Critical View Research Articles

Aberrant anatomy in the context of the critical view of safety.

The protective impact of the Critical View of Safety (CVS) approach on the vasculo-biliary injuries during laparoscopic cholecystectomy (LC) depends largely upon the understanding of the normal and variant anatomy. Structures exposed during the acquisition of the CVS can deviate from the typical dual configuration of the cystic duct and artery (gallbladder pedicle) representing either a third (supernumerary) or atypical in course (heterotopic) element. The aim of this study was to determine the identity and the frequency of these anatomical elements and to propose anatomic schemata that can guide the achievement of CVS by surgeons. Fourteen anatomic elements that can be encountered during LC were defined by members of the Hellenic task force on the typology of safe cholecystectomy using a literature review and expert consensus. Videos of 279 LCs performed for biliary colic were reviewed noting the presence of a third and or heterotopic anatomic element. In 108 LCs these elements were sought also intraoperatively. A CVS score according to Sanford and Strasberg was assigned to each video. The normal configuration of the gallbladder pedicle was present in 233 cases (83.51%). A third element was detected in 42 cases (15.05%) and was arterial in 41 cases and biliary in 1 case. A heterotopic course concerned exclusively the cystic artery in 24 cases (8.6%). Neither of these two variant patterns compromised achievement of the CVS during LC. CVS scores improved with the addition of intraoperative assessment. Typical and aberrant anatomy of LC was defined and anatomic schemata proposed to help the surgeon better understand aberrant anatomy and confidently and safely handle any encountered element that deviates from the normal configuration of the gallbladder pedicle during laparoscopic cholecystectomy.

A Dialectical Perspective on Reflective Function and the Concept of Compensation in Jung.

The construct of mentalization has a growing resonance in the theoretical and clinical spheres across different clinical and psychotherapeutic approaches, including that of analytical psychology. The aim of this paper is to relate the Reflective Function to the concept of Compensation, as it was re-invented by Jung (1914). Beginning with the original reading proposed by Jung in his work about the "interpretation of Daniel's interpretation" of Nebuchadnezzar's dream, the authors go so far as to propose that the interpretation of dreams can be a method for critical confrontation with oneself. In this perspective, the reflective function and the compensation principle can be considered as promoters of a critical (re)view of one's own assumptions/attitudes through confrontation with other points of view. This critical (re)view must be conducted first of all in the interior life of the person. In clinical practice, reflective function and the concept of compensation serve as essential tools for seeing differently and reshaping one's understanding of self and others. A brief "modern" clinical case is provided to illustrate the practical application and therapeutic value of this approach.

FERRAMENTAS DE TRIAGEM PARA AVALIAÇÃO DO RISCO DE DEMÊNCIA: UMA REVISÃO SOBRE OS QUESTIONÁRIOS COGNITIVOS

The growing global prevalence of dementia, aggravated by population aging, highlights the need for effective strategies for its early identification and prevention. In topics with this scope, narrative reviews allow exploring and synthesizing the existing literature, offering a critical and comprehensive view of screening tools. This study reviews the main cognitive questionnaires used in dementia risk assessment, focusing on their applicability, accuracy, and limitations. The tools analyzed include questionnaires based on self-perception, informant reports, and modifiable lifestyle factors, such as the SCC-Q, AD8, IQCODE, LIBRA, and STAD. The results highlight the relevance of these tools in clinical contexts and public health programs, contributing to preventive interventions and more effective management strategies. Thus, the integration of these tools into health practices is essential to mitigate the impact of dementia on aging populations, although additional validations are needed in different cultural and population contexts.

How to safely perform laparoscopic cholecystectomy: anatomical landmarks

Bile duct injury rates in laparoscopic cholecystectomy remain higher than during open cholecystectomy. Intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. Standard laparoscopic cholecystectomy requires proper dissection of Calot’s triangle to achieve the critical view of safety (CVS). The CVS is the end product of dissection, and bile duct injuries occur before the conclusion of that process. The CVS cannot always be achieved in cases of severe cholecystitis because of technical difficulties. A complete strategy of safety should therefore include early recognition of difficulties and identification of cholecystectomies, when the CVS cannot be achieved, in order to utilize new intraoperative technologies to clarify the anatomy. Fixed anatomical landmarks can help in proper orientation to ascertain the surgical anatomy correctly during surgery. Encompassed within the review are insights into identifying critical landmarks for assessing the positioning of vital structures in compromised anatomical conditions.

Technoscience: the ambiguity of the concept and scientific profiles

Relevance. The understanding of modern science as a branch of knowledge totally integrated with technology still causes heated discussions and, as a consequence, is ambiguously perceived in the scientific community, demonstrating both the position of supporters of the appropriate use of the concept of ‘technoscience’ and the arguments of those who consider the term far-fetched and artificial. The complexity and multidimensionality of this concept makes it difficult to incorporate it into both theoretical science and the language of practitioners.The purpose of the work is to clarify whether this phenomenon has philosophical and practical value in the context of the modern stage of science development.Objectives: to review the historical development of the term and to identify its three profiles in the scientific context; to analyse the epistemological, ontological, political and ethical aspects of technoscience; to show the mutual process of internal entry of science into technoreality and technology into science, the convergence of their values and approaches, which eventually leads to the idea of fusion in the term ‘technoscience’.Methodology. Philosophical analysis allows to characterise and structure science at the present stage, historical approach ‒ to identify the preconditions and trace the formation of the term ‘technoscience’.Results. The concept of technoscience can be a bridge between different studies of science, technology and society, as well as contribute to the development of critical views on fashionable terms and processes. A philosophical analysis of technoscience represents an important tool to better understand current scientific trends and their impact on society. The study of technoscience can open new philosophical perspectives and stimulate a deeper discussion of the problems arising at the interface between science and technology.Conclusions. Despite its controversial and ambiguous nature, technoscience is an important philosophical tool that can help to better understand current scientific trends and their impact on society. The study of technoscience can open up new philosophical perspectives and stimulate deeper discussion of the problems arising at the intersection of science and technology.

From Having Sympathy to Showing Empathy for the Demented: A Narratological Study of the Perspectives of Characters with Dementia in Away from Her, Still Alice, and The Father

The present study discusses the challenge of choosing an appropriate narrative structure for representing the unreliable perspective of characters with dementia in cinematic adaptations. The argument is that the chosen frameworks and techniques should create sympathy and empathy in readers/audience, and the ideal empathetic adaptation should choose narratological frameworks with the lowest level of coherence, narrative distancing and external focalization. As prototypical examples, the study focuses on the cinematic adaptations of three literary texts which treat dementia as their main thematic concern: Away from Her (2007), Still Alice (2014), and The Father (2021). The study employs critical categories and conceptualizations proposed by Per Krogh Hansen regarding unreliable perspectives, as well as the critical views of Gulce Torun, the latter of whom domesticates Endel Tulving’s mnemonic functions of episodic memory in her narratological discussions regarding the rapport between unreliable perspectives and memory. The analysis identifies features of intranarrational, internarrational, and extratextual unreliability as well as corresponding features of semantic, episodic, archival, and constructivist memory in the adaptations.

VAT in the digital age proposals: critical views

VAT in the digital age proposals: critical views

How Accurate Are Surgeons at Assessing the Quality of Their Critical View of Safety During Laparoscopic Cholecystectomy?

IntroductionObtaining the critical view of safety (CVS) is considered an important step to reduce bile duct injuries during laparoscopic cholecystectomy (LC). However, existing literature suggests that few surgeons obtain adequate CVS when LC videos are directly evaluated by experts. This discrepancy calls for effective, standardized CVS teaching methods. While self-assessment (SA) remains the principal tool utilized by practicing surgeons for performance improvement, its effectiveness is controversial. The aim of this study was to compare surgeon SAs of repeated LC performance and attainment of the CVS with that of expert raters. MethodsMulti-institutional study of surgeon members from the Society of American Gastrointestinal and Endoscopic Surgeons who volunteered to participate. All surgeons were asked to submit an LC video and complete a SA of the CVS quality using the Strasberg scale (0-6 score with ≥5 score indicating appropriate CVS). The same videos were reviewed by two blinded expert raters, members of the Society of American Gastrointestinal and Endoscopic Surgeons safe cholecystectomy task force, who had received prior rater training. Surgeon self-ratings and expert ratings were compared with a Wilcoxon signed-rank test. ResultsTwenty-five surgeon-participants were recruited, 13 of whom submitted an LC video. Surgeons did not achieve adequate CVS in their first submitted video based on expert ratings. Surgeons in the SA group overestimated their performance across all four scales: Operative Performance Rating System (z = −0.36, P = 0.715), Global Operative Assessment of Laparoscopic Skills (z = −0.37, P = 0.712), Strasberg (z = −1.84, P = 0.066), and Competency Assessment Tool (z = −0.73, P = 0.465). Surgeons in the coaching group overestimated their performance on each scale as well: Operative Performance Rating System (z = −0.67, P = 0.500), Global Operative Assessment of Laparoscopic Skills (z = −1.48, P = 0.138), Strasberg (z = −1.07, P = 0.285), and Competency Assessment Tool (z = −1.21, P = 0.225). ConclusionsOur study confirms that an adequate CVS is infrequently obtained during LC in a small but national sample of general surgeons. It further adds to the existing body of literature that suggests that SA alone may be inadequate for performance improvement. Effective teaching methods such as expert or artificial intelligence coaching are needed to improve the use of appropriate CVS by surgeons that may help decrease bile duct injury risk.

Searching for Law in Its Own Right: A Fresh Look at the Demarcation Problem

Abstract In this work, I address the “demarcation problem” in law, which invites us to look for the essential properties distinguishing law from nonlaw. First, I introduce the main terms of the discussion, which has seen the traditional view that law is a distinctive practice with its own distinguishing properties pitted against the critical view that law cannot be associated with any such properties. I then turn to what I take to be the core of truth that the critics of the demarcation project have brought to our attention, showing that they have offered a compelling argument even against the most sophisticated treatments of the distinctive traits of law contained in the work of influential mainstream legal theorists. Finally, I argue that, despite the best critical efforts, the demarcation question stands. For, while the critical stance does have a point in challenging the search for necessary and sufficient properties of law, it does not follow that there is no justification at all for the demarcation project, once this project is understood as a circumscribed and context-bound quest for the properties that are fundamental to the core cases of law in a specific tradition.

A case report of a mild neurologic deficit with extensive poststroke damage to the subdominant brain hemisphere: analysis of data obtained from magnetic resonance tractography, functional magnetic resonance imaging, and electroencephalography

The severity of damage to different brain areas, including the cortex, can vary significantly in the associated neurologic deficit and reduction in the quality of life, often regardless of the lesion volume. The localization of the abnormalities plays a large part. Lesions of the dominant and subdominant hemispheres can differ greatly in both clinical features and effects on the patient’s quality of life. In this case report, a patient admitted for rehabilitation after two ischemic strokes underwent neurological and neuropsychological examination, complex instrumental diagnostics using electroencephalography, magnetic resonance imaging, computed tomography perfusion, magnetic resonance tractography, and functional magnetic resonance imaging. The patient had minimal left-sided hemiparesis, impaired regulation of voluntary activity, mild decrease in neurodynamic indicators, mildly impaired concentration, and a critical view of his condition. Neuroimaging findings demonstrated extensive postinfarction damage to the right subdominant hemisphere of the brain in the middle cerebral artery circulation. A nonconformity between the brain damage volume and the severity of its clinical signs was observed. Based on functional examination data, the dominant hemisphere was determined, and restructuring the functional centers was suggested. This clinical case was compared with similar ones, and their relationship with the data was analyzed. Information that expands the knowledge of the topography of the altered zones involved in motor and speech functions and the ability to perform arithmetic counting was obtained.

Social Features of Gorizia and Carniola as Presented in Nektere opazke ruskega profesorja by Baudouin de Courtenay

Jan Ignacy Niecisław Baudouin de Courtenay (1845–1929) was a Polish linguist who devoted a significant part of his research to Slovenian dialects and their linguistic features by largely focusing on the western Slovenian ethnic area (Gorizia, Resia as well as the Torre/Ter Valley and the Natisone/Nadiža Valley). The article focuses on his first research visit to the provinces of Gorizia and Gradisca and Carniola in the second half of 1872 and early 1873. Emphasis is on describing the local environment and its reception of Baudouin de Courtenay’s fieldwork. The article also presents his records, titled Nektere opazke ruskega profesorja (A Few Observations Made by a Russian Professor), about society in Gorizia and Carniola, which he published in the feuilleton of the newspaper Soča. His writings offer an interesting and sometimes critical view of Slovenian environment from the perspective of a foreign observer. The article focuses on the segments describing the economic and social conditions, questions regarding national identity and determination as well as the role of women in society.

Nasilje nad ženskami v politiki na družbenem omrežju X: nov način izražanja starih oblik nasilja?

The present study explores the escalating concern regarding violence against women in politics within the realm of social media. Rather than contributing to the further democratisation of public and political space, social media platforms have become conduits for thedissemination of hate speech, aggression, violence, and misogyny against women engaged in politics at various levels, be it local, national, or international. This study endeavours to address the critical questions surrounding violence against women in politics on social media and examines the related risks and consequences for women at various stages of their political careers, including parliamentarians and those only setting out on their political journeys.Employing critical discourse analysis and social network analysis, our research delves into the discourse on the X network during the two months leading up to the Slovenian parliamentary election in April 2022. Through the meticulous examination of over 300 handcollectedposts in the Slovenian language, we aim to elucidate the impact of the discourse on the X network on the pre-election events and assess the extent of violent and misogynistic content directed at women actively participating in the election campaign. Our findingsreveal that misogynistic and violent attacks published on X manifest themselves in diverse forms of expression, targeting women with high prospects of achieving favourable election results and those expressing critical views towards the government. The overarching objective of these violent and misogynistic activities transcends mere psychological harm and theinstillation of fear; instead, they aim to induce a sense of inferiority and dissuade women from active political participation, compelling them to retreat from the public sphere intothe private domain.

Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO)

Background and objectives: Laparoscopic cholecystectomy (LC) is the most commonly performed operation in general surgery in the Western World. Gallbladder surgery, although most of the time simple, always offers the possibility of unpleasant surprises. Despite progress, the incidence of common bile duct injury is 0.2–0.4%, causing devastating implications for the patient and the surgeon. This is mainly due to the failure to identify the normal anatomy properly. The literature review reveals a lack of structured knowledge in the surgical anatomy of cholecystectomy. The aim of this study was to develop a framework with a common anatomical language for safe laparoscopic and open cholecystectomy. Materials and Methods: The Hellenic Task Force group on the typology for Safe Laparoscopic Cholecystectomy performed a critical review of the literature on the laparoscopic anatomy of cholecystectomy. The results were compared with those of a clinical study of 279 patients undergoing LC for uncomplicated symptomatic gallstone disease. Results: Fourteen elements encountered during LC under the critical view of safety (CVS) approach were determined. The typical vascular–biliary pedicle with one cystic duct distributed laterally (or caudally) and one cystic artery medially (or cranially) lying at any point of the hepatocystic space was found in 66% of the cases studied. Anatomical schemata were formulated corresponding to the norm and four variations. Conclusions: The proposed cognitive anatomical schemata summarize simply what one can expect in terms of deviation from the norm. We believe that the synergy between the correct application of the CVS and the structured knowledge of the surgical anatomy in cholecystectomy helps the surgeon to handle non-typical structures safely and to complete the laparoscopic or open cholecystectomy without vascular–biliary injuries.

Employee ownership for union workers: positive outcomes and negative perceptions

ABSTRACT Unions have a complicated history with employee ownership. Prior to the institutionalisation of collective bargaining, several nascent U.S. union movements in the late 19th century put worker ownership at the centre of their thinking and practice. Since formalised collective bargaining, unions have often resisted participating in employee ownership plans due to concerns about worker financial risk and blurring labour-management boundaries. However, more recently, some unions have experimented with employee ownership as a way to increase job security, income, and worker influence on company decisions. In this exploratory paper, we first assess the prevalence and trends in unionised workers participation in employee ownership plans using Department of Labour data on collectively bargained Employee Share Ownership Plans (ESOPs), plus employee-level data from the 2002–2022 General Social Surveys (GSS). We then use GSS data to compare the effects of employee ownership on union and non-union employee outcomes such as job satisfaction, turnover intention, and quality of work life. The results show that the combination of employee ownership and unions is linked to higher wages, training, and job security but also to more critical views of the workplace and relationships with managers. Importantly, employee ownership does not diminish the perceived need for unions.

Green High-Rise Buildings

Objectives: The study aims to critically analyze green high-rise buildings and their associated challenges based on peer-reviewed journals published between 2020 and 2024, in order to understand the effectiveness of sustainable practices applied to tall buildings. Theoretical Framework: The study explores the concepts of green and sustainable buildings, differentiating their respective short- and long-term approaches in the context of building, occupant, and environmental interactions. It also considers the concept of green retrofitting, which involves upgrading existing buildings to improve their efficiency and reduce their environmental impact. Method: The research was conducted through a bibliographic review of peer-reviewed articles, focusing on terms such as “green high-rise building” and “green skyscraper.” The analysis included 72 articles categorized into four main areas: economic sustainability, water management, energy efficiency, and environmental comfort. Results and Discussion: The results indicate that elements such as green facades and renewable energy systems are widely used to reduce the environmental impact of tall buildings. Key themes discussed include energy efficiency and the economic value of green buildings. Technical and economic challenges are emphasized, but it is believed that local-scale research can help overcome these obstacles. The benefits of green retrofitting are highlighted, as it improves energy efficiency, increases property value, and contributes to climate change mitigation. Research Implications: The research suggests that sustainable practices in tall buildings are essential for sustainable urban development and mitigating the effects of climate change. Legal and public incentives are recommended to support these initiatives, promoting more resilient cities. Originality/Value: This article contributes by demonstrating how sustainable practices applied to tall buildings can address urban environmental challenges and foster conscious development. It also offers an updated and critical view of green high-rise buildings and their challenges. By identifying the most effective practices and technical and economic obstacles, it contributes to the evolution of knowledge in sustainable construction, providing a foundation for future local and interdisciplinary research.

Conventional Versus Two Ports Plus One Puncture Laparoscopic Cholecystectomy: A Clinical Trial

Background: The gold standard treatment for calculus cholecystitis is laparoscopic cholecystectomy (LC). In the conventional laparoscopic cholecystectomy (CLC), three instruments are most useful in ensuring the critical view of safety. The two ports plus one puncture laparoscopic cholecystectomy (TPPOP LC) assisted needle grasper approach upholds the laparoscopic triangulation principles and allows an accessible critical view of safety. This technique successfully reduces port numbers while maintaining equivalent surgical outcomes. Method: The main objective is to compare clinical outcomes of conventional and two ports plus one puncture laparoscopic cholecystectomy. This is a single-center hospital based interventional double-blinded randomized controlled trial that included 98 patients undergoing laparoscopic cholecystectomy at No. (1) Military Hospital (700 bedded) from 01/12/2019 to 31/07/2021. The patients were randomized into group A (CLC) (n = 49) and group B (TPPOP LC) (n = 49). This trial was registered in the ISRCTN registry with the registration number ISRCTN50339464. Results: Among total of 98 patients, 46.9% were male patients and 53.1% were female patients. Mean age in group A was 49.86 ± 7.77 years and in group B was 49.33 ± 7.69 years. Mean operation time in group A was 57.9 ± 6.7 minutes and in group B was 58.5 ± 7.1 minutes, with no significant difference (p = 0.66). Although 4.1% of patients in CLC group and 12.2% in TPPOP LC group experienced bile spillage, no other major intraoperative complications were noted. A significant difference was observed at 36 and 48 hours postoperatively (VAS: 2.69 ± 1.16 in group A and 1.94 ± 0.83 in group B at 36 hours; p = 0.005 and VAS: 1.69 ± 0.92 in group A and 1.33 ± 0.63 in group B at 48 hours; p = 0.002). Postoperative minor wound infection was detected 6.1% in group A and 4.1% in group B (p = 0.64). The mean duration of the postoperative hospital stay was 5.24 ± 1.01 days in group A and 4.98 ± 0.92 days in group B (p = 0.17). Conclusion: This clinical trial concludes that two ports plus one puncture laparoscopic cholecystectomy is as effective and safe as conventional four-port laparoscopic cholecystectomy.

Efficacy and Validity of Percutaneous Transhepatic Gallbladder Drainage as a Bridge to Surgery for Octogenarian and Older Patients With Acute Cholecystitis: A Single-Center Retrospective Observational Study in Japan.

Japan currently has a super-aged society, with a rapid increase in elderly patients in need of medical care. Determining treatment strategies for acute cholecystitis (AC) in very elderly patients with various comorbidities is often difficult. Although percutaneous cholecystostomy (PC) is a less-invasive treatment option, its impact on subsequent surgery remains debatable. This study investigated the validity of PC as a bridge to surgery in very elderly patients with AC. Of 215 patients who underwent cholecystectomy for AC at our hospital, we retrospectively investigated 83 patients aged ≥80 years-53 and 30 who underwent upfront surgery (US) and PC before surgery, respectively-to assess the treatment strategies and clinical course. The PC group had a significantly worse systemic status at diagnosis than the US group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities, which improved after PC. The elective surgery rate was significantly higher in the PC group than in the US group. Despite the high number of severe cases in the PC group, surgical quality indicators, including the conversion rate to open surgery, operative time, blood loss, and critical view of safety achievement rate, tended to be better in the PC group, without severe perioperative complications. PC followed by cholecystectomy improves preoperative conditions, including systemic inflammation status and blood coagulation abnormalities, in very elderly patients, allowing safe elective surgical treatment while securing the quality of surgery and clinical outcomes.

PUBLIC POLICIES DEVELOPED IN WOMEN'S PRISONS IN ARGENTINA

The main objective of this study is to analyze public policies aimed at disrupting women's prisons in Argentina, seeking to understand their implications for social reintegration, reducing recidivism, and respecting the human rights of incarcerated women. The study addresses programs developed in the prison context for women, analyzing the conditional guidelines of international organizations, as well as Argentine legislation that aims to promote the dignity and rehabilitation of these inmates. Based on a theoretical and methodological review, questions were raised about relative gender inequalities, the conditions of incarceration, and the challenges of resocialization. The theoretical framework includes studies on gender, criminal policies, and human rights, providing a critical and multidimensional view. A qualitative approach was used, with documentary analysis and interviews with professionals in the prison system. The final considerations reveal that, although there has been progress in external policies for the female prison population, inequalities persist and deactivate greater attention from the State and civil society. It is concluded that the effectiveness of policies depends on an integrated approach, focusing on empowering women and combating the conditions of social exclusion that many face before and after incarceration.

How I Do It: Simplified Transcystic Antegrade-only Robotic Common Bile Duct Exploration (RCBDE).

Data consistently supports a surgery-first approach to common bile duct (CBD) stones in patients with a gallbladder via laparoscopic CBD exploration (LCBDE). LCBDE has equivalent efficacy and decreased cost as compared with cholecystectomy plus endoscopic retrograde cholangiopancreatography (ERCP). However, adoption has been low due to the technical limitations of laparoscopy. We describe a straightforward and highly reproducible robotic CBDE (RBCDE) technique. A cystic ductotomy is made after obtaining a critical view of safety. Through a 5mm port, a wire-ready cholangiogram catheter is secured in the cystic duct and intraoperative cholangiogram performed. Based on stone burden, small versus large, either an antegrade balloon snowplow (push stones forward) or sphincteroplasty is performed over a wire under fluoroscopy. If concern persists for retained stones, choledochoscopy is performed. Our simplified antegrade-only RCBDE technique allows surgeons to consistently offer a surgery-first, single-stage approach to CBD stones in patients with a gallbladder.

Fostering critical views on educational technology: A cooperative inquiry with novice teachers

This qualitative study used a cooperative inquiry design to explore novice teachers’ adoption of critical views in their descriptions, perceptions, and uses of technology during student teaching and first-year teaching. Interviews, observations, written philosophy of education statements, lesson plans, and digital teaching artifacts composed the body of evidence and informed the study’s findings. In alignment with a cooperative inquiry approach, participants (n = 4) engaged in the research process alongside the authors and contributed to the findings. Findings demonstrated that intentional focus on digital equity pedagogy and student-centered technology-enabled learning (TEL) throughout educator preparation programs (EPPs) support novice teachers’ adoption of a critical lens to determine whether technology is acting as a transformative or oppressive agent in the K-12 classroom.