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BACKGROUND: Although polyp size dictates surveillance intervals, endoscopists often estimate polyp size inaccurately. We hypothesized that an intervention providing didactic instruction and real-time feedback could significantly improve polyp size classification. METHODS: We conducted a multicenter randomized controlled trial to evaluate the impact of different components of an online educational module on polyp sizing. Participants were randomized to control (no video, no feedback), video only, feedback only, or video + feedback. The primary outcome was accuracy of polyp size classification into clinically relevant categories (diminutive [1-5mm], small [6-9mm], large [≥10mm]). Secondary outcomes included accuracy of exact polyp size (inmm), learning curves, and directionality of inaccuracy (over- vs. underestimation). RESULTS: 36 trainees from five training programs provided 1360 polyp size assessments. The feedback only (80.1%, P=0.01) and video + feedback (78.9%, P=0.02) groups had higher accuracy of polyp size classification compared with controls (71.6%). There was no significant difference in accuracy between the video only group (74.4%) and controls (P=0.42). Groups receiving feedback had higher accuracy of exact polyp size (inmm) and higher peak learning curves. Polyps were more likely to be overestimated than underestimated, and 29.3% of size inaccuracies impacted recommended surveillance intervals. CONCLUSIONS: Our online educational module significantly improved polyp size classification. Real-time feedback appeared to be a critical component in improving accuracy. This scalable and no-cost educational module could significantly decrease under- and overutilization of colonoscopy, improving patient outcomes while increasing colonoscopy access.

Perceptual learning is a multifaceted process, encompassing general learning, between-session forgetting or consolidation, and within-session fast relearning and deterioration. The learning curve constructed from threshold estimates in blocks or sessions, based on tens or hundreds of trials, may obscure component processes; high temporal resolution is necessary. We developed two nonparametric inference procedures: a Bayesian inference procedure (BIP) to estimate the posterior distribution of contrast threshold in each learning block for each learner independently and a hierarchical Bayesian model (HBM) that computes the joint posterior distribution of contrast threshold across all learning blocks at the population, subject, and test levels via the covariance of contrast thresholds across blocks. We applied the procedures to the data from two studies that investigated the interaction between feedback and training accuracy in Gabor orientation identification over 1920 trials across six sessions and estimated learning curve with block sizes L = 10, 20, 40, 80, 160, and 320 trials. The HBM generated significantly better fits to the data, smaller standard deviations, and more precise estimates, compared to the BIP across all block sizes. In addition, the HBM generated unbiased estimates, whereas the BIP only generated unbiased estimates with large block sizes but exhibited increased bias with small block sizes. With L = 10, 20, and 40, we were able to consistently identify general learning, between-session forgetting, and rapid relearning and adaptation within sessions. The nonparametric HBM provides a general framework for fine-grained assessment of the learning curve and enables identification of component processes in perceptual learning.

This study examines the effect of Industry 4.0 (I4.0) technologies on the learning process of operators. We collected data from the training of new operators in a quality inspection workstation. Two distinct scenarios were considered: before and after the adoption of I4.0 technologies. Data from 10 operators were collected in each scenario; the quality inspection cycle was repeated by each operator 30 consecutive times. A 2-parameter hyperbolic learning curve model was used to assess the learning process in the two groups. Results indicated that operators supported by I4.0 technologies had a significantly higher learning rate than those performing the same tasks without I4.0 support. No significant difference was found in the final performance level between groups. Our study bridges a theoretical gap in the relationship between I4.0 and learning by directly comparing the effect of digital support on the training of new employees in a manufacturing environment. We also offer arguments to support managerial decisions with regards to I4.0 adopti-on at an operational level. That allows organisations to prioritise their digitalisation efforts so that the training of operators in workstations can be expedited. [ABSTRACT FROM AUTHOR]

Study Design: Preclinical experimental study. Objective: To develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeons recognition of different tissue types during endoscopic spinal surgery (ESS). Summary of Background Data: ESS remains a challenging task for spinal surgeons. Great prof iciency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots. Methods: We constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a 2-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated for accuracy and consistency. Results: The probe can be easily used in the ESS working channel and produces clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosis, and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration. Conclusion: Our system was able to be used in existing ESS working channels and identify at-risk spinal structures in vitro. The trained algorithms could identify 6 intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety. [ABSTRACT FROM AUTHOR]

Introduction: A number of studies have demonstrated a significant reduction of surgical time for robotically assisted surgery (RAS) total knee arthroplasty (TKA) after the learning curve between 6 and 43 cases. It is unknown if the logistics of RAS produce a longer total theatre time since published literature only reflects the surgical time. It is also unknown how RAS surgical and total theatre times compare with computer assisted surgery (CAS) TKA. Methods: This is a prospective study of 524 consecutive patients undergoing a CAS or a RAS TKA using the same cementless implant. We recorded age, sex, body mass index (BMI), incision time of the first case, total surgical time, total theatre time, length of stay and 90-day complication and readmission rate. Results: During the study period, 205 CAS and 199 RAS TKA were performed. There was no difference at baseline in age (p = 0.546), sex (p = 0.920) or BMI (p = 0.791). Surgical time for CAS was 78.3 (± 22.2) min and for RAS was 80.1 (± 25.7) min, p = 0.451. Total theatre time for CAS was 117.4 (± 27.8) min and 119.3 (± 30.7) min for RAS, p = 0.515. There was no difference in length of stay (p = 0.674), 90-day complication (p = 0.530) or readmission rate (p = 0.930). There was a difference in skin-incision average time for the first case (p = 0.022). Conclusions: Although theatre set-up for the first case is 5 min longer, RAS-TKA does not prolong the surgical time or total theatre time when compared with CAS-TKA. There was no reduction in case volume since the introduction of robotics. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: Osteogenesis imperfecta (OI) is a genetic disorder characterized by low bone mass, bone fragility and short stature. There is a significant gap in knowledge regarding the growth patterns across different types of OI, and the prediction of height in individuals with OI was not adequately addressed. In this study, we described the growth patterns and predicted the height of individuals with OI employing multiple machine learning (ML) models. Accurate height prediction enables effective monitoring and facilitates the development of personalized intervention plans for managing OI. Method: This study included cross-sectional data for 323 participants with OI, and the median height Z-score for OI types I, III and IV were − 0.62 (-5.93 ~ 3.24), -3.97 (-10.44 ~ -0.02) and − 1.64 (-6.67 ~ 2.44), respectively. Based on the cross-sectional data of participants, the height curves across different gender and OI types were plotted and compared. Subsequently, feature selection techniques, specifically the filter and wrapper methods, were employed to identify predictive factors for the height of participants. Finally, multiple machine learning (ML) models were constructed for height prediction, and the performance of each model was systematically evaluated. Results: The analysis of height curves revealed that male with OI are significantly taller than female with OI from the age of 14 (p = 0.045), individuals with OI type III are statistically shorter than those with OI types I and IV starting from 3 years old (p = 0.006), and those with OI type IV are statistically shorter than those with OI type I from the age of 10 (p = 0.028). The application of filter and wrapper methods identified gender (p = 0.001), age (p < 0.001), Sillence types (p = 0.007), weight Z-score (p < 0.001) and aBMD Z-score (p = 0.021) as significant predictive factors for height. The optimal performance of predictive models was registered by gradient boosting classifier (GB) (bias = 5.783, accuracy = 92.59%, R2 = 0.828), random forest (RF) (bias = 6.155, accuracy = 90.12%, R2 = 0.788), ensemble machine learning (EML) (bias = 6.250, accuracy = 91.36%, R2 = 0.825) and deep neuron networks (DNNs) (bias = 6.223, accuracy = 90.12%, R2 = 0.821). Conclusion: This study analyzed a large cohort of individuals with OI and provided detailed height patterns across different gender and OI types that are crucial for assessing overall growth. Gender, age, Sillence types, weight Z-score and aBMD Z-score were identified as predictive factors for height. The predictive models of GB, RF, EML and DNNs had higher accuracy to evaluate the height of individuals with OI. This study allows guardians and physicians to timely monitor the height parameters, and facilitate the creation of personalized intervention schedules tailored to the needs of individuals with OI. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Colorectal endoscopic submucosal dissection is a technically demanding procedure with a steep learning curve. In Japan, the National Cancer Center Hospital allows overseas doctors to participate in hands‐on training. We aimed to assess the colorectal endoscopic submucosal dissection performance and learning curve of an endoscopist who participated in hands‐on training.In this retrospective analysis using a prospectively collected database, 100 consecutive superficial colorectal tumors from 100 patients treated with endoscopic submucosal dissection by a colorectal surgeon between January 2020 and May 2024 were included. The cases were grouped into three learning periods: phase I (the initial 30 cases under local expert supervision before training in Japan), phase II (the middle 30 cases), and phase III (the last 40 cases). The primary outcome was resection speed.The median resection speed was 5, 11.7, and 13.2 cm2/h in phases I, II, and III, respectively. In matched data, the resection speeds in phases II and III were higher than that in phase I (P = 0.02 and P < 0.001, respectively). En bloc and R0 resection rates were 99% and 95%, respectively. The en bloc resection, R0 resection, and complication rates were not different between phases. Cumulative sum analysis of the resection speed revealed that proficiency was achieved after 36 cases.An endoscopist who underwent a tutored approach and hands‐on training in Japan achieved the proficiency benchmarks for colorectal endoscopic submucosal dissection after 36 cases. However, the endoscopist's extensive experience before training may contribute to excellent outcomes. [ABSTRACT FROM AUTHOR]

Aim was to compare image-guided navigation with a robot-assisted solution for performing MISS regarding precision, required time and subjective aspects. 90 pedicles were instrumented on two torsos, half with navigation, half robot-assisted. Precision analysis between both solutions didn't show a significant difference. Time measurement showed a significantly longer duration per wire for the robot-arm on the first torso and a not significant longer duration on the second torso, where a significant reduction in the mean duration was shown. There was no significant difference in the subjective impressions comparing navigation and robot except the possibility to change the procedure. Precision of both methods is suitable for clinical use. A time advantage using the robot-arm couldn't be demonstrated in the present study. A significant learning curve was shown, so a reduction in the longer duration on the robot can be expected. Further studies in clinical use are necessary. [ABSTRACT FROM AUTHOR]

The use of virtual reality (VR) training in medical school education has increased over the last decade partly due to coronavirus-19 (COVID-19) and due to technology advancements in this integrative area. As medical students are being trained in new pedagogical interventions, it is important to drill-down and focus on the areas of most translational concern for assessing their competency and proficiency. Thus, the present pilot study sought to evaluate a group of fourth-year medical students' ability to learn a modified medical school curriculum on implementing a subdermal drain by first learning how to stitch on a silicone model (i.e., proper stitching only) and then being randomly assigned to either a third-person point-of-view (TP-POV) or first-person point-of-view (FP-POV) immersive VR group to learn how to conduct the surgical procedure (i.e., conceptually and procedurally). Then, the participants' surgical procedural motor skills were assessed on a single attempt to demonstrate their competency and proficiency on a cadaver. The results showed that the pedagogical learning differences in FP-POV immersive VR improved the cleanliness and accuracy of the surgical dissection movement and drain placement with 100% proficiency in the first attempt at implementing this surgical technique on a cadaver. Additionally, there was statistically significant improvement in the dissection movement (p < 0.05*) and the tension test (p < 0.01**) in the FP-POV group compared to the TP-POV group, even with a small sample size in the present pilot study. These findings offer unique training opportunities to be considered when designing future VR curriculum with the suggested use of repeated-measures designs on the surgical procedural motor skills to assess learning curves and their potential translations in reducing operating room errors, costs, planning and scheduling times, and surgery overlaps, thereby positively contributing to a more efficient and safer OR surgical experience by staff and patients in the near future. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of critical limb-threatening ischemia (CLTI) is revascularization. Lumbar sympathectomy (LS) could be attempted when this is not amenable. Using laparoscopic techniques to perform LS adds the advantages of minimally invasive surgery. Methods: Twenty-four patients, presenting with non-reconstructable CLTI and rest pain, were randomly divided into group I (14 patients) who underwent retroperitoneoscopic lumbar sympathectomy (RPLS) and group II (10 patients) who had conventional open lumber sympathectomy (COLS). Results: RPLS patients had shorter hospital stays, fewer intraoperative complications, and less postoperative pain. However, the mean operative time was significantly longer (86.4 ± 9.1 min, p-value: 0.02) in the RPLS group but decreased with each subsequent case after that. The differences in post-operative capillary refill time, ABI, TBI, and TcPO2 were not statistically significant between both groups (p-values: 0.97, 0.13, 0.32, 0.10, respectively). However, the difference in the quality-of-life score was statistically significant; the mean (± SD) SF-36 score increased from 48 ± 6.8 to 81 ± 4.4 (p-value < 0.001) in RPLS group compared to 52 ± 8.8 to 59 ± 1.2 (p-value: 0.52) in COLS group. Conclusion: RPLS is feasible, safe, and has the advantages of minimally invasive surgery: minimal blood loss, less intraoperative complications, shorter hospital stay, and less postoperative pain. However, the operative time in RPLS cases is longer than in the COLS; training on the procedure is recommended to improve the learning curve. [ABSTRACT FROM AUTHOR]

Green hydrogen is seen as a promising energy carrier contributing to the decarbonization of the energy system. The competitiveness of green hydrogen compared to conventional produced (grey) hydrogen strongly depends on the investment cost of electrolysers and the costs of required green electricity. Accordingly, the expected investment costs and the efficiency of the production process for electrolysis technologies will play a decisive role. Experience curves can help estimate these crucial key parameters better. This paper applies experience curves to electrolysis technologies to enhance the understanding of these developments, specifically for alkaline, proton exchange membranes and solid oxide electrolysis. Experience rates are estimated using one- and two-factor experience curves for CAPEX and one-factor experience curves for electricity consumption. An independent and extensive database of CAPEX, electrical consumption and cumulative installed capacity was developed. Additionally, two different time frames and different data handling techniques are applied to understand the impact on the experience rates and the fit of the experience curve to the data provided. Based on the extensive database developed, CAPEX experience rates for the technologies range from 7%–21%, depending on the technology. In almost all cases, a two-factor experience curve analysis reduces the experience rate based on the cumulative installed capacity with the experience rate based on the size ranging between 7.4-10.2 % for all technologies. Lastly, the experience curve of the electrical consumption expects a reduction of around 1-3.5 % with each doubling of the capacity. • Derivation of experience rates for the major electrolysis technologies (AEL, PEM, SOEC). • Calculation of one- and two-factor experience rates for CAPEX with considerable impact of sizes as a second factor. • Calculation of one-factor experience rates for electricity consumption, with results between 1-3.5 %. • In depth consideration of the effects on the experience rates of data handling techniques and time frame variation. • Estimating learning investment to reach CAPEX targets for electrolysers of the U.S. Department of Energy. [ABSTRACT FROM AUTHOR]

The article discusses the use of iris-sutured intraocular lenses in cases where capsular and zonular integrity are compromised. A retrospective study of 194 eyes showed improved visual outcomes with low long-term complication rates. The study highlighted the relevance and safety of iris-sutured intraocular lenses, especially in specific conditions, but cautioned about potential risks such as ocular hypertension and cystoid macular edema. The research emphasized the importance of multiple fixation techniques to address complex patient needs. [Extracted from the article]

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene's statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption. [ABSTRACT FROM AUTHOR]

Background: Since laparoscopic surgery became the gold standard for colorectal procedures, specific skills are required to achieve good outcomes. The best way to acquire basic and advanced skills and reach the learning curve plateau is by using dedicated simulators: box-trainers, video-trainers and virtual reality simulators. Laparoscopic skills training outside the operating room is cost-beneficial, faster and safer, and does not harm the patient. When compared to box-trainers, virtual reality simulators and cadaver models have no additional benefits. Several laparoscopic trainers available on the market as well as homemade box and video-trainers, most of them using plastic boxes and standard webcams, were described in the literature. The majority of them involve training on a flat surface without any anatomical environment. In addition to their demonstrated benefits, box-trainers which add anatomic details can improve the training quality and skills development of surgeons. Methods: We created a 3D-printed anatomic pelvi-trainer which offers a real-size narrow pelvic space environment for training. The model was created starting with a CT-scan performed on a female pelvis from the Anatomy Museum (Cluj-Napoca University of Medicine and Pharmacy, Romania), using Invesalius 3 software (Centro de Tecnologia da informação Renato Archer CTI, InVesalius open-source software, Campinas, Brazil) for segmentation, Fusion 360 with Netfabb software (Autodesk software company, Fusion 360 with Netfabb, San Francisco, CA, USA) for 3D modeling and a FDM technology 3D printer (Stratasys 3D printing company, Fortus 380mc 3D printer, Minneapolis, MN, USA). In addition, a metal mold for casting silicone valves was made for camera and endoscopic instruments ports. The trainer was tested and compared using a laparoscopic camera, a standard full HD webcam and "V-Box" (INTECH—Innovative Training Technologies, Milano, Italia), a dedicated hard paper box. The pelvi-trainer was tested by 33 surgeons with different qualifications and expertise. Results: We made a complete box-trainer with a versatile 3D-printed pelvi-trainer inside, designed for a wide range of basic and advanced laparoscopic skills training in the narrow pelvic space. We assessed the feedback of 33 surgeons regarding their experience using the anatomic 3D-printed pelvi-trainer for laparoscopic surgery training in the narrow pelvic space. Each surgeon tested the pelvi-trainer in three different setups: using a laparoscopic camera, using a webcam connected to a laptop and a "V-BOX" hard paper box. In the experiments that were performed, each participant completed a questionnaire regarding his/her experience using the pelvi-trainer. The results were positive, validating the device as a valid tool for training. Conclusions: We validated the anatomic pelvi-trainer designed by our team as a valuable alternative for basic and advanced laparoscopic surgery training outside the operating room for pelvic organs procedures, proving that it supports a much faster learning curve for colorectal procedures without harming the patients. [ABSTRACT FROM AUTHOR]

Objective To explore the learning curve of robotic-assisted kidney transplantation (RAKT). Methods The clinical data of 96 consecutive RAKT patients performed by the same surgical team were retrospectively analyzed. The arterial anastomosis time, venous anastomosis time, ureteral anastomosis time, hospital stay, and blood loss were selected as evaluation indicators. The learning curve of RAKT was analyzed using the cumulative sum (CUSUM), and the curve was divided into the learning improvement stage and the proficient mastery stage according to the learning curve. The learning curve was verified by comparing the general data and surgical data of patients in different learning stages, and the clinical efficacy of each stage was analyzed. Results The optimal fitting equation of the learning curve reached its peak at the 33rd case, which was the minimum number of surgeries required to master RAKT. There was no statistically significant difference in age, gender, dialysis type, previous abdominal surgery history, number of donor renal arteries, and preoperative serum creatinine between the learning improvement group and the proficient mastery group (all P>0.05). Compared with the learning improvement stage, the body mass index (BMI) was higher, and the number of right donor kidney was increased compared to the left donor kidney in the proficient mastery stage (both P<0.05). There were no significant differences in arterial anastomosis time, ureteral anastomosis time, postoperative serum creatinine, and complications between the two groups (all P>0.05). The iliac vessel dissection time, warm ischemia time, venous anastomosis time, blood loss, and hospital stay in the proficient mastery stage were superior to those in the learning improvement stage, with statistically significant differences (all P<0.05). Conclusions RAKT requires at least 33 cases to cross the learning curve. There is no difference in complications and recovery of transplant renal function between the learning improvement stage and the proficient mastery stage. [ABSTRACT FROM AUTHOR]

Background: This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively. Methods: Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters. Results: The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant (P <.001). Conclusions: From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time. [ABSTRACT FROM AUTHOR]

The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low‐radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a well‐established treatment for end‐stage knee osteoarthritis. However, in patients with concomitant extra‐articular deformities, conventional TKA techniques may lead to unsatisfactory outcomes and higher complication rates. This review summarizes the application of navigated TKA for treating knee osteoarthritis with extra‐articular deformities. The principles and potential benefits of computer navigation systems, including improved component alignment, soft tissue balancing, and restoration of mechanical axis, are discussed. Research studies demonstrate that navigated TKA can effectively correct deformities, relieve pain, and improve postoperative joint function and quality of life compared with conventional methods. The advantages of navigated TKA in terms of surgical precision, lower complication rates, and superior functional recovery are highlighted. Despite challenges like the learning curve and costs, navigated TKA is an increasingly indispensable tool for achieving satisfactory outcomes in TKA for knee osteoarthritis patients with extra‐articular deformities. [ABSTRACT FROM AUTHOR]

Purpose: A common spine surgery procedure involves decompression of the lumbar spine. The impact of the surgeon's learning curve on relevant clinical outcomes is currently not well examined in the literature. A variety of machine learning algorithms have been investigated in this study to determine how a surgeon's learning curve and other clinical parameters will influence prolonged lengths of stay (LOS), extended operating times (OT), and complications, as well as whether these clinical parameters can be reliably predicted. Methods: A retrospective monocentric cohort study of patients with lumbar spinal stenosis treated with microsurgical (MSD) and full-endoscopic (FED) decompression was conducted. The study included 206 patients with lumbar spinal stenosis who underwent FED (63; 30.6%) and MSD (118; 57.3%). Prolonged LOS and OT were defined as those exceeding the 75th percentile of the cohort. Furthermore, complications were assessed as a dependent variable. Using unsupervised learning, clusters were identified in the data, which helped distinguish between the early learning curve (ELC) and the late learning curve (LLC). From 15 algorithms, the top five algorithms that best fit the data were selected for each prediction task. We calculated the accuracy of prediction (Acc) and the area under the curve (AUC). The most significant predictors were determined using a feature importance analysis. Results: For the FED group, the median number of surgeries with case surgery type at the time of surgery was 72 in the ELC group and 274 in the LLC group. FED patients did not significantly differ in outcome variables (LOS, OT, complication rate) between the ELC and LLC group. The random forest model demonstrated the highest mean accuracy and AUC across all folds for each classification task. For OT, it achieved an accuracy of 76.08% and an AUC of 0.89. For LOS, the model reached an accuracy of 83.83% and an AUC of 0.91. Lastly, in predicting complications, the random forest model attained the highest accuracy of 89.90% and an AUC of 0.94. Feature importance analysis indicated that LOS, OT, and complications were more significantly affected by patient characteristics than the surgical technique (FED versus MSD) or the surgeon's learning curve. Conclusions: A median of 72 cases of FED surgeries led to comparable clinical outcomes in the early learning curve phase compared to experienced surgeons. These outcomes seem to be more significantly affected by patient characteristics than the learning curve or the surgical technique. Several study variables, including the learning curve, can be used to predict whether lumbar decompression surgery will result in an increased LOS, OT, or complications. To introduce the provided prediction tools into clinics, the algorithms need to be implemented into open-source software and externally validated through large-scale randomized controlled trials. [ABSTRACT FROM AUTHOR]

Purpose: Radiation-free systems based on dorsal surface topography can potentially represent an alternative to radiographic examination for early screening of scoliosis, based on the ability of recognizing the presence of deformity or classifying its severity. This study aims to assess the effectiveness of a deep learning model based on convolutional neural networks in directly predicting the Cobb angle from rasterstereographic images of the back surface in subjects with adolescent idiopathic scoliosis. Methods: Two datasets, comprising a total of 900 individuals, were utilized for model training (720 samples) and testing (180). Rasterstereographic scans were performed using the Formetric4D device. The true Cobb angle was obtained from radiographic examination. The best model configuration was identified by comparing different network architectures and hyperparameters through cross-validation in the training set. The performance of the developed model in predicting the Cobb angle was assessed on the test set. The accuracy in classifying scoliosis severity (non-scoliotic, mild, and moderate category) based on Cobb angle was evaluated as well. Results: The mean absolute error in predicting the Cobb angle was 6.1° ± 5.0°. Moderate correlation (r = 0.68) and a root-mean-square error of 8° between the predicted and true values was reported. The overall accuracy in classifying scoliosis severity was 59%. Conclusion: Despite some improvement over previous approaches that relied on spine shape reconstruction, the performance of the present fully automatic application is below that of radiographic evaluation performed by human operators. The study confirms that rasterstereography cannot be considered a valid non-invasive alternative to radiographic examination for clinical purposes. [ABSTRACT FROM AUTHOR]

The article "Weather Charts for the Modern Era" from Weatherwise discusses the evolution of weather charts over the years and their importance in meteorology. It explains the basics of weather charts, their use in forecasting, and introduces various websites and software programs for accessing and analyzing these diagrams. The article emphasizes the significance of tools like AWIPS, surface maps, upper-level charts, soundings, satellite images, and radar in understanding weather patterns. It also highlights popular mobile apps, websites like College of DuPage WeatherLab and Pivotal Weather, and desktop software such as Digital Atmosphere and GRLevelX for in-depth weather analysis. [Extracted from the article]

Purpose: This study aimed to assess the learning curve of robot-assisted intersphincteric resection for low rectal cancer. Methods: We retrospectively analyzed the clinical data of 89 patients who underwent robot-assisted intersphincteric resection. All surgeries were performed by the same group of surgeons at our institution between June 2016 and April 2021. The learning curve was evaluated using a cumulative sum analysis and the best-fit curve. The different stages of the learning curve were compared based on patient characteristics and short-term clinical outcomes to evaluate their impact on clinical efficacy. Results: The minimum number of cases required to overcome the learning curve was 47. The learning curve was divided into the learning improvement and proficiency stages. Significant differences were observed in the operation time and the number of lymph nodes between the two stages (P < 0.05), whereas no significant differences were found in intraoperative blood loss, first postoperative exhaust time, postoperative complications, 3-year progression-free survival, overall survival, and local recurrence-free survival (P > 0.05). Conclusion: Robotic-assisted intersphincteric resection for low rectal cancer exhibits a learning curve that can be divided into two stages: namely, learning improvement and proficiency. Achieving proficiency requires a minimum of 47 surgical cases. [ABSTRACT FROM AUTHOR]

Objective: To determine the individual learning curves for cordocentesis in a low‐cost simulator for maternal‐fetal medicine (MFM) fellows. Methods: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second‐year MFM fellow who accepted to participate in the study performed this procedure using a low‐cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM). Results: Seven second‐year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%). Conclusion: CUSUM analysis to assess learning curves, in addition to using low‐cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows. Synopsis: Using a low‐cost simulation model, cumulative sum analysis was used to determine individual learning curves for cordocentesis among maternal‐fetal medicine fellows. [ABSTRACT FROM AUTHOR]

Purpose: To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). Methods: This prospective interventional study was conducted among 30 patients by dividing into two equal groups over one year and six months. All patients were followed up for a minimum of at least six months. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. Results: The majority of patients (26.7%) were between 18 to 30 years, overall mean age was 44.4 years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. Conclusion: MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve. [ABSTRACT FROM AUTHOR]

Introduction: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. Materials and methods: In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. Results: In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Conclusion: Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate. [ABSTRACT FROM AUTHOR]

Background: This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). Methods: A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. Results: The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. Conclusions: The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR. [ABSTRACT FROM AUTHOR]

Localisation methods for surgical excision of impalpable breast lesions have advanced in recent years, with increasing utilization of new wire-free technologies. The Hologic LOCalizer™ radiofrequency identification (RFID) tag is one such device; however, as is the case when new technologies are first introduced, little is known about clinical experiences, potential complications, and learning used to overcome perioperative challenges when changing from guidewires to RFID tags. This study reports shared learning experiences of clinicians using the LOCalizer™ as part of the national iBRA-NET localisation study. This mixed-methods study captured shared-learning themes relating to LOCalizer™ usage as part of a multicentre prospective registry study, which collected data on each LOCalizer™ placement. Prospective, anonymized clinical and demographic data were collected and managed using a Research Electronic Data Capture (REDCap) database. Shared learning was captured prospectively as part of the registry study between January 2021 and July 2022, combined with a virtual qualitative webinar-style focus group. Learning events were then coded, grouped by theme, and suggestions for practice were produced. Twenty-four UK breast units submitted data on 1188 patient records pertaining to RFID-guided localisation between January 2021 and July 2022, of which 59 (5.0%) included a shared-learning event. The virtual webinar was attended by 108 healthcare professionals, including oncoplastic breast surgeons and breast radiologists. Shared-learning themes were categorized into preoperative, intraoperative, and postoperative events. By sharing learning outcomes associated with localisation techniques in this paper, the aim is to shorten the learning curve and potential for adverse events for users new to the LOCalizer™ technique. • Impalpable breast lesions requiring preoperative localisation are increasing. • Hologic LOCalizer™ radiofrequency identification (RFID) tag is a novel localisation device. • Shared learning aims to shorten learning curve associated with new techniques. • Includes suggestions for overcoming challenges encountered using this technique. [ABSTRACT FROM AUTHOR]

In our fast-paced modern world, software systems have become indispensable in both personal and professional spheres. With increasing reliance on software products, the demand for reliable and high-quality software has intensified, placing significant pressure on developers to stay competitive. Software reliability growth models (SRGMs) play a vital role in assessing the dependability of software systems during their development. These models mathematically analyze the relationship between detected faults, testing time, and failures, enabling the prediction of software failures. This paper introduces an approach to software reliability evaluation, considering the dynamic nature of fault removal efficiency (FRE) during development. Additionally, the model accounts for the change rate of residual errors, considering both error introduction and correction processes. Moreover, the adoption of S-shaped curves captures the learning process of software developers, enhancing the model's accuracy. This approach guides software developers to make informed decisions, leading to improved software reliability and performance, meeting escalating demands. [ABSTRACT FROM AUTHOR]

The direct anterior approach (DAA) for total hip arthroplasty (THA) is attracting attention as a minimally invasive surgery, but the learning curve to master this approach is a concern, and its effect on long-term results is unknown. The purpose of this prospective cohort study was to clarify how the learning curve affects the 5-year results of DAA THA with a traction table. Of 402 THA cases using DAA with a mobile traction table and fluoroscopy, 249 cases composed of the first 50 cases for each surgeon were assessed during a learning curve, and 153 cases were evaluated after more than 50 cases of experience. The 5-year-implant survival rate was 99.2% both during and after the learning curve. The 2-year complication rate in the learning curve group was 8.9 versus 5.9%, which was not statistically significant. The 2-to-5-year complication rates also did not differ between the cohorts (0 versus 0.7%). Both groups demonstrated decreased complication rates when comparing 2-year complications to 2-to-5-year complications. Clinical scores significantly improved by 2 years and were maintained at 5 years in both groups. The cup safe-zone success rates were 96.4% during the learning curve and 98.7% after the learning curve. The stem safe-zone success rates were 97.2% during the learning curve and 96.1% after the learning curve. Surgical time was approximately 20 minutes shorter after the first 50 cases than during the learning curve (70.8 versus 90.6 minutes, P =.001). Intraoperative blood loss was significantly less after the learning curve than during the learning curve. This study implies that the learning curve affects perioperative results such as surgical time and intraoperative blood loss, but has little effect on short-term results up to 2 years after surgery and no effect on mid-term results from 2 to 5 years after surgery. [ABSTRACT FROM AUTHOR]

This study introduces an ensemble model designed for real-time monitoring of bedridden patients. The model was developed using a unique dataset, specifically acquired for this study, that captures six typical movements. The dataset was balanced using the Synthetic Minority Over-sampling Technique, resulting in a diverse distribution of movement types. Three models were evaluated: a Decision Tree Regressor, a Gradient Boosting Regressor, and a Bagging Regressor. The Decision Tree Regressor achieved an accuracy of 0.892 and an R2 score of 1.0 on the training dataset, and 0.939 on the test dataset. The Boosting Regressor achieved an accuracy of 0.908 and an R2 score of 0.99 on the training dataset, and 0.943 on the test dataset. The Bagging Regressor was selected due to its superior performance and trade-offs such as computational cost and scalability. It achieved an accuracy of 0.950, an R2 score of 0.996 for the training data, and an R2 score of 0.959 for the test data. This study also employs K-Fold cross-validation and learning curves to validate the robustness of the Bagging Regressor model. The proposed system addresses practical implementation challenges in real-time monitoring, such as data latency and false positives/negatives, and is designed for seamless integration with hospital IT infrastructure. This research demonstrates the potential of machine learning to enhance patient safety in healthcare settings. [ABSTRACT FROM AUTHOR]

The structures laboratory is a crucial facility for supporting research development related to the construction industry. This kind of laboratory has several components, and one of its key components is the reaction wall. The reaction wall supports the execution of experimental tests on structural elements under specific configurations and loads. Constructing a reaction wall presents challenges due to the highest standards to be met. This research analyzes the construction process of a reaction wall at a private university in Peru. Initially, a schedule was proposed by a contractor. However, the client, knowing the complexity of such construction, asked to review the initial schedule to ensure that it would meet the constructability requirements under the integrated product-organization-process approach given by the virtual design and construction (VDC) methodology. The result of this study pointed out the need to revise the original proposed schedule, extending the construction time to 66% due to the lack of construction processes compatible with the requirements for the reaction wall's execution. Finally, a survey was conducted to observe the learning curve associated with implementing the VDC methodology. [ABSTRACT FROM AUTHOR]

Prostate cancer (PC) is common among men and has become a significant societal issue. Localized PC has a good prognosis with appropriate treatment. Prostatectomy, particularly robot-assisted radical prostatectomy (RARP), has become a common treatment since the da Vinci prostatectomy was approved by the FDA in 2001. The current study aimed to assess the learning curve for RARP, focusing on anastomosis time, using the cumulative sum (CUSUM) method. Data were collected from Nagoya City University Hospital between May 2011 and December 2018 and included 469 surgeries performed by experienced surgeons. Our findings indicated that, on average, 11 patients were required to complete the initial phase and 24 patients were required to complete the consolidation phase of anastomosis. Additionally, for complete resection of pT2c cases, 16 cases were required for the initial phase and 27 cases were required for the consolidation phase. The CUSUM method proved useful for visualizing trends in surgical proficiency, although the study noted potential confounding biases and limitations in evaluating surgical proficiency based solely on surgical time or positive surgical margins. [ABSTRACT FROM AUTHOR]

This qualitative phenomenology study aimed to address the experiences of Philippine Air Force officers stationed at the Air Education Training and Doctrine Command (AETDC) and their strategies for coping with challenges through in-depth interview and focus group discussion. There were ten participants for IDI and ten for FGD. For the first research question, five significant themes emerged related to the challenges faced by participants at AETDC, including adaptation, military learning curve, impact of military service, compliance and communication within the military, and ranking and length of service in the military. The second research question revealed four coping mechanisms adopted by the participants: adaptive resilience, psychological strategies in military service, collaborative support network, and creating a professional and resilient work environment. Lastly, the third research question exposed three insights from participants, namely workplace resilience, adjustments, and the dynamic and context-dependent nature of workplace strategies. The study concluded that participants shared similar challenges, coping mechanisms, and reflections, emphasizing the complex and multifaceted nature of military service and the importance of adaptive strategies for effective work adjustment. [ABSTRACT FROM AUTHOR]

Objective: The use of three-dimensional (3D) laparoscopy in surgical practice and training has been an area of research and discussion. Studies have suggested that 3D vision can improve speed and precision compared to traditional two-dimensional (2D) displays, while other authors found no benefits on the learning curves of laparoscopic novices. Modern two-dimensional laparoscopy with a resolution of 3840 × 2160 pixels (2D-4 K) seems to improve laparoscopic view and helps learners orient without stereopsis. However, evidence comparing these systems for laparoscopic training is limited. Therefore, the impact of viewing mode (2D-4 K vs. 3D) on learning and task proficiency remains unclear. Design: We performed a two-hour teaching intervention on basic laparoscopic skills for novices. In this parallel group randomized study, we randomly assigned learners to 2D-4 K or 3D teaching and performed tasks of increasing difficulty and complexity using standard laparoscopy box trainers. Before the last and most challenging task, learners had to crossover to the other laparoscopy setup. Our hypothesis was that learners would be faster and more precise when using a 3D setup. The primary endpoint was task proficiency measured by speed and failure rate. Secondary outcomes were performance using the viewing mode of the other group without familiarization, self-perception, and career aspirations before and after the teaching intervention, expressed on a Likert scale. Setting: The study was performed by the Department of General, Visceral and Thoracic Surgery at the German Armed Forces Hospital Ulm, which is an academic teaching hospital of the University of Ulm. Participants: Thirty-eight laparoscopic novices, including medical students and junior residents, participated voluntarily in this teaching intervention. Group allocation was performed via the virtual coin flip method. Apparently, participants and tutors were not blinded to group assignment. No formal approval by the ethics committee was needed for this noninvasive study in compliance with the World Medical Association Declaration of Helsinki as discussed with the ethics committee of the University of Ulm. Results: Thirty-eight laparoscopy novices were randomized in the study. The 3D group (n = 19) was significantly faster than the 2D-4 K group (n = 19) (p =.008) in a standard box trainer model, with 134.45 ± 41.45 s vs. 174.99 ± 54.03 s for task 1 and 195.97 ± 49.78 s vs. 276.56 ± 139.20 s for task 2, and the effect was consistent throughout the learning curve. The failure rate was not significantly affected by the viewing mode. After crossover to the other laparoscopy system, precision and time were not significantly different between the groups. Learners rated the difficulty of laparoscopy lower on a Likert scale after having two hours of basic laparoscopy training. The study was funded by the hospital's teaching budget. Conclusions: Laparoscopic novices can benefit from a 3D laparoscopy training setup. Exclusive 3D training prior to a complex task on a 2D-4 K setup does not negatively affect the learner's performance. [ABSTRACT FROM AUTHOR]

Objective: Oblique lateral interbody fusion (OLIF) is becoming widely used in patients with single-segment spinal tuberculosis (STB). The learning curve and complications associated with OLIF for the treatment of STB are still unknown. This study aims to figure out the learning curve and associated complications experience of OLIF for the treatment of STB. Methods: Between September 2018 and August 2023, 61 STB patients underwent OLIF plus percutaneous pedicle screw fixation (PPSF) were consecutively included in this research. Cumulative sum analysis (CUSUM) was applied to establish the learning curve of OLIF and determine the cut-off case number. All cases were divided into learning and experienced groups based on the cut-off case number. Clinical characteristics and relating surgical complications were compared and analyzed between the two groups. Results: The best-fitting curve was quadratic. The fitting equation was CUSUM (min) = 95.83 + 34.16x − 0.611 x 2 (x means operation case). The cut-off operation case number was 27 cases. The presence of significant differences particularly in the duration of operation, operative blood loss, overall incidence, and severity of postoperative complications was noteworthy between the two groups. Conclusion: A total of 27 cases is the minimum number to master OLIF combined with PPSF for the treatment of patients with single-segment STB. When surgeons master this operation, the operative time, operative blood loss, overall incidence, and severity of postoperative complications will improve. [ABSTRACT FROM AUTHOR]

Burnout has become a significant occupational concern for resident physicians, primarily attributed to chronic workplace stressors, inadequate work-life balance, high expectation from attending staffs, steep learning curve, and limited patient care experience. The study aimed to investigate the prevalence and associated factors of burnout in medical residents. This cross-sectional study was conducted online questionnaire of all specialists in a university hospital from September to October 2022. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. The data collection encompassed information on socio-demographics, working conditions, psychiatric issues, and medical errors as potential predictive variables. To analyze the association between these factors and burnout, a confounder summary score model was employed in four separate models utilizing multivariable logistic regression. A total of 238 participants, the average age of participants was 28.1 years (SD 2.7), and 56.2% of them were female. Weekly working hours averaged 75 (SD 21.8). Burnout prevalence was 46.3%. This prevalence was characterized by high levels of emotional exhaustion (57.1%) and depersonalization (36.1%), along with low levels of personal accomplishment (52.4%). Summary of association in each domain with burnout were as follow: demographic determinants, (adjusted odds ratio (aOR) 2.80, 95% CI 1.68–4.64), working conditions (aOR 2.97, 95% CI 1.54–5.71), psychiatric determinants (aOR 2.47, 95% CI 1.77–3.45) medical errors (aOR 2.14, 95% CI 1.05–4.34). Medical residency training programs should provide a supportive system that actively monitors and addresses depressive symptoms. Implementing preventive measures, such as increasing pay rates, can play a role in mitigating burnout. [ABSTRACT FROM AUTHOR]

The visualization of complex spatial data is typically achieved using the Windows, Icons, Menus, and Pointer (WIMP) method. However, this approach has limitations, including a steep learning curve, non-intuitive interfaces, and limited visualization capabilities. To overcome these challenges, this study proposes an augmented reality-based (AR-based) visualization and interaction method for complex spatial data. By customizing the rendering pipeline, various visualization effects, such as clipping and lighting adjustments, can be achieved. Additionally, a prototype system called ARSpatialDX is developed. Furthermore, a user study is conducted to compare the AR and WIMP methods. The results indicate that AR outperforms WIMP in terms of virtual-reality matching, perception of physical properties, attractiveness, stimulation, perspicuity, and novelty aspects. Users generally find the direct interaction with data using their hands in AR to be highly interesting and express a strong willingness to continue using it. [ABSTRACT FROM AUTHOR]

This study aims to employ machine learning, specifically artificial neural networks (ANNs), to predict the flow curve of hot-deformed steel alloys. The method involved creating a dense ANN with two hidden layers, trained with data from 70 steel classes, including information on chemical composition, temperature, and strain rate. The results indicate robustness and good generalization capability, with a mean absolute error of 11.4 MPa and a mean squared error of 10.3 MPa. The model demonstrates an R2 value of 0.98, highlighting its effectiveness in explaining variability in the data. The conclusions underscore the feasibility of ANNs in describing the mechanical behavior of steel alloys, providing an efficient and rapid tool for metal forming projects, with potential for future research and innovations in this field. [ABSTRACT FROM AUTHOR]

Background: One procedure that has gained popularity in the surgical management of hallux valgus is the minimally invasive Chevron and Akin osteotomy (MICA). The purpose of this systematic review was to evaluate the learning curve associated with this technically demanding procedure. Methods: A search of the EMBASE and PubMed databases was performed to identify all clinical studies that assessed the learning curve associated with the MICA procedure. Studies where patients were not diagnosed with hallux valgus, did not undergo MICA, or did not report data on operation time, fluoroscopy exposure, or complications were excluded. A risk of bias assessment was conducted to assess the validity of the studies. Results: The initial literature search yielded 287 studies, and seven studies were included in the final analysis. A quantitative comparative analysis could not be performed as the included studies used different statistical methods to quantify the learning curve. Lewis et al. determined that after 38 operations, there was a decrease in operation time and fluoroscopy exposure (p <.001). Merc et al. found that it took 29 and 30 operations to reach a plateau for operation time and fluoroscopy exposure, respectively (p <.001). Palmanovich et al. found that it took 20 and 26 operations to reach a plateau for operation time and fluoroscopy exposure, respectively (p <.001). Toepfer and Strässle found there was a significant decrease in operation time and fluoroscopy exposure after the first 19 procedures in their series (p <.001). With respect to complications, one study found a significant difference after the 42nd operation (p =.007). However, the remaining studies found that complication rates did not significantly change with increased technical proficiency. All seven studies were deemed to have a moderate risk of bias. Conclusions: Surgeons can expect a learning curve of 20 to 40 operations before reaching technical proficiency with the MICA procedure. After the learning curve is achieved, surgeons can expect to see a significant decrease in both operation times and fluoroscopy exposure. No consistent significant difference was found in complications as one becomes more technically proficient with the procedure. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusions Rigid surgical instruments limit movement whereas articulated instruments offer better control in small spaces and allow for intuitive and ergonomic movements. However, the effectiveness of the use of articulated instruments in improving colorectal laparoscopic outcomes remains unclear. The aim of this work was to determine whether colorectal laparoscopic surgical proficiency improved when multijoint instruments were used instead of conventional ones.We enrolled 70 consecutive patients (n = 20 for conventional instruments) aged 19–80 years who underwent elective laparoscopic surgery for colorectal diseases. Unedited surgery videos were validated using the modified Global Operative Assessment of Laparoscopic Skills (mGOALS) scale. Learning curves were analysed using a cumulative sum control chart for mGOALS grades.The surgery type, length of hospital stay and 30‐day postoperative complication rates were comparable between the groups, and the surgeon's mGOALS grades were similar (p = 0.190). However, in the articulated group, the scores were significantly higher for depth perception (p = 0.012) and tissue‐handling domains (p = 0.046), while surgical duration was significantly shorter and intraoperative blood loss was significantly lower (p = 0.022), compared with those in the conventional (p = 0.002) group. Learning curve findings indicated that the first 10 and subsequent 40 surgeries in the articulated group were within the inexperienced and experienced phases, respectively. The mGOALS score in the experienced phase improved in the articulated group compared with that in the conventional group (p = 0.036).The use of articulated instruments in laparoscopic colorectal surgery showed potential benefits. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Transbronchial lung cryobiopsy (TBLC) has emerged as a promising diagnostic tool for interstitial lung disease (ILD). This study aimed to assess the initial experience, procedural learning curve, and influence of sedative medications on complication rates, particularly bleeding and pneumothorax, in the implementation of a TBLC program for ILD diagnosis. Methods: In this retrospective cohort study, we analysed 119 patients who underwent TBLC at Nippon Medical School Hospital from April 2021 to March 2024. Procedural times, complication rates, and histopathological outcomes were evaluated. The learning curve was assessed using cumulative sum (CUSUM) analysis, focusing on procedure time and biopsy yield. The association between sedative medication dosages and bleeding risk was also examined. Results: The overall diagnostic yield was high, with alveolar tissue obtained in 97.5% of cases and a definitive pathological diagnosis achieved in 81.5% of patients. CUSUM analysis revealed a proficiency threshold at approximately 56 cases, with improved efficiency and biopsy yield in the consolidation phase. Fentanyl dosage was significantly associated with reduced bleeding complications (odds ratio 0.51, 95% confidence interval 0.27–0.97, p = 0.041). Conclusions: TBLC is a safe and effective diagnostic tool for ILDs, with a manageable learning curve for procedural efficiency. Sedation, particularly fentanyl dosage, may plays a crucial role in minimizing complications, but further research is needed to clarify this relationship. These findings support the adoption of TBLC as a standard diagnostic approach for ILD and highlight the importance of adequate training and optimized sedation protocols to ensure safety and efficacy in clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Medical residents learn how to perform many complex procedures in a short amount of time. Sequential learning, or learning in stages, is a method applied to complex motor skills to increase skill acquisition and retention but has not been widely applied in simulation-based training (SBT). Central venous catheterization (CVC) training could benefit from the implementation of sequential learning. CVC is typically taught with task trainers such as the dynamic haptic robotic trainer (DHRT). This study aims to determine the impact of sequential learning on skill gains and learning curves in CVC SBT by implementing a sequential learning walkthrough into the DHRT. METHODS: 103 medical residents participated in CVC training in 2021 and 2022. One group (N = 44) received training on the original DHRT system while the other group (N = 59) received training on the DHRTsequential with interactive videos and assessment activities. All residents were quantitatively assessed on (e.g. first trial success rate, distance to vein center, overall score) the DHRT or DHRTsequential systems. RESULTS: Residents in the DHRTsequential group exhibited a 3.58 times higher likelihood of successfully completing needle insertion on their first trial than those in the DHRT only group and required significantly fewer trials to reach a pre-defined mastery level of performance. The DHRTsequential group also had fewer significant learning curves compared to the DHRT only group. CONCLUSION: Implementing sequential learning into the DHRT system significantly benefitted CVC training by increasing the efficiency of initial skill gain, reducing the number of trials needed to complete training, and flattening the slope of the subsequent learning curve. [ABSTRACT FROM AUTHOR]

The article discusses a study on a cold-steel dissection tonsillectomy protocol that resulted in few complications in pediatric patients. The study included 953 patients who underwent tonsillectomy using this technique and a strict protocol. The results showed low rates of post-operative hemorrhage and readmission, indicating that the cold-steel dissection method can be effective in pediatric tonsillectomy. The study also highlighted the importance of minimizing risks associated with tonsillectomy, such as hemorrhage, and the need for advocating methods that reduce these risks. [Extracted from the article]

Background: This study aims to evaluate the surgical safety and effectiveness of gasless transaxillary endoscopic thyroidectomy (GTET), assess patients' shortterm perceptions and long-term outcomes, and delineate the learning curve and key surgical techniques of the operators. Materials and methods: Clinicopathological and postoperative follow-up data from patients with unilateral thyroid cancer in the same period were collected. These patients were divided into the GTET group and the traditional open surgery group to compare and analyze the differences and explore the factors affecting the learning curve of GTET. Results: Patients who chose GTET had better general health and thyroid conditions than those in the open group, and the quality of postoperative life was better in the GTET group than in the open group, with the main differences between the two groups being appearance and neck and shoulder function. The GTET learning curve in this study peaked at 19 cases, with slight differences between left and right, and a larger sample size is still needed to explore the factors affecting the learning curve. Conclusions: GTET has a reliable safety and efficacy profile for patients with unilateral thyroid cancer. Intraoperative nerve monitoring (IONM) techniques require some adaptation in GTET. In some respects, patients' postoperative experience and quality of life are superior to those of conventional open surgery. There is a learning curve for GTET, but large samples are still needed to explore its true significance. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to design a low-cost, simulation training platform for the ligation of deep dorsal vein (DVC) complex in radical prostatectomy and validate its training effectiveness. Methods: A simplified prostate urethra model was produced by 0-degree silica gel and pulse pressure banding. This model was placed on a slope of about 30 degrees using cardboard to thus creating a narrow environment of the pelvis. The DVC ligation was performed by a 2D laparoscopy simulator. A total of 27 participants completed the study include 13 novices, 10 surgical residents and 4 urology experts. The novices were trained five trails with 24 hours interval, the residents and experts completed the DVC ligation once. The construct validity of this simulation training platform was performed by completing time, the GOALS (Global Operative Assessment of Laparoscopic Skills) and TSA (i.e. Task Specific Assessments) score. The face validity and content validity were performed by a specific closed-ended questionnaire. Results: There was no significant difference among three groups in demographic or psychometric variables (p > 0.05). Compared to the novices, the residents spend a shorter time to complete the DVC ligation (p < 0.05) and had higher GOALS scores (p < 0.05), but had no significant difference in TSA scores (p > 0.05). Additionally, the experts groups had a better performance compared to residents group in the completing time (p < 0.05), GOALS score (p < 0.05) and TSA score (p < 0.05). The learning curve of novices significantly promoted along with the increased times of training. Almost 90 percent of subjects considered that this simulator had a good performance in the realism and practicability. Conclusion: We developed a novel low-cost a simulation training platform for the ligation of deep dorsal vein complex in radical prostatectomy, and this simulator had a good performance in the construct validity, face validity and content validity. [ABSTRACT FROM AUTHOR]

The degradation half-life (DegT50) of a substance in soil plays an important role in the approval process of a plant protection product and is a sensitive input parameter for regulatory models. It is usually derived through least squares optimizations of mathematical models to measured degradation data according to EU FOCUS degradation kinetics guidance. A strong consensus on degradation parameters provides a solid foundation for parts of the environmental risk assessment. The DegT50 of a substance for regulatory modeling is preferably derived from a single first-order (SFO) model as this is currently the only kinetic model implemented in EU regulatory models of the environmental fate of pesticides. However, kinetic optimisation tools do not always provide a regulatory acceptable SFO fit even though a visual inspection of the data suggests it may be possible. It was therefore hypothesized that more acceptable SFO fits might be achieved by adapting the objective function that is minimized during the optimization. Eight objective functions with varying weightings were tested on 29 laboratory soil degradation datasets. A web-based app was developed to allow experts in environmental safety of plant protection products to visually assess the goodness of fits resulting from different objective functions. The visual assessments and a quantitative metric, newly introduced in the proposed update of the FOCUS guidance, show that the acceptability of SFO fits can be increased, but no single objective function exclusively improves all fits. The assessment reveals that expert judgment is very subjective. Participants tended to change their mind when judging the acceptance of a fit, assumingly caused by a learning curve or a period of calibration. It is concluded that different objective functions could be considered in the kinetic assessment as it can improve the acceptability of SFO fits and hence endpoints for regulatory modeling. This study reveals that various qualitative factors influence the visual judgment of experts when performing a kinetic modeling assessment. The proposed quantitative metric seems to be in alignment with the visual assessment of fits to derive modeling endpoints and a promising step toward less subjective kinetic modeling assessments. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Purpose Methods and Materials Results Conclusions The learning curve effect of dynamic computer‐assisted implant surgery (D‐CAIS) was observed among inexperienced novice surgeons. The learning curves can provide valuable information for novice surgeons and valid comparisons between new and conventional techniques. Recently, robotic computer‐assisted implant surgery (R‐CAIS) has shown promise as a novel dental implant surgical technique for both partially and edentulous patients. However, its learning curve remains unknown.The aim of this study was to explore the learning curve of dental implant placement surgery with a task‐autonomous robotic system among young dentists with different specialties.Four young dentists (mean age: 25.3 ± 1.5 years at the beginning of their first attempt) with equal representation of males and females and with different specialties participated in this study. None of the participants had prior experience in R‐CAIS. Each operator placed eight implants over eight attempts using a semi‐active task‐autonomous robotic system. Among the eight implants, four were straight lateral incisor implants, and four were 30°‐tilted premolar implants. The implants were placed in each dental quadrant of the maxillary and mandibular jaw modules. The operation time was recorded. Coronal, apical, and angular deviations between the planned and actual sites of implant placement were measured by merging preoperative and postoperative cone‐beam computed tomography (CBCT) scans. The data were analyzed with repeated‐measures ANOVA (α = 0.05).The mean time for implant placement was associated with the number of attempts (p < 0.01). The time taken for the second attempt was significantly shorter than that of the first attempt (33.26 vs. 30.47 min; p < 0.001) then it plateaued. Three‐dimensional (3D) angular (p = 0.31), coronal deviation (p = 0.26), and apical deviation (p = 0.06) did not differ significantly among attempts. The mean values and standard deviations of 3D coronal deviation, 3D apical deviation, and 3D angular deviation were 0.71 ± 0.31 mm, 0.72 ± 0.30 mm, and 0.94 ± 0.58°, respectively. Neither the position of the jaw (p > 0.59) nor the tilt angle of the implant (straight or 30°‐tilted, p > 0.85) was related to implant placement accuracy.Dentists quickly learned the basic workflow of R‐CAIS and thus facilitated the clinicians in the mastery of implant placement on edentulous jaw modules, leading to a comparable operating speed and high precision. Moreover, the accuracy of placement of straight and tilted implants in both the maxilla and mandible with R‐CAIS was satisfactory. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice.A web‐based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi‐structured interview to explore key themes around competence. Thematic analysis was performed.Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post‐fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi‐structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant‐level competence; (2) the importance of sufficient training to develop clinical decision‐making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi‐disciplinary teams for complex cases including advanced cancers.Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non‐technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context. [ABSTRACT FROM AUTHOR]

The article "Decolonizing the English literary curriculum" explores the necessity of diversifying and decolonizing the English literary curriculum by moving away from a Eurocentric focus on British authors and colonial perspectives. Drawing on personal experiences in India, the author discusses the challenges of incorporating postcolonial perspectives into the curriculum to promote social justice and counter repressive forces. The text delves into the evolution of English literature curriculum in Indian universities, highlighting the complexities of incorporating diverse languages and cultures, particularly in African and Indigenous contexts. Emphasizing the importance of a culturally sensitive approach, the article calls for a reevaluation of traditional canons and a more inclusive approach to literature education in post-colonial societies. [Extracted from the article]