IntroductionYouTube, the world's largest video platform, hosts thousands of educational surgical videos that many trainees rely on to enhance their understanding and proficiency in various surgical procedures. Consequently, a crucial inquiry arises regarding the trustworthiness of these videos as a valuable resource for these trainees. In this article, we address this question by focusing on one of the most frequently performed surgical procedures in the field of urology and assessing the effectiveness of these videos as an educational tool for urology trainees .MethodologyWe conducted a comprehensive search on YouTube for all videos related to 'Testicular Exploration'. After applying specific inclusion and exclusion criteria, we identified a total of nine eligible videos for analysis. These videos were assessed using the LAParoscopic Surgery Video Educational GuidelineS (LAP-VEGaS) scoring system, which categorized them into two distinct groups. The first group, known as the 'high-quality group', included videos that scored 11 points or higher according to the LAP-VEGaS scoring criteria. The second group, termed the 'low-quality group', consisted of videos that scored less than 11 points using the LAP-VEGaS scoring tool. Additionally, we collected data on various metrics, such as video view counts, duration, likes and dislikes counts, comments count, like ratio, view ratio, and power index, and performed a comparative analysis between the two aforementioned groups.Results Between April 2013 and September 2023, the selected videos exhibited an average total view count of 95,546±138,000. The videos had an average duration of 6.35±2.26 minutes. Furthermore, the mean values for both likes and dislikes were 461.55±581 and 2.89±2.86, respectively. In contrast, the mean like ratio, view ratio, and power index were 0.98±0.0112, 176,00±13,100, and 173.80±131, respectively. The mean LAP-VEGaS scores for videos related to testicular exploration were 9.94±2.05. It is noteworthy that the first group had a statistically higher number of dislikes; however, the view count, comments count, likes count, and view ratio were statistically lower in the same group.ConclusionVideos related to testicular exploration on YouTube exhibit notably low quality and do not serve as a valuable resource for urology trainees. Key factors such as video duration, total view count, and viewer interactions  should not be relied upon as indicators of educational video quality. Consequently, it is advisable for urology trainees to refrain from using YouTube as a primary source for learning about testicular exploration. Instead, they should seek guidance and support from experienced senior colleagues, educational supervisors, or consultants to explore more reliable sources of information for this surgical procedure. Electronic learning (E-learning) is increasingly recognized as an efficient fundamental teaching approach that warrants promotion across all educational levels . MoreoveAnd with rapid technological advancements and emerging of video platforms that have countless surgical educational videos, which are an integral resource for surgical trainees looking to advance in their careers, a pressing need has developed to understand the usefulness and reliability of these videos and how they are considered as a good source of information. Likewise, within the field of Urology, there are a multitude of surgical procedures that urology trainees must familiarize themselves with in order to perform them safely and accurately.To acquire the necessary understanding and skills for these procedures, trainees should rely on a consensus among senior consultant urologists regarding what constitutes a 'high-quality' source. Taking the testicular exploration as a prime example of that, which is considered one of the most common urological procedures that any urology trainee should be able to perform in order to provide the best and quickest care to patients in need, numerous videos pertaining to this procedure are available. Yet questions surrounding their reliability persist.Utilizing YouTube videos for surgical education and training represents an inventive approach to instruct and acquaint learners with surgical procedures. The wide accessibility of YouTube offers an advantageous platform for educational content. Nevertheless, the absence of peer review in the current setup may result in deficient or erroneous content .On September 24, 2023, at 14:00 UK local time, we searched for 'Testicular Exploration' on the YouTube search bar, and a total of 34 videos were identified and sorted based on the views count from the most to the lowest count. The upload date range for our videos was between April 19, 2013 and September 9, 2023. Out of 34 videos, nine included, five shorts (YouTube videos less than 60 seconds), one playlist, one song, and 18 other excluded videos. Our exclusion criteria applied and removed any video that was 'Short' (less than 60 seconds in duration), any videos related to animal scrotal exploration, any videos featuring planned surgery for known pathology, any videos showing only a small part of the procedure or positive findings only, any educational videos that did not show an actual procedure, and the playlist that technically had duplication of already included videos. All nine videos were collected, and each video was analyzed for video duration, views count, comments count, likes count, dislikes count, like ratio (sum of likes/sum of likes and dislikes), view ratio (view count/years since uploaded), power index ([view ratio * like ratio]/100), high-quality video resolution ), skin-skin procedure, and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) score.The LAP-VEGaS score was performed for each of the nine videos by two senior urologists known to have a great involvement in surgical education. Each score was achieved by answering nine questions that each granted either 0 points (not presented in video), 1 point , and 2 points (completely presented). A minimum of 0 and a maximum of 18 for each video were expected. The scores were divided into two groups: the first group  had scores equal to or more than 11 points and the second group  had scores less than 11 points. We also calculated the video's views count, duration, both likes and dislikes count, comments count, like ratio, view ratio, and power index and compared the results across the abovementioned two groups using IBM SPSS Statistics for Windows, Version 28.0 . All nine videos obtained and analyzed as per the abovementioned methodology are shown in Table The mean video duration was 6.35±2.26 minutes. The mean of both likes and dislikes was 461.55±581 and 2.89±2.86, respectively. On the other hand, the mean like ratio, view ratio, and power index were 0.98±0.0112, 17,600±13,100, and 173.80±131, respectively. The mean of the LAP-VEGaS scores for testicular exploration videos was 9.94±2.05. The percentage of videos with a resolution of 1080p FHD quality was 56%, and procedures that involved a skin-skin procedure were 44%.Of the nine selected videos, three were high quality and six were low quality, making a ratio of 1:2 . The LAP-VEGaS score ranged from 5 for the lowest-scoring videos to 16 for the highest one. The dislike numbers were statistically higher for the first group; however, the views count, the comments count, the likes count, and the view ratio were statistically lower for the same group. The P-value was not significant for video duration, like ratio, and power index across both groups. All P-values are demonstrated in Table Upon comparing the two groups by examining both the mean view counts and view ratio, it is clearly noted that they were statistically lower in the high-quality group, with P-values of 0.016 and 0.023, respectively. In Figure Figure We wish to elucidate the fact that the nomenclature of this assessment tool could potentially be misleading, given its explicit reference to laparoscopic surgery, whereas our current utilization involves the evaluation of open surgical procedures. It is noteworthy to mention that this tool was initially conceived and developed with a predominant focus on assessing laparoscopic surgeries and subsequently underwent modifications to accommodate its applicability to open surgical contexts. Furthermore, it is important to note that this assessment tool is specifically designed to assess the scientific content of uploaded videos rather than gauging their overall quality or resolution. The tool comprises nine questions meticulously tailored to address scientific aspects of the video, such as whether the procedure was executed correctly in a step-wise manner, if there was a clear description during the procedure, whether anatomical details were elucidated, if pathological aspects were identified, and whether preoperative and intraoperative findings were adequately mentioned, among other criteria.The results of our study demonstrated a low quantity of testicular exploration videos on YouTube, and this is most probably due to uploading videos under other names like scrotal surgery, torsion surgery, and testicular surgery. The data showed a broad standard deviation across different parameters, indicating a significant variation in values among the videos that were assessed. For example, among the nine selected videos, three met the criteria for high quality, while the remaining six were considered low quality, resulting in a ratio of one high-quality video for every two low-quality ones. The LAP-VEGaS scores ranged from 5, the lowest, to 16, the highest, which again supports the wide range of quality and data gathered. Interestingly, the first group  had a statistically higher number of dislikes, but conversely, it had significantly lower counts in terms of views, comments, likes, and view ratios. And again, it is unexpected to have more dislikes for the highest quality videos, which makes the interactions on videos invalid factors to suggest whether this is of high or low quality. The utilization of the LAP-VEGaS score as a video assessment tool has the potential to elevate the overall caliber of published video content . Many stAt this juncture, we may contemplate how to enhance the quality of these uploaded videos. Since there are no stringent criteria for uploading content to YouTube and not all uploaders are acquainted with the LAP-VEGaS scoring tool, we need to consider potential improvements. One suggestion is to promote education about this scoring system and ensure that uploaded videos explicitly mention their high-quality LAP-VEGaS score. Additionally, with technology constantly advancing, we propose the integration of such assessment tools into medical school curricula, for example, within biostatistics syllabi. This way, medical students and trainees can distinguish and disregard low-quality videos, allowing high-quality content to occupy a prominent position in search results. Another crucial consideration to be emphasized is the need for medical schools and training programs to allocate more resources to video-based learning, given its cost-effectiveness and remarkable efficiency along with face-to-face teaching in today's educational landscape. For instance, teaching a student how to perform a urinary catheter insertion can be accomplished effectively in a well-structured five-minute video, compared to the time-consuming process of explaining the procedure face-to-face, which undoubtedly takes longer than five minutes. Furthermore, students and trainees have the advantage of pausing and replaying sections they find challenging as many times as needed to improve their understanding, as opposed to merely observing the entire procedure once without addressing specific areas of weakness. It is essential to underscore that effective teaching should incorporate a blend of both virtual and in-person instruction.Limitations Our study has a primary limitation stemming from the small sample size, primarily due to the scarcity of videos related to testicular exploration on the YouTube platform. This scarcity poses a challenge when it comes to establishing the true validity of specific results. Additionally, it's important to note the high popularity of the first two lower-quality videos, which contributed to a statistically lower P-value for the first group. These two videos focused on a critical step in testicular exploration, which is orchidectomy and fixation of the other testes. This particular aspect likely captured the interest of many urology trainees, resulting in their high view count and popularity.Additionally, we want to emphasize that trainees often limit their online searches to a particular surgical procedure on YouTube. They spent a significant amount of time browsing through the search results instead of modifying the search query, such as using "scrotal surgery," which could be time-consuming and somewhat distracting. According to the LAP-VEGaS tool, the primary emphasis should be placed on a single, commonly searched topic by trainees. In our study, our primary focus was on testicular exploration surgery. Considering that we had over 30 videos, each lasting more than five minutes, trainees would dedicate a significant portion of their research time to these specific videos. And again, delving into scrotal surgery to locate instances of testicular exploration would consume considerable time and potentially introduce distractions.Conversely, an additional constraint within our study could arise from the potentially inflated view counts of older, lower-quality videos in comparison to more recently uploaded ones. This discrepancy could potentially lead to erroneous findings in the correlation between video quality and view counts, as exemplified by the notably low P-value observed for high-quality videos.Another limitation we encountered was the inability to establish a correlation between user interactions on the videos, including likes, dislikes, and comments, and the educational quality as measured by the LAP-VEGaS score. For instance, the video with the highest LAP-VEGaS score had more dislikes and fewer comments compared to some low-quality videos. Furthermore, the most viewed video had a LAP-VEGaS score lower than 11, indicating that these user interactions are not reliable indicators of content quality. It is worth noting that some videos may initially hide the dislike button to prevent negative impressions during the initial upload period.All nine videos received a high score (+2) for the first question of the LAP-VEGaS tool, which assesses whether the title or procedure and pathology being treated are clearly documented. However, it is noteworthy that each of the nine selected videos received at least one zero score on certain questions, indicating that there was no single video that could be considered ideal in all aspects. Furthermore, it's important to mention that both consultants who assessed the LAP-VEGaS scores are highly experienced in the field of surgical education, which might have resulted in some conservative scoring. Nevertheless, the scores assigned to each video exhibited a consistent pattern, with a maximum difference of ±1 between the two scores, thereby ensuring that the overall LAP-VEGaS score was nearly accurate.The quality of YouTube videos related to testicular exploration is generally subpar, making them an ineffective resource for urology trainees. Metrics such as video duration, view count, and user interactions  are not dependable indicators of the educational value of these videos. Consequently, it is advisable for urology trainees to refrain from relying on YouTube as a source for learning about testicular exploration. Instead, they should seek guidance and support from experienced senior consultants in order to acquire the necessary skills for this surgical procedure or explore alternative, more reliable sources of information.


Background: Catheter-related bladder discomfort (CRBD) is a frequent occurrence following urinary catheterization during surgical procedures, as well as a commonly experienced bladder pain syndrome after surgery. There have been various studies on drugs and interventions to manage CRBD, but their comparative efficacy and safety are still a topic of debate. We conducted a meta-analysis to assess the efficacy and safety of nefopam for managing postoperative CRBD.Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to find randomized controlled trials (RCTs) on using nefopam in postoperative CRBD. The study employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data analysis was performed using RevMan version 5.4.1.Results: Five RCTs with 405 patients were analyzed to evaluate the efficacy of nefopam on postoperative CRBD. Short-term and long-term periods were defined as within 6 h and longer than 12 h after surgery, respectively. The incidence and severity of CRBD were compared between the two groups during these time periods. The analysis proved that nefopam reduced the short-term incidence of postoperative CRBD  and the long-term incidence  significantly. We compared the incidence of moderate-to-severe CRBD between groups based on the scaling system . This was used to assess the severity of postoperative CRBD. The results showed that patients in the nefopam group had a significantly lower incidence of moderate-to-severe CRBD compared to those in the placebo group in the short-term . However, there were no significant differences between the two groups in the incidence of moderate-to-severe CRBD in the long-term . There were no significant variations in the occurrence of adverse events between the nefopam and control groups, mainly including postoperative nausea and vomiting (PONV) , and tachycardia .Conclusion: The findings of this meta-analysis indicate that nefopam significantly reduced the incidence of short or long-term postoperative CRBD. Nefopam decreased the severity of postoperative CRBD, particularly significantly reducing the occurrence of moderate to severe CRBD in the short-term. Overall, patients have good tolerance and no apparent side effects.Systematic Review Registration: identifier PROSPERO (CRD42023475012) Large-diameter urinary catheters used after surgical procedures, particularly urological surgeries, may lead to CRBD. This discomfort is characterized by a sense of urgency and increased frequency in urination, accompanied or not by involuntary loss of urine . CRBD syThe current treatment options for postoperative CRBD are diverse, and novel strategies are continually sought to address this issue. Various agents have been studied and verified for the prevention and treatment of CRBD. Some of these agents include ketamine, dexmedetomidine, antimuscarinics, gabapentin, tolterodine, and tramadol . RecentlThis essay conducts a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of nefopam in managing this condition in postoperative urosurgical patients. The objective of this essay is to synthesize the findings of existing RCTs to provide a rigorous assessment of nefopam’s role in addressing CRBD, with implications for urosurgical practice.Up to 1 September 2023, we conducted a systematic literature search using several electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science. The search terms employed were a combination of controlled vocabulary terms  and free-text keywords. We included RCTs that investigated the efficacy and safety of nefopam in managing CRBD in urosurgical patients. The following search terms were applied for the search: RCT, nefopam, and CRBD.In our systematic review and meta-analysis, we followed a rigorous set of inclusion and exclusion criteria to select relevant studies for analysis. Two authors utilized PICOS  criteria to include relevant RCTs. All authors independently browsed and read all searched articles, and the final list of included articles was decided through a consensus discussion.1) Participants: Studies involving adult urosurgical patients who experienced CRBD were eligible for inclusion. 2) Intervention: Included studies administered nefopam as an intervention to manage CRBD. 3) Control: The included studies used saline as a placebo control treatment for managing CRBD. 4) Outcome Measures: Studies reporting relevant outcome measures, including the incidence of CRBD, the severity of CRBD symptoms, and postoperative side effects were considered. 5) Study Design: We included RCTs that investigated the efficacy and safety of nefopam in managing CRBD in urosurgical patients.Review, meta-analysis, none RCT, and no full text were not considered. characteristics of included studies.The retrieved studies were screened by two independent reviewers using predefined inclusion and exclusion criteria. Disagreements were resolved through discussion and consensus. A standardized data extraction form was utilized to collect the following information from each included study: 1) study characteristics ; 2) therapy in experimental group; 3) therapy in control group; 4) participant quantity demographics; 5) catheter size; 6) inflated balloon and volume; 7) types of surgery; 8) primary outcomes; 9) secondary outcomes; (10) check points and time. To evaluate the quality of the included studies, we employed the Cochrane Risk of Bias tool. . This to2 not greater than 50%), a fixed-effect model was employed; otherwise (I2 greater than 50%), a random-effects model was used. Statistical significance was determined using a p-value of less than 0.05.A meta-analysis was conducted using Review Manager software version 5.4.1 . Only variables evaluated by at least two studies were pooled. The mean difference (MD) with 95% confidence intervals (CIs) was used for continuous data, while risk ratios (RRs) with 95% confidence intervals were used for dichotomous data. When there was no significant heterogeneity , and data are presented as numbers. Three studies enrolling 196 participants (98 in the nefopam group and 98 in the control group)  were usep = 0.003, I2 = 78%) significantly; meanwhile, nefopam reduced the long-term incidence of postoperative CRBD . Overall, the meta-analysis revealed a statistically significant reduction in the incidence rates of postoperative CRBD favoring nefopam treatment   .Similarly, according to the short-term and long-term grouping, we compared the incidence of moderate-to-severe CRBD between groups based on the scaling system . The data is presented in numerical form to assess the severity of postoperative CRBD. Three studies enrolling 196 participants (98 in the nefopam group and 98 in the control group)  were usep < 0.00001; I2 = 0%). In contrast, there were no meaningful differences between the two groups in the severity of CRBD in the long-term . Overall, the meta-analysis revealed a statistically significant reduction in the severity of postoperative CRBD favoring nefopam treatment   .In addition to assessing efficacy, we also examined the safety profile of nefopam in the included RCTs. We evaluated the incidence of adverse events and patients tolerance to nefopam to determine its safety. The 202 patients in the nefopam group included in the five articles did not experience any specific adverse drug reactions, and overall, the patients exhibited good tolerance.p = 0.81), and tachycardia    .CRBD is a significant and distressing phenomenon in medical practice, posing a unique challenge to healthcare providers in ensuring patient comfort and wellbeing. Despite its widespread occurrence, effective management of CRBD remains a complex and underexplored territory. Existing treatment options, including antispasmodic agents and analgesics, often provide suboptimal relief and may carry adverse effects . In thisCRBD is caused by involuntary contractions of the bladder, mediated by muscarinic receptors located in the urothelium and on efferent nerves . CatheteIn clinical studies conducted in various medical contexts, nefopam has demonstrated a generally favorable adverse event profile. Common side effects include nausea, dizziness, and dry mouth . HoweverWhile preliminary findings indicate promise, it is vital to acknowledge the need for more robust, multicenter clinical trials to confirm nefopam’s efficacy in CRBD and further delineate its role in clinical practice. Nefopam primarily acts as a s Serotonin-Norepinephrine-Dopamine Reuptake Inhibitor (SNDRI) . By inhiWe noticed that three out of the five included studies used a dose of 20 mg of nefopam, which is consistent with the analgesic dose commonly used in our clinical practice. Previous studies have shown 20 mg of nefopam is approximately equivalent to 12 mg of morphine in terms of pain relief, but with reduced side effects . In YongNefopam can be delivered orally, intravenously, and through muscle injection, providing flexibility in tailoring treatment to individual patient needs. The dosage and duration of treatment can be adjusted based on the severity of postoperative CRBD and the patient’s overall response to the medication. Several studies have been conducted to evaluate the effectiveness of nefopam in alleviating postoperative catheter-related bladder discomfort. These studies have shown promising results, indicating that nefopam can significantly reduce the intensity and frequency of bladder discomfort, improve patient satisfaction, and enhance overall postoperative recovery . This isWe performed this meta-analysis with a total of five articles, and our study proved that nefopam significantly decreased the incidence of CRBD and the severity of CRBD in patients with urinary catheters, especially in the short-term postoperative period. We also noticed that nefopam did not significantly reduce the incidence of moderate-to-severe CRBD in patients with long-term postoperative indwelling urinary catheters. This may be attributed to the limited number of study included in our review, and it is also possible that the degree of pain and discomfort decreases as the duration of indwelling catheter increases. Additionally, the duration of indwelling catheter in patients undergoing nephrectomy and ureteroscopic litholapaxy is shorter compared to bladder tumor resection and prostatectomy. These factors combined resulted in a statistically insignificant impact of nefopam on the incidence of moderate-to-severe CRBD in patients with long-term postoperative indwelling urinary catheters.The studies analyzed were all RCTs, which improved the reliability of the findings. Despite the overall high quality of the included studies, our analysis did have certain limitations. Firstly, this meta-analysis only included 5 studies with small sample size, which was limited to the number of relevant original studies. Secondly, the patient’s perioperative indicators may be inconsistent, including different sizes of catheter, different doses of nefopam, different timing of administration, and various types of surgeries. In addition, due to the presence of heterogeneity, this may lead to a certain publication bias. This meta-analysis is important for evaluating the efficacy of nefopam compared to placebo in preventing or treating symptoms of CRBD when considering heterogeneity among articles.Nefopam, as the first study conducted on the topic, has been found to be more efficacy than placebo in relieving symptoms of CRBD. Extensive data analysis supports the conclusion that nefopam significantly outperforms placebo in alleviating CRBD symptoms. In the future, we look forward to more clinical scientists focusing on the plasma concentration of nefopam and hope for more clinical research data to supplement and further improve our analysis in the article’s main subject.The meta-analysis demonstrates that nefopam administration mitigates the frequency and severity of early postoperative CRBD without causing evident side effects. Further investigations, including well-designed RCTs with standardized dosing regimens and assessment methods, are needed to refine the efficacy and safety of nefopam in CRBD management.


Over-the-scope clip to the rescue: solution for duodenal perforation from migrated biliary stent. Iatrogenic perforation of the duodenum caused by biliary stents is a rare adverse event of ERCP.A 66-year-old man was referred to our institution to resume management of choledocholithiasis and indeterminate biliary stricture. Eighteen months prior, he had jaundice secondary to bile duct stones and mid-distal common bile duct stricture for which he underwent ERCP and plastic stent placement. The COVID-19 pandemic led to delay in the necessary follow-up.www.giejournal.org). The fluoroscopic image confirmed the perforation and approximately 1 cm of the stent extended outside the duodenal lumen. The defect measured 4 mm in diameter  (diameter ; Video 1diameter ; Video 1diameter ; Video 1diameter ; Video 1diameter ; Video 1A postprocedural CT scan showed no evidence of drainable fluid collection or extraluminal gas ; Video 1A 71-year-old woman presented to an outside hospital with painless jaundice requiring ERCP and bilateral plastic biliary stent placement. Five days later, she was referred to our hospital for duodenal perforation from a migrated biliary stent with retroperitoneal fluid collection seen on a CT scan. She underwent a similar approach with removal of the stent via rat-tooth forceps and primary endoscopic closure of the duodenal defect with tissue ablation with argon plasma coagulation and OTSC closure ; Video 1A 71-year-old woman with metastatic pancreatic adenocarcinoma presented with septic shock and encephalopathy, and she was found to have a migrated biliary stent with duodenal perforation. Her course was complicated by multiple intra-abdominal abscesses, extensive pneumoperitoneum ; Video 1She underwent an ERCP that showed a migrated biliary stent causing opposing duodenal wall perforation. The defect site was ablated and an OTSC mended the perforation. Antibiotics were continued and she underwent percutaneous drain placement with radiology. There were no immediate adverse events and she had improvement in pain and mentation.Duodenal perforations from migrating plastic biliary stents are rare; however, they can be significantly morbid when they occur. While the presentations and time intervals between original stent placement to identification of duodenal perforation differed among the 3 cases ; Video 1Dr Phan is a consultant for Boston Scientific, Olympus, and Noah Medical. All other authors disclosed no financial relationships.


The present study aims to assess the impact of the local language on the view count of patient-oriented educational Sports Medicine videos in an Orthopaedic and Sports Medicine Hospital in the Middle East and North Africa.An observational study on English and Arabic versions of Aspetar’s YouTube channel patient-oriented educational video series was conducted in February 2023, comparing the view count and viewer characteristics. Included videos were posted either simultaneously or in English version first, in both languages, and shared on the same media platforms. Collected data of interest included video title, view count in each language, age and sex of the viewers, location, and traffic source.P = 0.03). Viewers were predominantly males (73.9%) and between 18 and 44 years old (81.1%). Eleven out of 19 countries of the Middle East and North Africa region [11] were among the viewers’ top 20 countries. Traffic sources included YouTube search (45.9%), YouTube suggested videos (17%), external sources (14.4%), YouTube browse features (8.5%), and YouTube advertising (6%).Eleven videos of the patient-oriented educational video series were included in the present study. Except for one, the view count was significantly higher in the Arabic version of all 11 videos (minimum sevenfold, Patient-oriented educational Sports Medicine videos in Arabic yield higher view counts than their English version in young adult viewers from 11 countries in the Middle East and Africa among the top 20. Content creation on languages with limited online representation could effectively reach the targeted population by breaking language barriers. Patient-oriented educational videos are a growing and widespread tool in healthcare . They arYouTube is the second-largest social network, with 1.9 billion users, with young adults among their most common users , 4. DespAlthough the Middle East is among the regions with the most English speakers, their proficiency level is very low . ConsideAn observational study on English and Arabic versions of Aspetar’s YouTube channel patient-oriented educational Sports Medicine video series was conducted in February 2023, comparing the view count and viewer characteristics. Included videos were posted either simultaneously or in English version first, in both languages, and shared on the same media platforms. The videos were produced by the Hospital’s Marketing Department in collaboration with expert healthcare professionals and translated into modern standard Arabic by a certified translator. Collected data of interest included video title, view count in each language, age and sex of the viewers, geographic location, and traffic source.t-test was assessed to compare the view count of English and Arabic videos. All statistical tests were performed with SPSS V26.0 was used for analysis . P-values < 0.05 were considered to indicate statistical significance.Descriptive statistics were used to quantify view count and viewer characteristics. An unpaired P = 0.03). Viewers were predominantly males (73.9%) and between 18 and 44 years old (81.1%)  Table . Eleven The main finding of the present study is that patient-oriented educational Sports Medicine video series in Arabic yield higher view counts than their English version, including young adult viewers from 11 countries in the Middle East and Africa among the top 20.Given the limited online content in Arabic, patient-oriented educational videos are of great value. Our results show that almost half of the traffic to the videos are directly from YouTube search, suggesting the use of Arabic keywords during browsing is strongly related to the retrieval of the videos of our study among the targeted population. Social media use among sports surgeons is growing, especially among knee and shoulder specialists, mostly on academic platforms such as LinkedIn and ResearchGate , 13. On Most of the literature on YouTube patient-oriented educational videos has targeted content quality and reliability. Springer et al.  highlighOther researchers have assessed quality and reliability in their local languages, including Arabic, with comparable outcomes –23. HoweThis study is not free of limitations, but those are inherent to the metrics assessed by YouTube Analytics. Future studies should aim to develop content creation guidelines for physicians and institutions to improve video content quality and a registry of verified videos for patient education.Patient-oriented educational Sports Medicine videos in Arabic yield higher view counts than their English version in young adult viewers from 11 countries in the Middle East and Africa among the top 20. The results show that modern standard Arabic is not a barrier to explaining medical terms to the public. Content creation on languages with limited online representation could effectively reach the targeted population by breaking language barriers.


The thymus is the first lymphoid organ formed to regulate a newborn’s immunity. It reaches its maximum size during puberty, after which it undergoes an atrophic procedure called involution, but it was observed in humans that its ability to grow again in response to some stresses is maintained. There is no comprehensive study on computed tomographic features of thymus in dogs as a useful modality to evaluate the thoracic organs so this is our aim in the present study. According to our results, there is wide variation in thymic characteristics at different ages and there are some differences between breeds and genders. The present work can provide valuable information for veterinary literature.Background: The thymus is the first lymphoid organ formed to regulate a newborn’s immunity. It reaches its maximum size during puberty, after which it undergoes an atrophic procedure called involution, but its ability to grow again in response to some stresses, such as infections, neoplasia, surgeries, chemotherapy, and radiotherapy is maintained. There is no comprehensive study on computed tomographic features of thymus in dogs. So, the goal of the present study is to gain better insight into the thymus using computed tomography as a non-invasive method. Methods: One hundred and fifty dogs classified in five age groups and five breed groups were recruited to this study and the thymus was evaluated using a 2-slice computed tomography machine. The inclusion criteria for the present study were having a normal complete blood count, plain and post-contrast CT scan examination of the thoracic region and no history of neoplasia, chemotherapy or radiotherapy. The visibility, density, enhancement, grade, size, volume, shape, borders and lateralization of the thymus were evaluated and statistical analysis was performed. The effect of obesity on thymic grade and volume was also investigated. Results: The visibility, density, dorsal length, volume and grade decreased with increasing age. The thymic shape and lateralization were mostly wedge shaped and left sided, respectively. The borders became concave with aging and increasing body fat content caused an increase in the fatty degeneration of the thymus. Conclusions: Declining thymic density, grade, size and volume with aging are related to thymic involution and fatty degeneration was accelerated by increasing body fat content. Females and males were different only in thymic shape and small and large breeds were different only in thymic volume. The thymus was visible in some geriatric dogs with no underlying disease. We expect that the present work can be used by radiologists in reading thoracic computed tomography but investigation of thymic characteristics in dogs with neoplasia and history of chemotherapy, radiotherapy and thoracic surgeries can complete this study. The thymus is the first lymphoid organ formed to regulate newborns’ immunity ,2,3,4. IThere are different conditions of the thymus, such as aplasia, hypoplasia, juvenile thymic hematoma, true thymic hyperplasia, rebound hyperplasia, thymic cysts, and thymic tumors such as thymoma and lymphoma . ThymomaThis descriptive and prospective study recruited a total of 150 dogs, 74 females and 76 males, from February 2022 until February 2023. The criteria for inclusion in this study were having a normal complete blood count (CBC), a plain and post-contrast CT scan examination of the thoracic region, and referring for CT scan examination with no thymic abnormality, no neoplasia in the thymus or other organs, and metastasis detection. These patients were referred for computed tomography due to traumatic injuries and orthopedic reasons. All medical records and CT scan images were also evaluated to exclude patients with any pathologies that have a possible effect on the thymus, such as lung nodules or lesions, sternal, mediastinal, or perihilar lymphadenopathy. The patients were of different breeds . They were divided into five age groups, with 30 dogs in each group, according to their ages. Group 1 was a puppy group, including puppies from ages 0 to 6 months old; group 2 was a juvenile group, including 7–12 months old; group 3 was young adults, including 1–2-year-old dogs; group 4 was an old adult group, including dogs aged 3–7 years old; and group 5 was a geriatric group, including dogs more than 7 years old. They were also divided into five size groups based on their size .All CT examinations were performed by a 2-slice Somatom-Spirit CT scan machine  at the department of Diagnostic Imaging of Veterinary Faculty, Tehran University, Tehran, Iran. The contrast media used for all examinations were Omnipaque (240 mg/mL) with a dosage of 4 mL/kg or Visipaque (320 mg/mL) with a dosage of 2 mL/kg. The standard protocol for thoracic CT scan was used . Dorsal and sagittal images were reconstructed and used for better detection of the thymus. All examinations were stored in the PACS system and then free version of radiant viewer was used to evaluating the images. The Leonardo Syngo workstation  was also used for volumetry. Evaluations were performed by a board-certified radiologist in the Osteo window.2 was considered in the widest part of the organ for large thymus  and could not differentiate from mediastinal fat; grade 1: more than 50% fatty replacement of the thymus; grade 2: more than 50% soft tissue component in the thymus; grade 3: totally soft tissue component in the thymus. After grading the thymus, the attenuation (CT number) of thymic tissue in plain and contrast-enhanced images was measured. For this purpose, a round-shaped region of interest (ROI) with a surface equal to 75 mme thymus  and a smThe size of the thymus was also measured in transverse and dorsal images. The maximum height (TH) and diameter (TD) in transverse images and maximum diameter (DD) and length (DL) in the dorsal views were measured , as wellt-test was used for comparing numerical data between the two groups; and the Pearson Chi-square test was used to analyze the categorical variables such as enhancement, shape, predominant side, and grading. The Pearson correlation coefficient  was calculated for the evaluation of the repeatability and reliability of two-stage measurements (intra-observer agreement). All statistical analyses were performed with SPSS software version 16.Categorical data were collected as numbers and presented as a percent value. Continuous data were presented as the mean ± SD. Mean density, TD, TH, DD, DL, and TV were compared between groups using a one-way ANOVA and the Tukey method; the In the present study, the thymus was visible in 104 out of 150 cases. The distinct lobes of the thymus were not distinguishable. The visible thymus was noted with a soft tissue component and homogenous appearance or a combination of soft tissue and fat component based on the degree of involution with heterogenous (mottled) appearance . We accop-value ≤ 0.05, It was found that the mean density of the thymus decreased with increasing age from group 1 to group 5, but the pattern was not the same between the patients in one group with different ages and the distribution of CT numbers in one group was very wide. The mean, minimum, and maximum densities in plain and post-contrast CT scan examinations in each group were summarized in p-value for comparing enhancement showed a significant difference between age groups . There was no significant difference between the thymic enhancement of different breeds and genders. The thymus was enhanced in 93% of females and 96% of males. It was also noted that the blood supply of the thymus was mostly by the left and right internal thoracic arteries and veins . The other non-enhanced thymic tissues were non-visible (six patients out of 46). The percentage of enhancement in groups 1, 2, and 4 was 100%, and in groups 3 and 5, it was 93.3% and 80%, respectively. The nd veins .p-value = 0.006). The percent values of each kind of shape are summarized in Three different shapes of the thymus in the transverse section were noted in the present study: a rectangular shape with convex borders that was visible in younger patients, a wedge-shaped appearance with concave or straight borders in young or adult patients , and a lThe dominant side of the thymus in the cranial portion was evaluated because the thymus deviated to the left side caudally in all patients, resulting in the well-known ‘sail sign’ in radiographic images. The predominant side of the thymus was left sided in 46% of the cases and mid-line in 53% of the cases. However, there was only one patient with a thymus deviated to the right side in the cranial aspect of the mediastinum . The prep-value = 0.000). The mean volume of the thymus in females was 2.3 ± 2.6 cm3 and 2.5 ± 3.8 cm3 in males, with no significant difference between males and females, but a significant difference in volume between breeds. The mean values of volume in toy breeds, small breeds, large breeds and giant breeds were 1.4 cm3, 1.7 cm3, 2.9 cm3, and 3.6 cm3, respectively. The thymic volume in the only medium-sized breed patient was 2.3 cm3. The Pearson correlation coefficient was high between the 2-stage measurement of thymic volume (97.5%). There was no correlation between thymic volume and subcutaneous fat content (r = 0.053).The mean, maximum, and minimum thymus volumes of each group are summarized in p-value ≤ 0.05). The approximate ratio between TD and the height of the T2 midbody was 1.2 ± 0.7.The mean, minimum, and maximum values of the thymic diameter and height in the transverse view and the diameter and length in the dorsal view are shown in The grade of the thymus has been declining with increasing age. There was no grade 0 thymus in group 1. There was no grade 3 and 2 thymus in group 5. Based on our findings, the correlation between age and grade was significant. The percent value of each grade in each group is summarized in The thymus was visible in all puppies, most of the juveniles and young adults, half of the old adults and some geriatric dogs. According to the results, the thymic component started to atrophy and be replaced by fat from the first months of life, and the fat content was increasing with aging. In one ultrasonographic study of the thoracic region in dogs and cats carried out by Reiche and Wisner (2000) , they coWe observed that the thymic soft tissue component can be preserved in some healthy adult and geriatric dogs. Evans and de Lahunta  mentioneWe hypothesized that the early fatty degeneration of the thymus in some juveniles and young adults in our study can relate to some conditions, such as previous treated infections or inflammations which accelerated the thymic atrophy.As noticed in the present study, the distinct lobes of the thymus were not seen distinctly in both cranial and caudal portion and our hypothesis was the low accuracy of the 2-slice CT scan machine; but in a most recent study by Cordella et al. (2023)  that evaIn our study, the same thymic topographical characteristics as Evans and de Lahunta’s study were observed . From anAccording to the present results, thymic appearance was homogenous with a predominant component of soft tissue, and became heterogenous with mottled appearance by adipose substitution. Cordella et al. (2023)  also obsThe CT attenuations of thymus in the present study were in the range of soft tissue and fat based on the predominant component, but there was a wide spectrum of densities in each group and between individuals. CT numbers noted in our study for each patient matched the subjective grade. Declining CT numbers from puppies to geriatric dogs is also due to fat replacement by aging. In fact, there is a reverse correlation between thymus CT attenuation and aging which was also noticed in dogs according to Cordella et al. (2023)  and humaAccording to the present findings, only in eight patients, which were young adults and geriatric, no enhancement was notable. In six of these patients, the thymus was also non-visible (grade 0); so non-enhancement could be due to severe atrophy of the thymus. Another reason can be the very small size of the degenerated thymus, which reduces the accuracy of density measurement. Another hypothesis is insufficient injected contrast media, but when the enhancement of other organs was checked, this hypothesis was ruled out. The blood supply of the thymus was by left and right internal thoracic arteries based on our results, although according to Evans and de Lahunta , occasioThe shape of the thymus in the transverse section was variable between dogs, even in the same age and breed group, but we classified the shape. According to our results, it was observed that most of the thymic shapes in the transverse section were wedge shaped with straight and concave borders, perhaps because most of the patients were adults. Opposite of our expectations, most of the puppies’ thymus were wedge shaped with convex border and there were some with rectangular shape and convex border. We hypothesized that this finding was due to premature thymic involution following previous stresses or diseases in puppies. Alteration of thymic borders from convex to straight and concave with aging was also confirmed in human studies .The thymic shape was also significantly different between genders. Females had more rectangular-shaped thymus than males. Contrary to our presumption old adult dogs had more rectangular-shaped thymus than juveniles and young adults; it can be related to the body conformation of dogs in this group. Another reason can be related to the fact that there were more male dogs in the juvenile and young adult groups. The thymic shape was so variable in the sagittal view, making it impossible to classify it in this view. Thymic shape in the dorsal view was the same in all patients. According to Cordella et al. (2023)  who evalThe dominant side of the thymus was also variable, but in all of the samples, the caudal aspect of the thymus extends to the left side, which makes a ‘sail sign’ in ventrodorsal thoracic radiographs. This feature in humans is right-sided and the sail sign is notable on the right side in anterior-posterior radiographs . The domIn the present study, the transverse view was mostly used to evaluate the characteristics because it is the main non-reconstructed view with better resolution and because of the best categorization of features such as thymic shape and side predominancy in this view.In our study population, the volume and thymic length in the dorsal view decreased with aging. The mean values of each index of the thymus were measured with a high reliability coefficient, but there was a wide variation in thymic size between groups and there was no descending pattern in some measurements from puppies to geriatrics. We hypothesized that this finding is due to breed and weight differences. Cordella et al. (2023)  also obsAnatomically, in beagles, it is known that when the thymus is completely developed it is 12 cm long, 6 cm wide, and 3 cm high . MoarrabIt was observed that the fat replacement of the thymus increases with an increment in subcutaneous fat content, which can be an index of obesity and body condition in our population. The impact of obesity on the thymic attenuation in human patients between 20 and 30 years old was evaluated in one study that showed overweight patients were more likely to have higher levels of thymic fatty replacement than normal or underweight patients . In the There are many comprehensive studies on human’s thymus characteristics using imaging modalities which provide valuable data about this organ in newborns, children and adults. Based on these investigations, thymus CT attenuation in plain and contrast-enhanced examinations is variable ,18. In aAckman et al. 2016) [16 [20] dAs we noticed, there was a great variation in thymic shape in dogs, there was also significant variation in the CT scan appearance of a normal thymus in the preadolescent and adolescent age groups according to Heiberg et al. (1982)  that invVariation of normal thymus appearance on human CT scans and differences in thymic shape between males and females in the middle and older age was also reported by Araki et al. 2016) [16 [20] wA study by Hussain et al. (2020)  investigThe important limitation in the present study was the 2-slice CT scanner, which causes loss of some details and a decrease in resolution. Human studies for thymus CT scans were performed by different kinds of CT scan machines with different slices . MultideTo the best of our knowledge, this is the first study evaluating the normal thymus in dogs using computed tomography and performing classification and grading. As a conclusion, variable shapes, sizes, and densities of the thymus can be noted in dogs, although some patterns for alteration of these variables with aging are explained through this study. The ratio of thymus thickness in the transverse view to the height of the second thoracic vertebral midbody was approximately 1.2 ± 0.7. A grading system for thymic appearance based on predominant thymic components was also established through this study and can be used by radiologists for reading thoracic CT scans. The thymus was also visible in adult and geriatric dogs with no underlying non-thymic disease, but due to lack of sufficient data in this field, serial examinations were still suggested in the case of suspicions of infiltrative diseases in old dogs owing some remnant thymic tissue. According to the results, thymic atrophy did not significantly affect enhancement. Thymic characteristics were not significantly different between males and females except in the shape of the thymus, which needs more investigation to generalize this finding to other populations. Small and large breed dogs were different only in the volume of the thymus. Further, it can be concluded that increasing body fat content affects thymic fatty degeneration, which can influence the immunity. Finally, further investigation of thymic alterations in the case of infiltrative disease and some stresses such as chemotherapy and radiotherapy can complete the present study.


Theories of practice can support understanding of health-related behaviours, but few studies use quantitative methods to understand time-trends in practices. This paper describes changes in the prevalence and performance of alcohol drinking practices in Great Britain between 2009 and 2019.Latent class analyses of annual cross-sectional data collected between 2009 and 2019. The dataset come from a one-week retrospective diary survey of adults resident in Great Britain. It contains 604,578 drinking occasions reported by 213,470 adults (18+) who consumed alcohol in the diary-week. The measures describe occasion characteristics including companions, location, motivation, timings, accompanying activities and alcohol consumed. We estimate separate latent class models for each year and for off-trade only (e.g. home), on-trade only (e.g. bar) and mixed-trade occasions.Big nights out and towards other forms of heavy drinking in the on-trade. We identified five key trends in the performance of practices: (i) spirits increasingly replaced wine as the main beverage consumed in occasions; (ii) home-drinking moved away from routinised wine-drinking with meals on weekdays and towards spirits-drinking on weekends; (iii) the Male friends at the pub practice changed less than other pub-drinking practices; (iv) Big nights out started later, often in nightclubs, and involved less pub-drinking or heavy drinking and (v) the meal-based and Going out with partner practice formats showed few changes over time.We identified fifteen practices; four off-trade only, eight on-trade only and three mixed-trade. The prevalence of practices was largely stable over time except for shifts away from drinking with a partner and towards drinking alone in the off-trade, and shifts away from Key recent trends in British drinking practices include a decline in routinised wine-drinking at home, a transformation of big nights out and a mixture of stability and change in pub- and meal-based practices. •Few quantitative studies describe how drinking cultures and practices change over time.•Drinking diary data show how British drinking culture changed between 2009 and 2019.•People moved away from routine wine-drinking at home on weekdays.•Big nights out started later and were less likely to involve pub-drinking.•Traditional male pub-drinking changed less than other forms of pub-drinking. QuantitWe have previously argued that theories of practice provide an alternative conceptual framework that allows more nuanced analyses of drinking culture . We have1.1Our practice-based approach draws on Shove et al.‘s account of social practice theory as its accessibility and clear ontology support its use in quantitative research . We arguPractice theories often struggle to explain change as they necessarily focus on routines and habits that tend towards stability over time . Shove eA growing body of public health research draws on theories of practice to gain new insights into health risk factors e.g. . For exa1.2Alcohol consumption is a useful case study for studying practice changes as it has displayed marked trends in recent years. Litres of pure alcohol consumed per capita reached a historic peak in 2004 but then fell by 16% to 2019 . SeveralBig night out, Family meal). We argue that drinking occasions recorded in the diaries are observations of practice performances while the occasion types (i.e the latent classes) describe the prevalence and characteristics of practice formats. The present analysis builds on this approach by using extensions of the same dataset to estimate comparable latent class models for each year of our study period. This allows us to describe changes in the prevalence and characteristics of practice formats. Theoretically, it also allows us to detect new formats, although we did not anticipate doing so over our relatively short eleven-year study period.In our previous cross-sectional analyses of British drinking culture , we usedThis paper therefore aims to describe changes in the prevalence and performance of the practice formats that comprise British drinking culture between 2009 and 2019.22.1We used data from Alcovision, a continuous, cross-sectional study that has surveyed approximately 30,000 adults (18+) resident in Great Britain each year from 2009 onwards using largely consistent methods. The market research company Kantar collects Alcovision data for commercial purposes and draws quota samples based on age, sex, socioeconomic status and geographic region from its online managed access panels. It times invitations to participate to spread fieldwork evenly throughout the year and include every day of the year. Residents of Scotland and 18-34 year-olds are oversampled to allow detailed analyses of these populations. Kantar then constructs sampling weights based on age-sex groups, social class and geographic region using UK census data. The present analysis used updated weights constructed by the authors using a bespoke raking technique see . The maiThe main component of Alcovision is a retrospective drinking diary, in which participants report the characteristics of their drinking occasions over the previous seven days. This study used Alcovision data from 2009 to 2019, which includes 1,042,942 drinking occasions. However, we combined some closely-related occasions where individuals moved between off-trade and on-trade drinking . It divides these occasions into two trade sectors: those in the off-trade (e.g. at home) and on-trade (e.g. at a pub or restaurant), with participants able to report up to two occasions in each trade sector per day. Alcovision's division of occasions into off-trade and on-trade does not allow for direct analysis of familiar occasions that span both trade sectors (e.g. pre-drinking before a night out). We therefore used an alternative definition based on the start-time and duration of each reported occasion. This defines occasions as a period of alcohol consumption with no more than 2 h between drinks and allowed us to combine temporally adjacent occasions within and across trade sectors. We then separated occasions into three group for all analyses: off-trade only, on-trade only and mixed-trade.Participants record the characteristics of each reported drinking occasion via a series of categorical variables that did not change across the study period. As noted in the introduction, these do not fit neatly into sex composition  and companions . Four measures capture the locations: the venue , on-trade venue locations , the reasons for choosing on-trade venues  and a dichotomous variable for visiting multiple on-trade venues. Two measures capture the nature of the occasion: the purpose  and the motivation for the occasion . Two measures capture activities accompanying drinking: general activities  and food eaten . Four measures capture the occasion timings: the duration , the start-time , the day of the week  and the sequencing of off-trade and on-trade drinking in mixed-trade occasions . Two measures capture alcohol consumption: volume consumed based on units  and the predominant beverage type based on the largest number of servings reported .Two measures capture the people present: 2.3Latent class analysis is a statistical method used to identify distinct subgroups of cases in a dataset based on them having similar patterns of observed characteristics. It assumes that a latent (i.e. unobserved) categorical variable explains the correlation between a set of observed variables. The estimated model describes the probability of a case belonging to a specific subgroup (i.e. latent class) and, conditional on belonging to a subgroup, the probability of it having each observed characteristic. In this analysis, drinking occasions (i.e. practice performances) are the cases, their characteristics are the observed variables and occasion types (i.e. practice formats) are the subgroups or latent classes.We estimated separate latent class models for off-trade only, on-trade only and mixed-trade sectors in each year, using the occasion characteristics above. Estimating separate models for each trade sector was necessary given the occasion characteristic variables differ across trade sectors. Latent class models estimate the joint distribution of all of the observed variables and the latent class variable under the assumption of conditional independence. The association between the observed and latent variables are parameterised using probits, ordered probits and multinomial logits for binary, ordered and unordered categorical variables respectively, whereas the probability of belonging to a specific class is parameterised using a multinomial logit. The analyst iteratively determines the number of classes the model should identify by assessing the impact of additional classes on model fit and interpretability. All models used weighted data and accounted for the clustering of occasions within individuals using clustered standard errors. The latent class models were estimated via maximum likelihood using Mplus v8.3.0.1.We first examined the model fit statistics and interpretability for a series of preliminary LCA models for each year to assess whether the appropriate number of latent classes differed across years, whether the identified classes were broadly consistent, whether some classes emerged or disappeared over time, or whether the model results were fundamentally unstable across years. Specifically, we used the Bayesian Information Criterion (BIC), Sample-Size Adjusted BIC, Akaike's Information Criterion, and model entropy as standard goodness of fit measures, and also used the Vuong-Lo-Mendell-Rubin likelihood ratio test (LRT), the Lo-Mendell-Rubin adjusted LRT and the parametric bootstrapped LRT to test whether each additional class improved model fit. These tests require careful interpretation as they are sensitive to the sample size and number of model parameters, both of which are large in Alcovision . We asseWe tested several approaches to analysing change in drinking practices over time. These included estimating a single latent transition model for each trade sector covering the whole study period, estimating several latent transition models covering shorter time periods, and estimating separate latent class models for each year and then using pairwise comparisons to test for significant differences in model parameters between years. However, these approaches encountered problems with insufficient computational power, unfeasible model run-times, and the large sample size meaning even very small differences between parameters were statistically significant despite having little practical significance.The results reported below are therefore based on a simpler approach in which we estimated separate latent class models for each year between 2009 and 2019 and visually inspected the results to identify changes of practical significance. We defined practical significance as any sustained change of five percentage points in either the proportion of occasions within a latent class or the probability of a latent class having a particular characteristic. We defined sustained change as a change observed for three years and maintained to 2019. Applying this definition of practical significance required some subjective judgements for changes at the end of the study period, where parameters were unstable  between 2009 and 2019 in drinking venues, reason, purpose, motivations and most accompanying activities. The main changes related to drinking companions, food, timings and alcohol consumption. The proportion of occasions involving a mixed sex pair decreased by 5.9pp and the proportion involving a partner decreased by 3.2pp. The proportion of occasions involving no food consumption increased by 5.8pp, largely due to a 5.5pp decrease in the proportion involving a full meal. The proportion of occasions lasting less than 1 h decreased by 6.1pp, the proportion starting in the afternoon increased by 5.0pp, the proportion on a weekday decreased 3.7pp while the proportion on Friday night or Saturday increased by 5.3pp. Broadly, these temporal shifts suggest a move away from short, weekday drinking occasions, which typically start in the evening, and towards longer weekend occasions, which are more likely to start in the afternoon. The largest change was a 9.9pp drop in the proportion of occasions where wine was the dominant beverage. This contrasts with increases in the proportion of occasions where spirits and cider were the dominant beverage of 5.2pp and 3.8pp respectively, with only marginal changes for beer. Finally the proportion of occasions where individuals consumed 12 or more units increased by 4.6pp.3.2We estimated models with between two and eight latent classes for each trade sector , Meals with friends (−0.2pp) and Going out with partner (−0.1pp). However, there was a shift in the off-trade away from Evening at home with partner (−5.4pp) and Family time at home (−1.1pp) and towards Quiet drinks at home alone (+3.9pp). Similarly, there was a shift away from Big nights out (−0.8pp) and Big nights out with pre-drinking (−0.5pp) and towards other forms of heavy drinking occasion such as Extended occasions (on-trade) (+1.5pp) and Quiet drink at home and with friends at the local (+1.4pp).Big nights out (+27.1pp), Extended occasions (on-trade) (+13.8pp) and Extended occasions (mixed-trade) (+8.7pp). Conversely, the proportion of occasions where wine was the dominant beverage decreased in all but two occasion types, with large decreases seen in all off-trade only types. The proportion of occasions with beer as the dominant beverage changed less in the off-trade but did decrease substantially in some on-trade occasion types, including Big nights out (−21.3pp) and Meeting friends at the pub (−12.2pp). Some types showed only small changes in the dominant beverage, particularly pub-drinking occasions where beer was often dominant, such as Male friends at the pub, Quiet drink at the pub and Quiet drink at home alone and with friends in the local.The dominant beverage within occasions changed markedly across the study period . The proQuiet drink at home alone, Family time at home and Evening at home with partner occasions suggest performances of these practices are moving away from shorter, weekday occasions where respondents consumed wine with meals and towards longer, weekend occasions where they consumed spirits without a meal , games or quiz machines (−8.0pp), beer as the dominant beverage (−12.2pp), consuming 12 or more units (−8.9pp) and friends (−12.5pp), with the latter trend suggesting a more fundamental change in the occasion type. Quiet drink at the pub occasions also saw significant changes, with the proportion involving a mixed sex group decreasing by 12.2pp and the proportion involving friends decreasing by 5.4pp, while the proportion involving a male on his own increased by 11.3pp. These occasions also became longer and involved more TV watching. Finally, Male friends at the pub occasions changed less, with an increase in TV watching (+5.2pp), decrease in games or quiz machine use (−7.4pp) and consumption of snacks (+10.7pp) but few other specific changes , while the proportion involving a traditional pub or modern bar decreased by 21.4pp and 13.6pp respectively. In line with this, these occasions also became more likely to involve dancing or listening to a band, live act or DJ, and less likely to involve barroom games or a snack or meal. The timing of Big nights out also changed, with the proportion starting after 22:00 increasing by 27.8pp (subject to volatility) and the proportion lasting more than 4 h decreasing by 23.8pp. They also saw lighter drinking, with the proportion involving consumption of 12 or more units of alcohol decreasing by 19.3pp. As noted above, the proportion where spirits was the dominant beverage also increased by 27.1pp while the proportion with beer as the dominant beverage decreased by 21.3pp. Changes were less marked for the mixed-trade Big night out with preloading occasions, although some changes are still visible. For this occasion type we compared between 2009 and the average of results for 2016 and 2017 due to volatility in latent class models for later years. The main changes related to reduced activity in the on-trade before visiting a nightclub. For example, the proportion of Big night out with preloading occasions involving a modern bar or multiple venues decreased by 7.0pp and 7.1pp respectively, the proportion involving watching TV decreased by 7.7pp, and the proportion involving no food increased by 8.4pp.On-trade only and mixed-trade big night out occasions changed markedly over the study period. For example, the proportion of on-trade only Extended occasions (on-trade) and Extended occasions (mixed-trade) show substantial evidence of change over time, although this is not consistent across the two trade sectors. In contrast, other occasion types, such as Family meal, Meal with friends, and Going out with partner show only modest evidence of change beyond those shifts common to many occasion types, such as a decline in the proportion of occasions taking place in village/rural locations or on weekdays, and where the dominant beverage is wine or beer rather than spirits. However, despite the label we assigned to them, all of these occasion types became less likely to involve a meal, with the proportion doing so decreasing by between 8.8pp and 11.8pp.Beyond these changes, the latent class model results show a mixture of more difficult to interpret changes and some evidence of stability in particular occasion types. For example, 4Big night out and towards the more nebulous Extended occasions in the on-trade. Changes in the performance of drinking practices were complex and open to multiple interpretations, but we highlight four robust changes. First, spirits were increasingly likely to be the dominant beverage in performances of most practices. The extent to which spirits displaced wine and beer as the dominant beverage varied substantially, but those practices associated with higher levels of alcohol consumption were particularly affected (e.g. Big nights out and Off-trade get togethers). Second, there was evidence of shifts in home drinking consistent with a move away from routine wine-drinking with meals on weekdays. Third, all pub-drinking practices changed to some degree but to differing extents, with Male friends at the pub appearing the most stable. Fourth, changes in the on-trade only Big night out and the mixed-trade Big night out with pre-drinking were consistent with a move away from the stereotypical pub-crawl before visiting a nightclub and towards going directly to the nightclub later in the evening, sometimes after drinking at home first.The results above suggest that British drinking culture and the practices that comprise it showed aspects of both stability and change between 2009 and 2019. The overall distribution of drinking occasions (i.e. practice performances) across occasion types (i.e. practice formats) remained relatively stable despite evidence of two modest shifts: (i) away from drinking with a partner and towards drinking alone in the off-trade and (ii) away from the stereotypical This study used a novel quantitative approach to describe change in the predominant drinking practices observed in Great Britain over an eleven-year period. It drew on a highly detailed event-level dataset collected from a large, nationally-representative sample using consistent methods. The analytical process also involved extensive testing to assess the statistical and face validity of the final models. The key limitations are similar to our previous work with this dataset . In partOur findings provide new evidence to explain familiar alcohol consumption trends. Three examples demonstrate this. First, researchers and commentators have increasingly paid attention to habitual drinking in domestic settings , and parMale friends at the pub, Going out with partner, and meal-based on-trade practices changed only incrementally and to accommodate major trends (e.g. the growth of spirits drinking), suggesting that these practice formats each have a tightly interconnected set of core elements that limit individuals' scope to adapt their performances of the practice in response to external changes. This is reflected, for example, in Second, on-trade drinking in Britain changed substantially across recent decades, with the rise and fall of club culture, expansion and diversification of the restaurant sector and the decline of traditional pubs . While sBig night out as ‘pub crawl then nightclub’ and more recent Big nights out. Even when people do not preload in this practice they increasingly omit key elements, such as the dominance of beer, visiting multiple venues and starting early- or mid-evening. This may help to explain the concentration of the night-time economy into a smaller number of late night venues  licence* to any Author Accepted Manuscript version arising.This work was supported by This study received ethical approval from the University of Sheffield ethics committee .John Holmes: Conceptualisation, Methodology, Data curation, Writing – Original draft, Supervision, Funding acquisition.Alessandro Sasso: Methodology, Formal analysis, Data curation, Writing – Original draft.Mónica Hernándes Alava: Methodology, Formal analysis, Writing - Review & Editing, Funding acquisition.Abigail K Stevely: Data curation, Writing - Review & Editing.Alan Warde: Conceptualisation, Writing - Review & Editing, Funding acquisition.Colin Angus: Writing - Review & Editing, Visualisation.Petra S Meier: Conceptualisation, Methodology, Writing - Review & Editing, Supervision, Project administration, Funding acquisition.10.13039/501100000858University of Sheffield, and later the University of Glasgow, purchased the data under license from Kantar using funds provided at different time points by the Medical Research Council, 10.13039/501100000269Economic and Social Research Council, Public Health Scotland and the 10.13039/501100000858University of Sheffield.We have no conflicts to declare. Use of the Alcovision data is allowed under the terms of the contract and nondisclosure agreement between Kantar and the University of Sheffield. This requires research outputs to be submitted to the data provider ahead of publication. The data provider's right to request changes is limited to matters of accuracy regarding descriptions of the data and data collection methods. The data provider played no further role in the research process, including in conception, design, analysis, interpretation, write-up or the decision to publish. The


Malnourished patients had longer hospital stays  and higher 30-day readmission rates . Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources , leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes . About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years,  Patients admitted to the pediatric intensive care unit (PICU) may have either acute illness or acute exacerbations of complex chronic conditions. Common reasons for admission to the PICU include respiratory disease, cardiac disease, and neurologic disorders ,2. ChildIn children, malnutrition (or undernutrition) can either contribute to disease vulnerability or may be caused by the disease itself . For exaOur study involved critically ill pediatric patients admitted to an urban academic medical center; our primary objectives were to (i) determine the proportion of children admitted to the PICU with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices. Optimal management of hospitalized infants and children who require critical care is essential and can be lifesaving. We posit that attention to nutritional needs is an important component of PICU care. Hospitals across the nation thus need public health standards to ensure access, trained staff, and guidelines for nutritional assessment and care of hospitalized children, especially those in the PICU.In 2013, New York-Presbyterian Morgan Stanley Children’s Hospital (NYP-MSCH) implemented a program to improve malnutrition screening and coding with a goal to identify pediatric malnutrition in a timely manner and standardize the threshold for intervention. Patients at NYP-MSCH were diagnosed as malnourished when their weight for length or BMI were z-scores of −1 , −2 , or −3 , or when the patients had an unplanned decline in these z-scores of 1, 2, or 3 standard deviations. In 2015, the mid-upper arm circumference (MUAC) measurement tool was introduced as a second criterion to screen for malnutrition and prompt further assessment for malnutrition diagnosis. The MUAC measurement requires simple equipment (paper tape) and is easy to perform, even on medically complex patients. It is a valuable screening tool to assess malnutrition risk in children 3 months through 18 years of age. In children aged 3–60 months, per The World Health Organization, MUAC of less than 11.5 cm meets the criterion for severe malnutrition . Screenin = 8725). From the EMR, a subset of non-neo-natal PICU patients who had received a coded diagnosis of malnutrition (CDM) was identified based on ICD-9  or ICD-10 codes , but was not otherwise limited by patient diagnosis or procedure.This retrospective study used electronic medical records (EMR) from a 200-bed pediatric hospital in a tertiary care academic medical center in an urban setting. This study included children admitted to the 41-bed Pediatric Intensive Care Unit (PICU) from 2011 through 2019  regression of hospital LOS on patient characteristics and indicators for the period after implementation of the hospital program emphasizing malnutrition diagnosis and care were performed.n = 4106), we found that 783 (19.1%) had CDM. The mean age was 6.74 years (±6.12 standard deviation), and 52% of patients were males  and more often male (55.6% vs. 51.2%). Malnourished PICU patients had nearly twice as many clinical diagnoses as non-malnourished patients, indicating these children were more severely ill  (p = 0.03).In the present analysis, the data show that patients with diagnosed malnutrition experienced mean PICU stays that were 2.6 times or 16 days longer than those of non-malnourished patients  . This isPrevious research has estimated the average cost of a day of PICU care at $5799 for medical patients  . ApplyinPatient characteristics in the periods before (pre-2015) and after (post-2015) implementation of malnutrition coding are presented in The regression analysis shows a strong positive association between CDM and longer LOS . The negp < 0.01) and had more comorbid conditions  than those without malnutrition. Patients with CDM had 2.6-times longer hospital stays  and higher 30-day readmission rates . After implementation of the malnutrition screening protocol, there was a decline in length of stay noted in all groups. The analysis controlled for patient characteristics and observable differences between groups. Estimates showed that longer PICU stays for patients diagnosed with malnutrition cost over $60,000 per patient stay.Diagnosing pediatric malnutrition is imperative to establish the true prevalence of the disorder and provide adequate treatment and education. Additionally, identifying patients with malnutrition and providing them with appropriate care can improve patient outcomes and reduce unnecessary hospital readmissions. In our retrospective study at a US academic tertiary medical center, almost 1 of every 5 PICU-admitted patients (783/4106) had a CDM. Patients with malnutrition were younger  screen for malnutrition risk, and (ii) assess for diagnosis of malnutrition and determine its severity ,21. In sMUAC is recognized as validated nutrition screening tool ,28, an aTwo additional points are important to the clinical implications of our study findings. First, once malnutrition is diagnosed, nutritional interventions should be in place. Such interventions may include provision of micro- and macronutrients ,37. SecoIn this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses, prolonged hospitalizations, and increased 30-day readmission rates, all leading to higher healthcare utilization. Implementation of screening and coding for diagnosis of malnutrition in our center was associated with a reduction in hospital LOS. We estimated that the costs of PICU care for a malnourished child could be as much as $100,000 more per hospitalization than for a child without malnutrition. Such findings underscore the need to build hospital policies, train staff, and implement programs for malnutrition identification and treatment at hospital sites caring for critically ill children.This study has limitations related to its conduct and implications. The study focused on the impact of implementing a diagnostic process on the number of diagnoses, and the impact of malnutrition on patient outcomes. However, changes in patient care due to diagnosis were not examined and should be the topic of future research. Thus, the implications of the study relate to the ability of the process to identify malnourished patients and describe the impact of malnutrition on patient outcomes. Additionally, the study used a convenience sample of available patient data between 2011 and 2019, so no power analysis was conducted to determine the relevance and generalizability of our statistical results. Our sample also lacked information on some patient characteristics that may have impacted malnutrition incidence, as well as patient comorbidities and outcomes. Socioeconomic status, race, and ethnicity are correlated with food insecurity and other drivers of malnutrition and patient outcomes, but were not available in our dataset.Additionally, this study used the Elixhauser comorbidity index to control for patient severity. This index, originally developed for adult inpatients, is commonly used to measure comorbidities and patient severity of illness and is useful because it was designed for use in administrative data such as those used in this study. However, some of the comorbidities included in the index, such as congestive heart failure and chronic pulmonary disease, may not be as prevalent or predictive in a pediatric population. Although not designed for pediatric populations, it has been analyzed in pediatric populations and found to perform similar to other comorbidity measures . ComparaIn this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses, prolonged hospitalizations, and increased 30-day readmission rates, all leading to higher healthcare utilization. Implementation of screening and coding for diagnosis of malnutrition in our center was associated with a reduction in hospital LOS. We estimated that costs of PICU care for a malnourished child could be as much as $100,000 more per hospitalization than for a child without malnutrition. Such findings underscore the need to build hospital policies, train staff, and implement programs for malnutrition identification and treatment at hospital sites caring for critically ill children.


Using robotic technology and communications infrastructure to remotely perform surgery has been a persistent goal in medical research in the past three decades. The recent deployment of the Fifth-Generation Wireless Networks has revitalized the research efforts in the telesurgery paradigm. Offering low latency and high bandwidth communication, they are well suited for applications that require real-time data transmission and can allow smoother communication between surgeon and patient, making it possible to remotely perform complex surgeries. In this paper, we investigate the effects of the 5 G network on surgical performance during a telesurgical demonstration where the surgeon and the robot are separated by nearly 300 km.The surgeon performed surgical exercises on a robotic surgery training phantom using a novel telesurgical platform. The master controllers were connected to the local site on a 5 G network, teleoperating the robot remotely in a hospital. A video feed of the remote site was also streamed. The surgeon performed various tasks on the phantom such as cutting, dissection, pick-and-place and ring tower transfer. To assess the usefulness, usability and image quality of the system, the surgeon was subsequently interviewed using three structured questionnaires.All tasks were completed successfully. The low latency and high bandwidth of the network resulted into a latency of 18 ms for the motion commands while the video delay was about 350 ms. This enabled the surgeon to operate smoothly with a high-definition video from about 300 km away. The surgeon viewed the system’s usability in a neutral to positive way while the video image was rated as of good quality.5 G networks provide significant advancement in the field of telecommunications, offering faster speeds and lower latency than previous generations of wireless technology. They can serve as an enabling technology for telesurgery and further advance its application and adoption.The online version contains supplementary material available at 10.1007/s11548-023-02913-2. Due to its significant value, the projection of surgical skill over long distances through electromechanical means, i.e., remote surgery, has been a consistent goal in surgery since the advent of surgical robots. Indeed, one of its main advantages is the ability to perform surgery on patients who are located in remote or underserved areas, which could significantly increase access to medical care for individuals in those areas and reduce the need for patients to travel long distances, to receive treatment. Furthermore, surgeons can remotely perform surgical procedures on patients who may not have access to specialized medical facilities or trained medical professionals in their local area. This could be particularly beneficial in developing countries, where access to quality medical care is often limited, or even in extreme environments such as space and under the sea . In addiLindbergh Operation from New York to Strasbourg, performed by Prof. Marescaux in 2001 [Following the pioneering transatlantic  in 2001 , over th in 2001 , 5, the  in 2001 , 7, remo in 2001 , field d in 2001 , 10 and  in 2001 –13).latency in the communication between the surgeon and the robot [quality of the video image itself [Crucial components of remote surgery are the perceived he robot –16, conce itself , 18. Resnd above . A delayIn this paper, we report on a set of telesurgery experiments over 5 G in Greece using a novel prototype surgical robot called the “Double Delta” . The expIn recent years, there has been an increasing interest in utilizing 5 G technology to enhance the remote surgery paradigm, with demonstrated interventions steadily emerging. Acemoglu et al.  presenteThe authors in  report oThe application of ultra-remote robot-assisted laparoscopic surgery in China using 5 G, was presented in . The autRobotic telestenting has also been demonstrated in . The autBesides telesurgical procedures, 5 G has also been used to transmit physiological and imaging information. For example, in  the authA residential telemonitoring system which collects physiological and environmental data, streaming them over 5 G, is analyzed in . The sys5G-assisted telementored surgery is mentioned in . The autRemote ultrasonography has been demonstrated in several cases. For example, emergency mobile bidirectional communication between an ambulance and a hospital has been described in . UltrasoThe telesurgery demonstration was a collaboration between the National Technical University of Athens, the Athens Medical Centre and Vodafone Greece. The aim was to observe the performance of the 5 G communications network with respect to a demanding use case such a remote surgery, to investigate the effects of ultra-low latency and high bandwidth on remote surgical manipulation and also to provide a first demonstration of the novel Double Delta surgical robot in a relevant environment.The surgeon console, comprising the master controls, imaging equipment for viewing the remote site and telecommunications equipment, was located at a suitable hotel area at Trikala Fig. . A portaThe remote site was located at an operating room inside the Athens Medical Centre hospital, where the slave robot was residing, along with networking and video equipment. The telesurgical equipment was connected to the hospital’s local wired Gigabit Ethernet network through a switch. This was routed to the Internet via Vodafone’s Fixed Network, enabling communication with the Trikala site via a UDP connection.DDelta  sensing  and 3 Dofs actuation Fig. b. They aThe surgeon viewed the robot using video from a monocular camera located at the remote site. This image was transmitted over the internet and displayed on a large overhead monitor at the local site Fig. c. The caDuring the two days of the demonstration, the surgeon performed a number of trials in various training exercises using a standardized phantom for robotic surgery training, viz. the FRS Dome  Fig. 2dd2d. The Modified System Usability Scale and the Robot Usability Score found in [Video Quality Assessment questionnaire in [For the subjective evaluation, after the demonstration the surgeon was presented with three structured questionnaires regarding the assessment of the robot usability and the image quality. For the former, we used the found in , deployenaire in  was usedModified System Usability Scale (m-SUS) is based on the System Usability Scale which was developed as a reliable tool for measuring the usability of systems. The m-SUS was used to evaluate the usability of the telesurgical system in our demonstration. It consists of nine questions rated in a 5-point Likert scale, in descending order of usefulness  was created by the authors in [The thors in , used toVideo Quality Assessment questionnaire consists of five questions which investigate the relevant aspects of the video: colors, edges, details, 3D relief and so on  from the surgeon’s controllers to the robot at the remote site, and back, was 18 ms. Video transmission from the remote site to the network end on the surgeon’s site was 250 ms. A further 100 ms was added from there to the surgeon’s monitor, thus resulting in 350 ms latency for the entire video pipeline (from the camera at the patient side to the monitor at the surgeon’s site). m-SUS was 28, with the individual question scores being presented in Fig. The total score for theRUS, the surgeon responded that the robot had good controls , was using it comfortably , and it largely worked as intended . As expected, however, the 3D vision component was inadequate (“Good 3D vision” = 1) along with the perception that it can be used in real surgeries .Regarding the Video, the image was generally perceived as of high quality , with moderate texture detail (“Textures” = 5) and an absence of 3D (“3D (relief)” = 2). The last point was also mentioned in the free text question from the surgeon, where he responded that the main two difficulties he faced were the lack of depth perception and the latency.For the evaluation of the All the exercises were carried out successfully but the lack of depth perception, since the video was not stereoscopic, was a limiting factor. The surgeon’s extensive experience in laparoscopic surgery managed to compensate for this, something which he also noted himself in the free text question. However, the execution speed was reduced. This was largely expected since the use of stereoscopy in robotic surgery has been shown to provide a significant advantage over monocular vision, improving the spatial perception, task efficiency and completion times .Regarding the robotic system, the surgeon managed to get acquainted with it fairly quickly and operated the controls with proficiency. By observing the m-SUS score, the system’s usefulness and usability were viewed in a largely neutral to positive light, something which reflects the need to evolve the robot’s operation and performance. For comparison, the m-SUS reported in  for a siAnalyzing the items in the RUS, we see that the system was seen largely favorably. Notable exceptions are the perceived unsuitability of the platform for real surgical operations and the system’s lack of 3D vision. The former is expected since the platform is a prototype meant for research and was not built for actual surgery. For the latter, the lack of 3D vision might explain the moderate score for the “texture” rendering in the Video Quality Assessment questionnaire, as the surgeon is used to viewing the surgical field through the high- definition stereoscopic imaging system of a commercial platform. Therefore, reverting to monocular vision might reduce the perceived details of the operating field.The implicit comparison with the dominant surgical platform can also explain the reported difficulty with the system’s latency. The measured delay of 350 ms is considered safe but tiring  and deviThis paper reports on a set of telesurgery experiments over 5 G in Greece, using a novel prototype surgical robot called the “Double Delta.” The experiments consisted of simple surgical exercises on a robotic surgery training kit, and the surgeon was located 300 km away. The round trip delay for the transmission of the manipulation commands was measured to 18 ms while the latency of the video feed was 350 ms. All exercises were performed successfully, with the experience of the surgeon compensating for various limitations of the setup. The results of this study highlight the potential of 5 G technology to significantly enhance the capabilities of telesurgery by providing faster speeds and lower latency which is crucial for real-time data transmission. Future work will focus on evolving the Double Delta platform, enhancing its usability, integrating 3D vision and streaming it in real time over the internet, as well as investigating novel telesurgical concepts such as haptic-enabled telesurgery over 5 G, portable/mobile telesurgery, collaborative telesurgery and others.Segments of various tasks are presented in the accompanying video.Supplementary file 1 (mp4 16901 KB)Below is the link to the electronic supplementary material.