Preferred Operation Research Articles

Are YouTube Videos Useful in Robot-Assisted Segmentectomy Education?

Segmentectomy operation became a preferable operation for small lesions due to the importance of saving lung parenchyma. Using robotic technology has too many advantages for segmentectomy operations. Websites such as YouTube have become educational tools for surgical trainees. The aim of our study is to analyze YouTube videos for accurate and up-to-date information about robotic segmentectomy operations. The videos on www.youtube.com, which were reached on July 11, 2024, by using the keywords 'Robot segmentectomy' and 'Robotic segmentectomy lung', were evaluated in this research. The videos were evaluated by using the Journal of the American Medical Association (JAMA) scoring system, critical view of safety (CVS), and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). Eighty-one videos were included. Almost half of the videos (n = 42) were affiliated with university hospitals. Preoperative imaging was seen in 49% of all videos; however, the rates were 32% and 20.9% for patients' demographics and preoperative assessment information, respectively. Only 29.6% of the videos presented the placement of trocars during the presentation. It has become possible to record high-quality videos easily with developing technology. However, our results showed that many of the videos don't include the parameters, especially related to education. Therefore, we believe that those videos are inadequate for trainees.

Fuel consumption analysis and cost overview of mechanical vehicles in petroleum drilling rig

During the drilling activities carried out before the use of Petroleum and Geothermal Energy resources, daily fuel consumption occurs depending on the operational diversity of the mechanical components of different types of rigs in our country. In this study, a time-dependent financial analysis of the preferred operating procedure and fuel consumption during drilling operations was performed, both in engineering studies and in order to reach a predictable level in terms of cost, oil drilling operations were mentioned by drilling rig type today, and comparisons of mechanical evenings were made to provide an economically predictable earning environment for daily fuel consumption. As a result of the research and findings, Group Motors/Drawworks, Pump Motor and Generators were actively used during the idling of mechanical evenings, and the average daily diesel consumption of 23.61 lt/h, 45.8 lt/h and 33.3 lt/h was reached, respectively. Maneuver Opr. the average daily diesel consumption of 37.5 lt/h, 0 lt/h and 39.58 lt/h was reached based on the active use of Group Motors/Drawworks, Pump Motors and Generators during the operation. Drilling Opr. the average diesel consumption of 26.24 lt/h, 129 lt/h, 33.3 lt/h and 83 lt/h respectively was reached based on the active use of Group Motors/Drawworks, Pump Motor, Generators and Top Drive.

Elbow arthritis

Most patients with primary osteoarthritis of the elbow report a history of heavy lifting work with the affected upper limb. Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drug (NSAID) intake, and intra-articular injections can provide sufficient pain relief in the early stages when used in combination. If surgery is required, many patients experience significant pain relief from joint-preserving procedures despite existing cartilage damage. Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has become established as the preferred surgical procedure. The ulnar nerve should be assessed during surgery and treated if necessary. Total elbow arthroplasty (TEP) is successful in terms of pain relief and function; however, it is recommended for older patients with advanced osteoarthritis or for whom joint-preserving procedures have failed.

Efficacy and Complications Comparison Between Emergent and Elective Laparoscopic Cholecystectomy Surgery

Background: Laparoscopic cholecystectomy (LC) is the preferred surgical procedure for treating symptomatic gallstone (GS) disease. Objectives: This study aimed to evaluate and compare the outcomes of emergent and elective LC, focusing on complications, conversion rates, duration of surgery (DOS), length of hospital stay, and post-operative pain. Methods: A total of 166 patients who underwent LC surgery at Baqiyatallah Hospital, Tehran, Iran, between 2021 and 2022 were included in the study. Of these, 64 patients underwent emergent LC, and 102 underwent elective LC. The groups were compared for complications, conversion rates, DOS, length of hospital stay, and post-operative pain. Results: The study revealed that while intraoperative complications did not differ significantly between the two groups (P = 0.14), there was a significant difference in the conversion of surgical methods from three to four trocars (P = 0.007). Additionally, more patients in the emergent group required drain insertion during surgery (P = 0.003). Regarding post-operative outcomes, no significant differences were observed between the emergent and elective LC groups in terms of local (P = 0.77) and systemic complications (P = 0.37). However, patients in the elective LC group experienced a significantly shorter post-operative hospital stay (P = 0.002). Pain levels one day (1.02 ± 0.80) and one week (0.14 ± 0.43) after surgery were lower in the elective LC group. Furthermore, patients in the elective group returned to daily activities earlier (3.77 ± 1.21 days). Conclusions: The findings of this study indicate that emergent LC is as safe as elective LC. However, patients undergoing elective LC may benefit from a shorter recovery period and reduced post-operative pain. Overall, LC remains a low-risk and safe option for managing emergent gallstone cases.

Partial adrenalectomy by the posterior retroperitoneoscopic approach: A single institution series of 766 consecutive procedures.

Partial adrenalectomy (PA), as an alternative to total adrenalectomy in selected cases, allows for the preservation of adrenocortical function, especially in hereditary and/or bilateral diseases. In this study, we analyze our experience in posterior retroperitoneoscopic PA (PRPA) and its impact on adrenocortical function. From January 2010 to December 2023, 709 PRPAs were performed on 766 adrenal glands in a total of 697 patients (421F; 276M; and mean age 49.3±15.3). Patients suffered from all types of adrenal tumors (239 pheochromocytoma, 225 Conn's syndrome, 102 Cushing's syndrome (CS), 66 nonfunctioning adenomas, 38 adrenal metastases, and 27 others). Mean tumor size was 2.7±1.5cm. Bilateral disease occurred in 135 patients (60 pheochromocytoma, 19 Conn's syndrome, 32 CS, 2 nonfunctioning adenomas, 17 adrenal metastases, and 5 combined diseases). Mean operating time for unilateral operation was 39.2±17.2min. Minor postoperative complications were observed in 1.5% and major complications in 0.1%. The median hospital stay was 2days. In bilateral cases, 18 of 33 (54%) Cushing patients and nine of 102 (9%) non-Cushing patients received corticosteroid replacement therapy (CRT) early postoperatively. Long-term follow-up data were collected for 242 patients (35%). After unilateral surgery, only patients with CS required CRT (8/24). Eleven (24.4%) out of 45 patients with bilateral non-Cushing disease needed CRT. Eight patients (3%) developed ipsilateral recurrent disease. PRPA is a safe procedure with a low complication and recurrence rate. This makes it the preferred operation in cases of bilateral disease and for selected patients with benign pathologies.

Arthroscopic Partial Meniscectomy in Adult Patient with Symptomatic Discoid Lateral Meniscus: A Case Report

Introduction: For many years, the discoid meniscus was synonymous with snapping knee syndrome. incidence of discoid lateral meniscus is estimated to be 0.4% to 17%, whereas the discoid medial meniscus is extremely rare (0.1% to 0.3%). It has been reported that about 20% of cases are bilateral. Patients with discoid lateral meniscus (DLM) often show normal plain radiography findings but may also show subtle indirect signs. Case Presentation: Female, 59 years old, complained of pain on her left knee after walking and climbing stairs for the last two months. On examination, the range of motion of knee joint was limited due to the pain for flexion more than 90°. Patient had medial joint line tenderness, and a McMurray test elicited pain on the lateral joint line. Radiographs of the left knee showed lateral joint space widening and high fibular head. Arthroscopic examination of the left knee confirmed the presence of discoid lateral menisci (DLM). Discussion: Discoid lateral meniscus (DLM), often referred to as "popping knee syndrome," is an abnormal variation of the meniscus, primarily affecting the lateral side and more common in young individuals. This condition increases the risk of knee injury, especially if the ligament attachment to the tibia is absent. In our case, radiographic findings and a positive McMurray test led to the diagnosis, confirmed by arthroscopy showing a complete DLM. While some recommend for total meniscectomy, studies suggest that partial meniscectomy can offer good initial results, though long-term outcomes may vary. Conclusion: In symptomatic DLM, surgical treatment is necessary to treat the patient. Arthroscopic partial meniscectomy is the preferred surgical procedure to treat symptomatic DLM. Keywords: Discoid lateral meniscus, arthroscopic menisectomy, WOMAC score

Bullectomy with video-assisted thoracic surgery and minimally invasive repair of pectus excavatum simultaneously

IntroductionPectus excavatum (PE) is the most common chest wall deformity. Surgical treatment with minimally invasive repair (MIRPE) is the most preferred surgical procedure. In the presence of additional pulmonary pathologies, simultaneous surgical procedures have been considered, but there are few cases reported in the literature.Case presentationMIRPE was planned for a 15-year-old male patient due to PE. The day before the surgery, the patient developed sudden onset of shortness of breath. Pneumothorax was observed on the right side in the chest radiograph. Thereupon, the surgery was brought forward. Video-assisted thoracoscopic surgery (VATS) bullectomy was performed in the left lateral decubitus position. MIRPE was then performed through the same incision in the semi-lateral decubitus position. The patient was planned to be discharged on the 7th day, but on the day of discharge, a pneumothorax on the left was observed on the chest x-ray. VATS bullectomy was performed in the left semi-lateral decubitus position. The patient was discharged on postoperative day five.ConclusionSince the long-term results of simultaneous surgical procedures are unknown. With MIRPE, results such as less pain, shorter hospital stays, and earlier involvement in social life are achieved. Keeping in mind that these advantages may be lost with additional procedures, we think that simultaneous procedures should be planned.

Outcomes of minimally invasive and open prophylactic gastrectomy for hereditary diffuse gastric cancer

BackgroundMutations in the CDH1 gene predispose individuals to hereditary diffuse gastric cancer. As these tumors can evade endoscopic screening, prophylactic total gastrectomy is often recommended. Since skill with minimally invasive surgery (MIS) has progressed, we compared CDH1 mutation carriers who underwent open vs MIS total gastrectomy. MethodsA retrospective review of 48 CDH1 carriers who underwent total gastrectomy from May 2004 to April 2023 was performed. Eight patients were excluded because they were symptomatic prior to surgery and had advanced signet ring cell adenocarcinoma. ResultsTwenty-eight open and 12 MIS total gastrectomy patients were included; one MIS case was converted to open. The groups were comparable regarding age, comorbidities, and pre-operative carcinoma identified (42 % vs 36 %). Blood loss was lower with MIS gastrectomy (200 vs 23 mL) while operative time was longer (163 vs 286 minutes). The number of lymph nodes harvested (18 vs 23) and the percentage with carcinoma (86 % vs 92 %) were not different between open and MIS approaches. Length of stay was shorter after MIS gastrectomy (7 vs 5 days). In the MIS group, there were no major post-operative complications (2.5 % open) or readmissions within 90 days (11 % open). Subsequent surgery or dilation was infrequent (18 % vs 8 %). Less weight loss was seen after MIS gastrectomy, reaching significance at 9 months post-operatively (-25 % vs −13 %). ConclusionsMIS total gastrectomy is the preferred operation for CDH1 carriers, resulting in shorter hospitalization without compromising pathology or safety. SynopsisMinimally invasive total gastrectomy performed for patients with CDH1 mutations has minimal short- or long-term complications and was associated with shorter length of stay and less weight loss than open total gastrectomy, without compromising lymph node yield or margin status.

Preferences regarding the Booster Dose of Covid-19: a cross-sectional study in Central Italy

Abstract Background Examining information sources, communication channels, and preferred content formats is crucial for adapting and improving future communication strategies in vaccination campaigns. This study aims to evaluate the information and communication preferences regarding the booster dose of Covid-19 among employees of the Central Tuscany Local Health Authority (CT-LHA). Methods From July to October 2022, a questionnaire was administered to 7,000 out of approximately 15,000 CT-LHA employees. The questionnaire analyzed communication, organizational, and access aspects regarding preferences for the Covid-19 booster dose. The sample was stratified into healthcare workers (HCWs) and non-healthcare workers (NHCWs). Chi-squared tests were performed using STATA, with the significance level set at 95%. Results The returned questionnaires were 1,885 (26.9%), with the majority being HCWs (64.4%). HCWs rated the quality of communication significantly lower compared to NHCWs, who rated it very high (p < 0.05). HCWs also rated the ease of booking the Covid-19 booster dose and access modalities to vaccination significantly lower than NHCWs (p < 0.05). NHCWs expressed a preference for receiving scientific information from Ministry of Health tutorials, while HCWs preferred information from their general practitioner (p < 0.05). HCWs preferred to receive organizational information from healthcare management, while NHCWs preferred information from vaccination physicians (p < 0.05). Additionally, HCWs preferred company operating procedures for disseminating information, whereas NHCWs preferred corporate communications circulars (p < 0.05). Conclusions HCWs and NHCWs showed differences in perceived quality of communication, ease of access to vaccination services, and preferred sources of information. HCWs rated the quality of communication and access to vaccination services lower than NHCWs. This results suggest the need for tailored communication strategies to effectively reach both groups. Key messages • Health organizations need to develop targeted communication approaches that address the specific needs and preferences of their employees. • Flexibility and adaptability are crucial to adapt communication methods and channels to strengthen vaccination initiatives and promote public health outcomes.

The effect of erector spinae plane block on postoperative pain and quality of recovery in patients undergoing percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student’s T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010, respectively). Our study results indicated that patients who received the ESP block experienced reduced pain levels and had higher QoR-15 scores compared to those who did not receive the ESP block.

Pancreatic insulinomas: Our 15-year surgical experience.

Insulinomas are rare endocrine tumors of the pancreas. The majority are benign, sporadic, and solitary. Surgery is the only curative treatment. In this study, we present our experiences with the perioperative management of sporadic and benign pancreatic insulinomas. Patients who underwent surgery for pancreatic insulinoma in our clinic between 2008 and 2023 were retrospectively reviewed. Demographic data, preferred radiological methods, surgical procedures, and morbidity and mortality data were evaluated. Patients with malignant, invasive, or familial multiple endocrine neoplasia mutations were excluded from the study. Nineteen patients underwent surgery, with a median age of 49 years (range: 33-85). Symptoms related to hypoglycemia were the most commonly observed. The tumor location was identified preoperatively in 74% of cases using computed tomography. Palpation and intraoperative ultrasound identified the tumor location in 88% of patients. Enucleation (53%) were the most common surgical procedures. Pancreatic fistula occurred in three patients (17%). While serious morbidity was lower in patients who underwent enucleation, the rate of fistula formation was higher. The accurate localization of insulinomas plays a crucial role in determining the appropriate surgical procedure. With high success rates and lower morbidity, enucleation is the recommended procedure for suitable patients.

Technological And Connectivity Conditions of Undergraduate Students of Economics, Accounting and Administrative Sciences at A Peruvian Public University

The purpose of the research was to identify the ICT and connectivity conditions of university students and how they use them in their undergraduate studies at a Peruvian public university. Data was collected from 208 students of the Professional Schools of Business Administration, Tourism Administration, Accounting and Economics enrolled in the Academic Semester 2024-1, with the support of a Google Forms survey. The results show that students mainly use laptops (90%) and cell phones (95%). They use wifi networks for their studies, 35% of them do not a c c e s s a network at the University or home. The preferred mobile operators are Claro (38.3%) and Bitel (35%). The preferred online service is Canva (48.3%). The most used social network is Facebook (88.3%), followed by Tik Tok (66.7%), Instagram (60%), YouTube (43.3%) and Twitter (25%). Technological conditions are limited to promote academic learning.

A Comparative Survey on Daily Health Habits Among iPhone and Android Smartphone Users.

Background: With the increasing use of smartphone-based lifestyle interventions, it is important to understand whether people's preferred operating system (iOS or Android) is linked to their lifestyle habits. Purpose: Our goal was to determine whether the choice of an iOS- or Android-powered smartphone independently affected daily health habits. Methods: We recruited participants for an online survey using the CloudResearch® Connect™ platform. The survey collected basic sociodemographic data, information on the participant's primary smartphone operating system, and the HLPCQ to estimate daily health habits. Results: Of the 195 participants, 54.4% identified as Android users. We found that iOS users tended to be younger, had higher estimated annual household incomes, and had higher levels of education. However, we found no statistically significant link between the operating system and the HLPCQ total score or any of its subscales. Instead, age, employment status, and estimated annual household income were found to be more strongly associated with daily health habits. Conclusion: This study did not find a significant association between the smartphone operating system and daily health habits as measured by the HLPCQ. The findings suggest that future smartphone-based lifestyle interventions should instead focus on established sociodemographic factors linked to lifestyle habits.

Optionally green: The effect of hybrid product default policy on consumer response to hybrid products

AbstractIn today's marketplace, products can feature both “green” and “non‐green” attributes and consumers, with the press of a button, can select their preferred operating mode (green vs. nongreen). In this research, we define such products as hybrid, arguing that their choice architecture design—specifically, the default operational mode—plays a pivotal role in influencing consumer evaluation and purchase behavior. In four experiments, we found that consumers view a hybrid product as more environmentally friendly when the green mode is the default setting and can be turned off (opt‐out), rather than when the green mode must be activated (opt‐in). Specifically, we show that, when efficiency (vs. effectiveness)—related attributes are valued, the opt‐out (vs. opt‐in) default policy enhances purchase behavior. Moreover, we find that this effect is mediated by green attribute centrality, in that consumers perceive the opt‐out (vs. opt‐in) default policy as more central. Finally, we find that the effect of default policy is stronger for consumers with an analytical, as opposed to a holistic, thinking style. This article contributes to both default policy and hybrid product literature and provides managerial implications for the design and promotion of hybrid products.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study.

Performing bariatric surgery on patients with a BMI of over 50kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Reliable calibration and validation of phenomenological and hybrid models of high-cell-density fed-batch cultures subject to metabolic overflow

Fed-batch cultures are the preferred operation mode for industrial bioprocesses requiring high cellular densities. Avoids accumulation of major fermentation by-products due to metabolic overflow, increasing process productivity. Reproducible operation at high cell densities is challenging (>100 gDCW/L), which has precluded rigorous model evaluation. Here, we evaluated three phenomenological models and proposed a novel hybrid model including a neural network. For this task, we generated highly reproducible fed-batch datasets of a recombinant yeast growing under oxidative, oxygen-limited, and respiro-fermentative metabolic regimes. The models were reliably calibrated using a systematic workflow based on pre-and post-regression diagnostics. Compared to the best-performing phenomenological model, the hybrid model substantially improved performance by 3.6- and 1.7-fold in the training and test data, respectively. This study illustrates how hybrid modeling approaches can advance our description of complex bioprocesses that could support more efficient operation strategies.

A Clinical Comparative Study of Thoracoscopic Anatomical Lesion Resection and Lobectomy in the Treatment of Congenital Lung Malformations

BackgroundTo explore the safety and feasibility of HuaXi thoracoscopic anatomical lesion resection (HX-TALR) in the treatment of congenital lung malformations (CLMs) in children. MethodsA retrospective review of clinical data was conducted for patients who underwent HX-TALR and thoracoscopic lobectomy (TL) in our hospital from October 2017 to March 2023. Intraoperative and postoperative outcomes were compared between the HX-TALR and TL groups. ResultsThere were 485 patients in this study, 267 of whom underwent HX-TALR and 218 of whom underwent TL. All patients underwent thoracoscopic surgery without conversion to open surgery. No patients had major complications, including bronchopleural fistula, hemorrhage, atelectasis, recurrence or reoperation. The operative time, intraoperative bleeding volume, cases with thoracic drainage tubes, postoperative hospital stay, and cases with postoperative fever in HX-TALR were greater than those in TL (P < 0.05). ConclusionsHX-TALR is safe, feasible, and retains all normal lung tissue while removing the lesion, which is expected to become the preferable operation for the treatment of CLMs. HX-TALR is a new and technically challenging procedure that needs to be carried out after training. Level of EvidenceLevel IV.

A new method for quantifying redistribution of seabirds within operational offshore wind farms finds no evidence of within-wind farm displacement

The climate crisis is driving a rapid increase in size and number of offshore wind farms to reduce carbon emissions from electricity generation. However, there are concerns about the potential impact of offshore wind farms on the marine environment. Seabirds are considered to be at risk of being displaced from preferred foraging habitat, by construction and operation of offshore wind farms, resulting in reduced energy intake or elevated energetic costs and consequent decreases in survival and/or productivity. Typically, displacement or avoidance behaviour is assessed by comparing abundance and spatial distributions of seabirds before and after an offshore wind farm is constructed. However, seabird distributions are highly variable through time and space and so discerning a change in distribution caused by an offshore wind farm from other environmental variables can be challenging. We present a new method that controls for temporal variation by examining the location of individual seabirds relative to turbines. Mean seabird density at different distances from individual turbines (0-400m) was calculated from data collected on a total of 12 digital aerial surveys of the Beatrice Offshore Wind Farm (UK), in May-August in 2019 and 2021. Mean densities of common guillemot (Uria aalge), razorbill (Alca torda), Atlantic puffin (Fratercula arctica) and black-legged kittiwake (Rissa tridactyla), both flying and sat on the water, were calculated. If the presence of turbines had no effect on seabird distribution, there should be no relationship between distance from turbine and seabird density. This was tested by simulating a relocation of turbines, relative to seabird distribution, and recalculating seabird density over 0-400m from simulated turbine locations. This was repeated to generate a bootstrapped distribution of expected densities against which observed density was compared. If displacement was occurring, mean observed density close to turbines would be significantly lower than expected density, derived from the bootstrap distribution. Overall, observed mean density did not differ significantly from expected density, i.e. no displacement effect was detected. There was a slight tendency for guillemot and razorbill, when sat on the water, to be at higher densities than expected, near turbines, suggestive of possible attraction to turbines, and for flying birds to be at lower densities than expected, near turbines, suggestive of possible avoidance. No flying razorbills were recorded within 100m of turbines but sample sizes were small. Kittiwake tended to show no avoidance or attraction behaviour, although flying kittiwake density was slightly lower than expected at 200m from turbines. Puffins sat on the water were recorded in densities similar to the expected density. Overall, no effect of turbine rotor speed was found, i.e. birds were not more likely to be displaced/avoid turbines at higher or lower rotor speeds. The results of the turbine relocation analysis gave a more consistent and more easily interpreted assessment of displacement/avoidance behaviour than the typical approaches of comparing abundance and seabird distribution through time. We strongly encourage application of this new approach to post-construction spatial distribution data from other offshore wind farms, to build the evidence base on the effects of offshore wind farms on seabirds.

Ecosystem‐level reference points: Moving toward ecosystem‐based fisheries management

AbstractObjectiveTo support the movement in marine fisheries management toward ecosystem‐based fisheries management by exploring ecosystem‐level reference points (ELRPs) as an option for managing fisheries at the ecosystem level. An ELRP is an ecosystem harvest level or indicator with one or more associated benchmarks or thresholds (i.e., targets, limits) to identify, monitor, or maintain desirable ecosystem conditions and functions.MethodsThis paper explores the development and implementation of ELRPs in fisheries management to support ecosystem and fisheries sustainability, help identify when ecosystem changes that impact fisheries resources occur, and foster discussions of trade‐offs in management decisions.ResultWe organize existing and potential ELRPs into five categories (statistical analysis of nonlinear dynamics and tipping points, ecosystem productivity, ecosystem trophic information, biodiversity, and human dimensions), provide an overview of analytical methods that can estimate ELRP benchmarks, provide examples of where ELRP benchmarks are being used today, and evaluate pros and cons of the different ELRP categories. We also attempt to identify potential next steps for fisheries scientists and managers to further the science, development, and application of ELRPs.ConclusionEcosystem‐level reference points can be used as a proactive accountability mechanism to achieve ecosystem objectives and maintain the ecosystem in a preferred operating space or as an early warning that ecosystem‐level changes (e.g., tipping points) could be imminent if current biological and ecological trends in the system continue.

Diagnosis and treatment of primary ileal pouch leaks: a 27-year experience at a referral center

Ileal pouch-anal anastomosis (IPAA) is considered the preferred restorative surgical procedure for patients with ulcerative colitis and familial adenomatous polyposis requiring proctocolectomy. Unfortunately, postoperative leaks remain a complication with potentially significant ramifications. This study aimed to provide a comprehensive description of the evaluation, management, and outcomes of leaks after primary IPAA procedures. Between 1995 and 2022, a total of 4058 primary IPAA procedures were performed at Cleveland Clinic. From a prospectively maintained pouch registry, we retrospectively reviewed the data of 237 patients who presented to the pouch center for management. Of these, 114 (3%) had undergone the index IPAA procedure at our clinic (de novo cases), whereas 123 patients had their index IPAA performed elsewhere. Data were missing for 43 patients, resulting in a final cohort of 194 patients. Our cohort had an average age of 41 years (range, 16-76) at the time of leak diagnosis. Overall, 55.2% were males, average body mass index was 24.4kg/m2, and pain was the most prevalent presenting symptom (61.8%), followed by fever (34%). Leaks were confirmed through diagnostic testing in 141 cases, whereas 27.3% were detected intraoperatively. The most common initial diagnoses were pelvic abscess (47.4%) and enteric fistulas (26.8%), including cutaneous (9.8%), vaginal (7.2%), and bladder fistulas (3.1%). By location, leaks occurred at the tip of the "J" (52.6%), at the pouch-anal anastomotic site (35%), and in the body of the pouch (12.4%). A nonoperative management approach was initially attempted in 49.5% of cases, including antibiotic therapy, drainage, endoclip, and endo-sponge, with a success rate of 18.5%. Surgery was eventually required in 81.4% of patients, including (1) sutured or stapled pouch repair (52.5%), with diversion performed in 87.9% of these cases either before or during the salvage surgery; (2) pouch excision with neo-IPAA (22.7%), including 9 patients from the first group; and (3) pouch disconnection, repair, and reanastomosis (9.3%). Pouch failure occurred in 8.4%, with either pouch excision (11.1%) or permanent diversion (4.5%). Ultimately, 12.4% of patients (24 of 194) required permanent diversion, with all necessitating pouch excision. In the 30-day follow-up after salvage surgery, short-term complications arose in 38.7% of patients. The most common complications observed were ileus, pelvic abscess/sepsis, and fever. Leaks after primary IPAA procedures represent an infrequent, yet challenging, complication. Despite attempts at nonoperative management, the success rate is limited. Salvage surgery is associated with a high pouch retention rate, underscoring its importance in the management of post-IPAA leaks.