Objective classification of residents based on their psychomotor laparoscopic skills

Background - From the clinical point of view, it is important to recognize residents’ level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as ‘‘experienced,’’ ‘‘intermediates,’’ or ‘‘novices’’ according to their technical abilities. This study introduces a classification method for recognizing residents’ level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone. Methods - For this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10– 100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out crossvalidation. Results - Of 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices. Conclusions - The proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

How to keep drivers engaged while supervising driving automation? A literature survey and categorization of six solution areas

This work aimed to organise recommendations for keeping people engaged during human supervision of driving automation, encouraging a safe and acceptable introduction of automated driving systems. First, heuristic knowledge of human factors, ergonomics, and psychological theory was used to propose solution areas to human supervisory control problems of sustained attention. Driving and non-driving research examples were drawn to substantiate the solution areas. Automotive manufacturers might (1) avoid this supervisory role altogether, (2) reduce it in objective ways or (3) alter its subjective experiences, (4) utilize conditioning learning principles such as with gamification and/or selection/training techniques, (5) support internal driver cognitive processes and mental models and/or (6) leverage externally situated information regarding relations between the driver, the driving task, and the driving environment. Second, a cross-domain literature survey of influential human-automation interaction research was conducted for how to keep engagement/attention in supervisory control. The solution areas (via numeric theme codes) were found to be reliably applied from independent rater categorisations of research recommendations. Areas (5) and (6) were addressed by around 70% or more of the studies, areas (2) and (4) in around 50% of the studies, and areas (3) and (1) in less than around 20% and 5%, respectively. The present contribution offers a guiding organisational framework towards improving human attention while supervising driving automation.submittedVersio

Mutations in the histone methyltransferase gene KMT2B cause complex early-onset dystonia.

Histone lysine methylation, mediated by mixed-lineage leukemia (MLL) proteins, is now known to be critical in the regulation of gene expression, genomic stability, cell cycle and nuclear architecture. Despite MLL proteins being postulated as essential for normal development, little is known about the specific functions of the different MLL lysine methyltransferases. Here we report heterozygous variants in the gene KMT2B (also known as MLL4) in 27 unrelated individuals with a complex progressive childhood-onset dystonia, often associated with a typical facial appearance and characteristic brain magnetic resonance imaging findings. Over time, the majority of affected individuals developed prominent cervical, cranial and laryngeal dystonia. Marked clinical benefit, including the restoration of independent ambulation in some cases, was observed following deep brain stimulation (DBS). These findings highlight a clinically recognizable and potentially treatable form of genetic dystonia, demonstrating the crucial role of KMT2B in the physiological control of voluntary movement.Funding for the project was provided by the Wellcome Trust for UK10K (WT091310) and DDD Study. The DDD study presents independent research commissioned by the Health Innovation Challenge Fund [grant number HICF-1009-003] - see www.ddduk.org/access.html for full acknowledgement. This work was supported in part by the Intramural Research Program of the National Human Genome Research Institute and the Common Fund, NIH Office of the Director. This work was supported in part by the German Ministry of Research and Education (grant nos. 01GS08160 and 01GS08167; German Mental Retardation Network) as part of the National Genome Research Network to A.R. and D.W. and by the Deutsche Forschungsgemeinschaft (AB393/2-2) to A.R. Brain expression data was provided by the UK Human Brain Expression Consortium (UKBEC), which comprises John A. Hardy, Mina Ryten, Michael Weale, Daniah Trabzuni, Adaikalavan Ramasamy, Colin Smith and Robert Walker, affiliated with UCL Institute of Neurology (J.H., M.R., D.T.), King’s College London (M.R., M.W., A.R.) and the University of Edinburgh (C.S., R.W.)

Electric dipole moments and the search for new physics

Static electric dipole moments of nondegenerate systems probe mass scales for physics beyond the Standard Model well beyond those reached directly at high energy colliders. Discrimination between different physics models, however, requires complementary searches in atomic-molecular-and-optical, nuclear and particle physics. In this report, we discuss the current status and prospects in the near future for a compelling suite of such experiments, along with developments needed in the encompassing theoretical framework.Comment: Contribution to Snowmass 2021; updated with community edits and endorsement