A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies. Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive). Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis. Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1) Laparoscopic Robotic Complications N = 49,800 N = 50 P Value Odds ratio Any Complication 5302 (10.6%) 5 (10%) 1 1.06 Superficial surgical site infection 423 (0.8%) 0 >0.9 Organ Space SSI 1,355 (2.7%) 0 >0.9 Postoperative Intra-abdominal Abscess 1353 (2.7%) 0 >0.9 Sepsis 1,696 (3.4%) 1 (2%) >0.9 1.7 Table 1. Complications for Laparoscopic versus Robotic appendectomy. Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.

Resource endowments and the problem of small change: insights from two American mints, 1600–1700

This article discusses historical evidence from the Potosi mint and Massachusetts Bay mint that illustrates the importance of the resource endowment (in this case silver) for the provision of small change. We show that the availability of silver was fundamental in shaping incentives. The relative scarcity of silver in Massachusetts Bay contributed to the small scale of the mint's operations, and implied that neither the monetary authority nor the mintmaster faced a significant tradeoff between drawing seigniorage from the mint and the production of small-denomination coins. In contrast, in the Viceroyalty of Peru, the abundance of silver, and the consequent large level of production of the mint's heavy peso coin, heightened the tradeoff between the fiscal and monetary objectives of the coinage. We suggest that these incentives negatively affected the production of fractionary coinage in the Peruvian viceroyalty, whereas in Massachusetts Bay the production of small-denomination coins was the norm.

Reflections on the ‘Just Price’ in Times of Crisis (with Reference to Coronavirus … but not only)

The debate about the ‘just price’ has ancient origin and returns forcefully to the scene when, in the event of crises of various kinds, there is a rapid and significant increase in prices of given goods or services. The main issue is whether price increases of such a nature could, or should, be considered illicit and ground the issue of sanctions against the firms increasing prices, thus focusing on a macro-systemic level of analysis. The central part of the article reviews different theories on what a ‘just price’ should be and focuses on the idea that a price is ‘just’ when it functions as an index of relative scarcity in free markets. It is claimed that such a function deserves protection by Italian and EU law. Therefore price adjustments in response to shocks cannot and should not be considered illegal: it is unacceptable to sanction private firms by attributing them the wrong of not having substituted themselves, at their own expense, for the exercise of a public function (that of making sure that price increases do not put at risk solidarity and other constitutional principles).

Obstacles and Recommendations for Clinical Translation of Nanoparticle System-Based Targeted Alpha-Particle Therapy

The rationale for application of nanotechnology in targeted alpha therapy (TAT) is sound. However, the translational strategy requires attention. Formulation of TAT in nanoparticulate drug delivery systems has the potential to resolve many of the issues currently experienced. As α-particle emitters are more cytotoxic compared to beta-minus-emitting agents, the results of poor biodistribution are more dangerous. Formulation in nanotechnology is also suggested to be the ideal solution for containing the recoil daughters emitted by actinium-225, radium-223, and thorium-227. Nanoparticle-based TAT is likely to increase stability, enhance radiation dosimetry profiles, and increase therapeutic efficacy. Unfortunately, nanoparticles have their own unique barriers towards clinical translation. A major obstacle is accumulation in critical organs such as the spleen, liver, and lungs. Furthermore, inflammation, necrosis, reactive oxidative species, and apoptosis are key mechanisms through which nanoparticle-mediated toxicity takes place. It is important at this stage of the technology’s readiness level that focus is shifted to clinical translation. The relative scarcity of α-particle emitters also contributes to slow-moving research in the field of TAT nanotechnology. This review describes approaches and solutions which may overcome obstacles impeding nanoparticle-based TAT and enhance clinical translation. In addition, an in-depth discussion of relevant issues and a view on technical and regulatory barriers are presented.

A Simple Course in Capital Theory: A Misunderstood Debate

This short paper is a demonstration of the difficulty with the textbook production function which uses the notion of capital as a factor of production. Because, this notion is logically incompatible with the other notion of the money value of capital needed for distribution theory. Theories of production and distribution become incompatible. Outside a one commodity world, this leads to insurmountable circular reasoning. The value of capital cannot be measured without first knowing its distributional parameters (e.g. real wage or the profit rate) and if they are known the marginal productivity theory based on the notion of the relative scarcity of capital as a factor of production is not only superfluous but meaningless. The scarcity of something which cannot be measured even in theory cannot be defined.

Describing the potential of non-specific symptoms-based pathways for diagnosing less common cancers

Background: Although less common cancers account for over half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, longer times to diagnosis and poorer clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem. Aim: To examine the less common cancers identified during the MDC pilots and consider if such an approach improves the diagnosis of these cancers. Design and Setting: A service evaluation of five MDC pilot projects in England to 31st March 2019. Method: Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project specific items. Simple descriptive and comparative statistics were used, including chi-squared tests for proportions and t-tests for means where appropriate. Results: From 5,134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. Over 30 different less common tumour types were diagnosed within this cohort. 23% of MDC patients with less common cancers had ≥3 more GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types. Conclusion: A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.

Assessing Land Dynamics and Sustainability on the Pacific Coast of Nicaragua: A Method Based on Comprehensive Land Units

In the coastal zones, varied uses converge, some of them of priority interest. In this study, an integrated method for the planning and management of the territory is proposed, which includes the evaluation of sustainability. A total of 15 different land-use classes were estimated in 80 sampling units distributed regularly along the Pacific coastline of Nicaragua and classified to determine land management sectors. For each of the identified sectors, the ecological, economic, social, and productive dimensions were evaluated independently, handling a total of 53 variables from different databases, by means of ordination multivariate factor analysis. Subsequently, the four dimensions were integrated into a model and the results were evaluated based on their similarity with theoretical development scenarios, assessed by discriminant analysis. Among these, the scenarios considered as a goal for sustainability in the studied area were present. On the Pacific coast of Nicaragua, productive and economic activities are currently prioritized, without having an integrated planning scheme for the entire territory, which includes nature conservation. The main contribution has been to provide a method for evaluating the land in an integrative and multidimensional way, while at the same time qualifying the different territorial sectors from a sustainable development. Even under a context of relative scarcity of information for some relevant aspects, the dimension-values assessment is largely solved by ordering the territorial sectors with a multivariate strategy, so that they are classified in relative and not absolute terms, which allows the strategy to be very useful for countries lacking some databases and cartography. This holistic and comprehensive vision of the entire territory facilitates social participation and contributes to decision-making aimed at advancing toward sustainability.

Neonatal coagulopathies: A review of established and emerging treatments

Despite the relative frequency of both bleeding and clotting disorders among patients treated in the neonatal intensive care unit, few clear guidelines exist for treatment of neonatal coagulopathies. The study and treatment of neonatal coagulopathies are complicated by the distinct hemostatic balance and clotting components present during this developmental stage as well as the relative scarcity of studies specific to this age group. This mini-review examines the current understanding of neonatal hemostatic balance and treatment of neonatal coagulopathies, with particular emphasis on emerging treatment methods and areas in need of further investigative efforts.

Genotyping of the Major SARS-CoV-2 Clade by Short-Amplicon High-Resolution Melting (SA-HRM) Analysis

The genome of the SARS-CoV-2 virus, the causal agent of the COVID-19 pandemic, has diverged due to multiple mutations since its emergence as a human pathogen in December 2019. Some mutations have defined several SARS-CoV-2 clades that seem to behave differently in terms of regional distribution and other biological features. Next-generation sequencing (NGS) approaches are used to classify the sequence variants in viruses from individual human patients. However, the cost and relative scarcity of NGS equipment and expertise in developing countries prevent studies aimed to associate specific clades and variants to clinical features and outcomes in such territories. As of March 2021, the GR clade and its derivatives, including the B.1.1.7 and B.1.1.28 variants, predominate worldwide. We implemented the post-PCR small-amplicon high-resolution melting analysis to genotype SARS-CoV-2 viruses isolated from the saliva of individual patients. This procedure was able to clearly distinguish two groups of samples of SARS-CoV-2-positive samples predicted, according to their melting profiles, to contain GR and non-GR viruses. This grouping of the samples was validated by means of amplification-refractory mutation system (ARMS) assay as well as Sanger sequencing.

NOAA-CFSR Offshore Wind Validation

The wind field at sea is of considerable interest to identify suitable sites and for designing offshore wind energy production facility. However, the reliability of wind information suffers from the relative scarcity of offshore wind measurements to validate the wind models used in assessments. This paper presents a comparison of the publicly available NOAA-CFSR global re-analysis data set against offshore wind measurement collected in West Africa, Mediterranean Sea, Barents Sea and NW Australia, with the goal to investigate — in widely different meteorological conditions — the overall model reliability, in term of statistical indices of performance: Moreover, an attempt has been made to ascertain the representative averaging duration of model wind and the reliability of engineering formulas used to correlate wind of different averaging durations.