Distribution of innate psychomotor skills recognized as important for surgical specialization in unconditioned medical undergraduates

Abstract BACKGROUND: There is an increasing interest for a test assessing objectively the innate aptitude for surgery as a craft specialty to complement the current selection process of surgical residents. The aim of this study was to quantify the size of individuals with high, average, and low level of innate psychomotor skills among medical students. METHODS: A volunteer sample of 155 medical students, without prior experience with surgical simulator, executed five tasks at a virtual simulator for robot-assisted surgery. They had to reach proficiency twice consecutively in each before moving to the next one. A weighting based on time and number of attempts needed to reach proficiency was assigned to each task. RESULTS: Nine students (5.8%) out of 155 significantly outperformed all the others on median (i.q.r.) weighted time [44.7 (42.2-47.3) min vs. 98.5 (70.8-131.8) min, p < 0.001], and number of attempts to reach proficiency [14 (12-15) vs. 23 (19-32.75), p < 0.001). Seventeen students (11.0%) scored significantly much worse than the rest on median weighted time [202.2 (182.5-221.0) min vs. 84.3 (65.7-114.4) min, p < 0.001], and number of attempts [42 (40-48) vs. 22 (17.25-28), p < 0.001]. Low correlation between simulator scores and extracurricular activities, like videogames and musical instruments, was found. CONCLUSIONS: The test successfully identified two groups straddling the large cohort with average innate aptitude for psychomotor skills: (i) innately gifted and (ii) with scarce level. Hence, exercises on a virtual simulator are a valid test of innate manual dexterity and can be considered to complement the selection process for a surgical training program, primarily to identify individuals with low innate aptitude for surgery and advise them to consider specialization in other (non-craft) medical specialties

Ozone and PAN formation inside and outside of the Berlin plume - process analysis and numerical process simulation

During the BERLIOZ field phase on 20 July 1998 a 40 km wide ozone-plume 30 to 70 km north of Berlin in the lee of the city was detected. The ozone mixing ratio inside the plume was app. 15 ppb higher than outside, mainly caused by high ozone precursor emissions in Berlin, resulting in a net chemical ozone production of 6.5 ppb h(-1), which overcompensates ozone advection of -3.6 ppb h(-1) and turbulent diffusion of -1.1 ppb h(-1). That means, although more ozone leaves the control volume far in the lee of Berlin than enters it at the leeside cityborder and although turbulent diffusion causes a loss of ozone in the leeside control volume the chemical production inside the volume leads to a net ozone increase. Using a semi-Lagrangian mass budget method to estimate the net ozone production, 5.0 ppb h(-1) are calculated for the plume. This means a fraction of about 20% of ozone in the plume is produced by local emissions, therefore called 'home made' by the Berlin emissions. For the same area KAMM/DRAIS simulations using an observation based initialisation, results in a net production rate between 4.0 and 6.5 ppb h(-1), while the threefold nested EURAD model gives 6.0 ppb h(-1). The process analysis indicates in many cases good agreement (10% or better) between measurements and simulations not only in the ozone concentrations but also with respect to the physical and chemical processes governing the total change. Remaining differences are caused by different resolution in time and space of the models and measurements as well as by errors in the emission calculation.The upwind-downwind differences in PAN concentrations are partly similar to those of ozone, because in the BERLIOZ case they are governed mainly by photochemical production. While in the stable boundary layer at night and windward of Berlin 0.1 to 0.3 ppb are detected, in the centre of the plume at noon concentrations between 0.75 ppb and 1.0 ppb are measured. The O-3/PAN ratio is about 80 to 120 and thus due to the relatively low PAN concentrations significantly higher than found in previous studies. The low PAN formation on 20 July, was mainly restricted by the moderate nonmethane hydrocarbon levels, whereas high PAN concentrations of 3.0 ppb on 21 July, are caused by local production in the boundary layer and by large scale advection aloft