Validity, reliability and support for implementation of independence-scaled procedural assessment in laparoscopic surgery

Background There is no widely used method to evaluate procedure-specific laparoscopic skills. The first aim of this study was to develop a procedure-based assessment method. The second aim was to compare its validity, reliability and feasibility with currently available global rating scales (GRSs). Methods An independence-scaled procedural assessment was created by linking the procedural key steps of the laparoscopic cholecystectomy to an independence scale. Subtitled and blinded videos of a novice, an intermediate and an almost competent trainee, were evaluated with GRSs (OSATS and GOALS) and the independence-scaled procedural assessment by seven surgeons, three senior trainees and six scrub nurses. Participants received a short introduction to the GRSs and independence-scaled procedural assessment before assessment. The validity was estimated with the Friedman and Wilcoxon test and the reliability with the intra-class correlation coefficient (ICC). A questionnaire was used to evaluate user opinion. Results Independence-scaled procedural assessment and GRS scores improved significantly with surgical experience (OSATS p = 0.001, GOALS p <0.001, independence-scaled procedural assessment p <0.001). The ICCs of the OSATS, GOALS and independence-scaled procedural assessment were 0.78, 0.74 and 0.84, respectively, among surgeons. The ICCs increased when the ratings of scrub nurses were added to those of the surgeons. The independence-scaled procedural assessment was not considered more of an administrative burden than the GRSs (p = 0.692). Discussion/conclusion A procedural assessment created by combining procedural key steps to an independence scale is a valid, reliable and acceptable assessment instrument in surgery. In contrast to the GRSs, the reliability of the independence-scaled procedural assessment exceeded the threshold of 0.8, indicating that it can also be used for summative assessment. It furthermore seems that scrub nurses can assess the operative competence of surgical trainees

Final Design of the Production SSR1 Cryomodule for PIP-II Project at Fermilab

This contribution reports the design of the production Single Spoke Resonator Type 1 Cryomodule (SSR1 CM) for the PIP-II project at Fermilab. The innovative design is based on a structure, the strongback, which supports the coldmass from the bottom, stays at room temperature during operations, and can slide longitudinally with respect to the vacuum vessel. The Fermilab style cryomodule developed for the prototype Single Spoke Resonator Type 1 (pSSR1), the prototype High Beta 650 MHz (pHB650), and preproduction Single Spoke Resonator Type 2 (ppSSR2) cryomodules is the baseline of the present design. The focus of this contribution is on the results of calculations and finite element analyses performed to optimize the critical components of the cryomodule: vacuum vessel, strongback, thermal shield, and magnetic shield.Comment: 21st Intl Conf Radio Frequency Superconductivity (SRF 2023). arXiv admin note: substantial text overlap with arXiv:2209.0128

A novel, highly sensitive and specific biomarker for Niemann-Pick type C1 disease

Background Lysosomal storage disorders (LSDs), are a heterogeneous group of rare disorders caused by defects in genes encoding for proteins involved in the lysosomal degradation of macromolecules. They occur at a frequency of about 1 in 5,000 live births, though recent neonatal screening suggests a higher incidence. New treatment options for LSDs demand a rapid, early diagnosis of LSDs if maximal clinical benefit is to be achieved. Methods Here, we describe a novel, highly specific and sensitive biomarker for Niemann-Pick Type C disease type 1 (NPC1), lyso-sphingomyelin-509. We cross-validate this biomarker with cholestane-3β,5α,6β-triol and relative lysosomal volume. The primary cohort for establishment of the biomarker contained 135 NPC1 patients, 66 NPC1 carriers, 241 patients with other LSDs and 46 healthy controls. Results With a sensitivity of 100.0% and specificity of 91.0% a cut-off of 1.4 ng/ml was established. Comparison with cholestane-3β,5α,6β-triol and relative acidic compartment volume measurements were carried out with a subset of 125 subjects. Both cholestane-3β,5α,6β-triol and lyso-Sphingomyelin-509 were sufficient in establishing the diagnosis of NPC1 and correlated with disease severity. Conclusion In summary, we have established a new biomarker for the diagnosis of NPC1, and further studies will be conducted to assess correlation to disease progress and monitoring treatment

Sport coaches' experiences of athlete injury : the development and regulation of guilt

This study sought to examine coaches’ stories of guilt in the specific context of athlete injury. Using narrative interviews with a diverse group of ten coaches, guilt was found to be a commonly experienced emotion that the participants also sought to regulate. The coaches’ experiences of the embodiment and management of guilt is primarily, although not exclusively, interrogated using the mainstream psychological theorising of Kubany and Watson (2003). The article concludes by connecting the coaches’ experiences of guilt with critiques of the prevailing deontological approach used to define what it means to be a ‘good’ sport coach. Here we suggest that dominant perspectives in coach education may be instrumental in entrenching coaches’ experience of guilt

More than 50 years of successful continuous temperature section measurements by the global expendable bathythermograph network, its integrability, societal benefits, and future

The first eXpendable BathyThermographs (XBTs) were deployed in the 1960s in the North Atlantic Ocean. In 1967 XBTs were deployed in operational mode to provide a continuous record of temperature profile data along repeated transects, now known as the Global XBT Network. The current network is designed to monitor ocean circulation and boundary current variability, basin-wide and trans-basin ocean heat transport, and global and regional heat content. The ability of the XBT Network to systematically map the upper ocean thermal field in multiple basins with repeated trans-basin sections at eddy-resolving scales remains unmatched today and cannot be reproduced at present by any other observing platform. Some repeated XBT transects have now been continuously occupied for more than 30 years, providing an unprecedented long-term climate record of temperature, and geostrophic velocity profiles that are used to understand variability in ocean heat content (OHC), sea level change, and meridional ocean heat transport. Here, we present key scientific advances in understanding the changing ocean and climate system supported by XBT observations. Improvement in XBT data quality and its impact on computations, particularly of OHC, are presented. Technology development for probes, launchers, and transmission techniques are also discussed. Finally, we offer new perspectives for the future of the Global XBT Network

The Practice of Thresholds: Autonomy in Clinical Education Explored Through Variation Theory and the Threshold Concepts Framework

This paper demonstrates a practical dimension to the discussion about threshold concepts. Threshold concepts have thus far mostly been acknowledged to elucidate learning processes mainly connected to theoretical concepts. By exploring situations that prompted experiences of autonomy and authenticity in clinical learning, findings showed how a practical experience could have the same power to transform thinking and identity as theoretical thresholds and serve as a trigger for transformational learning, therefore making the discussion about ‘practical thresholds' or thresholds in practice possible. The present study explores situations that prompted autonomy and authenticity, and offers context for and substance to these situations by adopting variation theory and the threshold concept framework. In order to learn more about situations that prompt experiences of autonomy and authenticity, and create prerequisites for such experiences, this paper examines how students discern and interpret these situations by analysing them through variation theory and the threshold concept framework

Clinical characteristics and outcome of biopsy-proven myocarditis in children - Results of the German prospective multicentre registry "MYKKE"

BACKGROUND: Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. METHODS: Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint RESULTS: Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4–15.9) years. Time from symptom-onset to EMB was 11.0 (4.0–29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p = 0.294). A weaning rate of 64% from MCS was found in AM. CONCLUSIONS: EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE