Surgical Simulator Design and Development

With the introduction of minimally invasive surgery (MIS), it became necessary to develop training methods to learn skills outside the operating room. Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking. Three aspects of developing a training program are investigated here: what should be trained, how it should be trained, and how to assess the results of training. In addition, studies are presented that have investigated the role of force feedback in surgical simulators. Training should be adapted to the level of behavior: skill-based, rule-based, or knowledge-based. These levels can be used to design and structure a training program. Extra motivation for training can be created by assessment. During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar. The friction characteristics vary largely among instruments and trocars. When force feedback is incorporated into training, it should include the large variation in force feedback properties as well. Training different levels of behavior requires different training methods. Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well

Rationale and design of the randomised clinical trial comparing early medication change (EMC) strategy with treatment as usual (TAU) in patients with Major Depressive Disorder - the EMC trial

<p>Abstract</p> <p>Background</p> <p>In Major Depressive Disorder (MDD), the traditional belief of a delayed onset of antidepressants' effects has lead to the concept of current guidelines that treatment durations should be between 3-8 weeks before medication change in case of insufficient outcome. Post hoc analyses of clinical trials, however, have shown that improvement usually occurs within the first 10-14 days of treatment and that such early improvement (Hamilton Depression Rating Scale [HAMD] decrease ≥20%) has a substantial predictive value for final treatment outcome. Even more important, non-improvement (HAMD decrease <20%) after 14 days of treatment was found to be highly predictive for a poor final treatment outcome.</p> <p>Methods/Design</p> <p>The EMC trial is a phase IV, multi-centre, multi-step, randomized, observer-blinded, actively controlled parallel-group clinical trial to investigate for the first time prospectively, whether non-improvers after 14 days of antidepressant treatment with an early medication change (EMC) are more likely to attain remission (HAMD-17 ≤7) on treatment day 56 compared to patients treated according to current guideline recommendation (treatment as usual; TAU). In level 1 of the EMC trial, non-improvers after 14 days of antidepressant treatment will be randomised to an EMC strategy or TAU. The EMC strategy for this study schedules a first medication change on day 15; in case of non-improvement between days 15-28, a second medication change will be performed. TAU schedules the first medication change after 28 days in case of non-response (HAMD-17 decrease <50%). Both interventions will last 42 days. In levels 2 and 3, EMC strategies will be compared with TAU strategies in improvers on day 14, who experience a stagnation of improvement during the course of treatment. The trial is supported by the German Federal Ministry of Education and Research (BMBF) and will be conducted in cooperation with the BMBF funded Interdisciplinary Centre Clinical Trials (IZKS) at the University Medical Centre Mainz and at six clinical trial sites in Germany.</p> <p>Discussion</p> <p>If the EMC strategies lead to significantly more remitters, changes of clinical practice, guidelines for the treatment of MDD as well as research settings can be expected.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00974155; <b>EudraCT</b>: 2008-008280-96.</p

Associations between job demands, perceptions of noise at work and the psychological contract

Despite the widespread interest in the effects of workload on behaviour, there has been little research on the effects of it on attitudes and values in the workplace and life generally. The aim of the present research was to examine associations between noise exposure (which increases workload) and components of the psychological contract (fairness; trust; organisational commitment; work satisfaction; motivation; organisational citizenship; and intention to stay/quit). 166 workers completed a survey measuring components of the psychological contract, perceptions of noise exposure and other job characteristics. Univariate analyses showed that higher noise exposure was associated with a more negative psychological contract. However, adjustment for other job characteristics, both negative (e.g. job demands) and positive (e.g. control and support), removed the significant effects of noise. These results confirm previous research suggesting that psychosocial stressors have greater behavioural effects than components of the physical working environment such as noise

Student workload, wellbeing and academic attainment

There has been extensive research on workload, often in the laboratory or workplace. Less research has been conducted in educational settings and there is very little examining workload, wellbeing and academic attainment of university students. The present study of 1294 students examined associations between perceptions of workload, hours spent at university, time pressure and attainment and wellbeing outcomes (measured using the Wellbeing Process Questionnaire). Established predictors (stressors; social support; negative coping; positive personality and conscientiousness) were controlled for, and the analyses showed that workload was significantly associated with all outcomes whereas time pressure was only related to course stress and negative wellbeing (life stress, fatigue and anxiety/depression). Hours spent at the university had no significant effects. The effects of workload were interpreted in terms of an initial challenge leading to increased efficiency and attainment. These results show the importance of including workload in future longitudinal research on student wellbeing and attainment

Effects of perceptions of information overload, noise and environmental demands on wellbeing and academic attainment.

The present research considers components of information overload, which may have a negative impact on wellbeing and academic attainment. 179 university students completed a survey consisting of an information overload scale (IOS) and the wellbeing process questionnaire. Their academic attainment scores were also added to the database. The IOS scale also included questions relating to noise exposure. Both the noise scores and non-noise IOS scores were associated with greater negative wellbeing and lower positive wellbeing. There were no significant effects of noise or IOS scores on academic attainment. Wellbeing is predicted by a number of factors such as exposure to stressors, negative coping, social support and psychological capital. When these established factors were included in the analyses, the effects of noise and other aspects of IOS could be accounted for by exposure to other stressors and were no longer significant predictors of negative or positive wellbeing

The relationship between tree dimensions, yield and nutritional requirements of mango.

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