Critical View Research Articles

Bayesian process mapping for intraoperative decision making in laparoscopic cholecystectomy

Aim: Surgeon’s intraoperative decisions significantly impact patient outcomes. In the reconciliation cycle, interoperative decisions are guided by probabilistic reasoning, which is informed by the evolving intraoperative features. This paper aims to compare the utility of a traditional logistic regression (LR) model for critical view of safety (CVS) achievement to Bayesian network (BN) maps using intraoperative features. It hypothesizes that BN mapping better integrates with surgeon heuristics. Methods: Using prospectively gathered intraoperative data, BN maps were developed and tested to determine their ability to predict critical view of safety achievement. Performance was compared to traditional logistic regression models to consider their utility in practice. Results: In total, 4,663 patients were identified. Of these patients, 2,837 (61%) presented acutely and 3,122 (67%) were female. CVS was achieved in 4,131 (92%) of patients. In total, four BN were developed. Optimal performance was seen in model 2 with an AUC of 0.879 (0.798-0.960) (P < 0.001). Selecting a cut-off of 0.6 gave an optimized sensitivity of 99% and a specificity of 45% for CVS achievement. In comparison to this, for the combined acute LR model, ROC curve analysis gave an AUC of 0.829 (0.787-0.872 ) (P < 0.001). A cut-off of 75% probability resulted in a sensitivity of 95% and a specificity of 38% for CVS achievement. Conclusion: The present study illustrates how BN modeling can map to surgeon decision making to facilitate reasoning in complex environments. Further work is needed to facilitate data capture and implementation. Despite this, they represent a promising avenue for intuitive decision support tools.

Impact of an AI-Based laparoscopic cholecystectomy coaching program on the surgical performance: a randomized controlled trial.

Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallstones but carries inherent risks like bile duct injury (BDI). While critical view of safety (CVS) is advocated to mitigate BDI, its real-world adoption is limited. Additionally, significant variations in surgeon performance impede procedural standardization, highlighting the need for a feasible, innovative, and effective training approach. The aim of this study is to develop an Artificial Intelligence (AI)-assisted coaching program for LC to enhance surgical education and improve surgeon's performance. We conducted a multi-center, randomized controlled trial from May 2022 to August 2023 to assess the impact of an AI-based coaching program, SmartCoach, on novice performing LC. Surgeons and patients meeting specific inclusion criteria were randomly assigned to either a coaching group with AI-enhanced feedback or a self-learning group. The primary outcome was assessed using the Laparoscopic Cholecystectomy Rating Form (LCRF), with secondary outcomes including surgical safety, efficiency, and adverse events. Statistical analyses were performed using SPSS, with significance set at P-value less than 0.05. Between May 2022 and August 2023, 22 surgeons were initially enrolled from 10 hospitals, with 18 completing the study. No demographic differences were noted between coaching and self-learning groups. In terms of surgical performance (LCRF scores), the coaching group showed significant improvement over time (31 to 40, P=0.008), outperforming the self-learning group by study end (40 vs 38, P=0.032). Significant improvements in CVS achievement were also noted in the coaching group (11% to 78%, P=0.021). Overall, the coaching program was well-received, outpacing traditional educational methods in both understanding and execution of CVS and participants in the intervention group expressed strongly satisfaction with the program. The AI-assisted surgical coaching program effectively improved surgical performance and safety for novice surgeons in LC procedures. The model holds significant promise for advancing surgical education.

Nudging in organizations: How to avoid behavioral interventions being just a façade

The utilization of nudging—behavioral interventions aimed at influencing the actions of employees or clients—has gained traction in organizations due to its perceived universal efficacy and cost-effectiveness. However, this paper presents a critical view, arguing that the success of a nudge is significantly influenced by a specific context, challenging the notion of it being a universal solution for organizational behavior modification. This paper highlights three primary concerns: the absence of a comprehensive behavioral change framework; an overemphasis on immediate effects and ad hoc successes at the expense of changing deep-seated motivations, decision-making capabilities, or organizational processes; and a tendency among managers to rely on anecdotal beliefs rather than robust evidence. The paper offers a framework for understanding these challenges and proposes organizational policies (training of managers and continuous organizational experimentation) to implement effective nudging strategies. This framework’s validity is supported by evidence from semi-structured interviews and focus group with industry professionals.

A comparison of genomic and phenomic selection methods for yield prediction in Coffea canephora

AbstractGenomic prediction has been proposed as the standard method to predict the genetic merit of unphenotyped individuals. Despite the promising results reported in the plant breeding literature, its routine implementation remains difficult for some crops. This is the case with Coffea canephora, in which costs and availability of molecular tools are major challenges for most breeding programs. To circumvent this, the use of near‐infrared spectroscopy (NIR) has been recently proposed as an alternative to complement marker‐assisted selection. The so‐called phenomic selection relies on the reflectance spectrum to capture similarities between individuals and emerges as a valid approach for prediction. With promising results reported in multiple annual crops, we hypothesize that phenomic prediction could be a cost‐efficient approach to incorporate into a practical coffee breeding program. To test it, we relied on a diverse population of C. canephora, evaluated for yield production, in two geographical locations over four harvest seasons. Our contributions in this paper are twofold: (i) We compared phenomic and genomic selection results, and showed large predictive abilities when NIR is used as a predictor for within and across‐location predictions, and (ii) we presented a critical view of how both information sets could be combined into a contemporaneous coffee breeding program. Altogether, our results show how multi‐omic information could be integrated in the same framework to leverage genetic gains in the long term.

An abundance of caution for a ‘stagnation nation’? Financial services policy development in post-growth Britain

This commentary discusses the relationship between the UK Labour Party and the financial services sector in the context of an approach to economic policy and growth. It highlights the historical scepticism of the Labour Party towards financial services, rooted in ideology and practical experience alongside a recognition of the need to engage with the sector to promote economic growth and investment. The Labour Party’s evolving stance towards financial services is outlined, which has oscillated between support in the 1990s and early 2000s, to a more critical view in the 2010s, with a more recent return to advocacy. The commentary draws attention to a tension in the party’s encouragement of an industry that can provide economic growth at home, while at the same time being wary of developing policies designed to provide necessary growth in other areas, such as in green technologies, but that might incur the disapproval of global financial investors. Labour’s dilemmas are illustrative of the contemporary problems of policy formation in a relatively small but open economy, where options to promote growth and green investment are constrained in the face of the disciplinary power of global financial capital.

Standardized porcine integrated robotic inguinal hernia training: the SPIRIT model.

Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the technological aspects of the robotic system but also enhancing surgical proficiency in manipulating robotic instruments. Furthermore, procedural expertise in specific surgeries is critical. Minimally invasive inguinal hernia repair is particularly suitable as an initial procedure for human application. The development of a comprehensive training model for this type of repair is a crucial element of such an educational pathway. Anatomical dissections were carried out on pigs to assess both the similarities and differences between pig and human anatomy. A structured minimally invasive inguinal hernia repair was performed to determine the suitability of the porcine inguinal region for training purposes. A detailed anatomical description of the porcine inguinal region is outlined, to provide a framework for assessing the critical view of the porcine myopectineal orifice. By integrating the human 'ten golden rules' for safe and effective minimally invasive inguinal hernia repair, the standardized porcine integrated robotic inguinal hernia training (SPIRIT) model describes a step-by-step approach to practice surgical techniques in a realistic setting. The SPIRIT model is designed to be a well-structured training model for minimally invasive inguinal hernia repair and incorporates the specific surgical steps as encountered in a human patient.

Menemukan Makna Komunikasi di Era Teknologi: Perspektif Teori Heidegger, Logos, dan Kebenaran

Heidegger's thinking about Logos and truth shifts the focus from the traditional static view to a more dynamic and processual view. By emphasizing the role of language in revealing truth, Heidegger provides a new perspective on how we understand and experience reality. The aim of this research is to describe in detail how to find the meaning of communication in the technological era as viewed from the perspective of Heidegger's Theory, Logos and Truth. This research method applies Systematic Literature Review (SLR) using PRISMA guidelines. The research results show that Heidegger's logos theory provides a critical view of modern communication phenomena, especially in the context of social media, online news and instant communication. Logos, which Heidegger understood as the basis of human understanding and rationality, risks being reduced to a mere technical tool in the digital environment. Communication that occurs on these platforms often loses depth and nuance, replaced by information fragmentation and algorithmic interests that prioritize hype and user engagement over truth and deep understanding.

Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries and is considered the standard treatment for cholelithiasis. However, it is associated with a risk of bile duct or hepatic artery injuries. This study evaluated the safety of LCs and the conversion rate (CR) by achieving a critical view of safety (CVS) and identification of Rouviere's sulcus (RS). This was a single-group cohort study that included consecutive patients undergoing LC at Smart Health Tower (Sulaimani, Iraq) from January 2021 to January 2023. The data were prospectively collected from patients' profiles or surgical notes within the hospital's database. A total of 419 patients underwent LC, of which females were the predominant gender (78.5%). The mean and median ages of the cases were 46.3±15.8 and 45 years, with a range of 2-90 years, respectively. The most common indications for surgery were biliary colic (69.5%), followed by acute cholecystitis (23.9%). The duration of the operations was significantly shorter for cases in which the CVS (45.6±17.9 min) or identification of RS (45.6±18.6 min) was achieved compared to those where the CVS (63.7±27.7 min) or RS (50.7±21.7 min) was not observed. Surgeries for patients with both CVS achievement and RS identification were also significantly less time-consuming (44.3±17.6) than counterparts (53.3±22.6). Among the cases without CVS achievement or RS identification (n=97, 23%), eight (8.2%) had adhesions, 12 (12.4%) had a distended gallbladder (GB) and 10 (10.3%) had thick GB walls. In addition, four (4.1%) experienced GB perforation, two (2.1%) had bleeding and one (1%) had stone spillage. There was no conversion. The achievement of CVS and identification of RS are practical landmarks in performing safe LC and decreasing the CR.

AN INTIMATE DIALOGUE WITH GOD IN JOHN DONNE’S “HOLY SONNETS”: PETRARCHAN CONTEXT

The purpose of the paper is to study the images of the platonic and courtly in the protagonist’s personal relations with God in J. Donne’s “Holy Sonnets” in the context of the connection with the Petrarchan tradition. In order to accomplish this, a complex approach including elements of biographical, genealogical, typological, hermeneutic, comparative, and structural-semiotic methods of literary analysis has been used. The views of literary critics on the sources of the “Holy Sonnets” (Christian meditative practices, Bible books, traditions of English religious lyrics) have been reviewed, their connection with the Petrarchan poetic tradition has been pointed out and, in this context, one of the possible interpretations of J. Donne’s sonnet sequence has been proposed. It has been shown that three poems of the sequence – XIV, XVII and XIX – are especially important and conceptual for understanding the evolution of the protagonist’s relations with God in the “Holy Sonnets”. In the first of them, feeling his own weakness and impossibility to overcome the devil, J. Donne’s persona begs the Lord to win back his heart from the enemy, using a broad palette of military metaphors typical to the Petrarchan lyrics. However, the Lord, who in sonnets I – XIII is depicted in a Petrarchan manner as distant and completely deaf to the protagonist’s pleas, remains indifferent. In sonnet XVII, which looks similar to the lyrical texts of the “Canzoniere” dedicated to Laura’s death, a notable change in the relationship between the characters takes place. As in the Italian humanist’s poems, the life path of J. Donne’s persona finally turns to heaven after the death of his beloved, and he begins to feel that the loss of earthly love is compensated by the gaining of the Divine one. However, his further relations with God, once again, seem to be built according to the Petrarchan model, most fully described in the last text of the sequence. The sonnet XIX demonstrates all the complexity of the relationship between a human being and the Lord. J. Donne’s persona is constantly dominated by conflicting feelings and emotions, which generally correlates with Petrarchan understanding of the ambivalence of love, best shown by F. Petrarch in the sonnets CXXXII and CXXXIV. Moreover, the poetic vocabulary used by J. Donne in this poem indicates the specific character of his persona’s relations with God, which are supposed to have signs of courtly love, courtly bowing-service. It has been summed up that the protagonist’s relations with the Lord in the “Holy Sonnets” might be interpreted as generally built on the same principles that are immanent in the concept of love in the poetry of Petrarchism. The persona of the English poet, as well as the traditional hero of Petrarchan texts, also suffers from unrequited feelings, longs for reciprocity with all his heart, and, in addition, speaks in the specific metaphorical language. Even if the linguistic practice utilized by the author cannot be considered exclusively Petrarchan, since a similar rhetorical code, in which the experience of spiritual communication with the Lord was described with the help of erotic images, was widely used by the Christian mystics, the sonnet poetic structure is canonical for Petrarchan lyrical discourse and require following the established rules not only in terms of form, but also in terms of content.

Terrorism, Insecurity and Youth Criminality in Nigeria: A Critical View from A Criminological Lens

Objectives: Terrorism is a global social problem that is presently receiving overwhelming attention and concern from all corners. The government, researchers, policymakers, Non-Governmental affected by the effect of this cankerworm. If left to thrive, it might drag the world into oblivion. This study examines terrorism, insecurity, and youth criminality in Nigeria: a critical view from a criminological lens Organizations, and law enforcement are all striving daily to figure a way out of this malady. This is because the impact of terrorism is devastating and destructive. Everyone is in one way or another. Methods: The study made use of Leonard Berkowitz Frustration Aggression Theory (1989) and Robert Agnew General Strain Theory (GST, 1991) to explain terrorism, insecurity, and criminality in Nigeria. The study employed qualitative study using Key Informant Interview (KII) and Focus Group Discussion (FGD) using the youths as the population or universe. Results: The study concluded that terrorism is universally abhorred and generally seen as an unlawful, barbaric, and inhuman crime. It is a crime against man and society that must not be allowed to strive because it erodes peace, destroys properties, leads to loss of lives, and stampede growth and development. Conclusions: It was recommended in this study that the fight against terrorism should be an all-embracing one. Thus, the Government, parents, citizens, and youth must all be proactive in the fight against terrorism via effective strategize.

The Structure of Lanny Oral Literature: A Critical View

The Structure of Lanny Oral Literature: A Critical View

Exploring Black parents’ critical consciousness in relation to their engagement with their children's schools

AbstractDespite consensus that parent involvement is integral to children's educational success, Black parents’ involvement remains largely characterized from a deficits‐based perspective. Using critical race and critical consciousness theories, this study explored parents’ analysis of educational inequities and their school engagement. Using interview data from a sample of Black parents (n = 20), emergent understandings of parents’ thoughts, motivations, and actions to engage with their child's school were explored. Findings revealed that Black parents held both critical and traditional views, expressed themes of internal and external efficacy in their motivation, and engaged critically and traditionally in their child's education. Results are consonant with literature on Black parents’ engagement and to the nascent understanding of how parents' beliefs about structural racial oppression within schools impacts how they engage in that space.

LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE

Abstract We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach. Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy. Surgical procedure Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.

Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype.

Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.

Surgical quality assessment of critical view of safety in 283 laparoscopic cholecystectomy videos by surgical residents and surgeons.

Surgical quality assessment has improved the efficacy and efficiency of surgical training and has the potential to optimize the surgical learning curve. In laparoscopic cholecystectomy (LC), the critical view of safety (CVS) can be assessed with a 6-point competency assessment tool (CAT), a task commonly performed by experienced surgeons. The aim of this study is to determine the capability of surgical residents to perform this assessment. Both surgeons and surgical residents assessed unedited LC videos using a 6-point CVS, a CAT, using an online video assessment platform. The CAT consists of the following three criteria: 1. clearance of hepatocystic triangle, 2. cystic plate, and 3. two structures connect to the gallbladder, with a maximum of 2 points available for each criterion. A higher score indicates superior surgical performance. The intraclass correlation coefficient (ICC) was employed to assess the inter-rater reliability between surgeons and surgical residents. In total, 283 LC videos were assessed by 19 surgeons and 31 surgical residents. The overall ICC for all criteria was 0.628. Specifically, the ICC scores were 0.504 for criterion 1, 0.639 for criterion 2, and 0.719 for the criterion involving the two structures connected to the gallbladder. Consequently, only the criterion regarding clearance of the hepatocystic triangle exhibited fair agreement, whereas the other two criteria, as well as the overall scores, demonstrated good agreement. In 71% of cases, both surgeons and surgical residents scored a total score either ranging from 0 to 4 or from 5 to 6. Compared to the gold standard, i.e., the surgeons' assessments, surgical residents are equally skilled at assessing critical view of safety (CVS) in laparoscopic cholecystectomy (LC) videos. By incorporating video-based assessments of surgical procedures into their training, residents could potentially enhance their learning pace, which may result in better clinical outcomes.

A Critical View on Virudha Aahar: Dietic Incompatibility

The three Upstambha (Aahar, Swapna, and Brahmchraya) that describe in the Ayurvedic Samhitas. These three Upstambha hold the body. The body gains strength, firmness, and Varna by carefully using these three pillars. Aahar, the first Upstambha, is helpful for keeping the body in a healthy state. However, people are now consuming improper foods in the wrong combinations. Certain drugs and dietary combinations that have traits in opposition to body elements may decrease the body's immunity. Such types of foods are referred to as Virudha Aahar in old Ayurvedic texts. This article describes how individuals nowadays consume Virudha Aahar and how it has adverse effects on the human health. What impacts do they have on each physiological system of human body?

Materials for 3D Printed Metal and Metal‐Ion Batteries

AbstractThe review provides an overview of the latest innovations, trends, and challenges in the field of 3D‐printed metal and metal‐ion batteries. It focuses on the materials used in the printing of batteries, including electrodes, electrolytes, and other electroactive components. Compared to other high‐quality reviews on the topic, this review provides a broader selection of materials that are expected to gain attention in the next few years, such as redox‐active polymers and metal‐organic frameworks. This work gives an overview and insight into the latest trends in printing techniques as well as a statistical review of their uses and strengths. We have also gathered the latest works done for each of the material types, and we have taken the opportunity to put them in context and use them to exemplify in which direction is the field going. The review concludes with a critical view of the challenges ahead and a discussion of the direction that the field is taking as well as the external factors that might help to define its future.

Map as Conceived Space: a Critical View at the Cartographic Representation of Religious Buildings in the Brazil Official Mapping

A humanidade sempre retratou o espaço por meios de mapas, transformando-os em um importante instrumento de sua representação gráfica, proporcionando uma gamade interpretações e leituras. Dentre os diferentes elementos que compõem o espaço, as edificações religiosas são usualmente representadas nos mapas oficiais através de um olhar cristão do agente público detentor do poder legal, processo que não se tornou mais inclusivo mesmo com o advento de recursos viabilizados pelas novas tecnologias. Este artigo propõe uma reflexão sobre a construção de um espaço concebido – mapa oficial normatizado pelo poder público – sem considerar a vida cotidiana e os espaços socialmente produzidos com um caráter sagrado ou de práticas de diferentes denominações religiosas e seu ocultamento/apagamento nas normativas cartográficas em vigor no país.

Critical View on the Qualification of Electronic Tongues Regarding Their Performance in the Development of Peroral Drug Formulations with Bitter Ingredients.

In this review, we aim to highlight the advantages, challenges, and limitations of electronic tongues (e-tongues) in pharmaceutical drug development. The authors, therefore, critically evaluated the performance of e-tongues regarding their qualification to assess peroral formulations containing bitter active pharmaceutical ingredients. A literature search using the keywords 'electronic', 'tongue', 'bitter', and 'drug' in a Web of Science search was therefore initially conducted. Reviewing the publications of the past decade, and further literature where necessary, allowed the authors to discuss whether and how e-tongues perform as expected and whether they have the potential to become a standard tool in drug development. Specifically highlighted are the expectations an e-tongue should meet. Further, a brief insight into the technologies of the utilized e-tongues is given. Reliable protocols were found that enable (i) the qualified performance of e-tongue instruments from an analytical perspective, (ii) proper taste-masking assessments, and (iii) under certain circumstances, the evaluation of bitterness.

EVALUATING THE EFFECTIVENESS OF THE CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY AT BINH DAN HOSPITAL

Background: The aim of this study was to assess the safety of laparoscopic cholecystectomy using "The Critical View of Safety" (CVS) technique for the management of gallbladder stone disease. Subjects and methods: Prospective study, describing a series of cases of patients undergoing laparoscopic cholecystectomy with CVS applied to treat gallbladder stones at Binh Dan Hospital from January 2022 to October 2022. Results: We enrolled 89 patients and recorded the following outcomes: the success rate was high, at 97.8%. The failure cases were due to large stones blocking the gallbladder neck and severe adhesions in the hepatocystic triangle in necrotizing cholecystitis. There is a statistically significant difference in the success rate of achieving CVS between groups: gallbladder condition (p=0.02), degree of adhesion inflammation of the hepatocystic triangle (p=0.039). The overall bleeding complication rate was 10.3% (9 cases) and during CVS was 6.7% (6 cases). The overall gallbladder perforation complication rate was 8% (7 cases) and during CVS was 4.4% (4 cases), with no biliary tract injuries. The postoperative complications included fluid collection in the gallbladder bed in 10.3% of cases and surgical wound infection in 2.3% of cases. All were successfully treated with conservative measures. Conclusion: We concluded that CVS is a necessary, safe, and effective diagnostic method in laparoscopic cholecystectomy for gallbladder stone disease.