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For decades, literacy research has placed a great deal of emphasis on reading engagement. It is widely acknowledged as a complex involving cognitive, behavioral, and emotional engagement. Learning engagement is an essential predictor of learning outcomes. It mediates educational intervention and learning outcomes. Although empirical studies proved the effectiveness of engagement on reading success, few studies have comprehensively reviewed the relationship between the subscales of engagement and how these subscales affect learning outcomes. To fill this gap, this review focused on exploring the interaction among subsets of engagement and how they affect reading achievement. The findings revealed that how engagement affects learning outcomes is determined by the intervention and how the outcomes are assessed and reported. The relationship between the engagement subscales is complicated: cognitive and behavioral engagement is a constant predictor of reading outcomes; emotion is the facilitator and affects behavioral or cognitive engagement. Behavioral engagement mediates cognitive engagement. Furthermore, learning outcomes could enhance emotional engagement, forming a natural learning cycle. This model is significant in understanding how learning engagement affects learning outcomes. It also demonstrated how the engagement subscales interacted and worked together to facilitate learning outcomes.

Lo possiamo chiamare in molti modi, collage, cut-up, sampling, détournement, ma la sostanza non cambia: c'è un atto elementare praticato da più di cento anni che non perde la propria carica sovversiva di estrarre dei frammenti della realtà per ricomporli in configurazioni di senso che aprono a nuovi orizzonti.

La dicotomía pretérito indefinido / pretérito imperfecto siempre ha causado mucha dificultad para los aprendientes de español. El presente trabajo tiene como objetivo analizar la interlengua de los estudiantes taiwaneses de E/LE y comprobar la interdependencia de dos factores, el nivel de dominio lingüístico y el aspecto léxico, y la distinción del aspecto léxico. Hemos trabajado con 83 informantes, que pertenecen a dos grupos intactos, uno de 2º y el otro de 5º del Colegio Universitario de Idiomas Wenzao de Taiwán. Se ha realizado una investigación transversal y el corpus está formado por dos tipos de pruebas: un test para completar un cuento con pretérito indefinido/ imperfecto y una composición cuyo tema es “un día de las vacaciones de invierno”. De los resultados obtenidos del corpus se halla que la alternancia indefinido-imperfecto forma la mayor dificultad del aprendizaje del verbo español, pero no existe una correlación evidente entre el nivel de dominio lingüístico y la distinción del aspecto verbal. Sin embargo, la correlación entre el aspecto léxico y el aspecto gramatical de los verbos sí se ha comprobado. Por último, se observa que, para los alumnos taiwaneses, la distinción aspectual de estos pretéritos aparece más tarde que la distinción temporal presente-pasado. Al final se proponen unas sugerencias didácticas para esta oposición.

ATLS Courses were introduced in the USA in 1980 and have been taught in Italy since 1994. Through theoretical lessons and practical sessions, their scope is to provide proper training for doctors with every kind of speciality who work in Emergency Departments, in order to prepare them to rapidly and effectively intervene on a patient who has suffered a serious trauma. Universities, in fact, do not prepare doctors adequately on this topic, while the application of the ATLS method in the first hours after trauma can effectively improve the prognosis of the patient. This study collects the data of the Italian experience in ATLS training, which has been carried out under the aegis of the Italian Chapter of the American College of Surgeons. The ATLS Courses have become widespread throughout our Country, which today is the fourth in the world for number of courses held every year.

Purpose: To evaluate the use of Evidence-based Medicine (EBM) to build radiological Guidelines, with the aim to have a better compliance by users. It has been decided to work on minor head injury, where we have found, in our institution, a wide and unjustified use of conventional skull x-ray., Material and Methods: A Workgroup, that reunites the main figures that enter in the management of the patient with minor head injury, has been created within our Hospital. The bibliography relative to the problem has been selected, employing criteria that held account of the methodological correctness, and in particular the existing Guidelines have been carefully analysed. It is therefore proceeded drawing up a Guideline that adhered to the principles of the EBM, adapting it to the hospital environment. Subsequently it has been passed to the phase of its implementation, with reunions in small groups of the involved professional figures, the distribution of informative material and the use of poster that reassumed the diagnostic flow-chart. Moreover a survey of the relative data to the number of skull x-ray and brain TC, executed in the patients with head trauma, has been completed., Results: The analysis of the data relative to the variation of the number of demands for skull Rx after introduction of the Guideline has demonstrated a great reduction (-83,8%), with little variation of the number of brain TC (+17,0%); such reduction has naturally implicated an important reduction of costs (-25,2%) and of the x-ray dose to population, measured to the crystalline (34,5%) and to thyroid (-71,0%)., Conclusions: The employ of the EBM in the Guideline creation, beyond representing the more correct methodology, concurs to obtain a greater adhesion from the users involved in management of the patient; in particular this happens if the Guideline is a product of a vast contribution and if it is supported from all additional procedures that can be useful for its implementation.

During last 20 years ultrasonography has been widely used in Europe to investigate abdominal trauma. In United States it has not been considered a reliable test especially because of its lack of sensitivity in diagnosing parenchymal injuries. Recently American surgeons reconsidered ultrasonography in trauma and codified its use into FAST (Focused Assessment for the Sonographic examination of the Trauma patients). The goal is to detect hemoperitoneum and pericardial effusion. Advantages are remarkable: ultrasound is cost-effective, fast, non-invasive, can be performed by surgeons even on unstable patients. FAST is now included in ATLS framework for examination of thoraco-abdominal trauma.

The authors report a retrospective analysis of the immediate and long-term results of treatment of gastroesophageal reflux refractory to medical therapy using the insertion of Angelchik's prosthesis in a group of 26 patients operated at the Institute of Emergency Surgery of Turin University from January 1980 to December 1993. All patients underwent pre- and postoperative endoscopy and were then controlled using esophagogastric X-ray, esophagogastroscopy, esophageal manometry and pH-metry in the event of disorders of esophageal motility. Operative mortality was nil and no major surgical complications were reported. Postoperative endoscopy showed the resolution of esophagitis in 23 patients (88.4%); symptoms of slight esophagitis persisted in 2 cases, and moderate esophagitis in another. Eighteen patients were monitored over time with a minimum follow-up of more than 2 years: persistent dysphagia appeared in 3 cases (16.6%), and in one patient this led to the need for endoscopic dilatations. Two patients (11.1%) presented "gas bloat syndrome" which gradually improved. It was never necessary to remove the device. No cases were observed of erosion, migration or destruction of the prosthesis. Follow-up exceeded 10 years in 7 patients, at present asymptomatic. Angelchik's prosthesis proved to be efficacious, rapid and simple to insert, and characterised by a lower morbidity rate and shorter postoperative course. The incidence of postoperative dysphagia makes only it is use indicated only in patients with a high operative risk, obese subjects and in case of recidivation of reflux after fundoplication.

Current knowledge of physiopathology allows better understanding of the metabolic and immunological alterations that occur after trauma, thus allowing more adequate treatment. Nutritional support is recognized as an important therapeutic intervention to promote wound healing, reduce the risk of infection and improve survival. The patient with severe trauma needs nutritional support from the beginning of treatment. The early administration of enteral nutrition is an important factor in the reduction of gut bacterial translocation and thus of septic complications. In the early phase, the parenteral route is capable of providing a sufficient calorific and protein support, whilst awaiting the recovery of the enteral route.

The authors present their experience in the treatment of acute bleeding from oesophageal varices. From 1983 to 1991, 596 patients underwent sclerotherapy during diagnostic endoscopy; a stop to bleeding was achieved in 512 cases (86%). Twenty-seven surgical emergency decompressive shunts were performed, 14 total portal-systemic and 13 selective; operative mortality was 64% and 54% respectively. One patient was submitted to oesophageal-gastric devascularization. Hundred-sixty elective shunts were performed, 99 total portal-systemic and 61 selective; operative mortality was 8% and 11% respectively. Since 1990 3 patients received liver transplantation. The 5-year survival rate of patients submitted to selective shunts was 46%; the 5-year survival rate of nonalcoholic cirrhotics submitted to shunt SRD was 73%.

The treatment of traumatic ruptures of the duodenum is one of the greatest controversies in surgery. The injury mechanisms, diagnostic criteria and factors underlying the prognosis are analysed and indications suggested for the various types of intervention. The problem relating to the operating technique are specified.

The results of surgery in 5 cases of traumatic rupture of the duodenum are presented. The site of the laceration, the time between trauma and operation, associated lesions, diagnostic routine and type of operation are specified. The mortality encountered (40%) should be related to the seriousness of the lesions.

A rare case of intestinal metastasis of a neuroendocrine carcinoma of the skin (Merkel Cell Tumor) is reported. The primary tumor was excised from the left arm two years earlier and followed an aggressive course with lymph-nodes, tonsillar and intestinal spread. Histologically, the intestinal lesion was similar to the primary tumor with small, undifferentiated cells. Undifferentiated small cell carcinoma and lymphomas of the gastrointestinal tract are to be considered in the differential diagnosis. Merkel Cells Tumor usually affects head and neck (44%) and extremities (48%), and is a highly malignant neoplasia, with early recurrence and distant metastases. Wide surgical excision of the primary lesion is the treatment of choice, while controversial is the role of prophylactic regional lymphadenectomy. Adjuvant radio- and chemo-therapy is frequently associated.

A colour video picture transmission system in real time with data transmission via a broad wave optical fibre cable has been set up to link Turin University's Orthopaedic Traumatology Centre and Emergency Surgery Clinic. The system consists of two stations. The transmitter station is equipped with a mobile TV camera or TV monitor and various electrical medical equipment. The receiving station consists of a picture reception monitor. The coded video signal is transmitted via the optical fibre; sound transmission is via a special telephone line. This experimental system was set up to see if patients with multiple injuries could receive diagnosis at a distance, thus avoiding unnecessary travelling. Experience of 100 link-ups has demonstrated that the system effectively cuts diagnosis and therapy times and is as efficient as in loco inspection by a surgeon. In addition it can be used to provide specialised consulting services to rural hospitals without special equipment. This reduces waiting times for emergency treatment and can also prevent the pointless transfer of patients to big hospitals in cases where the specialist can prescribe intermediate therapy or surgery.

An assay of Kininase II activity in the serum of 92 jaundice patients revealed a significant difference between the group with viral hepatitis (268.48 +/- 70.93 U/ml), that with biliary obstructions (133.05 +/- 37.64 U/ml) and with cirrhosis (173.76 +/- 79.56 U/ml). The increase encountered in patients with medical jaundice correlates well with total bilirubinaemia but not with cytolysis enzymes. This suggests failed demolition of ACE by the hepatocyte during cellular stress.

Bayes theorem; multivariance analysis, and the discriminating function of Mahalanobis applied to sixteen laboratory examinations employed in the diagnosis of diseases of the extrahepatic bile ducts and pancreas gave the following results: 1) the weight of each test was first measured in general terms, and then with regard to different levels of differentiation, with a classification in decreasing order in each case; 2) little redundancy was noted, and few examinations were of relatively negligible importance; furthermore, combinations of several tests did not lead to positive results; 3) reclassification according to the formula of Bayes and by means of the discriminating function proved sound supports for clinical decision, since they provided 70% and 80% of exact classification respectively; 4) the importance of the minicomputer in the construction of experimental diagnostic models was substantiated.