Delay discounting in light-social and heavy-social drinkers

To examine the relation between alcohol consumption and delay discounting of monetary rewards and alcohol rewards, I gave 164 college students an online screener designed to measure the quantity and frequency of alcohol consumption, and hazardous drinking. I identified 20 light-social drinkers and one heavy-social drinker. I then compared how the heavy-social drinker and the light-social drinker discounted delayed monetary rewards and delayed alcohol rewards. The light-social drinking group and the heavy-social drinker both discounted alcohol rewards more impulsively than monetary rewards; the heavy-social drinker discounted more impulsively than the light-social drinking group on both tasks. I also found that the hyperbola-like function provided a relatively decent fit to much of the data. Together, these findings suggest that a delay-discounting task, along with analysis based on the hyperbola-like function, may be sensitive enough to detect qualitative differences in light-social and heavy-social college drinkers

Education of Residents in the Operating Room

Education of Residents in the Operating Room Megan Arnold1 and Lauren Alden1 Hubert K. Huang, Ph.D.1,2 1Division of Education, Lehigh Valley Health Network 2Research Scholar Program Mentor Abstract It is of paramount importance that the technical skills of surgical residents is evaluated. There are obstacles in the operating room setting, however, that interfere with teaching, such as limited time because of efficiency and patient safety. Debriefing after the case has been found to increase the educational value of a case. For this study, residents from the obstetrics and gynecology training program were observed performing four types of sentinel cases. The number of questions the resident asked and the number of teaching points the attending surgeon asked intraoperatively were observed and recorded. During a debriefing session following each case, the video footage collected was available for review and playback. Of the 40 cases that were observed throughout the study, sufficient data to analyze the educational value of the case was only collected from 15 of the cases. The overall average learning experience reported from the attending and resident surgeons for all collected cases was 4.5 on a 1 to 5 Likert scale. In conclusion, higher-level residents were found to ask less questions and were given fewer teaching points. SimCapture technology was found to be a useful tool for resident evaluation, and should be implemented into other specialties beyond obstetrics and gynecology. Keywords SimCapture, video capture, obstetrics and gynecology, OPRS, surgery, technical skill, evaluation, assessment Introduction Since the Accreditation Council for Graduate Medical Education (ACGME) created six general competencies to be used to evaluate medical education, the complicated system of assessing the proficiency of residents in the operating room has been based heavily on these competencies in many specialties. Patient care, medical knowledge, and interpersonal skills are among the competencies identified by the ACGME.3 Technical skill, however, is critical in the operating room and must also be evaluated. It is important for surgical residents to be objectively assessed concerning their technical skills during surgery. There are many ways to do so, ranging from direct observation to animal models to virtual simulation of procedures.1 Technical skill can be measured using standard validated scoring tools such as the Operative Performance Rating System (OPRS) and milestone evaluations. Financial pressure to increase productivity can limit the volume of surgeries residents are exposed to during their training period,1 therefore each teaching opportunity in the operating room is highly valuable. Residents must become proficient quickly. Video recording of residents performing surgical procedures is a method that may be utilized to assess technical skills without requiring extra staff members to be present in the operating room to watch the live procedure. The videos could be sent to various blinded faculty members for evaluation, which would increase the objectivity of the assessment.1 SimCapture is a portable, multi-camera system complete with video software that has been purchased by Lehigh Valley Health Network (LVHN). Implementation of this system is intended to enhance the education and feedback surgical residents receive after operative cases.2 The system is capable of connecting to the existing endoscopic towers in the operating rooms to record laparoscopic cases. Specific events that occur during the cases can be referenced during debriefing sessions to show residents areas of strength or weakness in their technical skills. The present study aims to assess whether video-capture technology, specifically the SimCapture system, is an effective evaluative tool for resident surgeons. Performance of the resident is to be evaluated by a proctoring surgeon as well as the resident themselves, using several evaluative tools. The patient as well as the operating surgeons will not be identifiable, as only the video from the endoscopic tower and the hands of the resident surgeon will be videotaped.2 Crowdsourcing is collecting services from a large number of people, generally through an online database.4 This study intends to eventually utilize crowdsourcing to evaluate resident performance of technical skills, in order increase objectivity and efficiency. In a recent study, Crowd Sourced Assessment of Technical Skill (CSATS) was used to rate skills of surgical trainees. Results of the study showed that CSATS is an accurate and fast way to gather technical skills assessments for residents, as inter-rater reliability between surgeons and the crowd was found to be excellent.4 Verbal interactions among resident and attending surgeons can serve to keep the operation flow moving forward, as well as provide teaching opportunities. The operating room is one of the most critical places for the education of residents to occur, despite the limited time that is available for teaching during surgical procedures.5 Educational value can be further increased by the attending and resident surgeons having a short debriefing following the case. Discussing the procedure and revisiting teaching points that were touched on during the operation helps solidify the information and leads to better performance in the future.5 Methods Participants comprised of different surgical residents from the obstetrics and gynecology training program. Attending surgeons in the respective programs were also involved in the study in that they participated in evaluation of the residents and debriefing sessions. All participants are employed by Lehigh Valley Health Network. Participants were selected based on operative schedules during weekdays; only resident surgeons performing five specified sentinel case types were recorded and evaluated. A SimCapture team made up of two summer research scholars oversaw the setup and recording of the selected procedures in the operating room. The SimCapture system, provided by B-Line Medical, was utilized for this project. OPRS and milestone evaluation forms were used by residents and attending physicians to rate the performance of the residents during the surgical procedures. An additional form was created for use by the SimCapture team to keep a record of the number of questions asked by the resident and teaching points given by the attending surgeon during each case. Four case types were evaluated for this study, including cesarean sections, operative hysteroscopy, laparoscopic bilateral tubal ligation, and robotic hysterectomy. A SimCapture team set up the system and cameras in the operating room immediately before or after the patient was brought into the operating room. Parts of the surgery that were performed by the resident surgeon were annotated using the SimCapture software for easy playback. During the procedure, a member of the SimCapture team counted the number of questions the resident surgeon asked and the number of teaching points that were offered by the attending surgeon throughout the procedure. After each case, both the resident surgeon and attending surgeon completed two evaluation forms, the OPRS (specific to the particular procedure) and milestone evaluations. A member of the SimCapture team then mediated a brief, five- to ten-minute discussion between resident and attending regarding the resident’s performance. This conversation allowed a comparison of the resident and attending surgeons’ perceptions of how the case went. Lastly, a short survey was sent electronically to both the resident and attending surgeon about their perception of the educational value of the procedure. Results After the collection of the needed data, the SimCapture team collected 40 cases that had usable material to be sent out to third party experts. Most of the results were coming from cesarean sections because they are simply the most common procedures that the SimCapture team was recording (almost always 3 a day are performed). We did run into some problems in the first couple weeks because of issues with the actual technology, and trial and error occurrences. Problems also occurred when cases were cancelled, pushed back, or the resident was simply not going to be performing any of the surgery. Some of the cases that were recorded could not be used due to HIPPA violations. Therefore, the SimCapture team has less data than was expected, but still enough for outside party members to create a fair assessment. Almost always, the attending surgeon, resident, and staff were receptive to the project overall. The SimCapture team was able to find that residents who are at a higher level generally ask less questions and are also given less teaching points, with the exception of some outliers due to the variety in attending surgeons and residents. Most residents who are their second year asked a lot of questions during the procedure as opposed to a fourth year resident. The debriefing sessions varied in length and quality; some were quick and precise and others were lengthy with a lot of description. Some debriefing sessions did not occur at all because of time or schedule conflicts The results from the outside party members is still to be collected although they have been sent out. The SimCapture team will then compare the results from a third party to the results of the attending evaluation of the same case. Discussion SimCapture technology provides an overall beneficial educational value of the residents’ crucial learning period. With the ability to watch the video at their leisure, and have a formal debriefing session with an attending, residents can become efficiently more competent. After analyzing data, we were able to find that both residents and attending physicians find the overall educational value to be very high, averaging a 4.2 on a 1 to 5 scale. The level of a resident was found to impact the number of teaching points as well as the amount of questions asked in the operating room. Many upper level residents asked fewer questions and received fewer teaching points whereas lower level resident tended to do the opposite. In these cases, the overall educational value was still ranked high, even if there were fewer questions asked and fewer teaching points. It was also found that there was no difference in the overall OPRS evaluation and the overall educational value, meaning that the OPRS is an evaluation tool of quality in which attending surgeons can formally recognize how well a resident is performing. Also, the OPRS provides a means for the resident and attending to sit down and have an open discussion about his or her performance, therefore increasing the education value. Because of this, SimCapture technology is crucial to a resident in training. They themselves can go back and watch the footage during a debriefing session and can assess their strengths and weakness. It would be beneficial to continue using SimCapture technology throughout not only the OB/GYN department but all other departments so that residents can more effectively and efficiently learn during a crucial time in their careers. Acknowledgements We would like to thank everyone who assisted us in our research and clinical observation. Thank you to Joe Patruno, President Elect of Medical Staff at Lehigh Valley Health Network, for his guidance and supervision. We could not have made the progress we did without his enthusiasm and help getting into the operating room. Thank you also to Martin A. Martino, gynecologic oncologist, and Timothy M. Pellini, obstetrics and gynecology, for their patience and assistance in getting this project off the ground. Thank you to our mentor and the Summer Research Scholars program director, Hubert Huang, for providing this opportunity for all of our personal and professional growth. References Moorthy Krishna, Munz Yaron, Sarker Sudip K,Darzi Ara. Objective assessment of technical skills in surgery BMJ 2003; 327 :1032 Patruno JE, Pellini T, Huang H, Cesanek P, Martino M. The use of video-capture technology to optimize the education, evaluate technical performance in residents. Greenberg JA, Irani JL, Greenberg CC, et al. The ACGME competencies in the operating room. Surgery.2007 Aug;142(2):180–4. Holst Daniel, Kowalewski Timothy M., White Lee W., Brand Timothy C., Harper Jonathan D., Sorenson Mathew D., Kirsch Sarah, and Lendvay Thomas S.. Journal of Endourology. May 2015, 29(5): 604-609. doi:10.1089/end.2014.0616. Roberts Nicole, Brenner Michael, Williams Reed, Kim Michael, Dunnington Gary. Capturing the teachable moment: A grounded theory study of verbal teaching interactions in the operating room. Surgery. 2012 May; 151(5):643-50

Discriminating single-photon states unambiguously in high dimensions

The ability to uniquely identify a quantum state is integral to quantum science, but for non-orthogonal states, quantum mechanics precludes deterministic, error-free discrimination. However, using the non-deterministic protocol of unambiguous state discrimination (USD) enables error-free differentiation of states, at the cost of a lower frequency of success. We discriminate experimentally between non-orthogonal, high-dimensional states encoded in single photons; our results range from dimension $d=2$ to $d=14$. We quantify the performance of our method by comparing the total measured error rate to the theoretical rate predicted by minimum-error state discrimination. For the chosen states, we find a lower error rate by more than one standard deviation for dimensions up to $d=12$. This method will find immediate application in high-dimensional implementations of quantum information protocols, such as quantum cryptography.Comment: 4 pages + 3 pages supplementary, 4 figure

Mindfulness as a Buffer of Leaders’ Self-Rated Behavioral Responses to Emotional Exhaustion: A Dual Process Model of Self-Regulation

In this study, we investigate the self-regulatory role of mindfulness in buffering the relationship between leaders’ emotional exhaustion and self-rated leadership behavior (transformational leadership and abusive supervision). Specifically, we propose that leader mindfulness buffers the relationship between emotional exhaustion and both negative affect and impaired perspective taking, which link leader emotional exhaustion and leadership behavior (i.e., moderated mediation). Using a time-lagged survey of leaders (N = 505) we found that leader perspective taking and negative affect mediated the relationships between emotional exhaustion and self-reported leadership behavior. Furthermore, we found that leader mindfulness buffers the relationship between emotional exhaustion and negative affect, which weakened the mediated relationship between emotional exhaustion and both transformational leadership and abusive supervision. However, leader mindfulness did not moderate the relationship between emotional exhaustion and perspective taking. Theoretical and practical implications are discussed

Convenient Synthesis of Copper (I) Thiolates and Related Compounds

Copper (I) salts of various anions including thiolates, diethyl dithiocarbamate, diethyl dithiophosphate, trithiocyanurate, 1-cyano-3-methylisothiourea, 2-aminothiazole, and tetrakis(1-imidazolyl)borate are conveniently synthesized by reducing copper (II) sulfate in aqueous ammonia. The addition of phosphine ligands to several of the products is demonstrated, and the crystal structure of [Cu2(MBT)2(DPPE)3] · Et2O (MBT = 2-mercaptobenzothiazolate, DPPE = 1,2-bis(diphenylphosphino)ethane) is reported

Entangled Bessel beams

Orbital angular momentum (OAM) entanglement is investigated in the Bessel-Gauss (BG) basis. Having a readily adjustable radial scale, BG modes provide a more favourable basis for OAM entanglement over Laguerre-Gaussian (LG) modes. The OAM bandwidth in terms of BG modes can be increased by selection of particular radial modes and leads to a flattening of the spectrum. The flattening of the spectrum allows for higher entanglement. We demonstrate increased entanglement in terms of BG modes by performing a Bell-type experiment and violating the appropriate Clauser Horne Shimony Holt (CHSH) inequality. In addition, we reconstruct the quantum state of BG modes entangled in high-dimensions.Comment: 8 pages, 4 figure

Preoperative botulinum neurotoxin A for children with bilateral cerebral palsy undergoing major hip surgery: a randomized double-blind placebo-controlled trial.

AIM: To assess whether preoperative botulinum neurotoxin A (BoNT-A) affects pain after major hip surgery for children with bilateral cerebral palsy (CP). METHOD: This was a randomized, parallel arms, placebo-contolled trial. Children with hypertonic CP aged 2 to 15 years awaiting bony hip surgery at a tertiary hospital were randomized to receive either BoNT-A or placebo injections into the muscles of the hip on a single occasion immediately before surgery. The primary outcome was the paediatric pain profile (PPP), which was assessed at baseline and weekly for 6 weeks. Treatment allocation was by minimization. Participants, clinicians, and outcome assessors were masked to group assignment. RESULTS: Twenty-seven participants (17 males, 10 females; mean 8y 8mo [SD 3y 9mo], range 3y 4mo-15y 10mo) were allocated to BoNT-A and 27 participants (14 males, 13 females; mean 8y 11mo [SD 3y 5mo], range 4y 1mo-15y 2mo) to placebo. Mean (SD) PPP at 6 weeks for the BoNT-A group (n=24 followed up) was 10.96 (7.22) and for the placebo group (n=26) was 10.04 (8.54) (p=0.69; 95% confidence interval [CI] -4.82, 3.18). There were 16 serious adverse events in total during 6 months of follow-up (n=6 in BoNT-A group). INTERPRETATION: Use of BoNT-A immediately before bony hip surgery for reducing postoperative pain for children with CP was not supported. WHAT THIS PAPER ADDS: Botulinum neurotoxin A (BoNT-A) does not reduce postoperative pain following bony hip surgery. BoNT-A also does not affect postoperative quality of life

Automated Reminders to Promote Radon Testing in a Lung Cancer Case Control Study

One of the four pilot projects of the Lung Cancer Initiative sponsored by the Department of Defense measures radon levels in the participants homes. Radon exposure is the second leading cause of Lung Cancer. The case-control study has a targeted accrual of 1800 with a case-control ratio of 1:4. The long-term radon kits remain in the home for 90 days and the participants are asked to mail the test kit to the company for analysis. In order to maximize the test kit return rate, reminder calls to the participants occurred 90 days after the home visit

Bimetallic uranium and cerium tetraphenolate complexes for the activation and functionalisation of small molecules

thesis describes the synthesis of bimetallic f-element complexes of meta-functionalised tetraphenol arene ligands, (mTP), and their reactivity, primarily towards small molecular substrates such as dinitrogen. Chapter one introduces the principles of uranium chemistry and the suitability of aryloxides as ligands for low oxidation state uranium. The synthesis and reactivity of selected examples of U(III) and U(IV) complexes are described and an overview of dinitrogen activation by selected transition metal complexes is provided. Chapter two reports the synthesis and characterisation of two meta-functionalised tetraphenol arene ligand precursors H4(mTPm) and H4(mTPt) and describes reactions designed to target closely related analogues. In 1:1 salt metathesis or protonolysis reactions, two tetradentate ligands and two U(IV) centres are combined to yield [U2(mTP)2] complexes with a novel ‘letterbox’ architecture. The reduction of some of these complexes under an atmosphere of dinitrogen yields bound [N2H2]2- following an intramolecular reaction of an activated N2 fragment with benzylic C−H bonds provided by the ligand. The [N2H2]2- moiety is susceptible to further functionalisation through reactions with external electrophiles. Stoichiometric and catalytic functionalisation reactions are discussed and a mechanistic pathway for these transformations is proposed. Chapter three presents the synthesis of another set of bimetallic complexes, [U2(mTP)X4] (X = one electron donor ligand), derived from 2:1 reactions of uranium(IV) with H4(mTP). The redox chemistry of these complexes is explored through cyclic voltammetry and the structure and reactivity of these ‘half-letterbox’ complexes is compared to the complexes reported in Chapter two. The work described in Chapter four returns to complexes with a ‘letterbox’ geometry but employs Ce(III) and potassium cations to prepare a set of heterobimetallic analogues, [K][Ce2(mTP)2K]. The oxidation chemistry of these complexes is investigated and an EPR study is used to examine the magnetic behaviour of the two 4f1 Ce(III) centres. Chapter five details the experimental procedures and characterisation data for the work described in the preceding chapters