The impact of innate ability and objective scoring methods on proficiency based training in minimally invasive surgery.

Background: The attainment of technical competence and accurate performanceassessment of surgical trainees for surgical procedures are the fundamentalcomponents of a proficiency-based surgical training programme. We hypothesised thataptitude may directly affect one’s ability to successfully complete the learning curve forminimally invasive procedures. Aim: The principle aim of this thesis was evaluate the impact of innate ability upon therate at which a surgical novice can achieve proficiency in index and advancedlaparoscopic procedures. Our secondary aim was to develop new objective methods oftechnical skills assessment for a proficiency-based programme. Materials \u26 Methods: We tested medical students (surgical novices) with disparateaptitude consecutively until they achieved proficiency in laparoscopic appendicectomyand laparoscopic suturing using objective and subjective scoring methods. Wedeveloped objective scoring methods by designing a new zone metric to assesslaparoscopic suturing and also a mathematical formula to provide meaningful metrics scores on the laparoscopic simulator ProMIS. Results: The results demonstrated that surgical novices with low aptitude took twice as long to reach proficiency targets. Aptitude predicted superior baseline performance in medical students. There is a group of surgical candidates who are unable to achieve proficiency despite repeated practice. It was shown that a new zone metric could be used to assess laparoscopic suturing. Finally we successfully developed a scoring method, which provides meaningful user scores on the ProMIS simulator. Conclusion: High aptitude is directly related to a rapid attainment of proficiency. It is likely that surgical trainees self select in surgery based on innate ability. The new zone metric and formulated scoring systems are valid tools for assessing laparoscopic tasks and provide meaningful scores. These findings have implications for developing a proficiency based training system according to a trainees natural ability

Changing environments and genetic variation: natural variation in inbreeding does not compromise short-term physiological responses

Selfing plant lineages are surprisingly widespread and successful in a broad range of environments, despite showing reduced genetic diversity, which is predicted to reduce their long-term evolutionary potential. However, appropriate short-term plastic responses to new environmental conditions might not require high levels of standing genetic variation. In this study, we tested whether mating system variation among populations, and associated changes in genetic variability, affected short-term responses to environmental challenges. We compared relative fitness and metabolome profiles of naturally outbreeding (genetically diverse) and inbreeding (genetically depauperate) populations of a perennial plant, Arabidopsis lyrata, under constant growth chamber conditions and an outdoor common garden environment outside its native range. We found no effect of inbreeding on survival, flowering phenology or short-term physiological responses. Specifically, naturally occurring inbreeding had no significant effects on the plasticity of metabolome profiles, using either multivariate approaches or analysis of variation in individual metabolites, with inbreeding populations showing similar physiological responses to outbreeding populations over time in both growing environments. We conclude that low genetic diversity in naturally inbred populations may not always compromise fitness or short-term physiological capacity to respond to environmental change, which could help to explain the global success of selfing mating strategies

Changing environments and genetic variation: natural variation in inbreeding does not compromise short-term physiological responses

Selfing plant lineages are surprisingly widespread and successful in a broad range of environments, despite showing reduced genetic diversity, which is predicted to reduce their long-term evolutionary potential. However, appropriate short-term plastic responses to new environmental conditions might not require high levels of standing genetic variation. In this study, we tested whether mating system variation among populations, and associated changes in genetic variability, affected short-term responses to environmental challenges. We compared relative fitness and metabolome profiles of naturally outbreeding (genetically diverse) and inbreeding (genetically depauperate) populations of a perennial plant, Arabidopsis lyrata, under constant growth chamber conditions and an outdoor common garden environment outside its native range. We found no effect of inbreeding on survival, flowering phenology or short-term physiological responses. Specifically, naturally occurring inbreeding had no significant effects on the plasticity of metabolome profiles, using either multivariate approaches or analysis of variation in individual metabolites, with inbreeding populations showing similar physiological responses to outbreeding populations over time in both growing environments. We conclude that low genetic diversity in naturally inbred populations may not always compromise fitness or short-term physiological capacity to respond to environmental change, which could help to explain the global success of selfing mating strategies

Oral health of the prehistoric Rima Rau cave burials, Atiu, Cook Islands.

The human skeletal remains buried in the cave of Rima Rau on the island of Atiu, have long been a subject of speculation as to their origins. Oral histories of a massacre, battle, famine and cannibal feast surround the sacred site. The local Atiuan community invited a group of bioarchaeologists from the University of Otago to help shed light on the people buried in the cave. We examined nearly 600 skeletal elements and 400 teeth, which represent at least 38 adults and 8 infants and children. This research is the assessment of their oral health, a first for a prehistoric Cook Island population. Oral health was within the range of other tropical Pacific skeletal assemblages, for dental caries, antemortem tooth loss, and supragingival calculus, with low rates of periodontal disease and periapical cavities. Degeneration of the temporomandibular joint was high and this was associated with enamel chipping, possibly linked to diet. Enamel defect prevalence indicates sex-specific health differences, but the population was robust with a good proportion who survived to adulthood despite periods of early childhood stress. Through the consideration of a skeletal census and oral health indicators, we begin to describe the burials in the cave

The Guaymas Basin Subseafloor Sedimentary Archaeome Reflects Complex Environmental Histories

Highlights • Archaeal community composition reflects locally specific environmental challenges • Biogeochemical properties do not predict archaeal community structure • Environmental history controls subseafloor archaeal populations Summary We explore archaeal distributions in sedimentary subseafloor habitats of Guaymas Basin and the adjacent Sonora Margin, located in the Gulf of California, México. Sampling locations include (1) control sediments without hydrothermal or seep influence, (2) Sonora Margin sediments underlying oxygen minimum zone water, (3) compacted, highly reduced sediments from a pressure ridge with numerous seeps at the base of the Sonora Margin, and (4) sediments impacted by hydrothermal circulation at the off-axis Ringvent site. Generally, archaeal communities largely comprise Bathyarchaeal lineages, members of the Hadesarchaea, MBG-D, TMEG, and ANME-1 groups. Variations in archaeal community composition reflect locally specific environmental challenges. Background sediments are divided into surface and subsurface niches. Overall, the environmental setting and history of a particular site, not isolated biogeochemical properties out of context, control the subseafloor archaeal communities in Guaymas Basin and Sonora Margin sediments

Co-design of an NHS Primary Care Health Check for Autistic Adults

Autistic people experience more health conditions and earlier mortality. This study investigated views about a primary care health check for autistic adults to inform its design. Fifty-one people participated in consultation groups and interviews, comprising autistic adults (some with co-occurring intellectual disabilities), adults with intellectual disabilities, supporters and health professionals. Participants wanted the health check to cover physical and mental health and social functioning. They emphasised the importance of sharing information about individual needs and associated adjustments before the health check. They highlighted the need to change the way healthcare services communicate with autistic people, such as reducing phone contact and booking appointments online. They wanted individual choice in how the health check was completed, with video call or email offered alongside face-to-face. Participants raised the need for further training of primary care staff on autism, to highlight the diversity of experiences of autistic people and ways in which difficulties, such as pain, may present differently. Clinicians raised questions about the capacity of mental health and social care services to meet the additional needs potentially identified through the health check. This study represents a key step in the development and co-design of a UK primary care health check for autistic people

Searching for Scandinavians in pre-Viking Scotland : Molecular fingerprinting of Early Medieval combs

The character and chronology of Norse colonisation in Early Medieval northern Scotland (8th–10th centuries AD) is hotly debated. The presence of reindeer antler raw material in ‘native’ or ‘Pictish’ type combs from the Orkney Isles, northern Scotland has been put forward as evidence for a long and largely peaceful initial period of cultural contact, as opposed to a shorter, more polarised period probably in the late ninth century. Here this hypothesis is tested using a minimally-destructive collagen peptide mass fingerprinting method (ZooMS) to speciate the raw material of 20 combs. Eleven were identified as red deer, four as reindeer and one as whale. The accuracy and gentleness of this method was tested by the subsequent application of ancient DNA (aDNA) methods to fourteen of the same samples: in ten, amplification was successful and all supported the preliminary ZooMS identification. All ‘native’-type combs in the sample are identified as red deer, and all Norse types as reindeer. These results challenge previous species identifications for these combs' raw materials. The balance of evidence no longer supports the existence of a long period of cultural contact between Atlantic Scotland and Scandinavian settlers before the late 9th century. ZooMS is shown to have considerable potential for identification of worked bone and antler artefacts, with applications in archaeology and wildlife/art-history forensics