Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: Short-term outcomes of a multi-center prospective trial

BACKGROUND: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. METHODS: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. RESULTS: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. CONCLUSION: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy

PENGARUH PRAKTIK KERJA INDUSTRI DAN KECERDASAN EMOSIONAL TERHADAP KESIAPAN KERJA SISWA JURUSAN OTKP DI SMK PASUNDAN 1 BANDUNG

Permasalahan yang dikaji dalam penelitian ini adalah rendahnya kesiapan siswa dalam bekerja. Hal ini antara lain disebabkan oleh faktor yang berasal dari individu siswa, seperti rendahnya tingkat keterampilan yang dimiliki, belum mampu beradaptasi dengan lingkungan kerja, serta tingkat kecerdasan emosional yang belum matang. Penelitian ini bertujuan untuk mengetahui gambaran tentang tingkat efektivitas praktik kerja industri dan kematangan kecerdasan emosional, kesiapan kerja siswa serta pengaruh praktik kerja industri dan kecerdasan emosional terhadap kesiapan kerja siswa jurusan OTKP di SMK Pasundan 1 Bandung. Dalam penelitian ini digunakan metode survei eksplanasi dengan pendekatan kuantitatif. Data penelitian diperoleh melalui penyebaran angket dengan model skala likert. Populasi yang digunakan dalam penelitian ini adalah siswa kelas XII jurusan OTKP sebanyak 99 orang. Teknik analisis data yang digunakan adalah analisis regresi berganda. Hasil penelitian yang diperoleh dalam penelitian ini menunjukkan bahwa kecenderungan tingkat praktik kerja industri berada pada pilihan efektif, kecerdasan emosional dan kesiapan kerja berada pada kecenderungan pilihan cukup tinggi. Secara simultan dan parsial praktik kerja industri dan kecerdasan emosional memiliki pengaruh positif dan signifikan terhadap kesiapan kerja siswa kelas XII jurusan OTKP di SMK Pasundan 1 Bandung. Kata Kunci: Praktik Kerja Industri, Kecerdasan Emosional, Kesiapan Kerja The problem studied in this study is the low readiness of students to work. This is partly due to factors derived from individual students, such as low levels of skills possessed, the ability to not adapt to the work environment, and the level of immature emotional intelligence. This study aims to determine an overview of the level of effectiveness of industrial work practices and the maturity of emotional intelligence, student work readiness, and the influence of industrial work practices and emotional intelligence on the work readiness of students majoring in OTKP at SMK Pasundan 1 Bandung. In this study, an explanatory survei method with a quantitative approach was used. The research data was obtained through the distribution of questionnaires with Likert scale models. The population used in this study was 99 class XII students majoring in OTKP. The data analysis technique used is multiple regression analysis. The results obtained in this study show that the tendency of industrial work practices to make effective choices, emotional intelligence, and job readiness is quite high. Imultaneously and partially, industrial work practices and emotional intelligence have a positive and significant influence on the job readiness of class XII students majoring in OTKP at SMK Pasundan 1 Bandung. Keywords: Industrial Work Practices, Emotional Intelligence, Job Readines

Práticas de Contratação em Escolas Públicas

Os procedimentos administrativos e de gestão associados à Contratação Pública pela generalidade da Administração Pública e, em particular, pelas escolas públicas, trouxeram novas formas de percecionar o relacionamento entre as entidades que efetuam as aquisições e as que fornecem os bens e serviços, bem como a própria natureza das relações comerciais. A necessidade de gerir de forma equilibrada os recursos económicos disponíveis, a promoção da transparência, da livre concorrência e do rigor nos procedimentos de Contratação Pública, modificaram a forma como as escolas públicas organizam os seus procedimentos internos, mobilizam os seus recursos humanos e planificam as suas atividades. As diversas formas de adquirir bens ou contratar serviços previstas no Código dos Contratos Públicos, bem como as diferentes características processuais, tendo subjacente a prestação de contas e a viabilidade financeira, levaram as escolas públicas utilizarem novos procedimentos. A utilização de Plataformas Eletrónicas de Contratação Pública introduziu elemento inovador, criou mais-valias económicas mas introduziu novas tarefas que necessitam formação específica dos utilizadores. Este trabalho de projeto visa compreender como as escolas respondem aos requisitos da Contratação Pública, planificam e organizam os seus processos internos de gestão e de administração de modo a desenvolver o seu plano anual de aquisições/contratações. Um Plano de Ação foi delineado e pretende constituir um guia de boaspráticas a utilizar no sistema de Contratação Pública das escolas públicasThe administrative and management procedures associated to Public Procurement by the majority of the Public Administration and, in particular, by public schools, brought new ways of perceiving the relationship between the organizations that make the acquisitions and those that provide the goods and services, as well as of perceiving the very nature of trade relations. The need to manage the economic resources available in a balanced way, the promotion of transparency, of free competition and of rigour in the procedures of Public Procurement, changed how public schools organise their internal procedures, mobilize their human resources and plan their activities. The various ways to acquire goods or services as stated in the Public Contracts Code as well as the different procedure characteristics, which take into account the income statement and the financial viability, led public schools to use new procedures. The use of electronic procurement platforms introduced an innovative element, creating more economic gains while introducing new tasks that require specific training of users. This project work aims to understand how schools respond to the requirements of Public Procurement, how they plan and organise their internal processes of management and administration in order to develop their annual acquisition/procurement plan. An Action Plan has been outlined and intends to be a guide of best practices to be used in the system of Public Procurement of public school

Brans-Dicke model constrained from Big Bang nucleosynthesis and magnitude redshift relations of Supernovae

The Brans-Dicke model with a variable cosmological term ($BD\Lambda$) has been investigated with use of the coupling constant of $\omega=10^4$. Parameters inherent in this model are constrained from comparison between Big Bang nucleosynthesis and the observed abundances. Furthermore, the magnitude redshift ($m-z$) relations are studied for $BD\Lambda$ with and without another constant cosmological term in a flat universe. Observational data of Type Ia Supernovae are used in the redshift range of $0.01<z<2$. It is found that our model with energy density of the constant cosmological term with the value of 0.7 can explain the SNIa observations, though the model parameters are insensitive to the $m-z$ relation.Comment: Submitted to A&A, 4 pages, 3 figure

O Impeachment de Dilma Rousseff nas capas do Correio Braziliense

O presente texto apresenta aspectos de uma investigação sobre a discursivização do acontecimento Impeachment de Dilma Rousseff em capas do diário Correio Braziliense. Como marco teórico-metodológico, trabalha-se a ligação entre características gerais de uma capa de jornal e os conceitos de dispositivo e cenas da enunciação. As cenas escolhidas, com primazia para o jogo de cartas, funcionam como a engrenagem que alimenta o discurso que se enuncia. Em um contexto de grande turbulência político-midiática, gerada pelo processo de Impeachment de Dilma Rousseff, um dos antecedentes da Era Bolsonaro, desenvolveu-se uma onda de discursos polarizados que foram disseminados e animados pelos veículos de comunicação

Total Neoadjuvant Therapy With Short-Course Radiation: US Experience of a Neoadjuvant Rectal Cancer Therapy

BACKGROUND: Short-course radiation followed by chemotherapy as total neoadjuvant therapy has been investigated primarily in Europe and Australia with increasing global acceptance. There are limited data on this regimen\u27s use in the United States, however, potentially delaying implementation. OBJECTIVE: This study aimed to compare clinical performance and oncologic outcomes of 2 rectal cancer neoadjuvant treatment modalities: short-course total neoadjuvant therapy versus standard chemoradiation. DESIGN: This is a retrospective cohort study. SETTING: This study was performed at a National Cancer Institute-designated cancer center. PATIENTS: A total of 413 patients had locally advanced rectal cancers diagnosed from June 2009 to May 2018 and received either short-course total neoadjuvant therapy or standard chemoradiation. INTERVENTIONS: There were 187 patients treated with short-course total neoadjuvant therapy (5 × 5 Gy radiation followed by consolidation oxaliplatin-based chemotherapy) compared with 226 chemoradiation recipients (approximately 50.4 Gy radiation in 28 fractions with concurrent fluorouracil equivalent). MAIN OUTCOME MEASURES: Primary end points were tumor downstaging, measured by complete response and low neoadjuvant rectal score rates, and progression-free survival. Secondary analyses included treatment characteristics and completion, sphincter preservation, and recurrence rates. RESULTS: Short-course total neoadjuvant therapy was associated with higher rates of complete response (26.2% vs 17.3%; p = 0.03) and low neoadjuvant rectal scores (40.1% vs 25.7%; p \u3c 0.01) despite a higher burden of node-positive disease (78.6% vs 68.9%; p = 0.03). Short-course recipients also completed trimodal treatment more frequently (88.4% vs 50.4%; p \u3c 0.01) and had fewer months with temporary stomas (4.8 vs 7.0; p \u3c 0.01). Both regimens achieved comparable local control (local recurrence: 2.7% short-course total neoadjuvant therapy vs 2.2% chemoradiation, p = 0.76) and 2-year progression-free survival (88.2% short-course total neoadjuvant therapy (95% CI, 82.9-93.5) vs 85.6% chemoradiation (95% CI, 80.5-90.7)). LIMITATIONS: Retrospective design, unbalanced disease severity, and variable dosing of neoadjuvant consolidation chemotherapy were limitations of this study. CONCLUSIONS: Short-course total neoadjuvant therapy was associated with improved downstaging and similar progression-free survival compared with chemoradiation. These results were achieved with shortened radiation courses, improved treatment completion, and less time with diverting ostomies. Short-course total neoadjuvant therapy is an optimal regimen for locally advanced rectal cancer

FDG-PET/MRI for nonoperative management of rectal cancer: A prospective pilot study

Nonoperative management (NOM) is increasingly utilized for rectal cancer patients with a clinical complete response (cCR) following total neoadjuvant therapy (TNT). The objective of this pilot study was to determine whether FDG-PET/MRI alters clinical response assessments among stage I-III rectal cancer patients undergoing TNT followed by NOM, relative to MRI alone. This prospective study included 14 subjects with new rectal cancer diagnoses. Imaging consisted of FDG-PET/MRI for initial staging, post-TNT restaging, and surveillance during NOM. Two independent readers assessed treatment response on MRI followed by FDG-PET/MRI. Inter-reader differences were resolved by consensus review. The reference standard for post-TNT restaging consisted of surgical pathology or clinical follow-up. 7/14 subjects completed post-TNT restaging FDG-PET/MRIs. 5/7 subjects had evidence of residual disease and underwent total mesorectal excision; 2/7 subjects had initial cCR with no evidence of disease after 12 months of NOM. FDG-PET/MRI assessments of cCR status at post-TNT restaging had an accuracy of 100%, compared with 71% for MRI alone, as FDG-PET detected residual tumor in 2 more subjects. Inter-reader agreement for cCR status on FDG-PET/MRI was moderate (kappa, 0.56). FDG-PET provided added value in 82% (9/11) of restaging/surveillance scans. Our preliminary data indicate that FDG-PET/MRI can detect more residual disease after TNT than MRI alone, with the FDG-PET component providing added value in most restaging/surveillance scans

Intracorporeal and Extracorporeal Anastomosis for Robotic-Assisted and Laparoscopic Right Colectomy: Short-Term Outcomes of a Multi-Center Prospective Trial

Background: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. Methods: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. Results: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. Conclusion: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy