Best Practices in Robot-assisted Radical Cystectomy and Urinary Reconstruction: Recommendations of the Pasadena Consensus Panel

CONTEXT Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. OBJECTIVE A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. EVIDENCE ACQUISITION A systematic review of the literature was performed in agreement with the PRISMA statement. EVIDENCE SYNTHESIS Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. CONCLUSIONS RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. PATIENT SUMMARY Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.

Ethics in science: enhancing the democratisation of knowledge production in transdisciplinary research partnerships for sustainable development

Better access to knowledge and knowledge production has to be reconsidered as key to successful individual and social mitigation and adaptation strategies for global change. Indeed, concepts of sustainable development imply a transformation of science towards fostering democratisation of knowledge production and the development of knowledge societies as a strategic goal. This means to open the process of scientific knowledge production while simultaneously empowering people to implement their own visions for sustainable development. Advocates of sustainability science support this transformation. In transdisciplinary practice, they advance equity and accountability in the access to and production of knowledge at the science–society interface. UNESCO points to advancements, yet Northern dominance persists in knowledge production as well as in technology design and transfer. Further, transdisciplinary practice remains experimental and hampered by inadequate and asymmetrically equipped institutions in the North and South and related epistemological and operational obscurity. To help identify clear, practicable transdisciplinary approaches, I recommend examining the institutional route – i.e., the learning and adaptation process – followed in concrete cases. The transdisciplinary Eastern and Southern Africa Partnership Programme (1998–2013) is a case ripe for such examination. Understanding transdisciplinarity as an integrative approach, I highlight ESAPP’s three key principles for a more democratised knowledge production for sustainable development: (1) integration of scientific and “non-scientific” knowledge systems; (2) integration of social actors and institutions; and (3) integrative learning processes. The analysis reveals ESAPP’s achievements in contributing to more democratic knowledge production and South ownership in the realm of sustainable development.

The application of medical informatics to the veterinary management programs at companion animal practices in Alberta, Canada: a case study.

Companion animals closely share their domestic environment with people and have the potential to, act as sources of zoonotic diseases. They also have the potential to be sentinels of infectious and noninfectious, diseases. With the exception of rabies, there has been minimal ongoing surveillance of, companion animals in Canada. We developed customized data extraction software, the University of, Calgary Data Extraction Program (UCDEP), to automatically extract and warehouse the electronic, medical records (EMR) from participating private veterinary practices to make them available for, disease surveillance and knowledge creation for evidence-based practice. It was not possible to build, generic data extraction software; the UCDEP required customization to meet the specific software, capabilities of the veterinary practices. The UCDEP, tailored to the participating veterinary practices', management software, was capable of extracting data from the EMR with greater than 99%, completeness and accuracy. The experiences of the people developing and using the UCDEP and the, quality of the extracted data were evaluated. The electronic medical record data stored in the data, warehouse may be a valuable resource for surveillance and evidence-based medical research.

Early developmental, temperamental and educational problems in ‘substance use disorder’ patients with and without ADHD. Does ADHD make a difference?

Introduction: The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants? Method: An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40 years and 27% of the sample was female. All par- ticipants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV. Results: SUD patients with ADHD (n = 196; 16.3% of the total sample) had a significantly slower infant develop- ment than SUD patients without ADHD (n = 1,009; 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD. Conclusion: The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Finding a voice - Nollywood inspired filmmaking practices in Switzerland

Under the name Nollywood a unique video film industry has developed in Nigeria in the last few decades, which now forms one of the world’s biggest entertainment industries. With its focus on stories reflecting „the values, desires and fears” (Haynes 2007: 133) of African viewers and its particular way of production, Nollywood brings „lived practices and its representation together in ways that make the films deeply accessible and entirely familiar to their audience“ (Marston et al. 2007: 57). In doing so, Nollywood shows its spectators new postcolonial forms of performative self‐expression and becomes a point of reference for a wide range of people. However, Nollywood not only excites a large number of viewers inside and outside Nigeria, it also inspires some of them to become active themselves and make their own films. This effect of Nigerian filmmaking can be found in many parts of sub‐Saharan Africa as well as in African diasporas all over the world – including Switzerland (Mooser 2011: 63‐66). As a source of inspiration, Nollywood and its unconventional ways of filmmaking offer African migrants a benchmark that meets their wish to express themselves as minority group in a foreign country. As Appadurai (1996: 53), Ginsburg (2003: 78) and Marks (2000: 21) assume, filmmakers with a migratory background have a specific need to express themselves through media. As minority group members in their country of residence they not only wish to reflect upon their situation within the diaspora and illustrate their everyday struggles as foreigners, but to also express their own views and ideas in order to challenge dominant public opinion (Ginsburg 2003: 78). They attempt to “talk back to the structures of power” (2003: 78) they live in. In this process, their audio-visual works become a means of response and “an answering echo to a previous presentation or representation” (Mitchell 1994: 421). The American art historian Mitchell, therefore, suggests interpreting representation as “the relay mechanism in exchange of power, value, and publicity” (1994: 420). This desire of interacting with the local public has also been expressed during a film project of African, mainly Nigerian, first-generation migrants in Switzerland I am currently partnering in. Several cast and crew members have expressed feelings of being under-represented, even misrepresented, in the dominant Swiss media discourse. In order to create a form of exchange and give themselves a voice, they consequently produce a Nollywood inspired film and wish to present it to the society they live in. My partnership in this on‐going film production (which forms the foundation of my PhD field study) allows me to observe and experience this process. By employing qualitative media anthropological methods and in particular Performance Ethnography, I seek to find out more about the ways African migrants represent themselves as a community through audio‐visual media and the effect the transnational use of Nollywood has on their form of self‐representations as well as the ways they express themselves.

Challenges in the participatory assessment of sustainable management practices in dryland ecosystems under regime shifts

Regime shifts, defined as a radical and persistent reconfiguration of an ecosystem following a disturbance, have been acknowledged by scientists as a very important aspect of the dynamic of ecosystems. However, their consideration in land management planning remains marginal and limited to specific processes and systems. Current research focuses on mathematical modeling and statistical analysis of spatio-temporal data for specific environmental variables. These methods do not fulfill the needs of land managers, who are confronted with a multitude of processes and pressure types and require clear and simple strategies to prevent regime shift or to increase the resilience of their environment. The EU-FP7 CASCADE project is looking at regime shifts of dryland ecosystems in southern Europe and specifically focuses on rangeland and forest systems which are prone to various land degradation threats. One of the aims of the project is to evaluate the impact of different management practices on the dynamic of the environment in a participatory manner, including a multi-stakeholder evaluation of the state of the environment and of the management potential. To achieve this objective we have organized several stakeholder meetings and we have compiled a review of management practices using the WOCAT methodology, which enables merging scientific and land users knowledge. We highlight here the main challenges we have encountered in applying the notion of regime shift to real world socio-ecological systems and in translating related concepts such as tipping points, stable states, hysteresis and resilience to land managers, using concrete examples from CASCADE study sites. Secondly, we explore the advantages of including land users’ knowledge in the scientific understanding of regime shifts. Moreover, we discuss useful alternative concepts and lessons learnt that will allow us to build a participatory method for the assessment of resilient management practices in specific socio-ecological systems and to foster adaptive dryland management.

The invention of democratic parliamentary practices in the Helvetic Republic

In this book, leading historians of the French, Batavian, Helvetic, Cisalpine, and Neapolitan revolutions bridge the gap between the historiographies of the so-called Sister Republics and explore political culture as a set of discourses or political practices. Parliamentary practices, the comparability of "universal" political concepts, late-eighteenth-century Republicanism, the relationship between press and politics, and the interaction between the Sister Republics and France are all examined from a comparative, transnational perspective.