The role of cognitive abilities in laparoscopic simulator training

Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs

Towards automated visual flexible endoscope navigation

Background:\ud The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research.\ud Methods:\ud A systematic literature search was performed using three general search terms in two medical–technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included.\ud Results:\ud Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date.\ud Conclusions:\ud Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process

Pension funds. asset allocation and participant age: a test of the life-cycle model

This paper examines the impact of participants. age distribution on the asset allocation of Dutch pension funds, using a unique data set of pension fund investment plans for 2007. Theory predicts a negative effect of age on (strategic) equity exposures. We observe that pension funds do indeed take the average age of their participants into account. However, the average age of active participants has been incorporated much more strongly in investment behaviour than the average ages of retired or dormant participants. This suggests that both employers and employees, who dominate pension fund boards, tend to show more interest in active participants. A one-year higher average age in active participants leads to a significant and robust reduction in the strategic equity exposure by around 0.5 percentage point. Larger pension funds show a stronger age-equity exposure effect than smaller pension funds. This age-dependent asset allocation of pension funds aligns with the original life-cycle model by which young workers should invest more in equity than older workers because of their larger human capital. Other factors, viz. fund size, funding ratio, and average pension wealth of participants, influence equity exposure positively and significantly, in line with theory. Pension plan type and pension fund type have no significant impact.Pension funds, strategic equity allocation, lifecycle saving and investing

Комп’ютерні прилади та інформаційні технології для прецизійного землеробства

Наукове повідомлення на засіданні Президії НАН України 28 березня 2012 року

Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study.

BACKGROUND: Spiromax® is a novel dry-powder inhaler containing formulations of budesonide plus formoterol (BF). The device is intended to provide dose equivalence with enhanced user-friendliness compared to BF Turbuhaler® in asthma and chronic obstructive pulmonary disease (COPD). The present study was performed to compare inhalation parameters with empty versions of the two devices, and to investigate the effects of enhanced training designed to encourage faster inhalation. METHODS: This randomised, open-label, cross-over study included children with asthma (n = 23), adolescents with asthma (n = 27), adults with asthma (n = 50), adults with COPD (n = 50) and healthy adult volunteers (n = 50). Inhalation manoeuvres were recorded with each device after training with the patient information leaflet (PIL) and after enhanced training using an In-Check Dial device. RESULTS: After PIL training, peak inspiratory flow (PIF), maximum change in pressure (∆P) and the inhalation volume (IV) were significantly higher with Spiromax than with the Turbuhaler device (p values were at least <0.05 in all patient groups). After enhanced training, numerically or significantly higher values for PIF, ∆P, IV and acceleration remained with Spiromax versus Turbuhaler, except for ∆P in COPD patients. After PIL training, one adult asthma patient and one COPD patient inhaled <30 L/min through the Spiromax compared to one adult asthma patient and five COPD patients with the Turbuhaler. All patients achieved PIF values of at least 30 L/min after enhanced training. CONCLUSIONS: The two inhalers have similar resistance so inhalation flows and pressure changes would be expected to be similar. The higher flow-related values noted for Spiromax versus Turbuhaler after PIL training suggest that Spiromax might have human factor advantages in real-world use. After enhanced training, the flow-related differences between devices persisted; increased flow rates were achieved with both devices, and all patients achieved the minimal flow required for adequate drug delivery. Enhanced training could be useful, especially in COPD patients

Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort study evaluated the outcome of this technique up to one year after surgery. From January 2005 to June 2006, 15 consecutive patients with a rectal prolapse, either with or without a concomitant rectocele or enterocele, underwent robot-assisted laparoscopic rectovaginopexy with support of the da Vinci robotic system. A prospective cohort study was performed on operating times, blood loss, intra-operative and post-operative complications, and outcome at a minimum of one year after surgery. Median age at time of operation was 62 years (33-72) and median body mass index 24.9 (20.9-33.9). Median robot set-up time was 10 min (3-15) and median skin-to-skin operating time was 160 min (120-180). No conversions to open surgery were necessary. No in-hospital complications occurred and there was no mortality. Median hospital stay was four days (2-9). During one year follow-up, two patients needed surgical reintervention. One patient was operated for recurrent enterocele and rectocele one week after surgery. In another patient an incisional hernia at the camera port occurred three months after surgery. At one year after surgery, 87% of patients claimed to be satisWed with their postoperative result. Robot-assisted laparoscopic rectovaginopexy proved to be an eVective technique with favourable outcomes in most patients in this prospective series. The operating team experienced the support of the robotic system as beneWcial, especially during the dissection of the rectovaginal plane and suturing in the Douglas pouch

Certification of Plasmidic DNA containing MON 810 Maize DNA fragments, Certified Reference Materials ERM-AD413

This report describes the preparation, homogeneity, stability and certification studies of a plasmidic deoxyribonucleic acid (DNA) (ERM-AD413) containing a defined DNA fragment specific for a genetic modification present in Zea Mays MON 810 event (1) as well as a defined DNA fragment specific for the Zea Mays taxon. The CRM was processed in 2005 and certified in 2007 by the European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements (IRMM) in Geel, Belgium. The CRM is available in plastic tubes containing 500 µL of the plasmidic DNA in 1 mmol/L EDTA pH 7.0 buffer. Each tube contains approximately 10 to the power of 9 copies of the ERM-AD413 plasmid which correspond approximately to 3.41 ng of DNA. The plasmid contains a 170 bp fragment of the MON 810 5' plant-P35S junction and a 351 bp fragment of the maize endogenous high mobility group gene (hmg) (2). both DNA sequences originated from DNA extracted from MON 810 seeds supplied by RAGT Semences (Rodez, France). The certified value is the number of each cloned DNA fragments per plasmid. The number ratio between those two DNA fragments is given as an indicative value measured by duplex and simplex real-time PCR.JRC.D.2-Reference material

Certification of Plasmid DNA containing 98140 Maize DNA Fragments - Certified Reference Material ERM®-AD427

This report describes the preparation, characterisation, stability and suitability of the certified reference material (CRM) ERM-AD427, which contains a plasmid (pIRMM-0090) carrying a defined 2'-desoxyribonucleic acid (DNA) fragment specific for a genetic modification present in Zea mays L. line 98140, as well as defined DNA fragment specific for the Zea Mays taxon. The CRM was processed in 2008 and certified in 2010 by the European Commission, Joint Research Centre, Institute for Reference Materials and Measurements (IRMM), Geel, BEJRC.DG.D.2-Reference material

Extrapolation of pre-screening trends: Impact of assumptions on overdiagnosis estimates by mammographic screening

Background: Overdiagnosis by mammographic screening is defined as the excess in breast cancer incidence in the presence of screening compared to the incidence in the absence of screening. The latter is often estimated by extrapolating the pre-screening incidence trend. The aim of this theoretical study is to investigate the impact of assumptions in extrapolating the pre-screening incidence trend of invasive breast cancer on the estimated percentage of overdiagnosis. Methods: We extracted data on invasive breast cancer incidence and person-years by calendar year (1975-2009) and 5-year age groups (0-85 years) from Dutch databases. Different combinations of assumptions for extrapolating the pre-screening period were investigated, such as variations in the type of regre