Critical View Research Articles

Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans.

Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years. We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time. Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident. The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.

Patients' knowledge, preferences, and perspectives about data protection and data control: an exploratory survey.

Background: In the European Union, the General Data Protection Regulation (GDPR) plays a central role in the complex health research legal framework. It aims to protect the fundamental right to the protection of individuals' personal data, while allowing the free movement of such data. However, it has been criticized for challenging the conduct of research. Existing scholarship has paid little attention to the experiences and views of the patient community. The aim of the study was to investigate 1) the awareness and knowledge of patients, carers, and members of patient organizations about the General Data Protection Regulation, 2) their experience with exercising data subject rights, and 3) their understanding of the notion of "data control" and preferences towards various data control tools. Methods: An online survey was disseminated between December 2022 and March 2023. Quantitative data was analyzed descriptively and inferentially. Answers to open-ended questions were analyzed using the thematic analysis method. Results: In total, 220 individuals from 28 European countries participated. The majority were patients (77%). Most participants had previously heard about the GDPR (90%) but had not exercised any of their data subject rights. Individual data control tools appeared to be marginally more important than collective tools. The willingness of participants to share personal data with data altruism organizations increased if patient representatives would be involved in the decision-making processes of such organizations. Conclusion: The results highlighted the importance of providing in-depth education about data protection. Although participants showed a slight preference towards individual control tools, the reflection based on existing scholarship identified that individual control holds risks that could be mitigated through carefully operationalized collective tools. The discussion of results was used to provide a critical view into the proposed European Health Data Space, which has yet to find a productive balance between individual control and allowing the reuse of personal data for research.

A critical view on using "life not worth living" in the bioethics of assisted reproduction.

This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies.

A Critical View on New and Future Antidepressants.

For the first time after many decades, many new antidepressants have been approved and many more are under various stages of development and will soon be available in the market. The new drugs present a range of new mechanisms of action with benefits in terms of speed of action, tolerability and range of treatable disorders. Neurosteroids have been recently approved and their rapid benefit may extend from postpartum depression to anxious depression and bipolar depression, dextromethorphan and bupropion combination may prove useful in major depression but also in treatment resistant depression, dextromethadone is a possible augmentation in partial antidepressant response, psychedelic drugs have the potential of long lasting benefits after a single administration, though are still experimental treatments. Botulinum has the same advantage of psychedelics of a single administration and its antidepressant effects may last for weeks or more. Further potentially interesting new antidepressant mechanisms include new drug targets, drug repurposing and genetic or epigenetic manipulations. It is therefore important that clinicians are kept up to date with new evidence so that new evidence can be rapidly translated into clinical practice.

CONVERSION TO OPEN CHOLECYSTECTOMY - A SAFE ALTERNATIVE, NOT A FAILURE!

Background: Understanding factors that predict conversion in laparoscopic cholecystectomy (LC) to an open procedure is important as it allows better patient selection, preparation, operating list planning, referral, counseling and lowers the threshold for a safe conversion, thereby minimizing undue prolongation of attempts at laparoscopic completion and inadvertent complications.Methods: Records of 1010 consecutive patients who were taken up for LC, at a tertiary care teaching institute in northern India, were reviewed retrospectively. Preoperative and intraoperative characteristics of patients who underwent a successful LC were compared with those who required conversion to open surgery.Results: The conversion rate was 7.5% (76 patients). The most common reason for conversion was the inability to define the ‘Critical view of safety’ in 48, (63%) of patients. Other reasons included dense peri-cholecystic 9 (12%) and intra-abdominal 8 (11%) adhesions, suspicion of bile duct injury 4 (5%) or malignancy 3 (4%). Prior upper abdominal surgery, intraoperative finding of a contracted and thick-walled gallbladder (GB), empyema GB, Mirizzi’s syndrome, cholecysto-enteric fistula, and a prior endoscopic common bile duct stone clearance were significant predictors of conversion. Xanthogranulomatous cholecystitis was found more commonly (43% vs 5%) in the conversion group.Conclusion: Conversion to an open procedure during LC should always be treated as an integral component of sound judgement to achieve the safest outcome in a particular patient. Due consideration of pre-operative and intra-operative factors predictive of a higher chance of conversion assists pre-operative patient preparation and counseling as well as surgical planning, conduct and mentoring of residents-in-training.

Critical View of Overland Flow Estimation in Semi-arid Catchments Under Land Subsidence with Long-term Field Measurements

Critical View of Overland Flow Estimation in Semi-arid Catchments Under Land Subsidence with Long-term Field Measurements

Navigating I-positionings in higher education Service Learning as hybrid scenarios: a case study

This paper is part of a larger study on learning processes and identity change in university students participating in Service Learning (SL) programmes, considered as hybrid activities containing practices and values from at least two settings: academic activity and professional intervention. Our SL programmes, carried out in formal schools serving children from Roma and migrant backgrounds, challenge dominant views on educational and psychological processes, offering a critical view of learning and development, where traditionally unrepresented “others”, along with their cultural knowledge, bring their own voices to the arena. Our aim is to show the transformations taking place within this SL by analysing the dialogicality contained in the field notes written by a participating psychology student, Nina (pseudonym), as an illustration of the complex dynamics of learning and identity change we encounter. By analysing Nina's reflections while acting in this SL project, we attempt to delve into these processes of transformation from the perspective of an agentive participant. In her case, we tried to unfold the complex way in which different cultural traditions entered into dialogue in her I-positions as she emotionally connected and engaged with the surrounding motives, finding her own way through cultural crossroads through affect and practice.

A critical view of WHO guidelines on management of low back pain.

A critical view of WHO guidelines on management of low back pain.

Applicability of Neural Combinatorial Optimization: A Critical View

Neural Combinatorial Optimization has emerged as a new paradigm in the optimization area. It attempts to solve optimization problems by means of neural networks and reinforcement learning. In the last few years, due to their novelty and presumably good performance, many research papers have been published introducing new neural architectures for a variety of combinatorial problems. However, the incorporation of such models in the conventional optimization portfolio raises many questions related to their performance compared to other existing methods, such as exact algorithms, heuristics or metaheuristics. This paper aims to present a critical view of these new proposals, discussing their benefits and drawbacks with respect to the tools and algorithms already present in the optimization field. For this purpose, a comprehensive study is carried out to analyse the fundamental aspects of such methods, including performance, computational cost, transferability and reusability of the trained model. Moreover, this discussion is accompanied by the design and validation of a new neural combinatorial optimization algorithm on two well-known combinatorial problems, the Linear Ordering Problem and the Permutation Flowshop Scheduling Problem. Finally, new directions for future work in the area of Neural Combinatorial Optimization algorithms are suggested.

Exploring flexible working practices and the digital divide in a post-lockdown era

PurposeThis paper explores flexible working practices (FWPs) and takes a critical view that argues a need to consider not only access to digital technological resources but also the vast array of factors that constrain one’s ability to use technology for its intended benefits, as constituting the digital divide post-COVID-19 lockdown.Design/methodology/approachUsing a critical evaluation of the extant literature, we engage in a conceptual undertaking to develop theoretical propositions that form the basis for future empirical undertakings. To theoretically ground the arguments raised, we deploy the ontological lens of actor-network theory to illuminate the socio-technical dimensions of the digital divide in light of FWPs.FindingsSince the COVID-19 pandemic, the need to adopt socially distanced work practices has become a reality for many organisations. We find that the adoption of FWPs, enabled by digital technologies, simultaneously signals hidden inequalities. We also develop a conceptual framework which depicts user responses in different technology environments that can either be limiting or enabling for individuals’ work productivity.Originality/valueWith regards to the digital divide, attention has often focused on access to digital technologies, as the term “digital divide” portrays. The implication is that the array of factors and resources that individuals are heterogeneously networked to, which also constitute the digital divide, is often taken for granted. We take a different ontological view that brings to the fore other factors at play within an individual’s network of relations.

The philosophical workshop as an intervention proposal based on István Mészáros

This research aims to reflect on the philosophical workshop as a possible intervention proposal for teaching philosophy to high school students in order to strengthen their interest in this curricular component. This is research that is based on the historical-dialectic materialist method and the thought of the philosopher István Mészáros, which inspires the debate on philosophy teaching committed to the omnilateral formation of the socio-historical subject. Six (06) high school students from a public school in the municipality of Joca Marques, in the State of Piauí, participated in the research. The data were organized and analyzed according to Bardin's content analysis technique. The results reveal that the intervention proposal is an important resource to help students arouse interest in philosophy classes, as they can take a critical position on a certain topic related to their daily lives. In view of this, it is hoped that the workshop can contribute to students, as it can educate them to be critical, to overcome common sense, to have a critical view of the world and to engage in the struggle to radically overcome class society.

Geographical Origin Authentication-A Mandatory Step in the Efficient Involvement of Honey in Medical Treatment.

Nowadays, in people's perceptions, the return to roots in all aspects of life is an increasing temptation. This tendency has also been observed in the medical field, despite the availability of high-level medical services with many years of research, expertise, and trials. Equilibrium is found in the combination of the two tendencies through the inclusion of the scientific experience with the advantages and benefits provided by nature. It is well accepted that the nutritional and medicinal properties of honey are closely related to the botanical origin of the plants at the base of honey production. Despite this, people perceive honey as a natural and subsequently a simple product from a chemical point of view. In reality, honey is a very complex matrix containing more than 200 compounds having a high degree of compositional variability as function of its origin. Therefore, when discussing the nutritional and medicinal properties of honey, the importance of the geographical origin and its link to the honey's composition, due to potential emerging contaminants such as Rare Earth Elements (REEs), should also be considered. This work offers a critical view on the use of honey as a natural superfood, in a direct relationship with its botanical and geographical origin.

Diagnosen Prolonged Grief Disorder ændrer forståelsen af sorg - en diskursanalyse i et sygeplejefagligt perspektiv

The purpose of the article is to create a foundation on which the profession can begin its professional approach to the diagnosis of grief and what opportunities and limitations this holds from a nursing perspective. Background We are witnessing a historic change in the way grief is practiced in connection with death, as the diagnosis "Prolonged Grief Disorder" appears in the diagnosis manual ICD-11 that appears in the latest version published in 2022. Nurses are considered central actors in the practice of the grief diagnosis. Either in relation to preventive measures or by identifying those suffering from complicated grief by referring them to appropriate services. Method A Foucault-inspired discourse analysis has been prepared, exploring how the expression of grief has changed and which societal conditions have supported the change. Results Pervasive patterns are identified, which are regarded as three discursive strategies; A love discourse, a psychological adaptation discourse and a diagnostic discourse. Conclusion Societal ideals have supported the change in the articulation of grief. Nurses can use the insight into this historical development as well as the critical view built on a social constructivist point of view as a foundation for positioning themselves scientifically in this field.

The Church Registration Processes in the Czech Republic: Current Situation from the Perspective of Sociological Jurisprudence

Abstract The study presents a critical view of the church registration processes in the Czech Republic from a sociological jurisprudence perspective. First, it reviews the main issues as they appear in the current debate on the relationship between the state and religion. Next, it addresses the socio-cultural specifics of the relationship between state and religion in the Czech Republic and describes the current legal settings. The analytical part focuses on the judicial review of church registration processes between 2010 and 2022. Finally, the authors review individual cases and their legal outcomes to gain insight into the key problematic issues. The authors argue that (a) the national legal setting creates an unequal environment for the organizations that have been assessed in the study, and that (b) consequently, the state often exceeds its authority in the church registration process.

Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.

Response to Critical Views of Phenomenology of Film

This article responds to critical views of John Rhym, Martin Rossouw, Ludo de Roo, and Annie Sandrussi on my 2017 book Phenomenology of Film: A Heideggerian Account of the Film Experience. The article also takes up positive footholds from the analyses of Chiara Quaranta and Jason Wirth. The main topics addressed include Martin Heidegger’s ontic-ontological distinction; the notion of film-as-philosophy; being-in-the-world read as being-in-the-film-world; and questions surrounding the facticity and identity of the film viewer.

Scale and Safety: Analyzing the Association Between Intraoperative Difficulty and Achieving the Critical View of Safety in Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred method for gallstone removal, but bile duct injuries remain a concern. Achieving the critical view of safety (CVS) is pivotal in preventing such injuries. The aim of this study was to compare the rates of difficult LC in those with CVS achieved compared to those with CVS not achieved. We performed a single-center prospective study on all patients with ultrasound-confirmed symptomatic gallstones. Patients were excluded if they refused to consent or if they underwent LC for indications other than gallstone disease. Patients were stratified into two groups as CVS not achieved and CVS achieved groups and compared for outcomes. Our primary outcome was the rate of intraoperative difficulty on the modified Nassar scale (MNS). Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY). We included 70 patients who underwent LC for gallstones (CVS not achieved = 24 and CVS achieved = 46). The mean (SD) age was 42.2 (12.3) years, and 73.5% were females. The mean (SD) weight in our study cohort was 74.1 (10.9) kg, and there was no difference between the two groups in terms of the baseline demographic characteristics, disease characteristics, and comorbid conditions (p > 0.05). On univariate analyses, achieving CVS was associated with lower rates of higher-grade operative difficulty on the MNS and lower rates of length of stay of more than one day. Achieving CVS is associated with easy LC based on significantly lower Nassar scores. These findings highlight the role of the MNS in the successful identification of the operative difficulty of LC and its correlation with achieving CVS.

Nanocomposite materials as observed by mass-selective neutron spectroscopy

Abstract This work provides a current, critical view of the application of MAss-selective Neutron SpEctroscopy (MANSE) to nanocomposite materials. MANSE is a unique technique made possible owing to the existence of the pulsed neutron sources. At present, the only operating MANSE spectrometer in the world, VESUVIO, is located at the ISIS Neutron and Muon Source in the UK. We start by providing a brief description of the neutron Compton scattering, the anatomy of a mass-selective neutron spectrometer, and the experimental data treatment. We continue by briefly outlining the main quantum mechanical concepts, models and approximations relevant both to the ab initio prediction and experimental measurement of main MANSE observables. Next, we present several recent exemplars chosen to highlight the use of MANSE in the field of nanocomposites. Our examples include, in chronological order, encapsulated nanoparticles in amorphous silica gel, bioactive glass-ionomer cement, Cu-Ti-C composites, and sodium carboxymethyl starch-based binders in the presence of a mineral matrix. We close by providing our view of the ongoing and future challenges and opportunities in the mass-selective neutron investigation of NQEs in nanocomposite materials.

Sulla scelta della filosofia secondo Fichte

The paper offers an interpretation of the thesis developed by Fichte in the Erste Einleitung in die Wissenschaftslehre following “the philosophy one chooses depends on the man one is” as a deepening of symbolic practices and dispositions that philosophy shares with ordinary consciousness. To support this interpretation, the paper describes how Fichte defines individual character formation and how it relates to a historical determinate is presented through a quick excursion in the Nicolaischrift of 1801 (§2). Through a critical and synthetic view of the process of initiation into philosophy, the paper shows how the choice of philosophy is a choice for philosophy (§ 3) and invests a certain “skill” that is produced in the pre-philosophical dimension (§ 4). Through discussion of the Fichtian concepts of “instinct of reason” and “new sensory,” how the choice for philosophy, interpretable as the production of a new habitus, the fichtean doctrine of Science realizes itself fully as ‘critique’ (§ 5).

ENVIRONMENTAL LAW ENFORCEMENT THROUGH STATE ADMINISTRATIVE LEGAL INSTRUMENTS IN ENVIRONMENTAL CASES IN INDONESIA

Enforcement of environmental law through administrative legal instruments is very important to deter polluters. This research is a type of normative legal research based on the problems and themes raised. The research approach used is a philosophical and analytical approach, focusing on rational, analytical, critical and philosophical views, and ends with drawing conclusions which aim to produce new findings on the main problems that have been determined. It will also use the analytical descriptive method, by describing the applicable laws and regulations with legal theory and law enforcement practices that are related to the problem. Apart from that, it can also be taken through the State Administrative Court regarding the granting of permits (beschikking) by state administrative officials. Its essence is to protect, overcome, and restore the quality of the environment from pollution or damage as well as providing a deterrent effect on those responsible for violating laws and regulations on environmental protection and provisions for managing environmental permits. Research is carried out to implement environmental protection and the government must also provide penalties to prevent environmental damage.