Randomized control trial for evaluation of a hands-free pointer for surgical instruction during laparoscopic cholecystectomy

Introduction: Training surgeons in minimally invasive surgery (MIS) requires surgical residents to operate under the direction of a consultant. The inability of the instructing surgeon to point at the laparoscopic monitor without releasing the instruments remains a barrier to effective instruction. The wireless hands-free surgical pointer (WHaSP) has been developed to aid instruction during MIS. Methods: The objective of this study was to evaluate the effectiveness and likeability of the WHaSP as an instructional tool compared with the conventional methods. Data were successfully collected during 103 laparoscopic cholecystectomy procedures, which had been randomized to use or not use the WHaSP as a teaching tool. Audio and video from the surgeries were recorded and analyzed. Instructing surgeons, operating surgeons, and camera assistants provided feedback through a post-operative questionnaire that used a five-level Likert scale. The questionnaire results were analyzed using a Mann–Whitney U test. Results: There were no negative effects on surgery completion time or instruction practice due to the use of the WHaSP. The number of times an instructor surgeon pointed to the laparoscopic screen with their hand was significantly reduced when the WHaSP was utilized (p \u3c 0.001). The questionnaires showed that WHaSP users found it to be comfortable, easy to use, and easy to control. Compared to when the WHaSP was not used, users found that communication was more effective (p = 0.002), locations were easier to communicate (p \u3c 0.001), and instructions were easier to follow (p = 0.005). Conclusions: The WHaSP system was successfully used in surgery. It integrated seamlessly into existing equipment within the operating room and did not affect flow. The positive outcomes of utilizing the WHaSP were improved communication in the OR, improved efficiency and safety of the surgery, easy to use, and comfortable to wear. The surgeons showed a preference for utilizing the WHaSP if given a choice

The application of LS-PIV to a small irregular river for inbank and overbank flows

This paper examines the feasibility of applying a mobile, large scale particle image velocimetry (LS-PIV) system to a 300 m reach of a small river in order to estimate the discharge. Detailed velocity measurements at a number of locations were carried out using an acoustic Doppler current profiler (ADCP) and acoustic Doppler velocimetry (ADV) for inbank, bankfull and overbank flows. The lateral distributions of the velocity index k (i.e., the ratio of the depth-averaged velocity to the surface velocity) were found to be influenced by the secondary currents, channel vegetation and flow conditions. An attempt is made to quantify the relationship between secondary flow and the velocity index. Appropriate conclusions and advice relating to the practical use of a LS-PIV system as applied to a small river are given

‘The Living Death of Alzheimer’s’ Versus ‘Take a Walk to Keep Dementia at Bay’: Representations of Dementia in Print Media and Carer Discourse

Understanding dementia is a pressing social challenge. This paper draws on the ‘Dementia talking: care conversation and communication’ project which aims to understand how talk about, and to, people living with dementia is constructed. In this paper I draw on the construction of dementia manifest in two data-sets - a corpus of 350 recent UK national newspaper articles and qualitative data derived from in-depth interviews with informal carers. These data were analysed using a thematic discursive approach. A ‘panic-blame’ framework was evident in much of the print media coverage. Dementia was represented in catastrophic terms as a ‘tsunami’ and ‘worse than death’, juxtaposed with coverage of individualistic behavioural change and lifestyle recommendations to ‘stave off’ the condition. Contrary to this media discourse, in carers’ talk there was scant use of hyperbolic metaphor or reference to individual responsibility for dementia, and any corresponding blame and accountability. I argue that the presence of individualistic dementia ‘preventative’ behaviours in media discourse is problematic, especially in comparison to other more ‘controllable’ and treatable chronic conditions. Engagement with, and critique of, the nascent ‘panic-blame’ cultural context may be fruitful in enhancing positive social change for people diagnosed with dementia and their carers

The first fossil owls (Aves: Strigiformes) from the Paleogene of Asia and a review of the fossil record of Strigiformes

e fossil record of owls (Strigiformes) is one of the most extensive among the neornithine birds, yet at the same time largely restricted geographically to Europe and North America. Various fossil owls are known from the Paleocene (ca. 60 Ma) to Recent. Here we present the first taxonomic description of new species of Paleogene owls from Asia, two new taxa from the Eocene and Oligocene of Mongolia. The anatomy of Heterostrix tatsinensis gen. et sp. nov., represented by a complete Early Oligocene tarsometatarsus, sheds light on the evolution of perching adaptations in these birds and expands the family diversity of this order. Eostrix tsaganica sp. nov. from the Early Eocene extend the known range of the protostrigid genus Eostrix into Asia (the other known species come from Europe and western North America). The paper also provides a review of the fossil record of owls, which gives evidence for the Late Cretaceous evolutionary radiation of this lineage. In spite of the absence of specimens from the Mesozoic, fossil owl collector-effort (since the 1860s) suggests that, in contrast to many other avian clades, the fossil record of these birds is complete enough for biological signal to be extracted