Can skills assessment on a virtual reality trainer predict a surgical trainee's talent in laparoscopic surgery?

Background: A number of studies have investigated several aspects of feasibility and validity of performance assessments with virtual reality surgical simulators. However, the validity of performance assessments is limited by the reliability of such measurements, and some issues of reliability still need to be addressed. This study aimed to evaluate the hypothesis that test subjects show logarithmic performance curves on repetitive trials for a component task of laparoscopic cholecystectomy on a virtual reality simulator, and that interindividual differences in performance after considerable training are significant. According to kinesiologic theory, logarithmic performance curves are expected and an individual's learning capacity for a specific task can be extrapolated, allowing quantification of a person's innate ability to develop task-specific skills. Methods: In this study, 20 medical students at the University of Basel Medical School performed five trials of a standardized task on the LS 500 virtual reality simulator for laparoscopic surgery. Task completion time, number of errors, economy of instrument movements, and maximum speed of instrument movements were measured. Results: The hypothesis was confirmed by the fact that the performance curves for some of the simulator measurements were very close to logarithmic curves, and there were significant interindividual differences in performance at the end of the repetitive trials. Conclusions: Assessment of perceptual motor skills and the innate ability of an individual with no prior experience in laparoscopic surgery to develop such skills using the LS 500 VR surgical simulator is feasible and reliabl

Randomized controlled trial investigating the effect of music on the virtual reality laparoscopic learning performance of novice surgeons

Background: Findings have shown that music affects cognitive performance, but little is known about its influence on surgical performance. The hypothesis of this randomized controlled trial was that arousing (activating) music has a beneficial effect on the surgical performance of novice surgeons in the setting of a laparoscopic virtual reality task. Methods: For this study, 45 junior surgeons with no previous laparoscopic experience were randomly assigned to three equal groups. Group 1 listened to activating music; group 2 listened to deactivating music; and group 3 had no music (control) while each participant solved a surgical task five times on a virtual laparoscopic simulator. The assessed global task score, the total task time, the instrument travel distances, and the surgeons' heart rate were assessed. Results: All surgical performance parameters improved significantly with experience (task repetition). The global score showed a trend for a between-groups difference, suggesting that the group listening to activating music had the worst performance. This observation was supported by a significant between-groups difference for the first trial but not subsequent trials (activating music, 35 points; deactivating music, 66 points; no music, 91 points; p=0.002). The global score (p=0.056) and total task time (p=0.065) showed a trend toward improvement when participants considered the music pleasant rather than unpleasant. Conclusions: Music in the operating theater may have a distracting effect on novice surgeons performing new tasks. Surgical trainers should consider categorically switching off music during teaching procedure

The prediction of macrophyte species occurrence in Swiss ponds

The study attempted to model the abundance of aquatic plant species recorded in a range of ponds in Switzerland. A stratified sample of 80 ponds, distributed all over the country, provided input data for model development. Of the 154 species recorded, 45 were selected for modelling. A total of 14 environmental parameters were preselected as candidate explanatory variables. Two types of statistical tools were used to explore the data and to develop the predictive models: linear regression (LR) and generalized additive models (GAMs). Six LR species models had a reasonable predictive ability (30-50% of variance explained by the selected predictors). There was a gradient in the quality of the 45 GAM models. Ten species models exhibited both a good fit and statistical robustness: Lemnaminor, Phragmitesaustralis, Lysimachiavulgaris, Galiumpalustre, Lysimachianummularia, Irispseudacorus, Lythrumsalicaria, Lycopuseuropaeus, Phalarisarundinacea, Alismaplantago-aquatica, Schoenoplectuslacustris, Carexnigra. Altitude appeared to be a key explanatory variable in most of the species models. In some cases, the degree to which the shore was shaded, connectivity between water bodies, pond area, mineral nitrogen levels, pond age, pond depth, and the extent of agriculture or pasture in the catchment were selected as additional explanatory variables. The species models demonstrated that it is possible to predict species abundance of aquatic macrophytes and that each species responded individually to distinct environmental variable

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Objective. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes. Design. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods. Setting. Tertiary referral university hospital with 30,000 surgical procedures per year. Methods. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection. Results. During baseline time period A (3,836 procedures), RAP was administered 30-74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate. Conclusions. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standar

Temporal dynamics of aquatic communities and implications for pond conservation

Conservation through the protection of particular habitats is predicated on the assumption that the conservation value of those habitats is stable. We test this assumption for ponds by investigating temporal variation in macroinvertebrate and macrophyte communities over a 10-year period in northwest England. We surveyed 51 ponds in northern England in 1995/6 and again in 2006, identifying all macrophytes (167 species) and all macroinvertebrates (221 species, excluding Diptera) to species. The alpha-diversity, beta-diversity and conservation value of these ponds were compared between surveys. We find that invertebrate species richness increased from an average of 29. 5 species to 39. 8 species between surveys. Invertebrate gamma-diversity also increased between the two surveys from 181 species to 201 species. However, this increase in diversity was accompanied by a decrease in beta-diversity. Plant alpha-, beta and gamma-diversity remained approximately constant between the two periods. However, increased proportions of grass species and a complete loss of charophytes suggests that the communities are undergoing succession. Conservation value was not correlated between sampling periods in either plants or invertebrates. This was confirmed by comparing ponds that had been disturbed with those that had no history of disturbance to demonstrate that levels of correlation between surveys were approximately equal in each group of ponds. This study has three important conservation implications: (i) a pond with high diversity or high conservation value may not remain that way and so it is unwise to base pond conservation measures upon protecting currently-speciose habitats; (ii) maximising pond gamma-diversity requires a combination of late and early succession ponds, especially for invertebrates; and (iii) invertebrate and plant communities in ponds may require different management strategies if succession occurs at varying rates in the two groups

Preservice teachers' sociopolitical consciousness in light of the racial disparities highlighted by the COVID-19 pandemic

Socioscientific issues (SSI) such as COVID-19 and climate change often highlight the inequalities that structural racism creates. If we ever wish to equitably solve these issues, we require a population that has the scientific literacy and the sociopolitical consciousness to do so. Yet, the push for culturally relevant education has had little movement in science education, partially because of the acultural view of science but also from the colorblind ideologies often held by teachers. The purpose of this pre-experimental study was to determine if a pre-service elementary science methods course that applies the SSI Teaching and Learning Framework for Social Justice promoted participant's sociopolitical consciousness, reduced their colorblind ideologies, and increased their socioscientific reasoning (SSR) skills. Linear mixed-effects regression models were run to assess these outcomes. Results indicate that preservice teachers' colorblind ideologies and socioscientific reasoning skills did not change through the semester. However, a statistically significant increase in their sociopolitical consciousness was found and this increase could be predicted by one of the components of SSR, perspective taking. Implications of these findings are discussed.Includes bibliographical references

Food-web structure in relation to environmental gradients and predator-prey ratios in tank-bromeliad ecosystems

Little is known of how linkage patterns between species change along environmental gradients. The small, spatially discrete food webs inhabiting tank-bromeliads provide an excellent opportunity to analyse patterns of community diversity and food-web topology (connectance, linkage density, nestedness) in relation to key environmental variables (habitat size, detrital resource, incident radiation) and predators: prey ratios. We sampled 365 bromeliads in a wide range of understorey environments in French Guiana and used gut contents of invertebrates to draw the corresponding 365 connectance webs. At the bromeliad scale, habitat size (water volume) determined the number of species that constitute food-web nodes, the proportion of predators, and food-web topology. The number of species as well as the proportion of predators within bromeliads declined from open to forested habitats, where the volume of water collected by bromeliads was generally lower because of rainfall interception by the canopy. A core group of microorganisms and generalist detritivores remained relatively constant across environments. This suggests that (i) a highly-connected core ensures food-web stability and key ecosystem functions across environments, and (ii) larger deviations in food-web structures can be expected following disturbance if detritivores share traits that determine responses to environmental changes. While linkage density and nestedness were lower in bromeliads in the forest than in open areas, experiments are needed to confirm a trend for lower food-web stability in the understorey of primary forests

Economic Burden of Surgical Site Infections at a European University Hospital

Objective. To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital. Design. Matched case-control study nested in a prospective observational cohort study. Setting. Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year. Methods. All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care. Results. A total of 6,283 procedures were performed:187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492-SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (n = 76). Conclusions. Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare provider