A narrative on diversity, equity, and inclusion in surgery: insights from the European Society of Coloproctology and identification of points for action

Diversity; Equity; InterviewDiversidad; Equidad; EntrevistaDiversitat; Equitat; EntrevistaThe focus of the 2022 European Society of Coloproctology (ESCP) annual campaign was diversity, equity, and inclusion (DEI) in surgery. The ESCP “Operation Equal Access” campaign sought to interview key-opinion leaders and trainees, to raise awareness on inequalities, inform the community of the status of the topic, and to identify future areas for improvement. The ESCP Social Media Working Group interviewed experts who have made significant contributions to DEI in colorectal surgery and were acknowledged opinion leaders in the field. The interviews focused on their career, professional life, experiences, and opportunities during their training, and their views on DEI in colorectal surgery. DEI principles, education, and values need further promotion to reduce and address bias within the profession and overall improve the experience of minority community including health professionals and patients. International Societies are working to facilitate training opportunities and overcome DEI, and networking have contributed to that. Collaborations between societies will be pivotal to contribute to offering research and leadership opportunities equally. Access to advanced workshops including cadaveric training and simulation can be consistently promoted and provided globally via societies through telemonitoring. Involving patients in research should be encouraged, as it brings the perspective of a living experience.Open access funding provided by Università degli Studi della Campania Luigi Vanvitelli within the CRUI-CARE Agreement

Efficient Industrial Solution for Robotic Task Sequencing Problem With Mutual Collision Avoidance & Cycle Time Optimization

© 2022 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksIn the automotive industry, several robots are required to simultaneously carry out welding sequences on the same vehicle. Coordinating and assigning welding points between robots is a manual and difficult phase that needs to be optimized using automatic tools. The cycle time of the cell strongly depends on different robotic factors such as the task allocation among the robots, the configuration solutions and obstacle avoidance. Moreover, a key aspect, often neglected in the state of the art, is to define a strategy to solve the robotic task sequencing with an effective robot-robot collision avoidance integration. In this paper, we present an efficient iterative algorithm that generates a high-quality solution for Multi-Robotic Task Sequencing Problem. This latter manages not only the mentioned robotic factors but also aspects related to accessibility constraints and mutual collision avoidance. In addition, a home-developed planner ( RoboTSPlanner ) handling 6 axis has been validated in a real case scenario. In order to ensure the completeness of the proposed methodology, we perform an optimization in the task, configuration and coordination space in a synergistic way. Comparing to the existing approaches, both simulation and real experiments reveal positive results in terms of cycle time and show the ability of this method to be interfaced with both industrial simulation software and ROS-I tools.Peer ReviewedPostprint (published version

Descripción de dos casos de babesiosis cerebral en terneros de hasta 15 días de edad

La babesiosis es una enfermedad causada por Babesia bovis y Babesia bigemina, integrante del complejo conocido como “Tristeza bovina” y relevante en el Noroeste argentino (NOA). La presentación clínica de esta enfermedad es infrecuente en bovinos jóvenes, a los que se considera parcialmente resistentes a la babesiosis. Este trabajo describe dos casos de babesiosis cerebral en terneros de dos rodeos de cría diferentes, que a la necropsia mostraron ictericia, esplenomegalia y severa congestión cerebral y hemoglobinuria. Estructuras intraeritrocitarias compatibles morfológicamente con B. bovis fueron identificadas en extendidos de sistema nervioso central y sangre periférica teñidos con Giemsa y se confirmó luego la infección por medio de técnicas moleculares. La evaluación del estatus epidemiológico en los rodeos de origen determinó diferentes contextos: uno de los casos fue aislado en un rodeo con estabilidad enzoótica para babesiosis, donde la enfermedad clínica era escasa a pesar de altas tasas de transmisión de B. bovis; el segundo caso ocurrió en un rodeo en situación de brote con niveles significativos de mortandad. La ocurrencia de babesiosis (B. bovis) no había sido descripta todavía en terneros de la Argentina, sumándose ahora al diagnóstico diferencial para esta categoría de bovinos en zonas donde la enfermedad es enzoótica.Bovine babesiosisis a disease caused by Babesia bovisand Babesia bigemina, as part of the tick fever complex and relevant in the Northwest of Argentina. Clinical occurrence of this illness is uncommon in young cattle, considered resistant to babesiosis. This work described two cases of cerebral babesiosis in calves of different beef herds. Jaundice, splenomegaly, severe cerebral congestion and hemoglobinuria was observed at necropsy. Babesia bovis-like structures were identified in cerebral and blood smears Giemsa stainedand confirmed by molecular techniques. Different situations were recognized following the evaluation of the epidemiological status of both herds: the first one was a single case in a herd with enzootic stability for babesiosis, with scarce clinical cases despite high rates of B. bovistransmission; the other case was in a context of outbreak with high level of mortality within a herd susceptible to babesiosis. Clinical babesiosis was not previously described in calves from Argentina. Babesiosis must be taken into account for the differential diagnosis in calves from endemic areas of the disease.Instituto de Investigación Animal del Chaco SemiáridoFil: Olmos, Leandro Hipólito. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Animal Chaco Semiarido; Argentina. Universidad Católica de Salta. Facultad de Ciencias Veterinarias; ArgentinaFil: Micheloud, Juan Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Animal Chaco Semiarido; Argentina. Universidad Católica de Salta. Facultad de Ciencias Veterinarias; ArgentinaFil: Morel, Nicolas. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; ArgentinaFil: Bertoni, Emiliano Agustí­n. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Animal del Chaco Semiárido; ArgentinaFil: Avellaneda-Cáceres, Agustín. Universidad Católica de Salta. Facultad de Ciencias Veterinarias; ArgentinaFil: Primo, María Evangelina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Thompson, Carolina Soledad. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; ArgentinaFil: Torioni, Susana Marta. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; ArgentinaFil: Aguirre, Daniel Hector. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Animal del Chaco Semiárido; Argentin

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Regenerative Livestock Farm Finca Campo Nuevo

La ganadería Campo Nuevo ofrece Carne de nuestro campo Colombiano pensada para el cuidado de tu salud y del medio ambiente, todo esto por medio de sistemas de producción regenerativo ubicados en Barbosa Santander, vereda canoas y san Rafael. Todos nuestros productos están pensados para ofrecer una mejor calidad, en base: menores costos, menor tiempo de producción, menor uso espacio, calidad de vida para los animales y principalmente responsabilidad ambiental, la cual será certificada para validar cada una de nuestras operaciones, con el fin de mejorar la carne, pastizales, suelos, ecosistemas y finanzas, y con miras hacia el futuro de constituir toda una marca regenerativa donde se pueda crear alianzas comerciales con instituciones como colegios, clubs, restaurantes y hoteles, con un sistema de afiliación, el cual nos asegurará nuestras ventas, fidelizaremos clientes y así ofreceremos precios competitivos siendo sostenibles y rentables. Por otro lado, queremos construir un modelo de negocio cooperativo, actualmente manejamos el modelo de venta de reses para carne en la región, y queremos implementar un sistema de “financiación” donde las personas podrán comprar nuestros terneros, crías de nuestras vacas, desde aproximadamente $1.300.000 c/u, el cual se criará en nuestra finca tecnificada y en un plazo aproximado de 18 meses tendrá una rentabilidad competitiva dentro del mercado, lo que nos beneficiará a nosotros en temas de apalancamiento y mercado y también le permitirá integrar a partes interesadas en la industria de la ganadería.The Campo Nuevo cattle farm offers Meat from our Colombian countryside, designed for the care of your health and the environment, we achieve this through regenerative production systems, Located in Barbosa Santander, vereda canoas and San Rafael, all our products are designed to offer a better quality, based on: lower costs, shorter production time, less use of space, quality of life for the animals and mainly environmental responsibility which will be certified to validate each of our operations, in order to improve meat, pastures , soils, ecosystems and finances, and with a view to the future of constituting a whole regenerative brand where commercial alliances can be created with institutions such as schools, clubs, restaurants and hotels, with a membership system, which will ensure our sales, we will build loyalty customers and thus we will offer competitive prices while being sustainable and profitable, on the other hand we want to build a cooperative business model, we currently manage the beef cattle sale model in the region, and we want to implement a "financing" system where people can buy our calves, calves of our cows, from approximately$1,300,000 each, which will be raised on our technical farm and within an approximate period of 18 months will have a competitive profitability within the market, which will benefit us in terms of leverage and market and will also allow you to integrate stakeholders in the livestock industry

Weighted Monte Carlo: A New Technique for Calibrating Asset-Pricing Models

A general approach for calibrating Monte Carlo models to the market prices of benchmark securities is presented. Starting from a given model for market dynamics (price diffusion, rate diffusion, etc.), the algorithm corrects for price-misspecifications and finite-sample effects in the simulation by assigning "probability weights" to the simulated paths. The choice of weights is done by minimizing the Kullback-Leibler relative entropy distance of the posterior measure to the empirical measure. The resulting ensemble prices the given set of benchmark instruments exactly or in the sense of least-squares. We discuss pricing and hedging in the context of these weighted Monte Carlo models. A significant reduction of variance is demonstrated theoretically as well as numerically. Concrete applications to the calibration of stochastic volatility models and term-structure models with up to forty benchmark instruments are presented. The construction of implied volatility surfaces and forward-rate..