Can mixed reality technologies teach surgical skills better than traditional methods? A prospective randomised feasibility study

Background Basic surgical skills teaching is often delivered with didactic audio-visual content, and new digital technologies may allow more engaging and effective ways of teaching to be developed. The Microsoft HoloLens 2 (HL2) is a multi-functional mixed reality headset. This prospective feasibility study sought to assess the device as a tool for enhancing technical surgical skills training. Methods A prospective randomised feasibility study was conducted. 36 novice medical students were trained to perform a basic arteriotomy and closure using a synthetic model. Participants were randomised to receive a structured surgical skills tutorial via a bespoke mixed reality HL2 tutorial (n = 18), or via a standard video-based tutorial (n = 18). Proficiency scores were assessed by blinded examiners using a validated objective scoring system and participant feedback collected. Results The HL2 group showed significantly greater improvement in overall technical proficiency compared to the video group (10.1 vs. 6.89, p = 0.0076), and a greater consistency in skill progression with a significantly narrower range of scores (SD 2.48 vs. 4.03, p = 0.026). Participant feedback showed the HL2 technology to be more interactive and engaging with minimal device related problems experienced. Conclusions This study has demonstrated that mixed reality technology may provide a higher quality educational experience, improved skill progression and greater consistency in learning when compared to traditional teaching methodologies for basic surgical skills. Further work is required to refine, translate, and evaluate the scalability and applicability of the technology across a broad range of skills-based disciplines

The use of mixed reality technology for the objective assessment of clinical skills: a validation study

Background Mixed Reality technology may provide many advantages over traditional teaching methods. Despite its potential, the technology has yet to be used for the formal assessment of clinical competency. This study sought to collect validity evidence and assess the feasibility of using the HoloLens 2 mixed reality headset for the conduct and augmentation of Objective Structured Clinical Examinations (OSCEs). Methods A prospective cohort study was conducted to compare the assessment of undergraduate medical students undertaking OSCEs via HoloLens 2 live (HLL) and recorded (HLR), and gold-standard in-person (IP) methods. An augmented mixed reality scenario was also assessed. Results 13 undergraduate participants completed a total of 65 OSCE stations. Overall inter-modality correlation was 0.81 (p=0.01), 0.98 (p=0.01) and 0.82 (p=0.01) for IP vs. HLL, HLL vs. HLR and IP vs. HLR respectively. Skill based correlations for IP vs. HLR were assessed for history taking (0.82, p=0.01), clinical examination (0.81, p=0.01), procedural (0.88, p=0.01) and clinical skills (0.92, p=0.01), and assessment of a virtual mixed reality patient (0.74, p=0.01). The HoloLens device was deemed to be usable and practical (Standard Usability Scale (SUS) score = 51.5), and the technology was thought to deliver greater flexibility and convenience, and have the potential to expand and enhance assessment opportunities. Conclusions HoloLens 2 is comparable to traditional in-person examination of undergraduate medical students for both live and recorded assessments, and therefore is a valid and robust method for objectively assessing performance. The technology is in its infancy, and users need to develop confidence in its usability and reliability as an assessment tool. However, the potential to integrate additional functionality including holographic content, automated tracking and data analysis, and to facilitate remote assessment may allow the technology to enhance, expand and standardise examinations across a range of educational contexts

High energy Coulomb-scattered electrons for relativistic particle beam diagnostics

A new system used for monitoring energetic Coulomb-scattered electrons as the main diagnostic for accurately aligning the electron and ion beams in the new Relativistic Heavy Ion Collider (RHIC) electron lenses is described in detail. The theory of electron scattering from relativistic ions is developed and applied to the design and implementation of the system used to achieve and maintain the alignment. Commissioning with gold and 3He beams is then described as well as the successful utilization of the new system during the 2015 RHIC polarized proton run. Systematic errors of the new method are then estimated. Finally, some possible future applications of Coulomb-scattered electrons for beam diagnostics are briefly discussed.Comment: 16 pages, 23 figure

MULTIPLE HIGH CURRENT BUNCHES IN PEP-II

Operation with colliding beams at PEP-II has progressed remarkably well with over half the design specific luminosity and 5:2 10 32 cm,2s,1 in multiple bunches demonstrated during the last commissioning period before installation of the BABAR detector. Further luminosity increases are anticipated as the vertical beam size is reduced and beam currents are raised towards design values. At high currents interesting multibunch dynamics, which depend strongly on current distribution, have been observed during single-beam commissioning studies. Transverse beam instabilities nominally controlled using bunch-by-bunch feedback were observed to be significantly suppressed, in the absence of feedback, with beams in collision.

Semilinear mixed problems on Hilbert complexes and their numerical approximation

Arnold, Falk, and Winther recently showed [Bull. Amer. Math. Soc. 47 (2010), 281-354] that linear, mixed variational problems, and their numerical approximation by mixed finite element methods, can be studied using the powerful, abstract language of Hilbert complexes. In another recent article [arXiv:1005.4455], we extended the Arnold-Falk-Winther framework by analyzing variational crimes (a la Strang) on Hilbert complexes. In particular, this gave a treatment of finite element exterior calculus on manifolds, generalizing techniques from surface finite element methods and recovering earlier a priori estimates for the Laplace-Beltrami operator on 2- and 3-surfaces, due to Dziuk [Lecture Notes in Math., vol. 1357 (1988), 142-155] and later Demlow [SIAM J. Numer. Anal., 47 (2009), 805-827], as special cases. In the present article, we extend the Hilbert complex framework in a second distinct direction: to the study of semilinear mixed problems. We do this, first, by introducing an operator-theoretic reformulation of the linear mixed problem, so that the semilinear problem can be expressed as an abstract Hammerstein equation. This allows us to obtain, for semilinear problems, a priori solution estimates and error estimates that reduce to the Arnold-Falk-Winther results in the linear case. We also consider the impact of variational crimes, extending the results of our previous article to these semilinear problems. As an immediate application, this new framework allows for mixed finite element methods to be applied to semilinear problems on surfaces.Comment: 22 pages; v2: major revision, particularly sharpening of error estimates in Section

Measurement with beam of the deflecting higher order modes in the TTF superconducting cavities

This paper reports on recent beam measurements of higher order modes in the TESLA Test Facility (TTF) accelerating modules. Using bunch trains of about 0.5 ms with 54MHz bunch repetition and up to 90% modulated intensity, transverse higher order modes are resonantly excited when the beam is offset and their frequency on resonance with the modulation frequency. With this method, the trapped modes can be excited and their counteraction on the beam observed on a wide-band BPM downstream of the module. Scanning the modulation frequency from 0 to 27MHz allows a systematic investigation of all possible dangerous modes in the modules

School-based curriculum development in Scotland: Curriculum policy and enactment

Recent worldwide trends in curriculum policy have re-emphasised the role of teachers in school-based curriculum development. Scotland’s Curriculum for Excellence is typical of these trends, stressing that teachers are agents of change. This paper draws upon empirical data to explore school-based curriculum development in response to Curriculum for Excellence. We focus on two case studies – secondary schools within a single Scottish local education authority. In the paper we argue that the nature and extent of innovation in schools is dependent upon teachers being able to make sense of often complex and confusing curriculum policy, including the articulation of a clear vision about what such policy means for education within each school

Consumer credit in comparative perspective

We review the literature in sociology and related fields on the fast global growth of consumer credit and debt and the possible explanations for this expansion. We describe the ways people interact with the strongly segmented consumer credit system around the world—more specifically, the way they access credit and the way they are held accountable for their debt. We then report on research on two areas in which consumer credit is consequential: its effects on social relations and on physical and mental health. Throughout the article, we point out national variations and discuss explanations for these differences. We conclude with a brief discussion of the future tasks and challenges of comparative research on consumer credit.Accepted manuscrip