Systematic review of the current status of cadaveric simulation for surgical training

Background: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. Methods: A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. Results: A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). Conclusion: There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre

The difference between secondary school principals' servant leadership in lower achieving and higher achieving secondary schools

Title from PDF of title page (University of Missouri--Columbia, viewed on March 7, 2011).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Dissertation advisor: Dr. Cynthia MacGregor.Vita.Ed. D. University of Missouri--Columbia 2010.The purpose of the study was to develop an understanding of the relationships between secondary school principals' servant leadership in lower achieving and higher achieving schools and student achievement as determined by the end of course exams in Algebra I, Biology, and English II. Data on servant leadership was collected from 70 teachers from five higher achieving schools and five lower achieving schools during the fall of 2010. The data analysis for the study included independent samples t-tests and open coding. The results of the study found the two constructs of humility and vision have a significant difference in principals between the higher and lower achieving schools. Results concluded with a diagnosis of open ended questions focused on the principal's philosophy of leadership and impact on student achievement. The responses for the higher achieving schools revealed shared decision making and principal compassion and positive attitude as additional data to consider. The lower achieving schools revealed teacher autonomy and teacher input but principal decisions. The last theme to emerge with the lower achieving schools principals was positive and supportive in relation to student achievement.Includes bibliographical reference

Polarization-dependence of anomalous scattering in brominated DNA and RNA molecules, and importance of crystal orientation in single- and multiple-wavelength anomalous diffraction phasing

In this paper the anisotropy of anomalous scattering at the Br K-absorption edge in brominated nucleotides is investigated, and it is shown that this effect can give rise to a marked directional dependence of the anomalous signal strength in X-ray diffraction data. This implies that choosing the correct orientation for crystals of such molecules can be a crucial determinant of success or failure when using single- and multiple-wavelength anomalous diffraction (SAD or MAD) methods to solve their structure. In particular, polarized absorption spectra on an oriented crystal of a brominated DNA molecule were measured, and were used to determine the orientation that yields a maximum anomalous signal in the diffraction data. Out of several SAD data sets, only those collected at or near that optimal orientation allowed interpretable electron density maps to be obtained. The findings of this study have implications for instrumental choices in experimental stations at synchrotron beamlines, as well as for the development of data collection strategy programs

Hanging In, Stepping up and Stepping Out: Livelihood Aspirations and Strategies of the Poor Development in Practice

In recent years understanding of poverty and of ways in which people escape from or fall into poverty has become more holistic. This should improve the capabilities of policy analysts and others working to reduce poverty, but it also makes analysis more complex. This paper describes a simple schema which integrates multidimensional, multilevel and dynamic understandings of poverty, of poor people’s livelihoods, and of changing roles of agricultural systems. The paper suggests three broad types of strategy pursued by poor people: ‘hanging in’; ‘stepping up’; and ‘stepping out’. This simple schema explicitly recognises the dynamic aspirations of poor people; diversity among them; and livelihood diversification. It also brings together aspirations of poor people with wider sectoral, inter-sectoral and macro-economic questions about policies necessary for realisation of those aspirations

The Reliability and Validity of Fatigue Measures During Multiple-Sprint Work: An Issue Revisited

The ability to repeatedly produce a high-power output or sprint speed is a key fitness component of most field and court sports. The aim of this study was to evaluate the validity and reliability of eight different approaches to quantify this parameter in tests of multiple-sprint performance. Ten physically active men completed two trials of each of two multiple-sprint running protocols with contrasting recovery periods. Protocol 1 consisted of 12 × 30-m sprints repeated every 35 seconds; protocol 2 consisted of 12 × 30-m sprints repeated every 65 seconds. All testing was performed in an indoor sports facility, and sprint times were recorded using twin-beam photocells. All but one of the formulae showed good construct validity, as evidenced by similar within-protocol fatigue scores. However, the assumptions on which many of the formulae were based, combined with poor or inconsistent test-retest reliability (coefficient of variation range: 0.8-145.7%; intraclass correlation coefficient range: 0.09-0.75), suggested many problems regarding logical validity. In line with previous research, the results support the percentage decrement calculation as the most valid and reliable method of quantifying fatigue in tests of multiple-sprint performance

Perceptual and Physiological Responses to Recovery from a Maximal 30-Second Sprint

The aims of this study were to evaluate perceptions of post-exercise recovery and to compare patterns of perceived recovery with those of several potential mediating physiological variables. Seventeen well-trained men (age: 22 ± 4 years; height: 1.83 ± 0.05 m; body mass: 78.9 ± 7.6 kg; and body fat: 11.1 ± 2.2%) completed 10 sprint trials on an electromagnetically braked cycle ergometer. Trial 1 evaluated peak power via a 5-second sprint. The remaining trials evaluated (a) the recovery of peak power after a maximal 30-second sprint using rest intervals of 5, 10, 20, 40, 80, and 160 seconds; (b) perceived recovery via visual analog scales; and (c) physiological responses during recovery. The time point in recovery at which individuals perceived they had fully recovered was 163.3 ± 57.5 seconds. Power output at that same time point was 83.6 ± 5.2% of peak power. There were no significant differences between perceived recovery and the recovery processes of VO2 or minute ventilation (VE). Despite differences in the time courses of perceived recovery and the recovery of power output, individuals were able to closely predict full recovery without the need for external timepieces. Moreover, the time course of perceived recovery is similar to that of VO2 and VE

The influence of aerobic fitness on the recovery of peak power output

Purpose The aims of this study were to evaluate the recovery kinetics of peak power output (PPO) following a maximal sprint, and to evaluate the influence of aerobic fitness on that recovery process. Methods On separate occasions, 16 well-trained men (age: 21 ± 3 years; height: 1.84 ± 0.05 m; and body mass: 78.8 ± 7.8 kg) performed a 30 s maximal sprint on a cycle ergometer, followed by a predetermined stationary rest period (5, 10, 20, 40, 80, and 160 s) and a subsequent 5 s sprint to determine PPO recovery kinetics. On another occasion, V ˙ O 2 was monitored during recovery from a 30 s sprint to provide a comparison with the recovery of PPO. Finally, subjects completed a V ˙ O 2max test to evaluate the influence of aerobic fitness on the recovery of PPO. Results Despite following similar time courses (F = 0.36, p = 0.558), and being well described by double-exponential models, the kinetic parameters of PPO and V ˙ O 2 in recovery were significantly different (p < 0.05). There was no significant relationship (r = 0.15; p = 0.578) between V ˙ O 2max and the time to achieve 50 % recovery of PPO. Moreover, there was no difference (p = 0.61) between the recovery kinetics of participants classified according to their V ˙ O 2max (59.4 ± 1.3 vs 48.5 ± 2.2 ml·kg−1·min−1). Conclusion Despite similar overall recovery kinetics, V ˙ O 2 and PPO show differences in key model parameters. Moreover, the recovery of PPO does not appear to be affected by aerobic fitness

The Effect of Ischemic Preconditioning on Repeated Sprint Cycling Performance

Purpose: Ischemic preconditioning enhances exercise performance. We tested the hypothesis that ischemic preconditioning would improve intermittent exercise in the form of a repeated sprint test during cycling ergometry.Methods: In a single-blind, crossover study, 14 recreationally active men (mean ± SD age, 22.9 ± 3.7 yr; height, 1.80 ± 0.07 m; and mass, 77.3 ± 9.2 kg) performed twelve 6-s sprints after four 5-min periods of bilateral limb occlusion at 220 mm Hg (ischemic preconditioning) or 20 mm Hg (placebo).Results: Ischemic preconditioning resulted in a 2.4% ± 2.2%, 2.6% ± 2.7%, and 3.7% ± 2.4% substantial increase in peak power for sprints 1, 2, and 3, respectively, relative to placebo, with no further changes between trials observed for any other sprint. Similar findings were observed in the first three sprints for mean power output after ischemic preconditioning (2.8% ± 2.5%, 2.6% ± 2.5%, and 3.4% ± 2.1%, for sprints 1, 2, and 3, respectively), relative to placebo. Fatigue index was not substantially different between trials. At rest, tissue saturation index was not different between the trials. During the ischemic preconditioning/placebo stimulus, there was a -19.7% ± 3.6% decrease in tissue saturation index in the ischemic preconditioning trial, relative to placebo. During exercise, there was a 5.4% ± 4.8% greater maintenance of tissue saturation index in the ischemic preconditioning trial, relative to placebo. There were no substantial differences between trials for blood lactate, electromyography (EMG) median frequency, oxygen uptake, or rating of perceived exertion (RPE) at any time points.Conclusion: Ischemic preconditioning improved peak and mean power output during the early stages of repeated sprint cycling and may be beneficial for sprint sports