Implementation of robotic laparoscopic cholecystectomy in a university hospital.

BACKGROUND: Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. METHODS: The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. RESULTS: Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. CONCLUSION: Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed.

Pediatric emergencies admitted in the resuscitation room of a swiss university hospital.

OBJECTIVES: Pediatric resuscitation is an intense, stressful, and challenging process. The aim of this study was to review the life-threatening pediatric (LTP) emergencies admitted in a Swiss university hospital with regards to patients' demographics, reason for admission, diagnosis, treatment, significant events, critical incidents, and outcomes. METHODS: A retrospective observational cohort study of prospectively collected data was conducted, including all LTP emergencies admitted over a period of 2 years in the resuscitation room (RR). Variables, including indication for transfer, mode of prehospital transportation, diagnosis, and time spent in RR, were recorded. RESULTS: Of the 60,939 pediatric emergencies treated in our university hospital over 2 years, a total of 277 LTP emergencies (0.46%) were admitted in the RR. They included 160 boys and 117 girls, aged 6 days to 15.95 years (mean, 6.69 years; median, 5.06). A medical problem was identified in 55.9% (n = 155) of the children. Of the 122 children treated for a surgical problem, 35 (28.3%) went directly from the RR to the operating room. Hemodynamic instability was noted in 19.5% of all LTP emergencies, of which 1.1% benefited from O negative transfusion. Admission to the intensive care unit was necessary for 61.6% of the children transferred from another hospital. The average time spent in the RR was 46 minutes. The overall mortality rate was 7.2%. CONCLUSIONS: The LTP emergencies accounted for a small proportion of all pediatric emergencies. They were more medical than surgical cases and resuscitation measures because of hemodynamic instability were the most frequent treatment.

Political economics and normative analysis

The approaches and opinions of economists often dominate public policy discussion. Economists have gained this privileged position partly (or perhaps mainly) because of the obvious relevance of their subject matter, but also because of the unified methodology (neo-classical economics) that the vast majority of modern economists bring to their analysis of policy problems and proposed solutions. The idea of Pareto efficiency and its potential trade-off with equity is a central idea that is understood by all economists and this common language provides the economics profession with a powerful voice in public affairs. The purpose of this paper is to review and reflect upon the way in which economists find themselves analysing and providing suggestions for social improvements and how this role has changed over roughly the last 60 years. We focus on the fundamental split in the public economics tradition between those that adhere to public finance and those that adhere to public choice. A pure public finance perspective views failures in society as failures of the market. The solutions are technical, as might be enacted by a benevolent dictator. The pure public choice view accepts (sometimes grudgingly) that markets may fail, but so, it insists, does politics. This signals institutional reforms to constrain the potential for political failure. Certain policy recommendations may be viewed as compatible with both traditions, but other policy proposals will be the opposite of that proposed within the other tradition. In recent years a political economics synthesis emerged. This accepts that institutions are very important and governments require constraints, but that some degree of benevolence on the part of policy makers should not be assumed non-existent. The implications for public policy from this approach are, however, much less clear and perhaps more piecemeal. We also discuss analyses of systematic failure, not so much on the part of markets or politicians, but by voters. Most clearly this could lead to populism and relaxing the idea that voters necessarily choose their interests. The implications for public policy are addressed. Throughout the paper we will relate the discussion to the experience of UK government policy-making.

Ischemic heart disease in postmortem CT and CT angiography

Objective: Postmortem radiology had in recent years appeared in the field of forensic medicine and is now considered by some authors as a good replacement for conventional autopsy and by others as a complementary examination. Although postmortem CT radiological imaging is very useful in demonstrating traumatic lesions, its utility is still quite limited in the cardiovascular field. This limitation could be minimized by the introduction of postmortem angiography. At the University Center of Legal Medicine of Lausanne, CT scans and postmortem multiphase CTangiography are used in cases with a suspicion of ischemic heart disease.Method: The goal of this presentation is to demonstrate some correlations between postmortem CT, CTangiography and conventional autopsy examination in cases of ischemic heart disease.Results: We observed that the native CT scan can show only some pathological findings as cardiac tamponade and calcifications of coronary arteries. However, postmortem angiography allows a better visualization of coronary arteries and evaluation of stenosis and occlusion as well as better imaging of soft tissue.Conclusion: The interpretation of postmortem modern radiology is a new field for both forensic pathologists and radiologists who have to learn to read the postmortem modified images. The information obtained from both parties can help to further the understanding of CT and CT angiography in postmortem cases.

Solovian and New Growth Theory from the Perspective of Allyn Young on Macroeconomic Increasing Returns

This paper evaluates, from an Allyn Youngian perspective, the neoclassical Solow model of growth and the associated empirical estimates of the sources of growth based on it. It attempts to clarify Young’s particular concept of generalised or macroeconomic “increasing returns” to show the limitations of a model of growth based on an assumption that the aggregate production function is characterised by constant returns to scale but “augmented” by exogenous technical progress. Young’s concept of endogenous, self-sustaining growth is also shown to differ in important respects (including in its policy implications) from modern endogenous growth theory.

Memòria justificativa del treball realitzat durant l'estada a la University of California at Los Angeles (UCLA)

Projecte de recerca elaborat a partir d’una estada a la Graduate School of Education and Information Studies (GSEIS) de la University of California at Los Angeles (UCLA), Estats Units, entre gener i juny del 2007. En el context d’elaboració d’una futura tesi doctoral sobre la metodologia comunicativa crítica i la interacció persona-ordinador, la intenció ha estat aprofundir des d'una perspectiva internacional. La GSEIS i la UCLA en general conta amb innumerables recursos bibliogràfics així com amb professorat de reconegut prestigi internacional en la recerca vinculada a la barreja de temes com l'educació, la inclusió i la transformació social, la Comunicació, les TIC i el disseny de la Interacció Persona Ordinador; integració de disciplines en la que es mou la meva tesi doctoral. La possibilitat d'accedir a la Young Research Library, així com l'assistència a diverses conferències relacionades amb el meu àmbit d'estudi, la celebració de diverses tutories amb professorat de la GSEIS i d'altres departaments de la UCLA, i la invitació a participar del seminari de doctorat del professor Douglas Kellner, han contribuït de forma remarcable al meu projecte amb: aportacions de la literatura internacional i nombrosos exemples de bones pràctiques de projectes vinculats al Participatory Design com a metodologia en si mateixa desvinculada del Disseny Centrat en l'Usuari, un dels aspectes centrals de la meva tesi. Amb tot això vaig poder reforçar i desenvolupar quatre dels capítols de la meva dissertació, concretament els relacionats amb el context social i metodològic, i els que presenten el disseny de la Interacció Persona ordinador des d'un enfocament general així com el que es centra en el Disseny participatiu i les seves vinculacions amb la metodologia comunicativa crítica.

Estimating United States Phillips Curves With Expectations Consistent With The Statistical Process Of Inflation

‘Modern’ Phillips curve theories predict inflation is an integrated, or near integrated, process. However, inflation appears bounded above and below in developed economies and so cannot be ‘truly’ integrated and more likely stationary around a shifting mean. If agents believe inflation is integrated as in the ‘modern’ theories then they are making systematic errors concerning the statistical process of inflation. An alternative theory of the Phillips curve is developed that is consistent with the ‘true’ statistical process of inflation. It is demonstrated that United States inflation data is consistent with the alternative theory but not with the existing ‘modern’ theories.

Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital.

BACKGROUND: Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65-84 years during this period and to investigate the evolution of these comparisons over time. METHODS: Data considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated. RESULTS: Between 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65-84 years. Compared to patients aged 65-84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010. CONCLUSIONS: Oldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.

Prof. Hugo de Souza Lopes and the modern system of Sarcophagidae (Diptera)

Prof. Dr. Hugo de Souza Lopes is one of the authors of the phylogenetic classification of Sarcophagidae, especially Sarcophaginae. In this paper I present the taxonomic key of the tribes of Sarcophaginae according to his opinion; a list of the 48 genera and subgenera and the 356 species described by Prof. Lopes; and a review of subtribal construction of tribe Sarcophagini with a key of the subtribes. One new subtribe Boettcheriiscina Verves, subtr. nov. and two new monotypic genera (Mufindia Verves, gen. nov., and Sabiella Verves, gen. nov.) are described. The role of Prof. Lopes in the knowledge of taxonomy and ecology of American, Oriental, Australian and Oceanic Sarcophagidae is illumined.

On the causes of the African Slave Trade

This paper offers an integrated analysis of the forces shaping the emergence of the African slave trade over the early modern period. We focus our attention on two questions. First, why most of the increase in the demand for slaves during this period came exclusively from western Europeans. Second, and of most relevance for present-day development outcomes, why was the overwhelming majority of slaves of African origin. Technological differences in manufacturing technology, the specificities of sugar (and other crops’) production, and the cultural fragmentation of the African continent all play a role in the analysis. Supporting evidence for each of our claims is provided from a broad corpus of relevant literature.

Expansió accelerada de l’univers i teories de gravetat modificada a grans escales

Estudi realitzat a partir d’una estada al Physics Department de la New York University, United States, Estats Units, entre 2006 i 2008. Una de les observacions de més impacte en la cosmologia moderna ha estat la determinació empírica que l’Univers es troba actualment en una fase d’Expansió Accelerada (EA). Aquest fenòmen implica que o bé l’Univers està dominat per un nou sector de matèria/energia, o bé la Relativitat General deixa de tenir validesa a escales cosmològiques. La primera possibilitat comprèn els models d’Energia Fosca (EF), i el seu principal problema és que l’EF ha de tenir propietats tan especials que es fan difícils de justificar teòricament. La segona possibilitat requereix la construcció de teories consistents de Gravetat Modificada a Grans Distàncies (GMGD), que són una generalització dels models de gravetat massiva. L’interès fenomenològic per aquestes teories també va resorgir amb l’aparició dels primers exemples de models de GMGD, com ara el model de Dvali, Gabadadze i Porrati (DGP), que consisteix en un tipus de brana en una dimensió extra. Malauradament, però, aquest model no permet explicar de forma consistent l’EA de l’Univers. Un dels objectius d’aquest projecte ha estat establir la viabilitat interna i fenomenològica dels models de GMGD. Des del punt de vista fenomenològic, ens hem centrat en la questió més important a la pràctica: trobar signatures observacionals que permetin distingir els models de GMGD dels d’EF. A nivell més teòric, també hem investigat el significat de les inestabilitats del model DGP.L’altre gran objectiu que ens vam proposar va ser la construcció de noves teories de GMGD. En la segona part d’aquest projecte, hem elaborat i mostrat la consistència del model “DGP en Cascada”, que generalitza el model DGP a més dimensions extra, i representa el segon model consistent i invariant-Lorentz a l’espai pla conegut. L’existència d’altres models de GMGD més enllà de DGP és de gran interès atès que podria permetre obtenir l’EA de l’Univers de forma purament geomètrica.

Dualizing complexes-The modern way

We give a survey of some recent results on Grothendieck duality. We begin with a brief reminder of the classical theory, and then launch into an overview of some of the striking developments since 2005.

Consumption Expenditures in Economic Impact Studies: An Application to University Students

This paper examines how appropriately to attribute economic impact to consumption expenditures. Consumption expenditures are often treated as either wholly endogenous or wholly exogenous, following a distinction from Input-Output analysis. For many applications, such as those focusing on the impacts of tourism or benefits systems, such binomial assumptions are not satisfactory. We argue that consumption is neither wholly endogenous nor wholly exogenous but that the degree of this distinction is rather an empirical matter. We set out a general model for the treatment of consumption expenditures and illustrate its application through the case of university students. We examine individual student groups and how the impacts of students at particular institutions. Furthermore we take into account the binding budget constraint of public expenditures (as is the case for devolved regions in the UK)and examine how this affects the impact attributed to students' consumption expenditures.