Freestyle deliberate practice cadaveric hand surgery simulation training for orthopedic residents : cohort study

Background: Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. Objective: The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. Methods: This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. Results: The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. Conclusions: Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work

Teaching Engineering Design Through Wearable Device Design Competition (Evaluation)

The Wearable Device Challenge was developed at the Nanosystems Engineering Research Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST). The Challenge is rooted in the research and innovation ecosystem of the Center and its vision: to have a transformational impact on the way doctors and patients manage wellness through wearable, self-powered health and environmental monitoring systems. At its core, the program teaches middle and high school teachers and students how to apply the engineering design process to solve real-world problems through a project-based approach. The program impacts several hundred students in North Carolina annually through real-world, relevant, hands-on engineering design challenges. Teachers are empowered to introduce engineering design into a variety of both formal and informal educational settings, and students are given the opportunity to explore exciting, cutting-edge applications of science and technology that will inspire them to continue in science, technology, engineering, and mathematics fields

Predicting Psychotherapy Session Attendance among Individuals Experiencing Gambling-Related Harms

Almost 2 in 5 individuals experiencing gambling-related harms will initiate treatment and then prematurely discontinue. However, studies have proven unsuccessful in identifying a consistent set of variables that predict discontinuation. The absence of consistent findings may be attributed to 1) disparate definitions of discontinuation and 2) the focus on demographic variables rather than personal history variables that might impact the receipt of treatment. The present study intends to improve upon existing research by focusing on treatment participation (i.e., number of sessions attended) rather than discontinuation and examining a broader set of variables that are specific to an individual’s gambling and financial status before deciding to enter treatment (i.e., pretreatment abstinence, bankruptcy, debt). Archival data from a sample of 128 patients receiving treatment for gambling-related harms at an outpatient treatment facility will be analyzed. On average, participants are 45 years old and predominantly men (55.8%) who represent diverse races (58% White and 37% Black). Participants completed a battery of self-report questions assessing for demographic information, pre-treatment financial status, and gambling history. Linear regressions and independent samples t-tests will be used. Implications: These results may elucidate a relation between previously unexplored variables and psychotherapy session attendance. We anticipate that this finding would enhance clinicians’ ability to identify patients at risk of low treatment engagement. It may also inform future research intending to mitigate the risk of low engagement through targeted interventions

Multiplex giant magnetoresistive biosensor microarrays identify interferon-associated autoantibodies in systemic lupus erythematosus.

High titer, class-switched autoantibodies are a hallmark of systemic lupus erythematosus (SLE). Dysregulation of the interferon (IFN) pathway is observed in individuals with active SLE, although the association of specific autoantibodies with chemokine score, a combined measurement of three IFN-regulated chemokines, is not known. To identify autoantibodies associated with chemokine score, we developed giant magnetoresistive (GMR) biosensor microarrays, which allow the parallel measurement of multiple serum antibodies to autoantigens and peptides. We used the microarrays to analyze serum samples from SLE patients and found individuals with high chemokine scores had significantly greater reactivity to 13 autoantigens than individuals with low chemokine scores. Our findings demonstrate that multiple autoantibodies, including antibodies to U1-70K and modified histone H2B tails, are associated with IFN dysregulation in SLE. Further, they show the microarrays are capable of identifying autoantibodies associated with relevant clinical manifestations of SLE, with potential for use as biomarkers in clinical practice

Economics of Field Pea Supplementation for Cattle Grazing Crested Wheatgrass

Heifers grazing crested wheat grass were supplemented either field peas or dried distillers grains plus solubles (DDGS) at 0.4% or 0.8% of body weight. Heifers supplemented with field peas had 10% lower daily gain compared to their DDGS supplemented counterparts. The decision to supplement field peas for producers depends on the price at which field peas can be acquired, as well as the distance that DDGS has to be hauled in order to be utilized. Field peas are a viable option in western Nebraska as a supplement for grazing cattle when DDGS is unavailable or field peas are in excess and can be obtained below the human consumption and pet food market price

Evaluation of the effects of biochar on diet digestibility and methane production from growing and finishing steers

The objectives of these studies were to evaluate the effects of biochar (0%, 0.8%, or 3% of diet dry matter) on diet digestibility and methane and carbon dioxide production from cattle on growing and finishing diets. The growing diet consisted of 21% brome hay, 20% wheat straw, 30% corn silage, 22% wet distillers grains plus solubles, and 7% supplement. The finishing diet consisted of 53% dry-rolled corn, 15% corn silage, 25% wet distillers grains plus solubles, and 7% supplement. In both trials biochar replaced fine ground corn in the supplement. Six crossbred steers (initial body weight [BW] 529 kg; SD = 16 kg) were used in both the growing and finishing trial. The growing diets were evaluated over 6 periods followed by the finishing trial with 3 periods. Digestibility measures were taken over 4 d after at least 8 d of adaptation to diets followed by 2 d of gas emission measurements using headbox calorimeters. Dry matter intake (DMI) was not affected (P ≥ 0.43; 7.91 kg/d) by biochar inclusion in the growing study and increased quadratically (P = 0.07) in the finishing study with 0.8% biochar inclusion having the greatest DMI (12.9 kg/d). Organic matter (OM) and neutral detergent fiber (NDF) digestibility increased quadratically (P = 0.10) in the growing study whereas OM digestibility tended to linearly decrease (P = 0.13) and NDF digestibility was not affected (P ≥ 0.39) by biochar inclusion in the finishing diet. Digestible energy intake (Mcal/d) was not affected (P ≥ 0.25) by biochar inclusion in the growing or finishing study. Methane production (g/d) tended to decrease quadratically (P = 0.14) in the growing study and was decreased 10.7% for the 0.8% biochar treatment relative to the control. There were no statistical differences in methane production (g/d) in the finishing study (P ≥ 0.32) but cattle on the 0.8% biochar treatment produced numerically less (9.6%) methane than the control. Methane production as g/kg DMI of the 0.8% biochar treatment relative to the control was numerically reduced 9.5% and 18.4% in the growing and finishing studies, respectively (P ≥ 0.13). Carbon dioxide production (g/d and g/kg of intake) quadratically decreased (P ≤ 0.06) in the growing study but was not affected by treatment in the finishing study (P ≥ 0.34). Although biochar is not a U.S. Food and Drug Administration -approved feed for cattle, the initial research shows potential as a methane mitigation strategy in both growing and finishing diets

Gene expression profiling to study racial differences after heart transplantation.

BackgroundThe basis for increased mortality after heart transplantation in African Americans and other non-Caucasian racial groups is poorly defined. We hypothesized that increased risk of adverse events is driven by biologic factors. To test this hypothesis in the Invasive Monitoring Attenuation through Gene Expression (IMAGE) study, we determined whether the event rate of the primary outcome of acute rejection, graft dysfunction, death, or retransplantation varied by race as a function of calcineurin inhibitor (CNI) levels and gene expression profile (GEP) scores.MethodsWe determined the event rate of the primary outcome, comparing racial groups, stratified by time after transplant. Logistic regression was used to compute the relative risk across racial groups, and linear modeling was used to measure the dependence of CNI levels and GEP score on race.ResultsIn 580 patients monitored for a median of 19 months, the incidence of the primary end point was 18.3% in African Americans, 22.2% in other non-Caucasians, and 8.5% in Caucasians (p < 0.001). There were small but significant correlations of race and tacrolimus trough levels to the GEP score. Tacrolimus levels were similar among the races. Of patients receiving tacrolimus, other non-Caucasians had higher GEP scores than the other racial groups. African American recipients demonstrated a unique decrease in expression of the FLT3 gene in response to higher tacrolimus levels.ConclusionsAfrican Americans and other non-Caucasian heart transplant recipients were 2.5-times to 3-times more likely than Caucasians to experience outcome events in the Invasive Monitoring Attenuation through Gene Expression study. The increased risk of adverse outcomes may be partly due to the biology of the alloimmune response, which is less effectively inhibited at similar tacrolimus levels in minority racial groups

Performance Testing of a Novel Off-plane Reflection Grating and Silicon Pore Optic Spectrograph at PANTER

An X-ray spectrograph consisting of radially ruled off-plane reflection gratings and silicon pore optics was tested at the Max Planck Institute for extraterrestrial Physics PANTER X-ray test facility. The silicon pore optic (SPO) stack used is a test module for the Arcus small explorer mission, which will also feature aligned off-plane reflection gratings. This test is the first time two off-plane gratings were actively aligned to each other and with a SPO to produce an overlapped spectrum. The gratings were aligned using an active alignment module which allows for the independent manipulation of subsequent gratings to a reference grating in three degrees of freedom using picomotor actuators which are controllable external to the test chamber. We report the line spread functions of the spectrograph and the actively aligned gratings, and plans for future development.Comment: Draft Version March 19, 201