Victim Support

Modern surgical practice unfolds in environments characterized by uncertainty, time pressure, technological complexity, and high clinical stakes. Within these conditions, cognitive load emerges as a critical determinant of surgical judgment and intraoperative decision-making. This integrative review synthesizes interdisciplinary evidence from cognitive neuroscience, human factors engineering, and surgical education to examine how mental workload influences performance stability, error vulnerability, and adaptive reasoning during high-risk procedures. The reviewed literature consistently demonstrates that increased cognitive load is associated with performance degradation, particularly when stress amplifies attentional demands and working memory capacity is exceeded. Expertise moderates this relationship by promoting automaticity and efficient cognitive resource allocation; however, even experienced surgeons remain susceptible to overload under unstable or unfamiliar conditions. Measurement methodologies—including subjective workload scales, physiological indicators, behavioral proxies, and neurophysiological signals—reflect ongoing efforts to operationalize cognitive strain within clinical environments. Simulation-based training, deliberate practice frameworks, team communication protocols, and cognitive offloading strategies are repeatedly described as mechanisms capable of enhancing decision stability under pressure. The findings suggest that cognitive load should be conceptualized as a modifiable patient safety variable rather than an unavoidable byproduct of surgical complexity. Integrating cognitive science principles into surgical training and workflow design may strengthen adaptive decision-making and reduce preventable errors. These implications are particularly relevant for diverse international healthcare systems, including those with heterogeneous institutional resources, where optimizing cognitive performance can contribute meaningfully to operative reliability and patient safety.

Patient: Female, 40-year-oldFinal Diagnosis: ObesitySymptoms: ObesityClinical Procedure: —Specialty: SurgeryObjective: Unusual clinical courseBackgroundMetabolic and bariatric surgeries (MBS) are effective treatments for obesity and related comorbidities, such as diabetes and hypertension. In patients with morbid obesity and challenges like hepatomegaly, conventional procedures may increase risks. Staged MBS was developed to address these issues, enhancing safety. This report highlights the successful use of isolated intestinal transit bipartition with duodeno-ileal anastomosis, preserving the duodenum, as the first stage of the duodenal switch.Case ReportA 40-year-old woman with a BMI of 40.2 kg/m2 was booked for MBS. Severe hepatomegaly impaired safe access to the esophagogastric junction, leading to the performance of only the intestinal stage of the duodenal switch. A duodeno-ileal anastomosis was created 250 cm from the ileocecal valve, preserving the stomach and partial duodenal function. Without the gastric stage, the patient achieved 50 kg of weight loss (equivalent to 78.7% excess weight loss) over 19 years, without requiring additional surgery. Minor complications included occasional diarrhea, meteorism, and difficulties with vitamin supplementation, all managed effectively through dietary adjustments and nutritional guidance. A benefit was increased satiety.ConclusionsIsolated intestinal transit bipartition with duodeno-ileal anastomosis is an approach that may be used in exceptional cases, such as with this patient. Despite the favorable long-term follow-up results, further studies are necessary to better understand this approach. This method demonstrated sustained weight loss and long-term metabolic control, potentially representing a promising initial treatment option for patients with lower BMIs, including those with type 2 diabetes.

The aim of this research was to examine the role of work motivation as a predictor of employee organizational commitment. Organizational commitment was operationalized based on Meyer’s and Allen’s model (1991), which distinguishes three interrelated components of commitment: affective, continuance, and normative commitment. Work motivation was defined using self-determination theory, which categorizes motivation into two broader factors: intrinsic and extrinsic motivation. The sample consisted of 218 participants, employees from Serbia and Bosnia and Herzegovina, of whom 61.5% were female, with ages ranging from 22 to 66 years. A series of linear regressions were conducted to test the hypotheses, with the two types of work motivation (intrinsic and extrinsic) as predictor variables, and the three components of organizational commitment (affective, continuance, and normative) as criterion variables. All three regression models were statistically significant. Results indicate that intrinsic motivation significantly predicts affective (β = .51), continuance (β = .28) and normative commitment (β = .20), while extrinsic motivation significantly predicts continuance ( β = .34) and normative commitment (β = .45). The findings underscore the importance of both extrinsic and intrinsic motivation in the development of employee organizational commitment.

BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.

Purpose This study examines the organizational determinants of generative AI adoption in US law enforcement, addressing a gap in systematic evidence on factors driving AI innovation within police agencies. Design/methodology/approach A total of 140 valid responses to an online survey of Texas police chiefs were analyzed. Generative AI engagement (from planning to extensive use) and four hypothesized drivers—transformational leadership style, prior body-worn camera deployment, presence of a formal AI policy, and agency capacity—were measured, with chiefs' demographic characteristics included as controls. Logistic and probit regression models were employed for data analysis. Findings Transformational leadership, larger budgets, and chiefs' advanced educational attainment each show significant positive associations with generative AI engagement. In contrast, prior BWC deployment and the mere presence of a formal AI policy do not predict AI adoption. Practical implications To foster responsible AI integration, agencies should invest in leadership development that cultivates transformational competencies, secure adequate funding, and support advanced education. Policymakers and grantors should prioritize capacity-building over standalone policy directives. Originality/value This study is among the first large-n quantitative analyses of generative AI adoption in policing, underscoring the primacy of visionary leadership and institutional capacity—rather than historical technology experience or policy frameworks alone—in driving AI innovation.

Speaking skills are one of the important skills in English that has a crucial role in oral communication, especially in maritime education which requires cadets to master technical and communicative competencies. The results of initial observations at the Sorong Shipping Polytechnic show that cadets of the Nautical 2C Study Program still face obstacles in the form of limited vocabulary, low confidence, and difficulties in grammar and pronunciation, which have an impact on low speaking skills. This class action research aims to improve cadets' Maritime English speaking skills through the integration of TikTok media as a means of digital learning. The research was carried out collaboratively in three cycles, each consisting of planning, action, observation, and reflection stages. Data were collected through observation sheets, speaking tests, pre-tests and post-tests, and interviews. The results showed a consistent improvement in both learning activities and speaking skills. The active participation of cadets increased from cycle I (55.29% of the fair category) to cycle III (75% of the good category). The average value of speaking skills increased from 65 (cycle I) to 77.12 (cycle III), with learning completeness increasing from 11.76% in cycle I, to 88.23% in cycle III. The post-test results strengthened this finding with an average score of 83.76 and 88.23% of cadets achieving the KKM. Interviews show that more than 85% of cadets consider TikTok effective in increasing motivation, creativity, and confidence in practicing speaking. It can be concluded that the integration of TikTok in Maritime English learning has proven to be effective in improving speaking skills, especially in terms of comprehension, fluency, and pronunciation, as well as encouraging motivation and active involvement of cadets.

BackgroundBurden of disease estimation and the attribution to risk factors are commonly done on national or regional scale. This research proposes a novel approach, where air pollution-related mortality in Belgium was estimated locally, and compares the results to those of the common ‘global’ approach.MethodsIn the local approach, mortality attributable to long-term exposure to particulate matter < 2.5 μm (PM2.5) and nitrogen dioxide (NO2) is derived at the level of census tracts. Relying on a statistical concentration-response function suggests potential bias when applied to such small scale. Therefore, the local method is validated by comparing aggregated results to estimates derived with a global approach. In a sensitivity analysis, the difference between the global and local approach is compared to the impact of other methodological choices and sources of uncertainty.ResultsThe local method estimates (95% confidence interval) 12,276 (6,695; 17,826) deaths for PM2.5 and 7,944 (4,725; 11,181) for NO2 in Belgium. For both pollutants, these national estimates never deviate more than 2% from those obtained with the global method, and never more than 4% in the individual provinces. The sensitivity analysis demonstrates the concentration-response function as having the largest contribution to overall uncertainty, while the global-local discrepancy is slightly larger compared to the exposure uncertainty.ConclusionsAggregated local burden estimates prove to be accurate compared to the global approach. This means the local method shows potential for comparing areas and population groups at subnational level, where estimates can be generated in a flexible manner depending on research or policy needs.

Background: Cervical spine degeneration is a progressive condition that can lead to signicant neurological impairment if not detected early. Magnetic Resonance Imaging (MRI) plays a crucial role in the evaluation of degenerative changes. Recently, Nakashima's grading score has emerged as a standardized method for assessing cervical spinal degeneration, offering a more detailed classication of pathological changes. This study Objective: aims to evaluate the effectiveness of MRI in the early detection and grading of cervical spine degeneration using Nakashima's classication system. Patients presenting with cervical spine symptoms underwent MRI evaluation. Th Methods: e severity of degeneration was assessed using Nakashima's grading score, focusing on disc degeneration, spinal cord compression, and signal intensity changes. Correlations between MRI ndings, clinical symptoms, and neurological impairment were analyzed to determine the grading system's diagnostic accuracy. MRI successfully identied early degenerativ Results: e changes, with Nakashima's grading score providing a structured assessment of disease progression. Higher-grade degeneration correlated signicantly with increased neurological symptoms and spinal cord signal alterations. The use of MRI enhanced early diagnosis, aiding in timely intervention and management. MRI, in conjunction with Nakashima's gradi Conclusion: ng score, serves as a valuable tool for the early detection and evaluation of cervical spine degeneration. This standardized grading system improves diagnostic accuracy and facilitates better clinical decision-making, potentially preventing disease progression and neurological complications.

El avance tecnológico y la virtualización de procesos educativos han impulsado el desarrollo de estrategias innovadoras para la formación profesional en áreas técnicas. Este artículo aborda el uso de entornos virtuales como herramienta pedagógica para la simulación de procesos mecánicos en la formación de estudiantes ecuatorianos del ámbito técnico. Se fundamenta en una revisión documental y estudios de caso nacionales e internacionales, los cuales evidencian la efectividad del aprendizaje basado en simulación para fortalecer competencias prácticas sin los riesgos inherentes a la formación presencial tradicional. El estudio destaca el potencial de las tecnologías como la realidad virtual, la gamificación y los simuladores interactivos en el aprendizaje de sistemas mecánicos complejos, incluyendo su aplicación en asignaturas como inyección diésel, mantenimiento de motores CRDI y procesos de soldadura. También, se identifican metodologías didácticas efectivas, plataformas educativas adaptadas al contexto ecuatoriano y condiciones mínimas de implementación. La propuesta considera la necesidad de integrar los entornos virtuales como complemento, y no sustituto, de las prácticas reales, garantizando la formación de profesionales técnicamente competentes y adaptados a los desafíos del entorno productivo actual. Este trabajo constituye un aporte a la mejora continua de la enseñanza técnica superior, proponiendo criterios y modelos para el diseño, desarrollo y evaluación de simulaciones educativas aplicadas al campo de la mecánica.