Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps

Introduction: Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. Materials and Methods: A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. Results: Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. Conclusions: Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training

Mental Skills Training Limits the Decay in Operative Technical Skill under Stressful Conditions: Results of a Multisite, Randomized Controlled Study

Background Overwhelming stress in the operating room can lead to decay in operative performance, particularly for residents who lack experience. Mental skills training can minimize deterioration in performance during challenging situations. We hypothesized that residents trained on mental skills would outperform controls under increased stress conditions in the simulated operating room. Methods Residents from Indiana University enrolled voluntarily in this institutional review board–approved study. Residents were stratified according to baseline characteristics and randomized into a mental skills and control group. Both groups trained to proficiency in laparoscopic suturing, but only the mental skills group received mental skills training. After training, technical skill transfer was assessed under regular and stressful conditions on a porcine model. Performance was assessed using an objective suturing score. The Test of Performance Strategies was used to assess the use of mental skills. Data were combined and compared with data that had been collected at Carolinas Healthcare System because residents underwent the same protocol. Results A total of 38 residents completed all study elements. There were no differences in the effects observed between sites. We observed no group differences at baseline. The groups achieved similar technical performance at baseline, posttest, and transfer test under low-stress conditions, but the mental skills group outperformed the control group during the transfer test under high-stress conditions. Conclusion Our comprehensive mental skills curriculum implemented with surgery residents at two institutions was effective at minimizing the deterioration of resident technical performance under stressful conditions compared with controls. These results provide further evidence for the effectiveness of mental skills training to optimize surgery trainees’ technical performance during challenging clinical situations

Phenotypic Characterization of Chicken Thymic Stromal Elements

Phenotypic profiles of the thymic stromal components provide an excellent approach to elucidating the nature of the microenvironment of this organ. To address this issue in chickens, we have produced an extensive panel of 18 mAb to the thymic stroma. These mAb have been extensively characterized with respect to their phenotypic specificities and reveal that the stromal cells are equally as complex as the T cells whose maturation they direct. They further demonstrate that, in comparison to the mammalian thymus, there is a remarkable degree of conservation in thymic architecture between phylogenetically diverse species. Eleven mAb reacted with thymic epithelial cells: MUI-73 was panepithelium, MUI-54 stained all cortical and medullary epithelium but only a minority of the subcapsule, MUI-52 was specific for isolated stellate cortical epithelial cells, MUI-62, -69, and -71 were specific for the medulla (including Hassall’s corpusclelike structures), MUI-51, -53, -70, and -75 reacted only with the type-I epithelium, or discrete regions therein, lining the subcapsular and perivascular regions and MUI-58 demonstrated the antigenic similarity between the subcapsule and the medulla. Seven other mAb identified distinct isolated stromal cells throughout the cortex and medulla. Large thymocyte-rich regions, which often spanned from the outer cortex to medulla, lacked epithelial cells. These mAb should prove invaluable for determining the functional significance of thymic stromal-cell subsets to thymopoiesis

On the Nature of Small Planets around the Coolest Kepler Stars

We constrain the densities of Earth- to Neptune-size planets around very cool (Te =3660-4660K) Kepler stars by comparing 1202 Keck/HIRES radial velocity measurements of 150 nearby stars to a model based on Kepler candidate planet radii and a power-law mass-radius relation. Our analysis is based on the presumption that the planet populations around the two sets of stars are the same. The model can reproduce the observed distribution of radial velocity variation over a range of parameter values, but, for the expected level of Doppler systematic error, the highest Kolmogorov-Smirnov probabilities occur for a power-law index alpha ~ 4, indicating that rocky-metal planets dominate the planet population in this size range. A single population of gas-rich, low-density planets with alpha = 2 is ruled out unless our Doppler errors are >= 5m/s, i.e., much larger than expected based on observations and stellar chromospheric emission. If small planets are a mix of gamma rocky planets (alpha = 3.85) and 1-gamma gas-rich planets (alpha = 2), then gamma > 0.5 unless Doppler errors are >=4 m/s. Our comparison also suggests that Kepler's detection efficiency relative to ideal calculations is less than unity. One possible source of incompleteness is target stars that are misclassified subgiants or giants, for which the transits of small planets would be impossible to detect. Our results are robust to systematic effects, and plausible errors in the estimated radii of Kepler stars have only moderate impact.Comment: Accepted to the Astrophysical Journa

Use of Rollover Protective Structures -- Iowa, Kentucky, New York, and Ohio, 1992-1997

Agriculture has one of the highest occupational fatality rates of all industries in the United States (1). Tractors and other types of agricultural equipment account for a large proportion of these fatalities, and farm-tractor rollovers account for approximately 130 work-related deaths each year in the United States (2). Although rollover protective structures (ROPS) are effective in protecting tractor operators from fatal injuries during rollovers (3-5), most tractors in the United States are not equipped with ROPS (4-7). Beginning in 1985, tractor manufacturers in the United Sates agreed to sell only tractors with ROPS; however, many older tractors without ROPS remain in use. To determine the prevalence of the use of ROPS, beginning in 1992, the Farm Family Health and Hazard Surveillance (FFHHS) program * collected state-based data on tractor age and use of ROPS from selected states. As of August 1997, four states had completed collection and analysis of data on farm tractors. This report summarizes the results of that survey, which indicates that 80%-90% of tractors in use in the four states were manufactured before 1985 and that less than 40% are equipped with ROPS

Ten New and Updated Multi-planet Systems, and a Survey of Exoplanetary Systems

We present the latest velocities for 10 multi-planet systems, including a re-analysis of archival Keck and Lick data, resulting in improved velocities that supersede our previously published measurements. We derive updated orbital fits for ten Lick and Keck systems, including two systems (HD 11964, HD 183263) for which we provide confirmation of second planets only tentatively identified elsewhere, and two others (HD 187123, and HD 217107) for which we provide a major revision of the outer planet's orbit. We compile orbital elements from the literature to generate a catalog of the 28 published multiple-planet systems around stars within 200 pc. From this catalog we find several intriguing patterns emerging: - Including those systems with long-term radial velocity trends, at least 28% of known planetary systems appear to contain multiple planets. - Planets in multiple-planet systems have somewhat smaller eccentricities than single planets. - The distribution of orbital distances of planets in multi-planet systems and single planets are inconsistent: single-planet systems show a pile-up at P ~ 3 days and a jump near 1 AU, while multi-planet systems show a more uniform distribution in log-period. In addition, among all planetary systems we find: - There may be an emerging, positive correlation between stellar mass and giant-planet semi-major axis. - Exoplanets more massive than Jupiter have eccentricities broadly distributed across 0 < e < 0.5, while lower-mass exoplanets exhibit a distribution peaked near e = 0.Comment: ApJ accepted. v.2 makes minor corrections to author list, citations, and provides a stable set of orbital parameters for HD 183263 in Table 1. v.3 makes preprint consistent with ApJ version, minor changes to wording, orbital parameters of HD 217107 and HD 187123c in Table

Transiting Exoplanet Studies and Community Targets for JWST's Early Release Science Program

The James Webb Space Telescope will revolutionize transiting exoplanet atmospheric science due to its capability for continuous, long-duration observations and its larger collecting area, spectral coverage, and spectral resolution compared to existing space-based facilities. However, it is unclear precisely how well JWST will perform and which of its myriad instruments and observing modes will be best suited for transiting exoplanet studies. In this article, we describe a prefatory JWST Early Release Science (ERS) program that focuses on testing specific observing modes to quickly give the community the data and experience it needs to plan more efficient and successful future transiting exoplanet characterization programs. We propose a multi-pronged approach wherein one aspect of the program focuses on observing transits of a single target with all of the recommended observing modes to identify and understand potential systematics, compare transmission spectra at overlapping and neighboring wavelength regions, confirm throughputs, and determine overall performances. In our search for transiting exoplanets that are well suited to achieving these goals, we identify 12 objects (dubbed "community targets") that meet our defined criteria. Currently, the most favorable target is WASP-62b because of its large predicted signal size, relatively bright host star, and location in JWST's continuous viewing zone. Since most of the community targets do not have well-characterized atmospheres, we recommend initiating preparatory observing programs to determine the presence of obscuring clouds/hazes within their atmospheres. Measurable spectroscopic features are needed to establish the optimal resolution and wavelength regions for exoplanet characterization. Other initiatives from our proposed ERS program include testing the instrument brightness limits and performing phase-curve observations.(Abridged)Comment: This is a white paper that originated from an open discussion at the Enabling Transiting Exoplanet Science with JWST workshop held November 16 - 18, 2015 at STScI (http://www.stsci.edu/jwst/science/exoplanets). Accepted for publication in PAS

Demographic change and conflict in Northern Ireland: reconciling qualitative and quantitative evidence

Recent large-N quantitative studies have failed to uncover a link between demographic change and conflict. This seems to refute quite powerful qualitative evidence from small-scale case studies that such a relationship exists. This article attempts to reconcile the conflicting evidence by revealing how population change—in this case a major decline in the size of the Protestant majority—matters for violent conflict, but not in a direct way. In addition, relationships differ by level of geography. In the case of Northern Ireland, no significant quantitative association exists between ethnic change and violence. This holds across both geographic units and years. However, there is a significant association between ethnic demography and Protestant mobilization into the Orange Order across counties. This in turn is related to Protestant resistance to reforms aimed at extending civil rights to the Catholic population during the Stormont period. This stance was a major factor in generating Catholic support for IRA violence. Moreover, in specific locations, a direct link between Protestant population decline relative to Catholics and loyalist violence against Catholics is evident. Hence demography matters, but in conjunction with other factors, and several steps upstream from the outbreak of violence