Critical View Research Articles

Gallbladder sinistroposition (left-sided) finding in laparoscopic cholecystectomy, a case report

A left-sided gallbladder (LSGB), also known as sinistropostition, is a rare anatomical variant with a reported incidence of 0.2-1.1%. It is defined as a gallbladder located on the left side of the falciform ligament, embedded in the third hepatic lobe, without situs inversus viscerum. A 37-year-old Latino man with a history of bilateral inguinal repair underwent a scheduled laparoscopic cholecystectomy due to multiple gallbladder polyps. Preoperative ultrasound reported a gallbladder of 60x20 mm, wall thickness of 1 mm, with polyps of up to 10 mm. Standard laparoscopic cholecystectomy trocar placement was used. Upon revision of the right hepatic lobe, there was an absence of the GB in the visceral side of segments IV, V, or VI. It was identified to the left of the falciform ligament with adhesions to the anterior and superior portions of the pylorus and lesser curvature. The subxiphoid trocar was adjusted to the left of the falciform ligament, and Calot’s triangle dissection was performed to obtain a critical view of safety. No other anatomical variants were identified. The procedure was performed safely with a satisfactory view of critical cholecystectomy steps and anatomy identification. After the procedure, the surgeon complained of right-hand pain and numbness due to a medial position of the subxiphoid trocar for dissection. The surgical approach of a LSGB in laparoscopic surgery should be individualized for each patient. A minimally invasive approach may be realized successfully when critical thinking by the surgeon is applied and always prioritizing the safety of the patient.

Water Supply Systems in Urban Slum Communities in Lagos, Nigeria: Between Self-supply and Co-production

By investigating the contribution of the ‘informal sector’, this article explores the resourcefulness of place-based practices and how they shape the urban water provision in Lagos. It also provides a detailed and critical view of the enormous efforts of inhabitants in urban slums in the daily water provision. Analysing the qualitative field data collected from observations, 89 semi-structured interviews (field notes), 6 focus group discussions and 12 expert interviews, water supply systems, the utilisation in slum communities and power and politics around it are exposed. Even if people can afford to pay the bills, the provision of urban services by state actors (or commissioned firms) is erratic and often not available. The daily infrastructure provision remains the responsibility of individuals and groups, mostly organised in complex yet fragile and changing networks. Drawing from the research on the existing, largely informal water supply in slum communities, this article argues for the recognition and pro-active implementation of hybrid approaches in the planning, implementation and administration of urban infrastructure. It calls for co-production and ‘hybrid water governance’.

Latent Graph Representations for Critical View of Safety Assessment.

Assessing the critical view of safety in laparoscopic cholecystectomy requires accurate identification and localization of key anatomical structures, reasoning about their geometric relationships to one another, and determining the quality of their exposure. Prior works have approached this task by including semantic segmentation as an intermediate step, using predicted segmentation masks to then predict the CVS. While these methods are effective, they rely on extremely expensive ground-truth segmentation annotations and tend to fail when the predicted segmentation is incorrect, limiting generalization. In this work, we propose a method for CVS prediction wherein we first represent a surgical image using a disentangled latent scene graph, then process this representation using a graph neural network. Our graph representations explicitly encode semantic information - object location, class information, geometric relations - to improve anatomy-driven reasoning, as well as visual features to retain differentiability and thereby provide robustness to semantic errors. Finally, to address annotation cost, we propose to train our method using only bounding box annotations, incorporating an auxiliary image reconstruction objective to learn fine-grained object boundaries. We show that our method not only outperforms several baseline methods when trained with bounding box annotations, but also scales effectively when trained with segmentation masks, maintaining state-of-the-art performance.

Impacts and challenges of eSocial in the accounting environment

In an increasingly technological world, accounting professionals cannot be left behind and must be constantly updated. An example of this advance is eSocial, a tool created by the Federal Government in the SPED project to submit labor information. Thus, both the accountant and the supervisory bodies needed to adapt to this reality and the internal and external environment. Thus, the study aimed to analyze the perception of accountants about the effects of contingency variables in the implementation of eSocial. The sample involved 103 accountants enrolled in the Regional Accounting Council of the state of Santa Catarina (CRC/SC), predominantly female. Data were analyzed using descriptive statistics, information entropy, and Pearson correlation. The results show that most respondents agree that their work environment has undergone organizational restructuring and cultural changes. Still, they are not sure about the impact of the implementation of eSocial by the government or that they are 100% prepared to manage the information generated by eSocial. Regarding the technology contingency variable, accountants believe it helps communicate between accounting and the tax authorities and between accounting and companies. Still, it also partly bureaucratizes the implementation of eSocial. It was also possible to observe that there is no agreement on the lack of technological improvement by the government, and most do not believe that the accounting software they use helps in submitting the eSocial. There was a mean relationship between the contingency variable that makes up the environment and the implementation of eSocial. It was possible to perceive a mean relationship between the technology contingency variable and the implementation of eSocial. Given the above, it can be concluded that contingency factors, even if moderately and even if often without the knowledge of accounting professionals, are present in accounting offices, especially in the implementation of eSocial. Thus, the study contributes to the scarcity of research linking contingency theory with eSocial. And yet, in a complementary way, it contributes to the government seeing through the eyes of accounting professionals what were their main difficulties with eSocial and their critical view of the government’s management of this data.

Depresi pada Tokoh Kiriyama Rei dalam Anime Sangatsu no Raion

This research focuses on the depression of the character Kiriyama Rei in the anime Sangatsu no Raion. The purpose of the research is to analyze the symptoms, causal factors, and impact of depression on Kiriyama Rei. The theories used are literary psychology theory by Wellek and Warren and cognitive theory of depression by Beck and Alford. Informal and descriptive methods are used as research methods. The method of data collection is the method of observe and note taking. In the data analysis stage, the descriptive analysis method is applied and in the data analysis presentation stage, the informal method is applied. Based on the results of the analysis, the symptoms of depression experienced by Kiriyama Rei are affective group in the form of emotions of sadness, motivational group in the form of desire to escape and loss of motivation, negative group in the form of negative view of self, negative interpretation of experience, and critical view of the future, and physical and vegetative group in the form of sleep disorders. The causative factors of Kiriyama Rei depression are specific stres and non-specific stres. The effects of Kiriyama Rei depression are negative view of self, negative view of life experience, and negative view of the future. Kiriyama Rei was declared a depressed patient because she experienced more than five symptoms of depression in a few weeks

Potret Kesedihan Tokoh dalam novel Gerhana Kembar karya Clara NG

This study aims to describe the portrait of sadness experienced by the main character in the novel Gerhana Kembar by Clara Ng. The type of research used is literary research with descriptive method. The methodological approach used in this research is literary psychology, with the theoretical framework of the Five Stages of Grief from Kübler-Ross (1969). The data source in this research is the novel Gerhana Kembar by Clara Ng published in 2015 by Gramedia Pustaka Utama. The data collection technique consists of intensive reading and understanding the contents of the novel carefully and meticulously to gain an understanding of the novel, marking the characters' speech and narration in the novel that is in accordance with the research problem, inventorying the required data contained in the novel. Data analysis techniques in this study are classifying data, analyzing data and connecting with theory and providing critical views, drawing conclusions from the analyzed data. The results of the analysis show that the stages of the main character's grief include the five stages of denial, anger, bargaining, depression and acceptance caused by the loss of valuable things, separation, changes in atmosphere and environment, conflicts in relationships and provide psychological impact and physical impact.

Towards a more effective REACH legislation in protecting human health.

There is growing evidence indicating the substantial contribution of man-made products to an increase in the risk of diseases of civilization. In this article, the Belgian Scientific Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) Committee gives a critical view on the working of REACH. The current regulatory framework needs to further evolve taking into account data generated using modern science and technology. There is a need for improved assessment process not only before but also after entering the market. Objectivity, transparency, and the follow-up after market access can be optimized. Additionally, no guidance documents exist for regulation of mixture effects. Further, the lengthiness before regulatory action is a big concern. Decision-making often takes several years leading to uncertainties for both producers and end users. A first proposed improvement is the implementation of independent toxicity testing, to assure objectivity, transparency, and check and improve compliance. A "no data, no market" principle could prevent access of hazardous chemicals to the market. Additionally, the introduction of novel testing could improve information on endpoints such as endocrine disrupting abilities, neurotoxicity, and immunotoxicity. An adapted regulatory framework that integrates data from different sources and comparing the outputs with estimates of exposure is required. Fast toxicology battery testing and toxicokinetic testing could improve speed of decision-making. Hereby, several improvements have been proposed that could improve the current REACH legislation.

For a more reflexive and humanistic scientific education: the contribution of Sandra Harding’s critical view of science

This text aims to present a synthesis of the main ideas of Sandra Harding’s critical feminist epistemology of science, with the aim of integrating these ideas into science education for the development of more reflective, humanistic citizens resistant to any form of discrimination. Some contemporary epistemological views are brought into dialogue, with the goal of inspiring students and teachers in basic education to rethink stereotypical conceptions of science that still persist today. Given the complexity and theoretical scope of Harding’s analysis, we focus on one of her main works and some articles. We hope that the concepts and layers discussed here can stimulate debates about feminist thought and encourage some teachers to discuss aspects of epistemology and the history of science in their science classes, bringing different perspectives to the process of scientific evolution.

Analysis of Criminal Policy against Perpetrators of Terrorism Crimes: Perspectives on the Death Penalty and Human Rights in Indonesia

The extent of the terrorist network in Indonesia threatens the threat and integrity of the Republic of Indonesia, manifested in broad trends, organization and systematic networks. Terrorist attacks are increasingly brutal, targeting innocent civilians. The threat is increasingly complex with increasing radicalization and online recruitment, requiring comprehensive action, including cooperation with government agencies, security forces, intelligence, and civil society, as well as a comprehensive approach involving intelligence, community participation, and addressing the root causes of radicalization to eradicate terrorist networks . Eradicating criminal acts of terrorism is a serious challenge for the Indonesian government, with one of the complicated aspects being the implementation of the death penalty against perpetrators of terrorism. This article analyzes Indonesian criminal policy, explains the method of punishment, the Human Rights (HAM) perspective, and critical views on the death penalty. In conclusion, it is important to strike a balance between efforts to enforce the death law and the desire for the principles of human rights and justice in the context of eradicating terrorism. Continuous evaluation of the application of the death law and open dialogue involving various parties are the keys to reaching an agreement that upholds humanitarian values and justice in efforts to overcome criminal acts of terrorism in Indonesia.

‘It is the Dose That Makes the Poison’ – A Critical View on Dose Level Setting in Extended-One Generation Reproductive Toxicity (EOGRT) Studies

Adequate dose level setting is essential for the evaluation of the toxicity of a substance, meaning that the dose level should not be too low to miss the potential of a substance to exert any toxic effects; it should also not be too high to induce various effects related to systemic toxicity that would hamper a proper evaluation of specific toxicity endpoints such as reproduction and fetal development. This discussion paper is meant to highlight the challenges faced by industry as a result of ECHA’s advice to select high dose levels when conducting EOGRT studies. In our view, in its concern for finding all possible hazards, ECHA is focused on testing at dose levels that may be too high for repeat dose toxicity studies. Such high dose levels may lead to an unethical increase in animal use and animal suffering, an inability to correctly interpret results and unacceptable requests for the repetition of studies leading to an even higher demand for experimental animals.

Political Party and Election in Indian Democracy: A study of Acharya Vinoba Bhave’s critical view

Acharya Vinoba Bhave was a non-violence activist, freedom activist, social reformer, and spiritual teacher. An avid follower of Mahatma Gandhi, Vinoba Bhave upheld his concepts of Sarvodaya and tried to make a new social order on love, peace, and ahimsa in India. He dedicated his life to serving the poor and the downtrodden and stood up for their rights. For most of his adult life, he led an ascetic style of existence centered on spiritual beliefs of right and wrong. He is best known for his 'Bhoodan Movement' (Gift of the Land). Vinoba once said, "All revolutions are spiritual at the source. All my activities have the sole purpose of achieving a union of hearts.”He strongly raised his voice against dominant party politics, corruption in electoral procedure, and parliamentary democracy in India. He gave his critical views on Indian democracy to establish a caste-less, classless, and egalitarian society in India. As a Gandhian follower, he never compromised with truth, justice, and people’s rights and justice.

The Swedish Apparatus of Contract Archaeology and its Entanglement with Society

The Swedish contract archaeology (CA) system has witnessed changes and new goals in the last couple of decades, becoming more steered by the market while new demands have come from Swedish cultural heritage legislation and policies for producing relevant knowledge to society and widening the inclusion of the public. In this paper I examine the Swedish CA system and programs from its three main parties, according to critical heritage studies by Rodney Harrison, especially focusing on the governing tool ‘apparatus’. Criticism, conveyed for instance in a recent survey, has claimed that the apparatus of Swedish CA is unsustainable and inefficient in its present form. This includes deficiencies in the relationships between the parties and with actors and stakeholders outside the system. There is also a democratic discrepancy towards the new heritage goals. I suggest that Harrisons critical view on heritage could be used to argue for changes in the role and boundaries of Swedish CA, taking into accord the conditions of local contexts, interests and needs of communities. An active stance for a more dialogical and inclusive nature of communication could diminish the risk for dissonance, conflict, and negative impacts while creating conditions for positive outcomes and values in society.

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.