techniques to the information systems of the Italian Public Administration are discussed.