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Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (- 47%), esophageal (- 17%), small and large intestinal (-16%), and hepatic (- 7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (- 10%), gastric (- 12%), intestinal (- 11%), hepatic (- 17%), biliary (- 10%), pancreatic (- 11%) and hernia procedures (- 14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (- 4% and - 22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The need for consortial programs to provide advanced education in food animal veterinary production medicine has been recognized and lauded for nearly three decades. This article describes one effort to create a dairy production medicine curriculum funded by a United States Department of Agriculture (USDA) Higher Education Challenge Grant. This National Center of Excellence in Dairy Production Medicine Education for Veterinarians is housed at the Dairy Education Center of the University of Minnesota and the project was a collaboration of the University of Minnesota, the University of Illinois, the University of Georgia, and Kansas State University. The article reviews the need for innovative ways to educate students who will optimally serve the dairy industry, provides a broad overview of the process of developing and delivering the eight-week dairy production medicine curriculum, and describes the challenges faced and lessons learned as a result of offering such a program.

Objectives: This paper has two objectives. First, it categorizes the Twitter handles tweeted flu related information based on the amount of replies and mentions within the Twitter network. The collected Twitter accounts are categorized as media, health related individuals, organizations, government, individuals with no background with media or medical field, in order to test the relationship between centrality measures of the accounts and their categories. The second objective is to examine the relationship between the importance of the Twitter accounts in the network, centrality measures, and specific characteristics of each account, including the number of tweets and followers as well as the number of accounts followed and liked., Methods: Using Twitter search network API, tweets with "flu" keyword were collected and tabulated. Network centralities were calculated with network analysis tool, NodeXL. The collected Twitters accounts were content analyzed and categorized by multiple coders., Results: When the media or organizational Twitter accounts were present in the list of important Twitter accounts, they were highly effective disseminating flu-related information. Also, they were more likely to stay active one year after the data collection period compared to other influential individual accounts., Conclusions: Health campaigns are recommended to focus on recruiting influential Twitter accounts and encouraging them to retweet or mention in order to produce better results in disseminating information. Although some individual social media users were valuable assets in terms of spreading information about flu, media and organization handles were more reliable information distributors. Thus, health information practitioners are advised to design health campaigns better utilizing media and organizations rather than individuals to achieve consistent and efficient campaign outcomes., (Published by Elsevier Ireland Ltd.)

Objective: To investigate intramammary infections in llamas, identify the pathogens responsible, and determine whether effects of intramammary infection could be detected by use of mastitis indicator tests commonly used for cows., Design: Observational study., Animals: 100 llamas on 10 farms., Procedure: Milk samples were evaluated by bacterial culturing and by determination of somatic cell count (SCC), using direct microscopic and automated counting methods, California Mastitis Test score, pH, and N-acetyl-beta-d-glucosaminidase activity. Correlation coefficients were determined among the various mastitis indicator tests, and test results were determined for milk from infected and uninfected glands., Results: Evidence of intramammary infection was evident in 76 of 369 (21%) milk samples, with 54 of 94 (57%) llamas having at least 1 infected gland. Staphylococcus sp other than Staphylococcus aureus were the predominant pathogens. None of the llamas had clinical signs of mastitis, and significant differences were not detected in SCC, California Mastitis Test score, pH, or N-acetyl-beta-d-glucosaminidase activity between infected and uninfected samples. California Mastitis Test scores were negative or trace for 307 of 313 (98%) samples, and SCC were low. In contrast, pH and N-acetyl-beta-d-glucosaminidase activity of milk from uninfected glands were higher than values reported for milk from uninfected cows, and neither variable was significantly correlated with the number of somatic cells in samples of llama milk., Clinical Implications: Although intramammary infections develop in llamas, inflammation (mastitis) appears to be rare. Values for mastitis indicator tests used for cows cannot be directly extrapolated to llamas. Subclinical mastitis is apparently not an important problem in llamas in the United States.

Psychiatry and criminal justice have been closely related for a long time. Traces of such ties can already be found during the 19th century through the establishment of the contemporary systems of social control. Various questions that will mark the development of policies in this domain were important objects of discussion and analysis: Is mental illness a cause of criminality? Should the "insane" be held responsible for their crimes? What are the appropriate measures to heal, reform, control? In other words, should we consider the individual as sick or as criminal? If these questions are formulated differently nowadays they haven't lost any of their relevance. In this article, we will briefly present the forms of intervention available to the criminal justice system when dealing with persons suffering from mental health problems. This presentation is based on recent studies conducted in Montreal, elsewhere in Canada, as well as in the United States. The main stages of the criminal justice process will be examined, taking into account the recent modifications to the Canadian Criminal Code and its impact on the relations between the courts and psychiatric facilities. This type of situation is not without impact on community mental health for two main reasons. First, with the diminishing public funding of various health services there seems to be a growing practice of criminalization of persons suffering from mental health problems, especially the most vulnerable segments of this population. Secondly, there is a growing trend, in the criminal justice system, of requiring support from community groups or facilities to deal with these criminalized individuals. In the coming years criminalization will constitute an increasing and complex challenge for community mental health.