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ObjectiveTo compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors.MethodsRetrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis.ResultsThe 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay.ConclusionTotal laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.

This study is aimed at examining the feasibility and effectiveness of aerobic and resistance training (WeActive) and mindful exercise (WeMindful) interventions in improving physical activity (PA), psychological well-being (PWB), and subjective vitality among college students. Participants in this study were 77 college students who were randomly assigned to either the WeActive group ( n = 43 ) or the WeMindful group ( n = 28 ). The WeActive group attended two 30-minute aerobic and resistance training sessions per week, and the WeMindful group attended two 30-minute yoga and mindful exercise sessions per week for eight weeks. All participants completed the International Physical Activity Questionnaire, the World Health Organization-Five Well-Being Index, and the Subjective Vitality Scale before and after the intervention, as well as the Assessing Feasibility and Acceptability Questionnaire at the end of the intervention. The primary study outcome measures were PA, PWB, and subjective vitality. A repeated-measures ANCOVA indicated a significant main effect of time for total PA ( F = 7.89 , p = 0.006 , η 2 = 0.049 ), vigorous PA ( F = 5.36 , p = 0.024 , η 2 = 0.022 ), and walking ( F = 7.34 , p = 0.009 , η 2 = 0.042 ) in both intervention groups. There was a significant interaction effect of time and group for PWB ( F = 11.26 , p = 0.001 , η 2 = 0.022 ), where the WeActive group experienced a decrease in PWB scores while participants in the WeMindful group experienced an increase in PWB scores over time. There was a main effect of group for subjective vitality ( F = 8.91 , p = 0.007 , η 2 = 0.088 ), indicating that the WeMindful group experienced a greater increase in subjective vitality than the WeActive group. Further, the participants in both groups indicated that the synchronized and asynchronized Zoom-based WeActive and WeMindful interventions were acceptable, appropriate, and feasible for participants. This study demonstrated that mindful exercise is effective in increasing PA, PWB, and subjective vitality while aerobic and resistance training may only be effective in increasing PA.

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For over a century, governments on both sides of the Canada-US border have employed diverse policy instruments and management tools to protect the Great Lakes. This crucial freshwater resource continues to show signs of degradation. We explore how the International Organization for Standardization Risk Management Standard (ISO 31000) can be used by governments to reduce the risk of failing to achieve the policy objectives of the Great Lakes. ISO 31000 facilitates the analysis of human activities that drive the causal pathways of ecosystem pressures-effects-impacts and analyzes the links between these causal pathways and the performance of management measures operating within the Great Lakes. ISO 31000 allows governments to shed light on why, despite best intentions, management measures are not working and enables governments to continually improve the management system until the risks of policy failures are reduced to acceptable levels, bringing new hope to the future of the Great Lakes.