Quality and Safety of Minimally Invasive Surgery: Past, Present, and Future

Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed

Can the palatability of healthy, satiety-promoting foods increase with repeated exposure during weight loss?

Repeated exposure to sugary, fatty, and salty foods often enhances their appeal. However, it is unknown if exposure influences learned palatability of foods typically promoted as part of a healthy diet. We tested whether the palatability of pulse containing foods provided during a weight loss intervention which were particularly high in fiber and low in energy density would increase with repeated exposure. At weeks 0, 3, and 6, participants (n = 42; body mass index (BMI) 31.2 ± 4.3 kg/m²) were given a test battery of 28 foods, approximately half which had been provided as part of the intervention, while the remaining half were not foods provided as part of the intervention. In addition, about half of each of the foods (provided as part or not provided as part of the intervention) contained pulses. Participants rated the taste, appearance, odor, and texture pleasantness of each food, and an overall flavor pleasantness score was calculated as the mean of these four scores. Linear mixed model analyses showed an exposure type by week interaction effect for taste, texture and overall flavor pleasantness indicating statistically significant increases in ratings of provided foods in taste and texture from weeks 0 to 3 and 0 to 6, and overall flavor from weeks 0 to 6. Repeated exposure to these foods, whether they contained pulses or not, resulted in a ~4% increase in pleasantness ratings. The long-term clinical relevance of this small increase requires further study.T32 AT000815 - NCCIH NIH HH

Is every toric variety an M-variety?

A complex algebraic variety X defined over the real numbers is called an M-variety if the sum of its Betti numbers (for homology with closed supports and coefficients in Z/2) coincides with the corresponding sum for the real part of X. It has been known for a long time that any nonsingular complete toric variety is an M-variety. In this paper we consider whether this remains true for toric varieties that are singular or not complete, and we give a positive answer when the dimension of X is less than or equal to 3.Comment: 13 page

Effects of dietary protein and fiber at breakfast on appetite, ad libitum energy intake at lunch, and neural responses to visual food stimuli in overweight adults

Increasing either protein or fiber at mealtimes has relatively modest effects on ingestive behavior. Whether protein and fiber have additive or interactive effects on ingestive behavior is not known. Fifteen overweight adults (5 female, 10 male; BMI: 27.1 ± 0.2 kg/m²; aged 26 ± 1 year) consumed four breakfast meals in a randomized crossover manner (normal protein (12 g) + normal fiber (2 g), normal protein (12 g) + high fiber (8 g), high protein (25 g) + normal fiber (2 g), high protein (25 g) + high fiber (8 g)). The amount of protein and fiber consumed at breakfast did not influence postprandial appetite or ad libitum energy intake at lunch. In the fasting-state, visual food stimuli elicited significant responses in the bilateral insula and amygdala and left orbitofrontal cortex. Contrary to our hypotheses, postprandial right insula responses were lower after consuming normal protein vs. high protein breakfasts. Postprandial responses in other a priori brain regions were not significantly influenced by protein or fiber intake at breakfast. In conclusion, these data do not support increasing dietary protein and fiber at breakfast as effective strategies for modulating neural reward processing and acute ingestive behavior in overweight adults.R01 MH102224 - NIMH NIH HHS; UL1 TR001108 - NCATS NIH HHS; UL1TR001108 - NCATS NIH HH

Autobiographical memory: A candidate latent vulnerability mechanism for psychiatric disorder following childhood maltreatment

BACKGROUND: Altered autobiographical memory (ABM) functioning has been implicated in the pathogenesis of depression and post-traumatic stress disorder and may represent one mechanism by which childhood maltreatment elevates psychiatric risk. AIMS: To investigate the impact of childhood maltreatment on ABM functioning. METHOD: Thirty-four children with documented maltreatment and 33 matched controls recalled specific ABMs in response to emotionally-valenced cue words during functional magnetic resonance imaging (fMRI). RESULTS: Children with maltreatment experience showed reduced hippocampal and increased middle temporal and para-hippocampal activation during positive ABM recall compared to peers. During negative ABM recall they exhibited increased amygdala activation, and greater amygdala connectivity with the salience network. CONCLUSIONS: Childhood maltreatment is associated with altered ABM functioning, specifically reduced activation in areas encoding specification of positive memories, and greater activation of the salience network for negative memories. This pattern may confer latent vulnerability to future depression and post-traumatic stress disorder

High level software for 4.8 GHz LHC Schottky system

The performance of the LHC depends critically on the accurate measurements of the betatron tunes. The betatron tune values of each LHC beam may be measured without excitation using a newly installed transverse Schottky monitor. A high-level software package written in Java has been developed for the Schottky system. The software allows end users to monitor and control the Schottky system, and provides them with non-destructive and continuous bunch-by-bunch measurements for the tunes, momentum spreads, chromaticities and emittances of the LHC beams. It has been tested with both proton and lead ion beams at the LHC with very successful results.Comment: 3 pp. Particle Accelerator, 24th Conference (PAC'11) 2011. 28 Mar - 1 Apr 2011. New York, US

Autobiographical memory as a latent vulnerability mechanism following childhood maltreatment: Association with future depression symptoms and prosocial behavior

OBJECTIVES: Childhood maltreatment is associated with altered neural reactivity during autobiographical memory (ABM) recall and a pattern of overgeneral memory (OGM). Altered ABM and OGM have been linked with psychopathology and poorer social functioning. The present study investigated the association between altered ABM and subsequent socio-emotional functioning (measured two years later) in a sample of adolescents with (N = 20; maltreatment group, MT) and without (N = 17; non-MT group) documented childhood maltreatment histories. METHOD: At baseline, adolescents (aged 12.6 ± 1.45 years) were administered the Autobiographical Memory Test to measure OGM. Participants also recalled specific ABMs in response to emotionally valenced cue words during functional MRI. Adolescents in both groups underwent assessments measuring depressive symptoms and prosocial behavior at both timepoints. Regression analyses were carried out to predict outcome measures at follow-up controlling for baseline levels. RESULTS: In the MT group, greater OGM at baseline significantly predicted reduced prosocial behavior at follow-up and showed a trend level association with elevated depressive symptoms. Patterns of altered ABM-related brain activity did not significantly predict future psycho-social functioning. CONCLUSIONS: The current findings highlight the potential value of OGM as a cognitive mechanism that could be targeted to reduce risk of depression in adolescents with prior histories of maltreatment