Determining the impact of surgical scissor type on patient experience during Mohs micrographic surgery : a randomized control trial

INTRODUCTION: Environmental factors during dermatologic surgery can exacerbate anxiety and affect patient experience. Previous studies have evaluated the impact of smells [1] and sounds [3] on patient experience during Mohs micrographic surgery (MMS), but no study has evaluated how the metallic clipping sound generated by surgical scissors impacts patient experience. METHODS: We conducted a prospective, single-blinded, randomized controlled trial including 148 adult patients presenting for MMS to evaluate how the clipping sound generated by surgical scissors impacts patient experience. Patients were randomized into one of three groups: 1. A control group with traditional curved Iris scissors, 2. An intervention group with modified curved Iris scissors, 3. A comparative arm where patients experienced both the traditional and modified scissors and were asked in a blinded fashion during surgery which scissor they preferred. RESULTS: The metallic clipping noise was noticed less by the modified group (p = 0.3747). The metallic clipping noise was less bothersome to patients in the modified group (p = 0.2258). In Group 3, of the 38 patients that selected a preference 60% chose the modified and 40% chose the traditional (p=0.2559). CONCLUSION While there was no significant difference between the two groups in terms of noticing the clipping noise and being bothered by the clipping noise, there may be some clinical significance to draw from this study. Patient preference tended toward the modified scissors and these quiet instruments may improve patient experience, especially for those who are extra sensitive to sensory stimuli or for those who have never undergone dermatologic surgery before

Pbx homeodomain proteins pattern both the zebrafish retina and tectum

<p>Abstract</p> <p>Background</p> <p><it>Pbx </it>genes encode TALE class homeodomain transcription factors that pattern the developing neural tube, pancreas, and blood. Within the hindbrain, Pbx cooperates with Hox proteins to regulate rhombomere segment identity. Pbx cooperates with Eng to regulate midbrain-hindbrain boundary maintenance, and with MyoD to control fast muscle cell differentiation. Although previous results have demonstrated that Pbx is required for proper eye size, functions in regulating retinal cell identity and patterning have not yet been examined.</p> <p>Results</p> <p>Analysis of retinal ganglion cell axon pathfinding and outgrowth in <it>pbx2/4 </it>null embryos demonstrated a key role for <it>pbx </it>genes in regulating neural cell behavior. To identify Pbx-dependent genes involved in regulating retino-tectal pathfinding, we conducted a microarray screen for Pbx-dependent transcripts in zebrafish, and detected genes that are specifically expressed in the eye and tectum. A subset of Pbx-dependent retinal transcripts delineate specific domains in the dorso-temporal lobe of the developing retina. Furthermore, we determined that some Pbx-dependent transcripts also require Meis1 and Gdf6a function. Since <it>gdf6a </it>expression is also dependent on Pbx, we propose a model in which Pbx proteins regulate expression of the growth factor <it>gdf6a</it>, which in turn regulates patterning of the dorso-temporal lobe of the retina. This, in concert with aberrant tectal patterning in <it>pbx2/4 </it>null embryos, may lead to the observed defects in RGC outgrowth.</p> <p>Conclusion</p> <p>These data define a novel role for Pbx in patterning the vertebrate retina and tectum in a manner required for proper retinal ganglion cell axon outgrowth.</p

The risk of burden shifting from embodied carbon calculation tools for the infrastructure sector

The infrastructure sector is associated with a large proportion of total greenhouse gas emissions, including the emissions from the production of materials and the construction of infrastructure assets, as well as use phase and end of life emissions. Largely due to the direct control the sector has over pre-use phase emissions, a number of carbon calculator tools for the sector focus exclusively on these sources. However, a recognised limitation with considering only parts of the whole life cycle is the risk of burden shifting, e.g. reducing material input emissions but increasing emissions in the use or end of life phases. Despite recognition of this problem in principle, there are very few empirical studies which explore the risk and impacts of burden shifting within the infrastructure sector, or construction sector more broadly. This paper addresses the gap in the existing literature by exploring the possibility of burden shifting occurring due to the use of an embodied carbon calculator. The analysis shows that burden shifting will occur for some actions aimed at reducing embodied carbon, but not others, e.g. in Decision Case 4, an initial saving of 4,500 tCO2e during construction was offset by increased use phase emissions in as little as four years. In order to support the use of embodied carbon calculators we propose a number of heuristics to identify cases where burden shifting may occur, and therefore where a whole-of-life assessment is needed. We also suggest that the infrastructure sector is in a learning process in terms of carbon measurement, and that over time there should be a transition from embodied carbon calculators to whole-of-life assessment, and from whole-of-life attributional life cycle assessment to consequential carbon assessment methods

Removing “Black Marks”: How States Can Preserve Wrongful Birth Suits Without Reliance on “Eugenic” Rhetoric

“[L]ebensunwertes Leben—Life Unworthy of Life.” Those words, used by the National Socialist (Nazi) Party in Germany to describe people with genetic disorders, ring throughout world history as a moral indictment of the Nazi German state and all those who collaborated with it. Unfortunately, Germany was not alone in its designation of some people as unworthy of life; the United States has also, throughout its history, given the same designation to portions of its population. From Japanese-Americans during the Second World War to people with disabilities in the era of eugenics, the American government has frequently singled out those whom it believes to be undeserving of full constitutional rights. When American courts ratified such actions, legal commentators rightly described these decisions as “black mark[s]” on the entirety of American jurisprudence

Autonomy based human-vehicle interface standards for remotely operated aircraft

This paper proposes a process for developing CNS (communication, navigation, and surveillance) human-vehicle interface standards specifically adapted for ROA aircraft. It is likely that no single standard will fit all ROAs, but rather these standards must be based on vehicle autonomy. The following sections will describe operator roles and information needs based on level of autonomy. We will first discuss the implications of varying levels of vehicle autonomy and propose a framework for categorizing ROA autonomy based on Billings taxonomy. Next, we will discuss operator information needs based on Sheridan's model of supervisory control. Finally, we will briefly describe civil CNS standards, suggest a methodology for adapting those standards for ROA operations, and identify some of the issues-that may require further study

OPTIMIZATION OF INTERNAL LOGISTICS USING A COMBINED BPMN AND SIMULATION APPROACH

The optimization of material flow systems requires a profound understanding of the underlying processes. Business Process Model and Notation (BPMN) is an established way of creating a process model that allows an interdisciplinary analysis and optimization. Quantitative exploration of systems using discrete-event simulation can help to enrich these insights. For that reason, this paper introduces a combined BPMN simulation approach that connects the advantages of both modeling frameworks. By synthesizing systems from generic modules, a comprehensive yet structured optimization process chain is developed. A case study evaluation based on key metrics for material flow.</jats:p