Training the next generation of surgeons in robotic surgery

Context: Robotic surgery has been used with rapidly increasing frequency within urology and across many other surgical specialties. A standardized curriculum for the training and credentialing of robotic surgeons has unfortunately trailed far behind the adoption of this surgical technology. Objective: To review the current available surgical skills training models, assessments, and curricula for the purpose of training resident, fellow, and practicing surgeons in an effort to promote surgical skill proficiency and mastery and to minimize the risk of patient harm. Evidence acquisition: We performed a thorough review of available literature through a PubMed database search in February 2015. Evidence synthesis: In this article, we compiled and scrutinized the available relevant literature regarding past and present robotic surgical training techniques and credentialing criteria. This review details the basic surgical skills (both technical and nontechnical) that are necessary for individuals and teams to be successful in the operative setting. We go on to discuss the role of current robotic surgical training techniques including dry lab and virtual simulators. Finally, we offer current validated training curricula, the Global Evaluative Assessment of Robotic Skills and Fundamentals of Robotic Surgery models, which have laid the groundwork for a future standardized model that could be applied on a national and international level and across several surgical subspecialties. The ultimate goal of the review is to provide a foundation from which a future standardized training and credentialing curriculum could be based. Conclusion: There is currently a great need for a standardized curriculum to be developed and employed for the use of training and credentialing future and current robotic surgeons

Embedding the Pentagon

The Pentagon Model is an explicit supersymmetric extension of the Standard Model, which involves a new strongly-interacting SU(5) gauge theory at TeV-scale energies. We show that the Pentagon can be embedded into an SU(5) x SU(5) x SU(5) gauge group at the GUT scale. The doublet-triplet splitting problem, and proton decay compatible with experimental bounds, can be successfully addressed in this context. The simplest approach fails to provide masses for the lighter two generations of quarks and leptons; however, this problem can be solved by the addition of a pair of antisymmetric tensor fields and an axion.Comment: 39 page

The nonlinear anomalous lattice elasticity associated with the high-pressure phase transition in spodumene: A high precission static compression study

The high-pressure behavior of the lattice elasticity of spodumene, LiAlSi2O6, was studied by static compression in a diamond-anvil cell up to 9.3 GPa. Investigations by means of single-crystal XRD and Raman spectroscopy within the hydrostatic limits of the pressure medium focus on the pressure ranges around similar to 3.2 and similar to 7.7 GPa, which have been reported previously to comprise two independent structural phase transitions. While our measurements confirm the well-established first-order C2/c-P2(1)/c transformation at 3.19 GPa (with 1.2% volume discontinuity and a hysteresis between 0.02 and 0.06 GPa), both unit-cell dimensions and the spectral changes observed in high-pressure Raman spectra give no evidence for structural changes related to a second phase transition. Monoclinic lattice parameters and unit-cell volumes at in total 59 different pressure points have been used to re-calculate the lattice-related properties of spontaneous strain, volume strain, and the bulk moduli as a function of pressure across the transition. A modified Landau free energy expansion in terms of a one component order parameter has been developed and tested against these experimentally determined data. The Landau solution provides a much better reproduction of the observed anomalies than any equation-of-state fit to data sets truncated below and above P (tr), thus giving Landau parameters of K (0) = 138.3(2) GPa, K' = 7.46(5), lambda (V) = 33.6(2) GPa, a = 0.486(3), b = -29.4(6) GPa and c = 551(11) GPa

Fabrication and delivery of non-destructive readout memory buffers using laminated layer technique Summary technical report

Material and processing development, magnetic storage devices, and design of memory incorporating foil storage devic

Nonstatistical dynamics on potentials exhibiting reaction path bifurcations and valley-ridge inflection points

We study reaction dynamics on a model potential energy surface exhibiting post-transition state bifurcation in the vicinity of a valley ridge inflection point. We compute fractional yields of products reached after the VRI region is traversed, both with and without dissipation. It is found that apparently minor variations in the potential lead to significant changes in the reaction dynamics. Moreover, when dissipative effects are incorporated, the product ratio depends in a complicated and highly non-monotonic fashion on the dissipation parameter. Dynamics in the vicinity of the VRI point itself play essentially no role in determining the product ratio, except in the highly dissipative regime.Comment: 33 pages, 10 figures, corrected the author name in reference [6

Oral contraceptives and cervical cancer--further findings from the Oxford Family Planning Association contraceptive study.

In 1983, we reported results from the Oxford Family Planning Association contraceptive study regarding the association between oral contraceptives (OCs) and cervical neoplasia, after a 10 year follow-up of a cohort of 17,000 women. Further findings from this study are reported here after an additional 12 years of follow-up. A nested case--control design was used in which cases were all women diagnosed under 45 years of age with invasive carcinoma (n = 33), carcinoma in situ (n = 121) or dysplasia (n = 159). Controls were randomly selected from among cohort members and matched to cases on exact year of birth and clinic attended at recruitment to study. Conditional logistic regression analysis was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with various aspects of OC use relative to never users adjusted for social class, smoking, age at first birth and ever use of diaphragm or condom. Ever users of OCs had a slightly elevated OR for all types of cervical neoplasia combined (OR = 1.40, 95% CI 1.00-1.96). Odds ratios were highest for invasive carcinoma (OR = 4.44, 95% CI 1.04-31.6), intermediate for carcinoma in situ (OR = 1.73, 95% CI 1.00-3.00) and lowest for dysplasia (OR = 1.07, 95% CI 0.69-1.66). The elevated risk associated with OC use appeared to be largely confined to current or recent (last use in the past 2 years) long-term users of OCs. Among current or recent users, ORs for all types of cervical neoplasia combined were 3.34 (95% CI 1.96-5.67) for 49-72 months of use, 1.69 (95% CI 0.97-2.95) for 73-96 months and 2.04 (95% CI 1.34-3.11) for 97 or more months. These results suggest a possible effect of OC use on later stages of cervical carcinogenesis, although residual confounding due to sexual factors or human papillomavirus (HPV) infection cannot be ruled out

Performance of Switched Mode Arbitrary Excitation using Harmonic Reduction Pulse Width Modulation (HRPWM) in Array Imaging Applications

Switched excitation allows the miniaturisation of excitation circuitry for transducer integrated front ends, high channel count and portable ultrasound systems. Harmonic Reduction Pulse Width Modulation (HRPWM) provides a method to design five level switched mode excitation signals with control of instantaneous amplitude, frequency and phase plus minimised third harmonics for advanced ultrasound applications. This paper details the application of HRPWM using commercial transmit front end integrated circuits and linear array transducers. The ability of HRPWM to control the pressure of the ultrasound wave is investigated. A full scale error between desired and measured pressure of 3.5% at 4.1 MHz is demonstrated. The temporal windowing of linear frequency modulated excitation signals using HRPWM is demonstrated. Pulse compression linear imaging of a tissue phantom is demonstrated where an improvement in the -20 dB axial resolution of a nylon mono-filament target from 2.14 mm using bipolar excitation to 1.88 mm using HRPWM is shown

Notification of Infectious Disease.

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Anion Pairs Template a Trigonal Prism with Disilver Vertices.

Here we describe the formation of a trigonal prismatic cage, utilizing 2-formyl-1,8-naphthyridine subcomponents to bind pairs of silver(I) ions in close proximity. This cage is the first example of a new class of subcomponent self-assembled polyhedral structures having bimetallic vertices, as opposed to the single metal centers that typically serve as structural elements within such cages. Our new cage self-assembles around a pair of anionic templates, which are shown by crystallographic and solution-phase data to bind within the central cavity of the structure. Many different anions serve as competent templates and guests. Elongated dianions, such as the strong oxidizing agent peroxysulfate, also serve to template and bind within the cavity of the prism. The principle of using subcomponents that have more than one spatially close, but nonchelating, binding site may thus allow access to other higher-order structures with multimetallic vertices.European Research Council (695009) and the UK Engineering and Physical Sciences Re‐ search Council (EPSRC, EP/P027067/1). European Union's Horizon 2020 research and innovation program, Marie Sklodowska‐Curie Grant (642192)