Is it all about the money? : The effects of low and high cost simulator training scenarios in surgical training

Background: The learning process is complex and dependent on several factors such as for instance, the environment to learn, prior knowledge and distinct abilities, motivation, goal-orientation as well as the effects of instructor feedback. Medical education, in particular within surgical domains is imperative due to its influence on patient safety. The demand for training surgeons has shifted from the “master-apprentice/practice on patients”, towards a safer modality, involving simulators. The positive effects laparoscopic simulator training has on laparoscopic performance is extensive, as well as its impact on operating room performance. Nonetheless, the difference in learning effect using either low-cost or high-fidelity laparoscopic simulators were not totally clear prior to study start. Aims 1. To examine whether laparoscopic surgical training may be offered at a lower cost, with maintained equivalent level of training and effect in knowledge/learning using a low-cost laparoscopic Blackbox (Paper I). 2. To study the impact of PC-gaming experience, visuospatial ability and gender on the various parameters of the MIST-VR simulator and its effect on the score (Paper II). 3. To further investigate the Blackbox, and if different adjuncts (video analysis) could provide more information regarding the effects of training (Paper III). 4. To study the effects on time to learn laparoscopic knot- and suturing skills in novices using two different laparoscopic needle holders in a more advanced Blackbox, evaluate outcomes regarding performance, ergonomic discomfort and time to perform laparoscopic knot- and suturing skills, as well as to evaluate an objective video evaluation scoring table (OVEST) (Paper IV). Materials and Methods: The participants were medical students from the surgical semester at Karolinska Institutet, Stockholm (Studies I-III) and medical students at Athens University Medical School in Athens, Athens, Greece (Study IV). The studies were conducted at CAMST (Center for Advanced Medical Simulation and Training), Karolinska University Hospital, Stockholm (Studies I-III), and at MPLSC (Medical Physics-Lab Simulation Center), Athens University Medical School, Athens, Greece (Study IV). In conjunction with inclusion, the students (Studies I-II) performed a test (MRT-A; Mental Rotation Test – A) for the assessment of their visuospatial ability, and questionnaires including baseline questions (Studies I-IV). The simulator training/tests were done using different laparoscopic simulators; Blackbox (Studies I and III); LapMentor (Study I); MIST-VR (Studies I-III); Simball box (Study IV). The participants’ simulator performance analyzed; time to completion and economy of movement (Studies I-IV); optical flow metrics (path-length and total number of particles) as displayed by the automated video analysis software (Study III); knot- and suturing skills (Study IV). Results: Studies I and II showed, as previous studies, that the visuospatial ability correlated with the initial simulator training sessions. Study I showed no significant difference in performance between laparoscopic basic skills training regardless of simulator used; low-cost or high-fidelity laparoscopy simulator. Studies I, II and III showed discrepancies between prior PC-gaming experience and the simulator performance, as well as some gender-specific differences. Study III also showed that the use of a low-cost automated video analysis software may be feasibly comparable to the build-in software of the MIST-VR simulator. Study IV presented a shortened time to learn for novices performing laparoscopic knot- and suturing tasks in a simulated environment when using the newly designed laparoscopic needle holder compared to a conventional market needle holder. Conclusions: Laparoscopic simulator training clearly facilitates laparoscopic skills performance. Improved prerequisites of training opportunities for surgeons could potentiate patient safety, especially since enhanced surgical performance improves patient safety. Subsequently, as depicted in this thesis, there is not one single truth or solution, rather different angles and several factors that affect learning in general and surgical performance in particular. Therefore, considerations of for instance individual differences, gender, and motivation, should all be included when producing laparoscopic skills training curriculum for future surgical trainees

Analogues of Poisson type limit theorems in discrete bm-Fock spaces

We present analogues of the Poisson limit distribution for the noncommutative bm-independence, which is associated with several positive symmetric cones. We construct related discrete Fock spaces with creation, annihilation and conservation operators, and prove Poisson type limit theorems for them. Properties of the positive cones, in particular the volume characteristic property they enjoy, and the combinatorics of labelled noncrossing partitions, play crucial role in these considerations

Integrative model of panic disorder : theoretical aspects and clinical implications

De nombreux modèles théoriques du trouble panique ont été proposés dans la littérature scientifique sans apporter des réponses convaincantes sur l'étiologie de ce trouble. L’étude a pour objectif, d'étudier un nouveau modèle intégratif de vulnérabilité psychologique du trouble panique en analysant différents facteurs de vulnérabilité cognitifs et émotionnels ainsi que leurs interactions et leurs différents impacts sur la symptomatologie du trouble panique. L'étude de ce nouveau modèle de vulnérabilité psychologique, permettra d’une part, de mieux comprendre l’étiologie de ce trouble, et d’autre part d’améliorer la prise en charge des patients atteints de ce trouble en ciblant plusieurs facteurs de vulnérabilité et en les intégrant dans les protocoles de traitements cognitifs et comportementaux.Many theoretical models of panic disorder have been proposed in the scientific literature without providing convincing answers on the etiology of this disorder. The aim of the study is to study a new integrative model of psychological vulnerability for panic disorder by analyzing different cognitive and emotional vulnerability factors as well as their interactions and their different impacts on the symptomatology of panic disorder. The study of this new model of psychological vulnerability will allow, on the one hand, a better understanding of the etiology of this disorder, and on the other hand improving the treatment protocol of patients with this disorder by targeting several vulnerability factors and integrating them into the Cognitive and behavioral therapies

Pouvoirs et médias de masse : éthiques politiques et économiques

Ce travail s'intéresse aux influences réciproques entre pouvoirs et médias de masse en Occident comme en Orient en insistant sur la situation particulière du Liban où les pratiques culturelles sont plus larges que dans bien d'autres pays. Notre but sera de montrer les interférences entre ces deux pouvoirs. Ce sujet n'est peut-être pas tout à fait neuf mais nous pensons y apporter des considérations nouvelles, pour ce qui est des particularités des pouvoirs dans les pays du Moyen Orient et la perception que les orientaux peuvent avoir des pouvoirs et des médias de masse dans les pays occidentaux. On s’y intéresse surtout aux pouvoirs politiques et économiques. Pour les médias de masse, on se limite aux journaux, radio, télévisions et internet. La conclusion insiste sur une nécessaire moralisation tant des médias que des hommes de pouvoir. En l’absence de prises de conscience forte, la seule solution est de recourir soit à l’exil soit à la loi à condition qu’elle soit assortie de contrôles et de sanctions. Le problème est que les Nouvelles Technologies apparaissent comme étant devenues d’une puissance incontournable et immaîtrisable à court terme. . Nul ne peut prévoir ce qui pourra en advenir. . Pour débuter on présente 4 auteurs qui ont illustré ce sujet dans la littérature et le cinéma montrant l’importance de cette interpénétration entres pouvoir et média de masse. On présente ensuite un aperçu historique sur l'évolution des pouvoirs montrant comment l'émergence des techniques d’information et de communications ont pu affecter ces différents pouvoirs. On montrera comment tout cela a pu affecter les concepts de liberté. A coté des pouvoirs politiques, un chapitre est consacré à la diffusion des informations dans le cadre des entreprises. Enfin dans une partie plus expérimentale, nous reportons des entretiens entre journalistes sur ce sujet puis dressons un cadre d’étude pour traduire les opinions de journalistes du Moyen Orient face à la question de ces influences réciproquesThis thesis aims at defining the reciprocal unfluences‘berween mass medias and political and economical powers. The research concentrates on Arabs and Middle East Countries. To start we present 4 authors that have illustrated this in the litterature and 7th art. After that we put our attention to the evolution of different powers and communication tools in past history. Then we put our attention on the different constitutions defining the limit of political powers.But also to the mangement of mass information required in the framework of firms and various institutions showing how the manner things that are presented can influence the public, executives and shareholders. In an experimental part we report interwiews taken from a pannel of journalists. Also we show the frame of an inquiry devoted to business and political people as to their attitufe vs mass medias and power influences that they can have experienced

Writing Assessment : A analysis of national writing tests in Swedish upper secondary school

Pisa results have continually indicated a deficiency in reading and writing amongst Swedish students, which have led to discussions within Swedish media and the political arena. It was my interest in the national-exam´s key role in the Swedish school that led me to examine the contruction and the students understanding of this test. Moreover, I have examined what abilities the exam tests. The main source I have used in my study is Borgstrom´s model for the contruction of the exam. He has categorized the contruction of the exam in different areas, namely subject, situation and instruction. Borgstrom states that the instruction in the exam influences the students to a specific way of writing. My study is based on the national exam for the new curriculum Lgy11. I have studied what the exam tests in relation to the curriculum and grade scale. My results indicate that the student is affected by the situation that is described in the exam. This situation leads to the students undertaking the exam in a certain way. In addition, the study shows that the text types, such as argumentative or investigative are supported by the way the exam is shaped. Moreover, the study also shows the way in which the student must gather information. The exam also tests the students´ability to critically analyze and refer to sources. Finally, the text needs to be adapted to the recipient in order for the student to receive the correct message.

Pathways and Glades : The Forms of the Chronotope of Initiation in Alessandro Baricco

The purpose of the present dissertation is to study the elaborations of the initiation myth in contemporary Italian author Alessandro Baricco. The theoretical and methodological framework consists mainly of Mircea Eliade’s phenomenological theory of initiation. It is argued that the categories of space and time are interdepent in religious thought and should thus be studied as a unit, through the notion of the chronotope. The dissertation therefore proposes to introduce the concept of the chronotope of initiation as an operative tool, the intersection of the theories of Eliade and Mikhail Bakhtin, for the literary subgenre of the initiation novel. A hermeneutical analysis of the novels Oceano mare, Emmaus and Mr Gwyn demonstrates that the initiation myth is present in all three novels. The symbolism of death and rebirth is coherently enacted as a movement via the categories cosmos-chaos-cosmos, for which the author uses the symbolism of the earth to define cosmos (regularity and structure) and water symbolism for the regenerating chaos (dissolution and renewal). The different chapters of analysis accentuate the interaction of space and time within the different phases of the initiation pattern: the profane, the threshold, the sacred, the centre (the place where the actual ritual is enacted) and the return, which are all defined as chronotopes. The analysis shows that although the chronotope of initiation – the concept intending the fusion of the temporal event of ritual at the spatial centre – assumes different forms throughout the corpus, its function remains unmodified, with its purpose being the creation of ontological change. In its inherent structure, the chronotope of initiation unites antithetical spatial and temporal characteristics. Spatially it unites infinite and dissolving chaotic space with the constitutive envelope or sacred vertical centre, and temporally it brings together the ultimative ontological change at a fixed, historical moment with the eternal, sacred, time opened by ritual, representing the coincidentia oppositorum of the sacred. The analysis also shows that the so-called “portraits of the ineffable”, present in all three novels, reflect the same qualities. As immanent works of art, they function as thresholds into the infinite. From a chronological perspective, the dissertation shows a modification of the initiation pattern in Baricco’s writing: from the classical form in Oceano mare, via a more realistic application in Emmaus, to the most elaborate, meta-literary adaption in Mr Gwyn. Nevertheless, the use of the pattern and its thematic coherence reveals that Baricco consciously elaborates on the pattern to suit the contemporary context

Religionslärares användning av tidningsartiklar : en kvalitativ undersökning om alternativa läromedel

This study discusses and examines the alternative teaching materials in religion class amongst seven teachers in Stockholm region. As religion is a complex subject to both learn and to teach it may be beneficial to use alternative texts to show the diversity of the subject. The aim of this study was to examine why teachers use news articles and other articles from daily magazines in their religion class. I also examined how the teachers motivated their choices of teaching materials. The study is qualitative and the empirical work was done by interviewing seven teachers in religion. The interviews were face to face and through email correspondence. The interviews were either recorded or noted. The result indicated that the teachers use news articles in their class to give their students a diverse picture of the subject. It also showed that some of the teachers found that text books often are outdated and do not necessarily show the complexity of the subject, hence giving them enough reason to chose the alternative teaching materials such as news articles. The study also found that the teachers using news articles believed their students were more engaged and curious through the new material than the text books. In addition, the teachers also found that their students were more able to evaluate and critique the news articles and the text books, giving them another reason to use news articles. In conclusion, the study showed the reasons and benefits of using news articles and how this was motivated by the teachers. It gives a diverse teaching of the subject religion and makes the students more engaged and up to date

Revision -och redovisningsbranschen : Hur väl sammanfaller utbildningskraven med arbetsmarknadens krav

Uppsatsen behandlar ämnet personalutbildning, som sträcker sig sedan långt tillbaka i tiden och omtalas i form av lärande. Detta har satt sina spår i många organisationer i form av interna utbildningar och vidareutbildningar. Uppsatsen inriktar sig på yrket revision och redovisning som är en bransch som satsar stark på personalutbildningar. Huvudsyftet med denna studie är att ta reda på vad revisionsbolagen söker för kvalifikationer hos den nyexaminerade samt se ifall den nyexaminerades tidigare utbildningskompetens matchar deras krav på vilka kompetenser denne skall besitta. Ett delsyfte är att få insyn i studentens uppfattning om den egna utbildningen i organisationen. Författarna har valt att använda sig utav både kvalitativa och kvantitativa ansatser, där den kvalitativa utgörs av tre intervjuer med tre olika revisionsbolag KPMG, Öhrling Pricewaterhouse Coopers och Linderbergs Grant Thorton. Den kvantitativa ansatsen utgörs av en ”begränsad attitydstudie”, där tio ny examinerade studenter tillfrågades, i form av en likertskala, om deras uppfattning av den egna organisationen. Uppsatsen slutsatser visar att revisionsbolagen söker olika kvalifikationer hos den nyexaminerade och en matchning av dessa kvalifikationer ger bästa möjliga resultat vid anställning. Den viktigaste kvalifikationen är den sociala kompetensen som speglar individens rätta jag och är även avgörande för karriärutvecklingen. En annan avgörande faktor för den sociala kompetensen är samarbetsförmågan, där de anställda ständigt arbetar i grupp men även samarbetet med kunder. Andra kvalifikationer är den personliga kompetensen, där etik, moral och värderingar hos den anställde prioriteras högt, strategiska kompetensen där den nyanställda ska vara införstådd med verksamhetens mål och innehåll, och den sista är yrkestekniska kompetensen som omges av utbildningar inom revision och redovisningar och dessa sätts ihop utav revisorsnämnden och FAR SRS. Den andra delen av slutsatsen behandlar studenternas egna uppfattningar om den egna utbildningen i organisationen, där majoriteten av dem tillfrågade nyexaminerade är ganska positiva till den egna organisationen och anser sig vara nöjda med tillämpningen av teorin i praktiken.This essay depicts the subject of educating personnel, an occurrence which stretches back a long period of time and has continuously been retold in the form of teaching. This has naturally affected several classes of education throughout countless organisations. The essay specifically describes accounts and the nature of the financial profession which is a field greatly focusing on educating personnel. The main purpose with this study is to gather information regarding the needs of the financial companies in terms of qualifications among the new graduates. Simultaneously find out whether or not the competence among the new graduates matches the requirements of the company. The secondary purpose is also to gather insight of the student's understanding of the education in question. The authors have chose to use both a qualitative and quantitative approach. The qualitative consists of three interviews with three different financial companies, KPMG, Öhrling Pricewaterhouse Coopers and Linderberg Grant Thorton. The quantitative approach, on the other hand, consists of a "limited attitude study", where ten new graduates participated in a poll regarding their understanding of the organisation in question. The conclusions in the essay shows that the financial companies are looking for different qualifications among the new graduates, and that when initiating employment a match of these qualifications generates the best result possible. The most important qualification is the social capability that reflects the true self of the individual and is crucial to the career development. Another imperative factor to the social capability is the ability to cooperate, where the employees constantly work in groups and even more importantly the cooperation with the customer. Another qualification is the personal competence where ethics, moral and values with employee are highly prioritised. Strategic competence, meaning that the new employee is to be in agreement with the organisation in terms of content and goals. The last qualification is to have competence included in the account and finance educations, both designed by the accounting committee and FAR SRS. The second part of the essay describes the students' personal understanding about the education in question, where the majority of the subjects are relatively positive towards the organisation and consider themselves pleased with the balance between theory and practice

bm-Central Limit Theorems associated with non-symmetric positive cones

Analogues of the classical Central Limit Theorem are proved in the noncommutative setting of random variables which are bmindependent and indexed by elements of positive non-symmetric cones, such as the circular cone, sectors in Euclidean spaces and the Vinberg cone. The geometry of the cones is shown to play a crucial role and the related volume characteristics of the cones is shown.Analogues of the classical Central Limit Theorem are proved in the noncommutative setting of random variables which are bmindependent and indexed by elements of positive non-symmetric cones, such as the circular cone, sectors in Euclidean spaces and the Vinberg cone. The geometry of the cones is shown to play a crucial role and the related volume characteristics of the cones is shown