Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

INTRODUCTION Flow disruptions (FD) in the operating room (OR) have been found to adversely affect the levels of stress and cognitive workload of the surgical team. It has been concluded that frequent disruptions also lead to impaired technical performance and subsequently pose a risk to patient safety. However, respective studies are scarce. We therefore aimed to determine if surgical performance failures increase after disruptive events during a complete surgical intervention. METHODS We set up a mixed-reality-based OR simulation study within a full-team scenario. Eleven orthopaedic surgeons performed a vertebroplasty procedure from incision to closure. Simulations were audio- and videotaped and key surgical instrument movements were automatically tracked to determine performance failures, i.e. injury of critical tissue. Flow disruptions were identified through retrospective video observation and evaluated according to duration, severity, source, and initiation. We applied a multilevel binary logistic regression model to determine the relationship between FDs and technical performance failures. For this purpose, we compared FDs in one-minute intervals before performance failures with intervals without subsequent performance failures. RESULTS Average simulation duration was 30:02~min (SD = 10:48~min). In 11 simulated cases, 114 flow disruption events were observed with a mean hourly rate of 20.4 (SD = 5.6) and substantial variation across FD sources. Overall, 53 performance failures were recorded. We observed no relationship between FDs and likelihood of immediate performance failures: Adjusted odds ratio = 1.03 (95% CI 0.46-2.30). Likewise, no evidence could be found for different source types of FDs. CONCLUSION Our study advances previous methodological approaches through the utilisation of a mixed-reality simulation environment, automated surgical performance assessments, and expert-rated observations of FD events. Our data do not support the common assumption that FDs adversely affect technical performance. Yet, future studies should focus on the determining factors, mechanisms, and dynamics underlying our findings

Notes on the Music: A social data infrastructure for music annotation

Beside transmitting musical meaning from composer to reader, symbolic music notation affords the dynamic addition of layers of information by annotation. This allows music scores to serve as rudimentary communication frameworks. Music encodings bring these affordances into the digital realm; though annotations may be represented as digital pen-strokes upon a score image, they must be captured using machine-interpretable semantics to fully benefit from this transformation. This is challenging, as annota- tors’ requirements are heterogeneous, varying both across different types of user (e.g., musician, scholar) and within these groups, de- pending on the specific use-case. A hypothetical all-encompassing tool catering to every conceivable annotation type, even if it were possible to build, would vastly complicate user interaction. This additional complexity would significantly increase cognitive load and impair usability, particularly in dynamic real-time usage con- texts, e.g., live annotation during music rehearsal or performance. To address this challenge, we present a social data infrastructure that facilitates the creation of use-case specific annotation toolkits. Its components include a selectable-score module that supports customisable click-and-drag selection of score elements (e.g., notes, measures, directives); the Web Annotations data model, extended to support the creation of custom, Web-addressable annotation types supporting the specification and (re-)use of annotation palettes; and the Music Encoding and Linked Data (MELD) Javascript client library, used to build interfaces that map annotation types to render- ing and interaction handlers. We have extended MELD to support the Solid platform for social Linked Data, allowing annotations to be privately stored in user-controlled Personal Online Datastores (Pods), or selectively shared or published. To demonstrate the feasi- bility of our proposed approach, we present annotation interfaces employing the outlined infrastructure in three distinct use-cases: scholarly communication; music rehearsal; and rating during music listening

Phase diagram for morphological transitions of wetting films on chemically structured substrates

Using an interface displacement model we calculate the shapes of thin liquidlike films adsorbed on flat substrates containing a chemical stripe. We determine the entire phase diagram of morphological phase transitions in these films as function of temperature, undersaturation, and stripe widthComment: 15 pages, RevTeX, 7 Figure

Dynamic splinting home therapy for toe walking: a case report

Serial casting is frequently prescribed for toe-walking but that does not allow continued physical therapy (PT). This report described a child and family who chose dynamic splinting (DS) with concurrent PT for treatment. The patient presented with right hemiparesis; below average motor skills and a gait pattern of toe contact (without ankle foot orthosis). Four months of PT plus 6 hours/night of DS as home therapy, the patient's passive dorsiflexion increased 14° and she gained the ability to walk in "flat foot" contact without the Ankle Foot Orthosis. This concurrent treatment achieved improved gait pattern and strength training not possible with casting

Correlative analysis of intra-versus extracellular cell detachment events via the alignment of optical imaging and detachment force quantification

In recent decades, hybrid characterization systems have become pillars in the study of cellular biomechanics. Especially, Atomic Force Microscopy (AFM) is combined with a variety of optical microscopy techniques to discover new aspects of cell adhesion. AFM, however, is limited to the early-stage of cell adhesion, so that the forces of mature cell contacts cannot be addressed. Even though the invention of Fluidic Force Microscopy (FluidFM) overcomes these limitations by combining the precise force-control of AFM with microfluidics, the correlative investigation of detachment forces arising from spread mammalian cells has been barely achieved. Here, a novel multifunctional device integrating Fluorescence Microscopy (FL) into FluidFM technology (FL-FluidFM) is introduced, enabling real-time optical tracking of entire cell detachment processes in parallel to the undisturbed acquisition of force-distance curves. This setup, thus, allows for entailing two pieces of information at once. As proof-of-principle experiment, this method is applied to fluorescently labeled rat embryonic fibroblast (REF52) cells, demonstrating a precise matching between identified force-jumps and visualized cellular unbinding steps. This study, thus, presents a novel characterization tool for the correlated evaluation of mature cell adhesion, which has great relevance, for instance, in the development of biomaterials or the fight against diseases such as cancer

Ethnic In-Group Favoritism Among Minority and Majority Groups: Testing the Self-Esteem Hypothesis Among Preadolescents

The self-esteem hypothesis in intergroup relations, as proposed by social identity theory (SIT), states that successful intergroup discrimination enhances momentary collective self-esteem. This hypothesis is a source of continuing controversy. Furthermore, although SIT is increasingly used to account for children’s group attitudes, few studies have examined the hypothesis among children. In addition, the hypothesis’s generality makes it important to study among children from different ethnic groups. The present study, conducted among Dutch and Turkish preadolescents, examined momentary collective self-feelings as a consequence of ethnic group evaluations. The results tended to support the self-esteem hypothesis. In-group favoritism was found to have a self-enhancing effect among participants high in ethnic identification. This result was found for ethnic majority (Dutch) and minority (Turkish) participants.

Measuring quality of life in rheumatic conditions

Musculoskeletal disorders often have associated pain, functional impairment and work disability, and, not surprisingly, are the most common reasons for utilizing healthcare resources. Rheumatoid arthritis (RA) and fibromyalgia (FM) are causes of musculoskeletal pain and disability. Research indicates that there is a widespread impact of RA and FM on physical, psychological and social factors in affected individuals, and thus, outcome measures that encompass multiple aspects of quality of life are needed. Generic measures of quality of life identify associations between physical conditions and mental health and highlight the need to address psychological functioning to ultimately improve the individuals’ quality of life

Spin-Dependent Twist-Four Matrix Elements from g_1 Data in the Resonance Region

Matrix elements of spin-dependent twist-four operators are extracted from recent data on the spin-dependent g_1 structure function of the proton and deuteron in the resonance region. We emphasize the need to include the elastic contributions to the first moments of the structure functions at Q^2 < 2 GeV^2. The coefficients of the 1/Q^2 corrections to the Ellis-Jaffe sum rules are found to be 0.04 \pm 0.02 and 0.03 \pm 0.04 GeV^2 for the proton and neutron, respectively.Comment: 10 pages REVTeX, 4 figure