Mental practice with interactive 3D visual aids enhances surgical performance

Background: Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. Methods: 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. Results: The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. Conclusion: These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance

The role of the ER stress response protein PERK in rhodopsin retinitis pigmentosa

Mutations in rhodopsin, the light sensitive protein of rod cells, are the most common cause of dominant retinitis pigmentosa (RP), a type of inherited blindness caused by the dysfunction and death of photoreceptor cells. The P23H mutation, the most frequent single cause of RP in the USA, causes rhodopsin misfolding and induction of the unfolded protein response (UPR), an adaptive ER stress response and signalling network that aims to enhance the folding and degradation of misfolded proteins to restore proteostasis. Prolonged UPR activation, and in particular the PERK branch, can reduce protein synthesis and initiate cell death through induction of pro-apoptotic pathways. Here, we investigated the effect of pharmacological PERK inhibition on retinal disease process in the P23H-1 transgenic rat model of retinal degeneration. PERK inhibition with GSK2606414A led to an inhibition of eIF2α phosphorylation, which correlated with reduced ERG function and decreased photoreceptor survival at both high and low doses of PERK inhibitor. Additionally, PERK inhibition increased the incidence of inclusion formation in cultured cells overexpressing P23H rod opsin, and increased rhodopsin aggregation in the P23H-1 rat retina, suggesting enhanced P23H misfolding and aggregation. In contrast, treatment of P23H-1 rats with an inhibitor of eIF2α phosphatase, salubrinal, led to improved photoreceptor survival. Collectively, these data suggest the activation of PERK is part of a protective response to mutant rhodopsin that ultimately limits photoreceptor cell death

Philanthropy or solidarity? Ethical dilemmas about humanitarianism in crisis afflicted Greece

That philanthropy perpetuates the conditions that cause inequality is an old argument shared by thinkers such as Karl Marx, Oscar Wilde and Slavoj Zizek. I recorded the same argument in conversations regarding a growing humanitarian concern in austerity-ridden Greece. At the local level a number of solidarity initiatives provide the most impoverished families with humanitarian help. Some citizens participate in such initiatives wholeheartedly, while some other citizens criticize solidarity movements drawing primarily from Marxist-inspired arguments, such as, for example, that humanitarianism rationalises state inaction. The local narratives presented in this article bring forward two parallel possibilities engendered by the humanitarian face of social solidarity: first, its empowering potential (where solidarity initiatives enhance local social awareness), and second, the de-politicisation of the crisis and the experience of suffering (a liability that stems from the effectiveness of humanitarianism in ameliorating only temporarily the superficial consequences of the crisis). These two overlapping possibilities can help us problematise the contextual specificity and strategic employment of humanitarian solidarity in times of austerity

Allocating the Burdens of Climate Action: Consumption-Based Carbon Accounting and the Polluter-Pays Principle

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties

The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases

BACKGROUND Ankle sprains are common in sports and can sometimes result in a persistent pain condition. PURPOSE Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series. METHODS Over around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain. RESULTS 43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49%) and rugby (14%). The main subjective complaint was exertion ankle pain (93%). Effusion (75%) and joint line tenderness on palpation (92%) were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9). 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39%) and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months), 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks). However 43% still suffered minor symptoms. CONCLUSION Arthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion

An exact formula for the radiation of a moving quark in N=4 super Yang Mills

We derive an exact formula for the cusp anomalous dimension at small angles. This is done by relating the latter to the computation of certain 1/8 BPS Wilson loops which was performed by supersymmetric localization. This function of the coupling also determines the power emitted by a moving quark in N=4 super Yang Mills, as well as the coefficient of the two point function of the displacement operator on the Wilson loop. By a similar method we compute the near BPS expansion of the generalized cusp anomalous dimension.Comment: 22 pages, 5 figures. v2: references added, typos correcte

Energy loss in a strongly coupled anisotropic plasma

We study the energy loss of a rotating infinitely massive quark moving, at constant velocity, through an anisotropic strongly-coupled N=4 plasma from holography. It is shown that, similar to the isotropic plasma, the energy loss of the rotating quark is due to either the drag force or radiation with a continuous crossover from drag-dominated regime to the radiation dominated regime. We find that the anisotropy has a significant effect on the energy loss of the heavy quark, specially in the crossover regime. We argue that the energy loss due to radiation in anisotropic media is less than the isotropic case. Interestingly this is similar to analogous calculations for the energy loss in weakly coupled anisotropic plasma.Comment: 26+1 pages, 10 figures, typos fixe

Laparoscopic vs Open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes

Background: Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. Methods: Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. Results: Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17). Conclusions: LPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer

Optical properties and resonant cavity modes in axial InGaN/GaN nanotube microcavities

Microcavities based on group-III nitride material offer a notable platform for the investigation of light-matter interactions as well as the development of devices such as high efficiency light emitting diodes (LEDs) and low-threshold nanolasers. Disk or tube geometries in particular are attractive for low-threshold lasing applications due to their ability to support high finesse whispering gallery modes (WGMs) and small modal volumes. In this article we present the fabrication of homogenous and dense arrays of axial InGaN/GaN nanotubes via a combination of displacement Talbot lithography (DTL) for patterning and inductively coupled plasma top-down dry-etching. Optical characterization highlights the homogeneous emission from nanotube structures. Power-dependent continuous excitation reveals a non-uniform light distribution within a single nanotube, with vertical confinement between the bottom and top facets, and radial confinement within the active region. Finite-difference time-domain simulations, taking into account the particular shape of the outer diameter, indicate that the cavity mode of a single nanotube has a mixed WGM-vertical Fabry-Perot mode (FPM) nature. Additional simulations demonstrate that the improvement of the shape symmetry and dimensions primarily influence the Q-factor of the WGMs whereas the position of the active region impacts the coupling efficiency with one or a family of vertical FPMs. These results show that regular arrays of axial InGaN/GaN nanotubes can be achieved via a low-cost, fast and large-scale process based on DTL and top-down etching. These techniques open a new perspective for cost effective fabrication of nano-LED and nano-laser structures along with bio-chemical sensing applications

Probe Branes, Time-dependent Couplings and Thermalization in AdS/CFT

We present holographic descriptions of thermalization in conformal field theories using probe D-branes in AdS X S space-times. We find that the induced metrics on Dp-brane worldvolumes which are rotating in an internal sphere direction have horizons with characteristic Hawking temperatures even if there is no black hole in the bulk AdS. The AdS/CFT correspondence applied to such systems indeed reveals thermal properties such as Brownian motions and AC conductivities in the dual conformal field theories. We also use this framework to holographically analyze time-dependent systems undergoing a quantum quench, where parameters in quantum field theories, such as a mass or a coupling constant, are suddenly changed. We confirm that this leads to thermal behavior by demonstrating the formation of apparent horizons in the induced metric after a certain time.Comment: LaTeX, 47 pages, 14 figures; Typos corrected and references added (v2); minor corrections, references added(v3