Uncomfortable Aspects Research Articles

Technological advancements in surgical laparoscopy considering artificial intelligence: a survey among surgeons in Germany

PurposeThe integration of artificial intelligence (AI) into surgical laparoscopy has shown promising results in recent years. This survey aims to investigate the inconveniences of current conventional laparoscopy and to evaluate the attitudes and desires of surgeons in Germany towards new AI-based laparoscopic systems.MethodsA 12-item web-based questionnaire was distributed to 38 German university hospitals as well as to a Germany-wide voluntary hospital association (CLINOTEL) consisting of 66 hospitals between July and November 2022.ResultsA total of 202 questionnaires were completed. The majority of respondents (88.1%) stated that they needed one assistant during laparoscopy and rated the assistants’ skillfulness as “very important” (39.6%) or “important” (49.5%). The most uncomfortable aspects of conventional laparoscopy were inappropriate camera movement (73.8%) and lens condensation (73.3%). Selected features that should be included in a new laparoscopic system were simple and intuitive maneuverability (81.2%), automatic de-fogging (80.7%), and self-cleaning of camera (77.2%). Furthermore, AI-based features were improvement of camera positioning (71.3%), visualization of anatomical landmarks (67.3%), image stabilization (66.8%), and tissue damage protection (59.4%). The reason for purchasing an AI-based system was to improve patient safety (86.1%); the reasonable price was €50.000–100.000 (34.2%), and it was expected to replace the existing assistants’ workflow up to 25% (41.6%).ConclusionSimple and intuitive maneuverability with improved and image-stabilized camera guidance in combination with a lens cleaning system as well as AI-based augmentation of anatomical landmarks and tissue damage protection seem to be significant requirements for the further development of laparoscopic systems.

The motivations and decision-making processes of parents who adopt older children

This article explores the motivations and decision-making processes of parents who adopt older children from the UK care system. It draws on interview data from parents from 14 adoptive families to consider what influenced their decision to adopt an older child. Data were analysed thematically, and the analysis was theoretically informed by the concept of adoption as a ‘marketplace’. The study shows how prospective adoptive parents can be influenced in their decision-making by the information they have been given or perceive about the state of the adoption marketplace and indicates that making choices and decisions around the characteristics of future children is often an uncomfortable aspect of the process. The participants cited moral reasoning and notions of fate as key factors influencing their decisions. The article concludes by making recommendations for practice.

Empirical Accounting Seminars: Elephants in the Room

Abstract Attendees of accounting empirical research seminars all too often come to view the conclusions presented in the papers as non-persuasive. This disappointing situation indicates that researchers employ data analysis methodologies which inherently support conclusions they are looking for. Such issues are rarely discussed because many participants have relied on the same methodologies – thus they have firsthand knowledge about the inherent deficiencies. The mantra becomes: “We are all aware of uncomfortable aspects of the methodologies used in our research, so why dwell on it?” Because these potential questions tend to be outside normal and acceptable bounds, I term them “elephants in the room”. Five such cases are delineated to illustrate incontrovertible problems therein. To sum it up, the elephants highlight that the purported substantive contents of most published papers will be taken with a grain of salt for the foreseeable future.

The Living Legacies of Slavery: Racism and Racial Acrobatics in North-East Brazilian Puppet Play, 1940–80

AbstractThis article probes the racially conflictual plotlines of mamulengo, a form of improvised popular puppetry in North-East Brazil. Drawing on a corpus of transcribed shows performed between the 1940s and 1970s, it shows how audacious Black protagonists – often named Baltazar or Benedito – took part in a game of racial ‘acrobatics’. By playing the roles of fools (bobos) and aggressors (desordeiros), these heroes simultaneously reproduced a racist status quo and offered a spirited and violent resistance to its abuses. While mamulengo has never been brought to bear on discussions of race in Brazil, this oft-overlooked form of cultural expression forces us to confront the uncomfortable aspects of race-making and belonging as they are elaborated ‘from below’.

Trooping the (School) Colour

Trooping the (School) Colour

A Venn diagram of vulnerability: The convergence of pediatric palliative care and child maltreatment a narrative review, and a focus on communication

Child maltreatment and end-of-life care independently represent two of the most emotion-laden and uncomfortable aspects of pediatric patient care. Their overlap can be uniquely distressing. This review explores ethical and legal principles in such cases and provides practical advice for clinicians. The review focuses on three archetypal scenarios of overlap: life-limiting illness in a child for whom parental rights have been terminated; life-threatening injury under CPS investigation; and complex end-of-life care which may warrant CPS involvement. While each scenario presents unique challenges, one consistent theme is the centrality of effective communication. This includes empathic communication with families and thoughtful communication with providers and community stakeholders. In almost all cases, everyone genuinely wants to do what is in the best interest of the child in these unthinkable circumstances. Transparent and collaborative communication can ensure that broad perspectives are considered to ensure that each child gets the best possible care in a manner adherent with ethical and legal standards, as they apply to each case.

Surfing with shivers: the Gothic Far North Coast in poetry

In 2015 Australian world champion surfer Mick Fanning disappeared behind a wave during a surfing competition, just as a great white shark’s fin rose up out of the water. The frantic fish thrashed about, knocking Fanning off his surfboard, leaving horrified viewers unsure of his fate (Lutz, 2015). The live television footage, broadcast to millions, became an uncanny reminder of one of the most uncomfortable aspects of surf culture: shark attacks. In fiction, memoir and creative nonfiction writing about surfing that acknowledges the underlying threat sharks represent, their presence in the line-up is referred to using euphemisms, ‘men in grey suits’ (Orgias, 2012), their impact is compared to being hit by a car with teeth (Adolph, 2019), and the aftermath of their interactions with humans is either horrific and tragic, or the inspiration for stories of resilience and adaptation (McAloon, 2016). The depiction of sharks in surfing culture is either darkly humorous or steeped in mythology (McCarthy, 2020). It is for these reasons the depictions fit within a Gothic tradition. My previous work on Australian coastal Gothic writing (Hawryluk, 2020) describes a place with underlying Gothic tones. The town of Ballina on the Far North Coast of New South Wales is one such place, becoming known internationally for a spate of shark attacks between 2015-2016 (McVeigh, 2016). This paper adds to existing Australian coastal Gothic writing and research focused on surf culture and depictions of interactions between surfers and sharks. A suite of my creative nonfiction poetry featured within demonstrates the Gothic elements present in Ballina’s history of shark attacks, interactions, and the way the town and its surfers have responded to its reputation as ‘shark city’ (Smith, 2016).

Heroes and hierarchies: the celebration and censure of victimhood in transitional justice

ABSTRACT Victims of past abuses are often the subject of transitional celebration, with previously marginalised and disrespected identities afforded recognition and support. Yet, the celebration of certain variants of victimhood and the censure of others readily lends itself to the creation of hierarchies of victimhood where those who consider themselves or are considered by others to be ‘good’ or ‘innocent’ victims dispute the ‘deservingness’ of other ‘bad’ or ‘impure’ victims. Based on fieldwork in Northern Ireland, this article deconstructs the creation of hierarchies of victimhood within a transitional context. It draws on three overlapping themes – hierarchies of ‘good’ and ‘bad’ victims; hierarchies and heroes for the cause; and hierarchies and ‘the silence of social opprobrium’. The overlapping connections between these three strands illustrates that the idea of a hierarchy of victimhood is in fact much more problematic than a simple division along communal lines. Rather, hierarchies of victimhood are predicated on highlighting the victimhood of one’s own heroes while silencing the uncomfortable aspects of one’s past. The result is not only a partial representation of who ‘counts’ as a victim, but the failure to recognise the victimhood of the vast majority of those affected by the conflict – members of the civilian population.

‘Look under the sheets!’ Fighting with the senses in relation to defecation and bodily care in hospitals and care institutions

This essay focuses on sensory aspects of care in situations surrounding defecation in hospitals and other care institutions. Sensory activity does not merely encompass pleasant experiences that enhance healing and...

Revisitando responsabilidades e violência através de agentes religiosos, na África do Sul e no País Basco.

Este texto trata de aspectos novos e desconfortáveis que enfatizam processos de gestão da violência interna e reconstrução nacional. Especificamente, analiso mobilizado por agentes religiosos que questionam esses esforços, mostrando outras figuras de responsabilidade e de sofrimento que normalmente são minimizados para colocar todos os olhos e dispositivos no atividades vítima-agressor essencializada par. Discuto isso a partir de exemplos de dois contextos diferentes: o pós-apartheid da África do Sul e o processo de paz basco (Espanha). O material etnográfico aborda os efeitos e várias facetas que envolvem pedidos de "restituição" mobilizada pela entidade sul-Africana Restitution Center que, sem abandonar a categoria de reconciliação que dominava o CVR, visa sensibilizar a comunidade branca sobre sua dívida, a sua responsabilidade durante o apartheid. O segundo é xm registro etnográfico de um mobilizados pela Diocese de Bilbao (País Basco) "BAKE topaketa, Encontro para a Paz", que visa sensibilizar o público em geral sobre casos de evento vítimas menos conhecidas, que por sua vez têm relacionamento com os vitimadores do ETA (organização ETA). É interessante pensar na complexidade das dimensões que englobam processos de violência interna que, com o passar dos anos, mostram novas facetas e novos protagonistas. A dimensão religiosa aqui funciona como uma força motriz para outros movimentos, através de especialistas ativistas religiosos, com sua retórica e recursos específicos.

Clinical Desire for an Artificial Intelligence-Based Surgical Assistant System: Electronic Survey-Based Study.

BackgroundTechniques utilizing artificial intelligence (AI) are rapidly growing in medical research and development, especially in the operating room. However, the application of AI in the operating room has been limited to small tasks or software, such as clinical decision systems. It still largely depends on human resources and technology involving the surgeons’ hands. Therefore, we conceptualized AI-based solo surgery (AISS) defined as laparoscopic surgery conducted by only one surgeon with support from an AI-based surgical assistant system, and we performed an electronic survey on the clinical desire for such a system.ObjectiveThis study aimed to evaluate the experiences of surgeons who have performed laparoscopic surgery, the limitations of conventional laparoscopic surgical systems, and the desire for an AI-based surgical assistant system for AISS.MethodsWe performed an online survey for gynecologists, urologists, and general surgeons from June to August 2017. The questionnaire consisted of six items about experience, two about limitations, and five about the clinical desire for an AI-based surgical assistant system for AISS.ResultsA total of 508 surgeons who have performed laparoscopic surgery responded to the survey. Most of the surgeons needed two or more assistants during laparoscopic surgery, and the rate was higher among gynecologists (251/278, 90.3%) than among general surgeons (123/173, 71.1%) and urologists (35/57, 61.4%). The majority of responders answered that the skillfulness of surgical assistants was “very important” or “important.” The most uncomfortable aspect of laparoscopic surgery was unskilled movement of the camera (431/508, 84.8%) and instruments (303/508, 59.6%). About 40% (199/508, 39.1%) of responders answered that the AI-based surgical assistant system could substitute 41%-60% of the current workforce, and 83.3% (423/508) showed willingness to buy the system. Furthermore, the most reasonable price was US $30,000-50,000.ConclusionsSurgeons who perform laparoscopic surgery may feel discomfort with the conventional laparoscopic surgical system in terms of assistant skillfulness, and they may think that the skillfulness of surgical assistants is essential. They desire to alleviate present inconveniences with the conventional laparoscopic surgical system and to perform a safe and comfortable operation by using an AI-based surgical assistant system for AISS.

Safeguarding Ayrshire’s Coalmining Past: Heritage, Nostalgia and Social Memory

Scotland’s industrial past is central to its national narrative, and heritage discourse has long focused on engineering and technical achievements. However, this article considers another facet of industrial heritage, one which is local, engages with deindustrialisation and, initiated from the grassroots, projects the vision of working-class communities. Focusing on the example of the Barony colliery in East Ayrshire, a former deep mine in the south west of Scotland, it explores the initiative undertaken by a local volunteer group to restore and interpret the site. This article argues that, whilst this project brings to light the multi-functional uses of heritage as a resource, it also underlines the crucial function of social memory in heritage work, particularly in districts with high levels of socio-economic deprivation twinned with a degraded self-image. Against a problematic present and future, the fostering of a sense of past and place, tinted with nostalgia, yet confronting painful and uncomfortable aspects of the past with their long-term consequences, serves healing and regenerative purposes, instilling a sense of pride and dignity in communities, and ultimately striving to shore up their self-esteem.

Recent Work on Canada's Second World War

This review essay reviews three recent books on Canadian military history: Mark Celinscak's Distance from the Belsen Heap, Daniel Byers's Zombie Army, and Tim Cook's Fight to the Finish. It examines their importance to the new and challenging directions that scholarship on Canada's Second World War is taking. Celinscak and Byers provide expert engagement with little-discussed and uncomfortable aspects of Canada's war, while Cook's sweeping history provides a framework for them that will be the new standard work on the subject.

Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome.

The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound.

Troubling Freedom: Antigua and the Aftermath of British Emancipation by Natasha Lightfoot

Reviewed by: Troubling Freedom: Antigua and the Aftermath of British Emancipation by Natasha Lightfoot Lawrence Celani Troubling Freedom: Antigua and the Aftermath of British Emancipation. By natasha lightfoot. Durham: Duke University Press, 2015. 336pp. $94.95 (cloth); $25.95 (paper). Antigua has always held a unique place in the history of the Caribbean and in the history of Atlantic slavery more generally. In few places in the Leeward Islands or in the greater Caribbean, was slavery so dominant and pervasive. Antigua was also the only British colony in the Caribbean to move directly from slavery to freedom, when Antigua’s legislature emancipated the island’s slaves in 1834. Natasha Lightfoot’s book Troubling Freedom details the history of Antigua and its unique position within the British Empire, both before and after emancipation. As historians of slavery undoubtedly know, emancipation created a whole new set of issues with which the British Parliament was unprepared and ill-equipped to deal. While emancipation [End Page 298] guaranteed the bodily freedom of the enslaved people of Antigua, emancipated blacks became even more embedded in the colonial regime, and now were accountable to a state that disenfranchised them, both politically and customarily. In Antigua, both blacks and whites struggled to understand freedom on their own terms, and both engaged in a political struggle to assert their specific definition of the term. With emancipation, blacks were legally free but were still forced to engage in actions to secure their material and financial well-being. Lightfoot centers her study around the quotidian actions of enslaved and formerly enslaved blacks, whom she terms freedpeople, from actions to secure better labor and working conditions, to negotiating with their masters for the freedom to attend and participate in the island’s Sunday market, to attempts by the Moravian church to regulate the cultural and sexual lives of the black community, and freedpeople’s reactions against that. Long before formal black political and economic institutions were formed, “everyday life in postslavery Antigua was the laboratory for black working people’s politics” (p. 4). Lightfoot presents an unromanticized portrait of Antigua and of the island’s black population. A real strength of the book is her depiction of the many uncomfortable aspects that historians often overlook when portraying slave or free black communities because of the uneasiness it engenders in those who study it. Lightfoot humanizes everyday enslaved and freedpeople by portraying them as human beings who were forced to find meaning within a colonial system not of their making and the often contradictory and violent ways they went about to secure their own liberty. The black community in Antigua, both in slavery and in freedom, was neither unified nor idyllic, and Lightfoot is right to portray them as people sometimes working against the interests of other members of their community in their efforts to expand freedom’s meaning. Lightfoot, associate professor of history at Columbia University, builds on the work of a multitude of other scholars who have contributed to the historiography of abolition and newly freedpeople’s experiences in navigating that system. Historians of the Caribbean such as Rebecca Scott and Thomas Holt, to works by Steven Hahn and Eric Foner on Reconstruction in the United States provide a crucial framework for her study.1 While labor and politics is one focus of this [End Page 299] work, Lightfoot is more concerned with the everyday struggles of freedpeople, and joins a recent trend of scholars, like Melanie Newton, Roseanne Adderley, among others, who emphasize the daily struggle of freedpeople who worked to extend the narrow and incomplete freedom granted to them by the British Government.2 Her first chapter serves the purpose of orienting the reader into the social, cultural, and legal context of Antigua and its sister island of Barbuda in the period directly preceding emancipation. Much of the difficulties that followed emancipation can be traced to the limits of the island’s scarce land resources and geography. Slaves formed what she terms a “rival geography and alternative social milieu” (p. 55), where slaves expanded the spatial limits of their freedom, which helped to differentiate the island from others in the British Caribbean. The 1831 Sunday Market Rebellion is...

Uncomfortable aspects in Hegelian concept of freedom:the rivality between its introversive and extroversive kinetics

Uncomfortable aspects in Hegelian concept of freedom:the rivality between its introversive and extroversive kinetics

I am not a tourist: Aims and implications of “traveling”

Popular reaction against the uncomfortable aspects of modern mass tourism has led to the emergence of new forms of cross-cultural travel. One important form is traveling, in which self-described “travelers” aim to dissociate themselves from tourism altogether. As travelers, rather than tourists, these people present themselves as engaged in a morally superior alternative that does not create the same problems as tourism. This article shows that in the light of critiques of mass tourism, traveling in fact exacerbates existing problems raised by these critiques, in the domains of economic inequity, mobility, and representation. The failure of traveling to overcome these problems of tourism lies in the travelers’ fixation on having “authentic” experiences and in their interpretation of the authentic non-West as being outside modernity.

유아(幼兒) 실내복 개발을 위한 착의실태 조사 -만 3~6세 유아를 중심으로-

Clothes for a 3 to 6 year-old toddler should be made in consideration of their behavioral characteristics since it is when the physical ability of toddlers has rapidly developed and their social, emotional, and cognitive development are increasingly active. Indoor clothes are the item that consumers prefer because they provide the function of outside underwear when functioning as outerwear when indoors that is used frequently for toddlers. We analyzed the wearing condition and the uncomfortable aspects of toddler's clothes worn indoors through consumer surveys of toddler wear. This study gathers data for the development of indoor clothing that is useful for 3-6 year old toddlers. Consumer surveys indicate that the clothes most worn indoors were underwear (69.4%). The most important aspect in the selection of indoor clothes was the suitability for activities (29%). The preferred colors for indoor clothes were found to be pastel-tone colors (66%). Regarding the uncomfortable aspects of indoor clothes, knees of the clothes (36.8%) have the most naps and the breast of the clothes (37.8%) dirty quickly. Knee parts (35.4%) become worn easily; in addition, the material for the knee area is likely to have naps and require special functions. In conclusion, designing toddler clothing requires elaborated design techniques that consider the characteristics of the subject group and reduce inconveniences. This study will serve as preliminary data to develop ultimate products that have the functionality to meet gender behavior characteristics and the aesthetics for toddlers 3 to 6 years of age.

Emotions and ‘getting by’: a pre-service teacher navigating professional experience

Professional experience is a field increasingly defined by institutionally prescribed practices and outcomes. However, for the pre-service teacher, at an individual level, it is commonly navigated through complex and diverse experiences that for them may defy coherence. What is publicly shared is filtered frequently through a pre-service teacher's own hesitancies and censors. These influence what is deemed by them to be appropriate and strategically wise to share, as well as their perceptions of what needs to be accommodated within institutionally sanctioned versions of the ‘good’ teacher. Drawing on Deborah Britzman's work over the past two decades and, in particular, her claim that teacher becoming is a ‘struggle for voice’, this paper focuses on the three dimensions of ‘voice’ – biography, emotion and institutional structures. In attending to the more personal and emotional within one pre-service teacher's journey through Internship, questions are raised as to how teacher educators can productively work with the more difficult and uncomfortable aspects of pre-service teachers' learning and identity formation.

Rural property restitution in Germany's New Bundesländer: the case of Bergholz

Property restitution has been a widespread fact of life in Germany's New Bundesländer—the former German Democratic Republic or East Germany—since unification in 1990. It has widely been viewed as essentially an urban issue, but restitution has been widespread in rural areas as well, though on a smaller scale than in the major towns and cities. This paper uses the evidence from the statistics published by the Offices for the Settlement of Disputed Property Claims, together with the results of a detailed case study in the village of Bergholz in Mecklenburg-Vorpommern, the Land in the far northeast of the New Bundesländer, to reveal the impact of property restitution on change in the rural landscape. By way of background, the paper also explains the different political contexts of restitution, including the expropriations of the Nazi era from 1933 to 1945, the land reform under the Soviet occupation between 1945 and 1949, and the expropriations of the GDR régime between 1949 and 1990. There is also a discussion of the inherent conflicts and contradictions of restitution and an explanation of how the administrative process is organised. It appears that property restitution has been absorbed with much less economic and social disruption in rural as opposed to urban areas, and that in some respects it has even provided a vehicle for confronting and laying to rest some of the more uncomfortable aspects of Germany's 20th century past.