Observational Learning During Simulation-Based Training in Arthroscopy: Is It Useful to Novices?

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.OBJECTIVE: Observing experts constitutes an important and common learning experience for surgical residents before operating under direct guidance. However, studies suggest that exclusively observing experts may induce suboptimal motor learning, and watching errors from non-experts performing simple motor tasks may generate better performance. We investigated whether observational learning is transferrable to arthroscopy learning using virtual reality (VR) simulation. SETTING/DESIGN: In our surgical simulation laboratory, we compared students learning basic skills on a VR arthroscopy simulator after watching an expert video demonstration of VR arthroscopy tasks or a non-expert video demonstration of the same tasks to a Control group without video demonstration. Ninety students in 3 observing groups (expert, non-expert, and Control) subsequently completed the same procedure on a VR arthroscopy simulator. We hypothesized the non-expert-watching group would outperform the expert-watching group, and both groups to outperform the Control group. We examined performance pretest, posttest, and 1 week later. PARTICIPANTS: Participants were recruited from the final year of medical school and the very early first year of surgical residency training programs (orthopaedic surgery, urology, plastic surgery, and general surgery) at Western University (Ontario, Canada). RESULTS: All participants improved their overall performance from pretest to retention (p < 0.001). At initial retention testing, non-expert-watching group outperformed the other groups in camera path length p < 0.05 and time to completion, p < 0.05, and both the expert/non-expert groups surpassed the Control group in camera path length (p < 0.05). CONCLUSION: We suggest that error-observation may contribute to skills improvement in the non-expert-watching group. Allowing novices to observe techniques/errors of other novices may assist internalization of specific movements/skills required for effective motor performances. This study highlights the potential effect of observational learning on surgical skills acquisition and offers preliminary evidence for peer-based practice (combined non-experts and experts) as a complementary surgical motor skills training strategy.This project was supported by a Physicians׳ Services Incorporated (PSI) Foundation, Canada grant. Funds were used to pay for salary and employee benefits (LvE). The PSI Foundation did not play a role in the investigation

Six simple guidelines for introducing new genera of fungi

We formulate five guidelines for introducing new genera, plus one recommendation how to publish the results of scientific research. We recommend that reviewers and editors adhere to these guidelines. We propose that the underlying research is solid, and that the results and the final solutions are properly discussed. The six criteria are: (1) all genera that are recognized should be monophyletic; (2) the coverage of the phylogenetic tree should be wide in number of species, geographic coverage, and type species of the genera under study; (3) the branching of the phylogenetic trees has to have sufficient statistical support; (4) different options for the translation of the phylogenetic tree into a formal classification should be discussed and the final decision justified; (5) the phylogenetic evidence should be based on more than one gene; and (6) all supporting evidence and background information should be included in the publication in which the new taxa are proposed, and this publication should be peer-reviewed

A two-phase flow model to simulate mold filling and saturation in Resin Transfer Molding

The final publication is available at Springer via http://dx.doi.org/10.1007/s12289-015-1225-zThis paper addresses the numerical simulation of void formation and transport during mold filling in Resin Transfer Molding (RTM). The saturation equation, based on a two-phase flow model resin/air, is coupled with Darcy s law and mass conservation to simulate the unsaturated filling flow that takes place in a RTM mold when resin is injected through the fiber bed. These equations lead to a system composed of an advection diffusion equation for saturation including capillary effects and an elliptic equation for pressure taking into account the effect of air residual saturation. The model introduces the relative permeability as a function of resin saturation. When capillary effects are omitted, the hyperbolic nature of the saturation equation and its strong coupling with Darcy equation through relative permeability represent a challenging numerical issue. The combination of the constitutive physical laws relating permeability to saturation with the coupled system of the pressure and saturation equations allows predicting the saturation profiles. The model was validated by comparison with experimental data obtained for a fiberglass reinforcement injected in a RTM mold at constant flow rate. The saturation measured as a function of time during the resin impregnation of the fiber bed compared very well with numerical predictions.The authors acknowledge financial support of the Spanish Government (Projects DPI2010-20333 and DPI2013-44903-R-AR), of the National Science and Research Council of Canada (NSERC) and of the Canada Reseach Chair (CRC) program.Gascón Martínez, ML.; García Manrique, JA.; Lebel, F.; Ruiz, E.; Trochu, F. (2016). A two-phase flow model to simulate mold filling and saturation in Resin Transfer Molding. International Journal of Material Forming. 9(2):229-239. doi:10.1007/s12289-015-1225-zS22923992Patel N, Lee LJ (1996) Modeling of void formation and removal in liquid composite molding. Part I: wettability analysis. Polym Compos 17(1):96–103Ruiz E, Achim V, Soukane S, Trochu F, Bréard J (2006) Optimization of injection flow rate to minimize micro/macro-voids formation in resin transfer molded composites. Compos Sci Technol 66(3–4):475–486Trochu F, Ruiz E, Achim V, Soukane S (2006) Advanced numerical simulation of liquid composite molding for process analysis and optimization. Compos A: Appl Sci Manuf 37(6):890–902Park CH, Lee W (2011) Modeling void formation and unsaturated flow in liquid composite molding processes: a survey and review. J Reinf Plast Compos 30(11):957–977Pillai KM (2004) Modeling the unsaturated flow in liquid composite molding processes: a review and some thoughts. J Compos Mater 38(23):2097–2118Breard J, Saouab A, Bouquet G (2003) Numerical simulation of void formation in LCM. Compos A: Appl Sci Manuf 34:517–523Breard J, Henzel Y, Trochu F, Gauvin R (2003) Analysis of dynamic flows through porous media. Part I: comparison between saturated and unsaturated flows in fibrous reinforcements. Polym Compos 24(3):391–408Parnas RS, Phelan FR Jr (1991) The effect of heterogeneous porous media on mold filling in Resin Transfer Molding. SAMPE Q 22(2):53–60Parseval DY, Pillai KM, Advani SG (1997) A simple model for the variation of permeability due to partial saturation in dual scale porous media. Transp Porous Media 27(3):243–264Pillai KM (2002) Governing equations for unsaturated flow through woven fiber mats. Part 1. Isothermal flows. Compos A: Appl Sci Manuf 33(7):1007–1019Simacek P, Advani SG (2003) A numerical model to predict fiber tow saturation during Liquid Composite Molding. Compos Sci Technol 63:1725–1736García JA, Gascón L, Chinesta F (2010) A flux limiter strategy for solving the saturation equation in RTM process simulation. Compos A: Appl Sci Manuf 41:78–82Chui WK, Glimm J, Tangerman FM, Jardine AP, Madsen JS, Donnellan TM, Leek R (1997) Process modeling in Resin Transfer Molding as a method to enhance product quality. SIAM Rev 39(4):714–727Nordlund M, Michaud V (2012) Dynamic saturation curve measurement for resin flow in glass fibre reinforcement. Compos A: Appl Sci Manuf 43:333–343García JA, Ll G, Chinesta F (2003) A fixed mesh numerical method for modelling the flow in liquid composites moulding processes using a volume of fluid technique. Comput Methods Appl Mech Eng 192(7–8):877–893García JA, Ll G, Chinesta F, Trochu F, Ruiz E (2010) An efficient solver of the saturation equation in liquid composite molding processes. Int J Mater Form 3(2):1295–1302Lebel F (2012) Contrôle de la fabrication des composites par injection sur renforts. École Polytechnique de Montréal, CanadaVan Genuchten MT (1980) Closed-form equation for predicting the hydraulic conductivity of unsaturated soils. Soil Sci Soc Am J 44(5):892–898Buckley SE, Leverett MC (1942) Mechanism of fluid displacement in sands. Pet Trans AWME 146:107–116Lundstrom TS, Gebart BR (1994) Influence from process parameters on void formation in Resin Transfer Molding. Polym Compos 15(1):25–33Lundstrom TS (1997) Measurement of void collapse during Resin Transfer Molding. Compos A: Appl Sci Manuf 28(3):201–214Lundstrom TS, Frishfelds V, Jakovics A (2010) Bubble formation and motion in non-crimp fabrics with perturbed bundle geometry. Compos A: Appl Sci Manuf 41:83–92Lebel F, Fanaei A, Ruiz E, Trochu F (2012) Experimental characterization by fluorescence of capillary flows in the fiber tows of engineering fabrics. Open J Inorg Non-Metallic Mater 2(3):25–45Brooks RH, Corey AT (1964) Hydraulic properties of porous media. Colorado State University. Hydrology Papers 1–37Corey AT (1954) The interrelation between gas and oil relative permeabilities. Prod Monthly 19(1):38–4

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Biological and behavioral markers of pain following nerve injury in humans

The evolution of peripheral and central changes following a peripheral nerve injury imply the onset of afferent signals that affect the brain. Changes to inflammatory processes may contribute to peripheral and central alterations such as altered psychological state and are not well characterized in humans. We focused on four elements that change peripheral and central nervous systems following ankle injury in 24 adolescent patients and 12 age-sex matched controls. Findings include (a) Changes in tibial, fibular, and sciatic nerve divisions consistent with neurodegeneration; (b) Changes within the primary motor and somatosensory areas as well as higher order brain regions implicated in pain processing; (c) Increased expression of fear of pain and pain reporting; and (d) Significant changes in cytokine profiles relating to neuroinflammatory signaling pathways. Findings address how changes resulting from peripheral nerve injury may develop into chronic neuropathic pain through changes in the peripheral and central nervous system

The effect of observing novice and expert performance on acquisition of surgical skills on a robotic platform

Observational learning plays an important role in surgical skills training, following the traditional model of learning from expertise. Recent findings have, however, highlighted the benefit of observing not only expert performance but also error-strewn performance. The aim of this study was to determine which model (novice vs. expert) would lead to the greatest benefits when learning robotically assisted surgical skillsThis article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Expanding Stereochemical and Skeletal Diversity Using Petasis Reactions and 1,3-Dipolar Cycloadditions

A short and modular synthetic pathway using intramolecular 1,3-dipolar cycloaddition reactions and yielding functionalized isoxazoles, isoxazolines, and isoxazolidines is described. The change in shape of previous compounds and those in this study is quantified and compared using principal moment-of-inertia shape analysis.Chemistry and Chemical Biolog

Adolescent brain maturation and cortical folding: evidence for reductions in gyrification

Evidence from anatomical and functional imaging studies have highlighted major modifications of cortical circuits during adolescence. These include reductions of gray matter (GM), increases in the myelination of cortico-cortical connections and changes in the architecture of large-scale cortical networks. It is currently unclear, however, how the ongoing developmental processes impact upon the folding of the cerebral cortex and how changes in gyrification relate to maturation of GM/WM-volume, thickness and surface area. In the current study, we acquired high-resolution (3 Tesla) magnetic resonance imaging (MRI) data from 79 healthy subjects (34 males and 45 females) between the ages of 12 and 23 years and performed whole brain analysis of cortical folding patterns with the gyrification index (GI). In addition to GI-values, we obtained estimates of cortical thickness, surface area, GM and white matter (WM) volume which permitted correlations with changes in gyrification. Our data show pronounced and widespread reductions in GI-values during adolescence in several cortical regions which include precentral, temporal and frontal areas. Decreases in gyrification overlap only partially with changes in the thickness, volume and surface of GM and were characterized overall by a linear developmental trajectory. Our data suggest that the observed reductions in GI-values represent an additional, important modification of the cerebral cortex during late brain maturation which may be related to cognitive development

Unidimensional scales for fears of cancer recurrence and their psychometric properties : the FCR4 and FCR7

Funding: Support was received from SUPAC (NCRI) Early Career Fund to complete this study. NCRI Supportive & Palliative Care (SuPaC) Research Collaboratives Capacity Building Grant Scheme: G Ozakinci (PI), G Humphris, M Sharpe.Background:  The assessment of fear of recurrence (FCR) is crucial for understanding an important psychological state in patients diagnosed and treated for cancer. The study aim was to determine psychometric details of a seven question self-report scale (FCR7) and a short form (FCR4) based upon items already used in various extensive measures of FCR. Methods:  Two consecutive samples of patients (breast and colorectal) were recruited from a single specialist cancer centre. The survey instrument contained the FCR7 items, Hospital Anxiety and Depression Scale (HADS), and demographic details. Clinical information was obtained from patient hospital records. Statistical analyses were performed using classical test and item response theory approaches, to demonstrate unidimensional factor structure and testing key parameters. Construct validity was inspected through nomological and theoretical prediction. Results:  Internal consistency was demonstrated by alpha coefficients (FCR4: 0.93 and FCR7: 0.92). Both scales (FCR7 & FCR4) were associated with the HADs subscales as predicted. Patients who experienced chemotherapy, minor aches/pains, thought avoidance of cancer and high cancer risk belief were more fearful. Detailed inspection of item responses profile provided some support for measurement properties of scales. Conclusion: The internal consistency, and pattern of key associations and discriminability indices provided positive psychometric evidence for these scales. The brief measures of FCR may be considered for audit, screening or routine use in clinical service and research investigations.Publisher PDFPeer reviewe

Single hadron response measurement and calorimeter jet energy scale uncertainty with the ATLAS detector at the LHC

The uncertainty on the calorimeter energy response to jets of particles is derived for the ATLAS experiment at the Large Hadron Collider (LHC). First, the calorimeter response to single isolated charged hadrons is measured and compared to the Monte Carlo simulation using proton-proton collisions at centre-of-mass energies of sqrt(s) = 900 GeV and 7 TeV collected during 2009 and 2010. Then, using the decay of K_s and Lambda particles, the calorimeter response to specific types of particles (positively and negatively charged pions, protons, and anti-protons) is measured and compared to the Monte Carlo predictions. Finally, the jet energy scale uncertainty is determined by propagating the response uncertainty for single charged and neutral particles to jets. The response uncertainty is 2-5% for central isolated hadrons and 1-3% for the final calorimeter jet energy scale.Comment: 24 pages plus author list (36 pages total), 23 figures, 1 table, submitted to European Physical Journal