World scientists' warning: The behavioural crisis driving ecological overshoot.

Previously, anthropogenic ecological overshoot has been identified as a fundamental cause of the myriad symptoms we see around the globe today from biodiversity loss and ocean acidification to the disturbing rise in novel entities and climate change. In the present paper, we have examined this more deeply, and explore the behavioural drivers of overshoot, providing evidence that overshoot is itself a symptom of a deeper, more subversive modern crisis of human behaviour. We work to name and frame this crisis as 'the Human Behavioural Crisis' and propose the crisis be recognised globally as a critical intervention point for tackling ecological overshoot.

Deep Learning for FAST Quality Assessment.

Objectives: To determine the feasibility of using a deep learning (DL) algorithm to assess the quality of focused assessment with sonography in trauma (FAST) exams.

Methods: Our dataset consists of 441 FAST exams, classified as good-quality or poor-quality, with 3161 videos. We first used convolutional neural networks (CNNs), pretrained on the Imagenet dataset and fine-tuned on the FAST dataset.

Ruptured Splenic Artery Aneurysm in the Postpartum Patient: A Case Series.

Introduction: The evaluation of an unstable peripartum patient in the emergency department includes a differential diagnosis spanning multiple organ systems. Splenic artery aneurysm (SAA) is one of those rare diagnoses with potentially high morbidity and mortality.

Case Series: This case series explores two unusual cases of postpartum SAAs.

Gluteal Fascial Advancement for Pilonidal Cyst Disease: A 10-year Review.

Elective excision of noninfected pilonidal cysts has historically been plagued by a high rate of complications, such as wound breakdown and recurrence. Debate remains regarding the most effective method of wound closure. We previously reported a small group of patients (n = 17 out of 83 patients) in which a novel technique decreased wound complications and recurrence.

HIDA Scan with Ejection Fraction Is over Utilized in the Management of Biliary Dyskinesia.

Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy.

A perspective on the role and utility of haptic feedback in laparoscopic skills training.

Laparoscopic surgery is a minimally invasive surgical technique with significant potential benefits to the patient, including shorter recovery time, less scarring, and decreased costs. There is a growing need to teach surgical trainees this emerging surgical technique. Simulators, ranging from simple "box" trainers to complex virtual reality (VR) trainers, have emerged as the most promising method for teaching basic laparoscopic surgical skills.

Simulator-based assessment of haptic surgical skill: a comparative study.

The aim of this study was to examine if the forces applied by users of a haptic simulator could be used to distinguish expert surgeons from novices. Seven surgeons with significant operating room expertise and 9 novices with no surgical experience participated in this study. The experimental task comprised exploring 4 virtual materials with the haptic device and learning the precise forces required to compress the materials to various depths.

Endovascular seldinger needle placement: a simulator for examining haptic skills.

In this work, we develop an affordable haptic simulator for examining haptic skills required for endovascular Seldinger needle placement.

The need for fundoplication at the time of laparoscopic paraesophageal hernia repair.

Most authors recommend an antireflux operation at the time of laparoscopic paraesophageal hernia (PEH) repair. A fundoplication combats the potential postoperative reflux resulting from disruption of the hiatal anatomy and may minimize recurrence. The purpose of this study is to evaluate the differences in postoperative dysphagia, reflux symptoms, and hiatal hernia recurrence in patients with and without a fundoplication at the time of laparoscopic paraesophageal hernia repair.

A haptic simulator to increase laparoscopic force application sensitivity.

Laparoscopic surgery demands perceptual-motor skills that are fundamentally different from open surgery, and laparoscopists must be adept at perceiving tissue interaction at the surgical site and then applying precise amounts of forces through instruments without damaging tissues. A haptic simulator that emulates multiple salient laparoscopic tasks and renders differing degrees of forces was created. Two of the haptic skills tasks were evaluated in two studies to determine their ability to distinguish and then train laparoscopic force application sensitivity.

Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery.

Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current era of laparoscopic surgery.

Salient haptic skills trainer: initial validation of a novel simulator for training force-based laparoscopic surgical skills.

Background: There is an increasing need for efficient training simulators to teach advanced laparoscopic skills beyond those imparted by a box trainer. In particular, force-based or haptic skills must be addressed in simulators, especially because a large percentage of surgical errors are caused by the over-application of force. In this work, the efficacy of a novel, salient haptic skills simulator is tested as a training tool for force-based laparoscopic skills.

Objective differentiation of force-based laparoscopic skills using a novel haptic simulator.

Background: There is a growing need for effective surgical simulators to train the novice resident with a core skill set that can be later used in advanced operating room training. The most common simulator-based laparoscopic skills curriculum, the Fundamentals of Laparoscopic Skills (FLS), has been demonstrated to effectively teach basic surgical skills; however, a key deficiency in current surgical simulators is lack of validated training for force-based or haptic skills. In this study, a novel haptic simulator was examined for construct validity by determining its ability to differentiate between the force skills of surgeons and novices.

Service versus education, what are we talking about?

Objective: To investigate the degree of variability in perception as related to the service versus education issue in general surgery residency education.

Study Design: A survey questionnaire was designed with 15 scenarios constructed by the author to represent an array of resident experiences with differing educational and noneducational value. After appropriate Institutional Review Board (IRB) approval, the survey was administered to a variety of medical student, resident, and faculty groups.

Haptic tasks for physical laparoscopic ("Box") trainers to differentiate surgeon skill.

In this work, we present four tasks, primarily testing haptic laparoscopic skill that can be simulated in a conventional box trainer. Results from examining expert surgeon and novice performance is presented as evidence that these tasks can be used for training haptic skills for laparoscopy in a box trainer.

Assessing surgeon and novice force skill on a haptic stiffness simulator for laparoscopic surgery.

Though several simulators and training methods are available for basic laparoscopic skills, few have addressed force-based skills. In this work, we discuss a haptic simulator that renders virtual materials of different stiffness profiles to be used for haptic skills differentiation. A force-based task was designed on the simulator and the performance of surgeons and novices was analyzed.

Concomitant sublay mesh repair of umbilical hernia and abdominoplasty.

Concomitant mesh repair of large umbilical hernias and abdominoplasty pose a serious risk of devascularizing the umbilical stalk. A technique of placing mesh in a sublay manner, deep to the fascial defect, for an umbilical herniorrhaphy to avoid damage to the deep umbilical perforators during an abdominoplasty is described.

Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation.

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009.

Impact of Nissen fundoplication on laryngopharyngeal reflux symptoms.

The reliability of Nissen fundoplication for the successful treatment of laryngopharyngeal reflux (LPR) symptoms remains in question. The purpose of this study was to assess the effect that antireflux surgery has on a variety of LPR symptoms as well as the patient's perceived success of surgical intervention. A retrospective review of all antireflux surgeries between 1998 and 2008 provided a patient base for a survey in which patients ranked pre- and postoperative LPR symptoms in addition to patient satisfaction with the outcome.

Gluteal fascial advancement: an innovative, effective method for treating pilonidal disease.

The ideal elective surgical procedure for pilonidal disease is debated. Simple excision and closure is commonly performed but is associated with a high incidence of wound complications and recurrence. We developed a simple modification of primary closure, which involves the elevation, mobilization, and closure of the gluteal fascia.

The impact of a formal minimally invasive service on the resident's ability to achieve new ACGME guidelines for laparoscopy.

Purpose: As laparoscopy continues to permeate general surgery, there is an increased need for residents to acquire advanced laparoscopic skills during a surgical training program. To underscore its importance, the Accreditation Council of Graduate Medical Education (ACGME) recently increased the requirements for laparoscopy from 34 to 60 basic cases and from 0 to 25 advanced cases. With this in mind, the purpose of this study is to assess the impact of an organized minimally invasive surgical service on the volume of advanced laparoscopic cases of a general surgery residency program.