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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]

In recent years, machine learning (ML) has emerged as a potential tool in the exploration of thermoelectric (TE) materials. This study exploits the StarryData2 public database to construct an ML model for predicting the figure‐of‐merit ZT of TE materials. The original dataset from StarryData2 (372,480 datapoints) underwent systematic cleaning, resulting in a refined dataset of 18,126 instances with 2,761 unique compounds. The cleaned data is employed to train an XGBoost regressor model, utilizing chemical formulas of TE compounds as features to predict ZT at given temperatures. The XGBoost regressor exhibited high prediction accuracy, achieving the coefficient of determination (R2) scores of 0.815 and mean absolute error (MAE) of 0.103 for the test set, further evaluated through cross‐validation across 5 folds. The learning curve analysis demonstrated improved model performance with increased training data. Furthermore, the contributions of different chemical descriptors to ZT are analyzed based on feature importance analysis. Beyond conventional TE families in the training set, the trained model is applied to predict ZT for promising unexplored TE materials and estimate optimal doping concentrations. This comprehensive study shows the impact of ML on TE material research, offering valuable insights and accelerating the discovery of materials with enhanced TE properties. [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]

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]

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]

Serious games can play a crucial role in developing competencies for the job market, offering an innovative and engaging approach to learning. This study uses FLIGBY to develop employability skills among computer engineering graduates. FLIGBY is a serious game that simulates a virtual company environment where players make strategic decisions, emphasizing the principles of flow and positive psychology. Immersion in realistic scenarios provides practical experience, contributing to the development of market‐ready skills. A quantitative methodology based on descriptive statistics and hypothesis testing was adopted to measure the development of competencies for the job market using the Systems Engineering Competency Framework. The results show that competence development occurs mainly in the professional and managerial dimensions. In contrast, there is no development of core and technical competencies. Furthermore, the perception of the development of these competencies occurs mainly for students with more years of professional experience. The experiential nature of FLIGBY allows users to develop practical knowledge, promoting adaptability and resilience. This gamified approach accelerates the learning curve, preparing individuals for real‐world challenges in the computer engineering workplace. [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]

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]

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]

Introduction Methods Results Conclusion To evaluate the cost and efficiency of suture‐mediated percutaneous closure (SMC) compared to manual compression (MC) after atrial fibrillation (AF) ablation.SMC has been demonstrated to be efficacious in reducing hemostasis and bedrest times after AF ablation. To date, randomized data comparing the direct and indirect cost between the two techniques have not been described.We conducted a 1:1 randomized trial comparing SMC to MC following AF ablation. The primary endpoints have been previously published. However, secondary endpoints pertinent to indirect cost including complication rates, hospital utilization (i.e., delays in discharge, additional patient encounters, nursing utilization), pain, patient reported outcomes, as well as the direct costs of care associated with AF ablation were collected. We also performed secondary analysis of the primary endpoint to evaluate for a learning curve, and subgroups analysis comparing efficacy across different numbers of access sites and compared to those in the MC group with a figure‐of‐eight suture (Fo8), that could potentially have impacted the relative efficiency of the procedure.A total of 107 patients were randomized and included: 53 in the SMC group and 54 in MC. A learning curve was observed in the SMC group between the first and second half of the study group (p = 0.037), with no such difference in the MC group. After accounting for the number of access sites, time to hemostasis remained shorter in the SMC Group (p = 0.002). Compared to those in the Fo8 arm (n = 37), the time to hemostasis remained shorter in the SMC group (p = 0.001). Among those planned for same‐day discharge, there were more delays in the MC group (31.5% vs. 11.3%, p = 0.0144). Rates of major and minor complications were similar between SMC and MC groups at discharge (p = 0.243) and 30 days (p = 1.00), as were nursing utilization, self‐reported pain, and overall patient reported outcomes. The overall cost of care related to the procedure was similar between the MC and SMC groups ($56 533.65 [$45 699.47, $66 987.64] vs. $57 050.44 [$47 251.40, $66 426.34], p = 0.601).SMC has been shown to decrease time to hemostasis and ambulation and facilitate earlier same‐day discharge after AF ablation without an increase in direct or indirect costs. [ABSTRACT FROM AUTHOR]

Introduction: Practical simulation training with proper haptic feedback and the fragility of the human body is required to overcome the long learning curve associated with laparoscopic inguinal hernia repair (LIHR). However, few hernia models accurately reflect the texture and fragility of the human body. Therefore, in this study, we developed a novel model for transabdominal preperitoneal (TAPP) LIHR training and evaluated its validity. Methods: We developed a high‐quality mock peritoneum with a hydrated polyvinyl alcohol layer and a unique two‐way crossing cellulose fiber layer. To complete the simulation, the peritoneum was adhered to a urethane foam inguinal base with surgical landmarks. Participants could perform all the procedures required for the TAPP LIHR. Twenty‐four surgeons performed TAPP LIHR simulation using a novel simulator. Their opinions were rated on a 5‐point Likert scale. Additionally, 6 surgical residents and 10 surgical experts performed the procedure. Their performance was evaluated using the TAPP checklist score and procedure time. Results: Most participants strongly agreed that the TAPP LIHR simulator with an exchangeable peritoneum model was useful. The participants agreed on the model fidelity for tactile sensation, forceps handling, and humanlike anatomy. In comparisons between surgical residents and experts, the experts had significantly higher scores (10.6 vs. 17.2, p < 0.05) and shorter procedure times (92.3 vs. 55.9 min; p <.05) than did surgical residents. Conclusions: We developed a high‐quality exchangeable peritoneal model that mimics the human peritoneum's texture and fragility. This model enhances laparoscopic simulation training, potentially shortening TAPP LIHR learning curves. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF). Materials and methods: A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time. Results: Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern. Conclusion: Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary. [ABSTRACT FROM AUTHOR]

The extent to which coding skills are taught within ecology and evolution curricula remains largely unquantified. While coding, and especially R, proficiency is increasingly demanded in academic and professional contexts, many students encounter coding for the first time as postgraduates, presenting a steep learning curve alongside learning advanced statistics.With the emergence of large language models (LLMs), questions arise regarding the relevance of teaching coding when many of these tasks can now be automated. Here, we explore students' experiences with using LLMs for coding, highlighting both benefits and limitations.Through qualitative analysis of student perspectives, we identify several advantages of using LLMs for coding tasks, including enhanced search capabilities, provision of starting points and clear instructions, and troubleshooting support. However, limitations such as a lack of responsiveness to feedback and the prerequisite of extensive prior knowledge pose challenges to the effectiveness of student use of LLMs for coding at a beginner level. Concerns also arise regarding future access to LLMs, potentially exacerbating inequities in education.Despite the potential of LLMs, we argue for the continued importance of teaching coding skills alongside their integration with LLM support. Tutor‐supported learning is essential for building foundational knowledge, facilitating comprehension of LLM outputs and fostering students' confidence in their abilities. Moreover, reliance solely on LLMs risks hindering deep learning and comprehension, thereby undermining the educational process. Our experiences underscore the significance of maintaining a balanced approach, leveraging LLMs as supplementary tools rather than substitutes for coding education in ecology and evolution courses. [ABSTRACT FROM AUTHOR]

Confocal laser endomicroscopy (CLE) is a novel technique allowing real time in vivo microscopy during standard endoscopy. Recently, acute mucosal alterations after food administration visualized by CLE have been linked to symptoms in irritable bowel syndrome (IBS). Interestingly, the observed reactions occurred in subjects without demonstrable allergic sensitization to food—this is in line with mechanistic research showing local but not systemic allergic sensitization to foods in an animal model for IBS. Here, European experts conducting CLE with food administration provide a narrative review of the available literature and propose practical guidance on the use of this technique. CLE allows physicians to observe acute mucosal reactions after the application of food to the duodenal mucosa in patients with functional gastrointestinal disorders. Some open‐label interventions show a symptomatic benefit when patients exclude the nutrient that triggered an acute mucosal reaction. However, many technical, mechanistic, and clinical questions remain unanswered to date. Technically, the interobserver variability and learning curve requires systematic evaluation and criteria or cutoffs for alterations require validation. Mechanistic studies are needed to enhance our understanding of the mechanisms underlying observed alterations. Finally, rigorous blinded controlled studies are needed to assess a link of these observed alterations with symptom generation. CLE offers a platform allowing scientific insights related to food induced acute mucosal alterations. However, many questions remain unanswered, and more research is warranted to understand the role of acute mucosal alterations visualized upon food administration in IBS pathophysiology and treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion The robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation.To compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation.Thirteen Chinese male patients with Norwood–Hamilton II–IV AGA aged 25–35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow‐up results were investigated and evaluated.The total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries.The current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery. [ABSTRACT FROM AUTHOR]

Effective professional development (PD) in teaching writing involves supporting teachers' knowledge of the writer's craft, including their thinking processes, linguistic knowledge and practical strategies for teaching these. Grammar‐for‐writing approaches support teachers' knowledge of how grammar creates meaningful effects in writing. While training initiatives support teachers' knowledge of writing processes, more is needed to transfer process knowledge into effective teaching. Synthesising “writerly processes” with grammar‐for‐writing strategies may support teachers' classroom practice. This article explores the development of a workshop for teachers on a novel imaginative embodiment approach for teaching narrative writing, which links imaginative thinking and linguistic knowledge. The article reports on a study with Year 5 international school teachers in Hong Kong and their perceived efficacy of the approach after trialling it in their classrooms throughout a narrative writing unit, with the purpose of informing future teacher training. Findings from semi‐structured interviews showed that teachers perceived imaginative embodiment as supporting their “insider” understanding of writing processes through purposeful and specific strategies resulting in student improvements. However, unfamiliarity with the approach and insecure linguistic subject knowledge resulted in a steep learning curve. It is argued that imaginative embodiment training may develop teachers' understanding of, and strategies for, teaching the link between narrative imagination and grammatical choice, but training should cater to teachers' prior linguistic knowledge. [ABSTRACT FROM AUTHOR]

The article discusses the use of transvaginal ultrasound (TVUS) for diagnosing endometriosis. It suggests that a simplified protocol focusing on specific anatomical structures can provide an efficient and accessible method for initial assessment. The authors argue for wider availability of TVUS in community imaging facilities to reduce diagnostic delay and improve quality of life for those with endometriosis. They also emphasize the importance of early diagnosis and propose incorporating endometriosis assessment into routine gynecological ultrasound examinations. However, they caution that a negative scan result does not rule out the possibility of endometriosis and further investigations may be needed. [Extracted from the article]

Objectives: To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience. Methods: Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log‐rank testing as appropriate. Results: From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (p = 0.0004). Conclusions: During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve. [ABSTRACT FROM AUTHOR]

The article "Jung vs Borg: Finding the Deeply Human in a Posthuman Age" by Glen Slater explores the intersection of C.G. Jung's work and the impact of AI and cyborgs on humanity. Slater argues for a synthesis between technology and humanity that values depth, enchantment, and the arts. He critiques the horizontal world of information saturation and the devaluation of the natural, psychic, and spiritual worlds. Slater also examines the role of postmodernism and the unconscious in shaping our understanding of reality and the potential loss of our authentic human responses. The article concludes with a call for a contemplative shift in vision that restores vertical modes of understanding and embraces timeless archetypal patterns. [Extracted from the article]

Objectives: There is a lack of data on the number of surgeries required for endoscopic combined intrarenal surgery (ECIRS). Accordingly, we aimed to identify the learning curve for ECIRS performed by multiple surgeons. Methods: We included 296 patients who underwent ECIRS at our university hospital between 2016 and 2021. A learning curve for percutaneous nephrolithotomy side was calculated considering urology‐resident surgeons. The learning curve was retrospectively analyzed for surgical time, renal puncture time, stone‐free rate, and complications and corrected for age, body mass index, stone size, computed tomography value, cumulative number of surgeries, and stone location. Results: This study included cases performed by 32 surgeons, including 30 residents and 2 attending surgeons. The median number of surgeries performed by the residents and attending surgeons prior to this study was 4.5 and 90, respectively. The median number of surgical procedures performed during the training period was seven. The surgical time of the residents decreased as the number of cases increased, reaching a median surgical time of 111 min for the attending surgeons after 16.4 cases. Renal puncture time was achieved in 20.1 cases. Complications related to renal access were observed in 13.0% (34 patients), Clavien–Dindo grade II in 1.9% (5 patients), and grade III or higher in 0.8% (2 patients). Comparing the first to fifth cases with the 21st and subsequent cases, the complication rate improved from 35% to 13%. Conclusion: Our study demonstrated that ECIRS training provided 16–20 cases with a learning curve to achieve acceptable surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether individuals with long‐term reduced stereopsis were able to obtain the same level of surgical skills in simulated vitreoretinal surgery on the Eyesi Surgical Simulator as individuals with normal stereopsis. Methods: Twenty‐four medical students were recruited and divided into two groups according to their degree of stereopsis: Group 1 (n = 12) included subjects with normal stereopsis (60 arcsec or lower) and Group 2 (n = 12) included subjects with reduced stereopsis (120 arcsec or higher). Stereopsis was tested using the TNO test (Lameris Ootech BV, Nieuwegein, the Netherlands). The participants were trained in virtual reality‐simulated vitreoretinal surgery and continuously measured using a test with solid validity evidence and a pre‐defined pass–fail score. All data were analysed using the Wilcoxon rank sum test. Results: We observed no differences in overall performance scores for any of the four modules. The participants with reduced stereopsis used 5.8 more attempts in bimanual training (p = 0.04), 8.8 more attempts in removal of posterior hyaloid (p = 0.04), 9.1 more attempts in navigation training (p = 0.20) and 0.3 fewer attempts in removal of internal limiting membrane (p = 0.69). Conclusion: The final performance scores on the Eyesi Surgical Simulator were independent of the degree of stereopsis. However, the number of attempts to achieve the pre‐defined pass–fail score increased significantly with reduced stereopsis in two of four modules. These results indicate that a high degree of stereopsis is not necessary to become proficient in microsurgery but may prolong the learning curve. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Two Hong Kong Chinese non‐laboratory‐based prediabetes/diabetes mellitus (pre‐DM/DM) risk models were developed using logistic regression (LR) and machine learning, respectively. We aimed to evaluate the models' validity in case finding of pre‐DM/DM in a Chinese primary care (PC) population. We also evaluated the validity of a risk‐scoring algorithm derived from the LR model. Materials and Methods: This was a cross‐sectional external validation study on Chinese adults, without a prior DM diagnosis, who were recruited from public/private PC clinics in Hong Kong. A total of 1,237 participants completed a questionnaire on the models' predictors. Of that, 919 underwent blood glucose testing. The primary outcome was the models' and the algorithm's sensitivity in finding pre‐DM/DM cases. The secondary outcomes were the models' and the algorithm's specificity, positive/negative predictive values, discrimination and calibration. Results: The models' sensitivity were 0.70 (machine learning) and 0.72 (LR). Both showed good external discrimination (area under the receiver operating characteristic curve: machine learning 0.744, LR 0.739). The risks estimated by the models were lower than the observed incidence, indicating poor calibration. Both models were more effective among participants with lower pretest probabilities; that is, age 18–44 years. The algorithm's sensitivity was 0.77 at the cut‐off score of ≥16 out of 41. Conclusion: This study showed the validity of the models and the algorithm for finding pre‐DM/DM cases in a Chinese PC population in Hong Kong. They can facilitate more cost‐effective identification of high‐risk individuals for blood testing to diagnose pre‐DM/DM in PC. Further studies should recalibrate the models for more precise risk estimation in PC populations. [ABSTRACT FROM AUTHOR]

Objective: Three‐dimensional (3D) endoscopy has been developed to provide depth perception to allow for improved visualisation during otolaryngology surgery. We conducted a systematic review to determine the surgical safety and efficacy of 3D endoscopy in comparison to two‐dimensional (2D) endoscopy in performing otolaryngology procedures, and the role of 3D endoscopy as a training tool for novice otolaryngology surgeons. Methods: Primary studies were identified through MEDLINE, Embase and Web of Science databases, which were searched for articles published through June 2022 that compared the outcomes of 2D and 3D endoscopy in otolaryngology surgical procedures or otolaryngology‐relevant simulations. Candidate articles were independently reviewed by two authors. Results: A total of 18 full‐text articles met inclusion criteria for this study. In clinical trials (n = 8 studies, 362 subjects), there were no significant differences in performance time, intraoperative or postoperative complications with 3D endoscopes when compared to 2D. In simulation studies (n = 10 studies, 336 participants), 3D endoscopes demonstrated a decreased error rate (n = 5 studies) and shorter performance time (n = 3 studies). Studies also reported improved depth perception (n = 14 studies) and visualisation preference (n = 5 studies) with 3D over 2D systems. The 3D systems were found to have a shorter learning curve and better manoeuvrability among novice surgeons. Conclusion: 3D endoscopy showed equivalent safety and efficacy compared to 2D endoscopy in otolaryngology surgery. The improved depth perception and performance for novices using 3D endoscopes suggests the technology may be superior to 2D endoscopes as a training tool for otolaryngology surgeons. [ABSTRACT FROM AUTHOR]

Although warmth is a key sign of inflammatory skin lesions, an objective assessment and follow‐up of the temperature changes are rarely done in dermatology. The recent availability of accurate, sensitive and cost‐effective thermography devices has made the implementation of thermography in clinical settings feasible. The aim of this scoping review is to summarize the evidence around the value and pitfalls of infrared thermography (IRT) when used in the dermatology clinic. A systematic literature search was done for original articles using IRT in skin disorders. The results concerning the potential of IRT for diagnosis, severity staging and monitoring of skin diseases were collected. The data on the sensitivity and specificity of IRT were extracted. Numerous studies have investigated IRT in various skin diseases, revealing its significant value in wound management, skin infections (e.g. cellulitis), vascular abnormalities and deep skin inflammation (e.g. hidradenitis suppurativa). For other dermatological applications such as the interpretation of intradermal and patch allergy testing, hyper−/anhidrosis, erythromelalgia, cold urticaria and lymph node metastases more complex calculations, provocation tests or active cooling procedures are required. Dermatologists should be aware of a learning curve of IRT and recognize factors contributing to false positive and false negative results. Nonetheless, enough evidence is available to recommend IRT as a supplement to the clinical evaluation for the diagnosis, severity and follow‐up of several skin diseases. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion This EUROMACS study was conducted with the primary aim of investigating the association between a centre's annual caseload and postoperative outcomes among patients undergoing left ventricular assist device (LVAD) implantation.A total of 4802 patients identified between 2011 and 2020 from 35 participating centres were dichotomized based on the annual caseload of the treating centre at the time of device implant (≤30 vs. >30 LVAD implantations/year). The primary endpoint was 1‐year survival. Secondary outcomes included overall survival analysis, device‐related adverse events and readmissions. Cumulative follow‐up was 10 003 patient‐years, with a median follow‐up of 1.54 years (interquartile range 0.52–3.15). Patients from higher volume centres more frequently presented in INTERMACS levels 1 and 2, suffered from right heart dysfunction and needed inotropic support. No difference was observed in adjusted 1‐year survival. Adjusted overall survival probability was lower in higher volume centres (p = 0.002). In the subgroup analysis of HeartMate 3 devices only, higher volume centres were associated with decreased odds of 1‐year survival (adjusted odds ratio 0.43, 95% confidence interval 0.20–0.97, p = 0.041). Similar findings were observed in the cumulative (i.e. learning curve) caseload analyses.In patients undergoing LVAD implantation, centre volume was not associated with 1‐year survival, but was related to device‐related adverse events. Patient profiles differed with respect to centre size. These findings underscore the necessity for ongoing quality improvement initiatives in all centres, regardless of their annual caseload. Efforts are needed to standardize patient selection and preconditioning to further improve patient outcome. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To determine the number of sessions required using procedural simulation to acquire the skill of vaginal examination, which is an essential part of obstetrics, but a difficult learned skill.Using a high‐fidelity simulator, we conducted a prospective, single‐center, single‐blind study, at the Angers School of Midwifery. A class of students completed a theory course, and took part in three simulation sessions. During the simulation sessions, each student was asked to describe five different cervixes, under five criteria: position, length, consistency, dilation, and head station. Each participant received individual feedback as part of a debrief session, after completing their description. A pass rate of 80% was set for the entire class.Twenty‐six students participated. The class achieved a mean score of 70.77 ± 10.23% in the first session, 81.85 ± 9.91% in the second session, and 81.23 ± 8.63% in the third session. There was a significant improvement only between the first and second sessions (P < 0.001). Of the 26 participants, 6 (23%) scored over 80% in the first session, 17 participants (65%) scored above 80% in the first two sessions, and 21 participants (80%) scored above 80% over the three sessions.Learning vaginal examination by procedural simulation with the aid of a high‐fidelity simulator, and receiving individual feedback and debrief, resulted in an 80% pass rate in two practical sessions, working to describe 10 cervixes. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. Methods: A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre‐ and postoperative urinary flow tests, and complications were collected retrospectively. Results: We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51–92 years) and prostate volume was 56 cc (15–190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. Conclusions: Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results. [ABSTRACT FROM AUTHOR]

This article discusses a new surgical method for laparoscopic total colectomy, a procedure used to treat conditions such as ulcerative colitis and familial adenomatous polyposis. The traditional laparoscopic approach to this procedure is complex and challenging, requiring constant adjustments to trocars and the laparoscopic monitor. The new method, called laparoscopic total colectomy via bilateral lateral-to-medial dissection approach, simplifies the procedure and reduces surgical time. The article provides a detailed description of the surgical steps involved in this new approach and highlights its advantages, including minimal blood loss and injury, reduced operating time, and ease of mastery. The authors recommend this technique to others. [Extracted from the article]

Background and Aim: Tip‐in endoscopic mucosal resection (EMR) has a high en bloc resection rate for large colorectal neoplasms. However, non‐experts' performance in Tip‐in EMR has not been investigated. We investigated whether Tip‐in EMR can be achieved effectively and safely even by non‐experts. Methods: This retrospective study included consecutive patients who underwent Tip‐in EMR for 15–25 mm colorectal nonpedunculated neoplasms at a Japanese tertiary cancer center between January 2014 and December 2020. Baseline characteristics, treatment outcomes, learning curve of non‐experts, and risk factors of failing self‐achieved en bloc resection were analyzed. Results: A total of 597 lesions were analyzed (438 by experts and 159 by non‐experts). The self‐achieved en bloc resection (69.8% vs 88.6%, P < 0.001) and self‐achieved R0 resection (58.3% vs 76.5%, P < 0.001) rates were significantly lower in non‐experts with <10 cases of experience than in experts, but not in non‐experts with >10 cases. Adverse event (P = 0.165) and local recurrence (P = 0.892) rates were not significantly different between experts and non‐experts. Risk factors of failing self‐achieved en bloc resection were non‐polypoid morphology (OR 3.4, 95% CI 1.6–7.3, P = 0.001), lesions with an underlying semilunar fold (OR 3.6, 95% CI 1.6–7.3, P < 0.001), positive non‐lifting sign (OR 3.1, 95% CI 1.2–8.0, P = 0.023), and non‐experts with an experience of ≤10 cases (OR 3.6, 95% CI 2.1–6.3, P < 0.001). Conclusion: The clinical outcomes of Tip‐in EMR for 15–25 mm lesions performed by non‐experts were favorable. [ABSTRACT FROM AUTHOR]

Introduction: The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single‐center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center. Methods: A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty‐one patients were implanted by primary or bail‐out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath. Results: Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP. Conclusion: Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates. [ABSTRACT FROM AUTHOR]

The Limnology & Oceanography (L&O) Letters Early Career Publication Honor (ECPH) was created to amplify underrepresented voices in aquatic sciences and support the publication of Open Access articles by selected early career researchers. The program provides honorees with pre-submission editorial support, a waiver for the Article Processing Charge, and post-publication social media promotion. The ECRs who received the honor share their perspectives and advice, highlighting the benefits of the friendly review process, the opportunity to be lead and corresponding authors, the waiver of publication fees, and the cumulative impacts of the experience. They also provide tips for manuscript writing and publishing in L&O Letters, and encourage other ECRs to apply for the ECPH. [Extracted from the article]

Machine learning (ML) has been extensively applied in various disciplines. However, not much attention has been paid to data heterogeneity in databases and number of samples used to train ML models in hydrology. In this study, we addressed these issues and their impacts on the accuracy and reliability of ML models in the estimation of saturated hydraulic conductivity, Ks. We selected 17,990 soil samples from the USKSAT database and created random subsets N = 2,000, 4,000, 6,000, 8,000, 10,000, 12,000, 14,000, 16,000, and 17,990, 80% of which were used for training. The random subset selection was repeated 50 times. The extreme gradient boosting (XGBoost) algorithm was used to estimate Ks from other soil properties, such as bulk density, soil depth, texture, and organic content. For each subset, we conducted the learning curve analysis on the training and cross‐validation data sets. Results showed that for all training sample sizes the number of samples was not enough for the training and cross‐validation curves to reach a plateau. We also applied the concept of representative elementary volume by plotting the average coefficient of determination, R2, and root mean square log‐transformed error, RMSLE, against the training sample size. For the testing data set, as the number of training sample size increased from 1,600 to 14,392 the average R2 value increased from 0.74 to 0.90, while the average RMSLE value decreased from 1.08 to 0.69. Either the learning curve or representative sample size analysis is required to investigate whether the number of samples is enough or not. Key Points: Learning curves were applied to address effects of data heterogeneity and number of samples on machine learning‐based model estimationsConcept of representative elementary volume was used to determine the representative sample size in machine learningThe number of samples was not enough for the training and cross‐validation curves to reach a plateau [ABSTRACT FROM AUTHOR]

This article is concerned with sample size determination methodology for prediction models. We propose to combine the individual calculations via learning‐type curves. We suggest two distinct ways of doing so, a deterministic skeleton of a learning curve and a Gaussian process centered upon its deterministic counterpart. We employ several learning algorithms for modeling the primary endpoint and distinct measures for trial efficacy. We find that the performance may vary with the sample size, but borrowing information across sample size universally improves the performance of such calculations. The Gaussian process‐based learning curve appears more robust and statistically efficient, while computational efficiency is comparable. We suggest that anchoring against historical evidence when extrapolating sample sizes should be adopted when such data are available. The methods are illustrated on binary and survival endpoints. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the learning curve (LC) on perioperative and long‐term functional outcomes of a consecutive single‐centre series of robot‐assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. Patients and Methods: Patients treated between 2013 and 2022 were included, with ≥1 year of follow‐up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1‐year day‐ and night‐time continence. Uni‐ and multivariable Cox regression analyses identified predictors of day‐ and night‐time continence recovery. Day‐time continence was defined as 'totally dry' (no pads), night‐time continence as pad wetness ≤50 mL (one safety pad). Results: Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30‐day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1‐year day‐ and night‐time continence probabilities displayed a significant improving trend (day‐time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night‐time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day‐ (hazard ratio [HR] 1.008; P < 0.001) and night‐time continence (HR 1.004; P = 0.03) over time. Conclusion: Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10‐year analyses, we observed a significant improving trend for both the 1‐year day‐ and night‐time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day‐ and night‐time continence rates. [ABSTRACT FROM AUTHOR]

In recent decades, nursing has been integrated into increasingly advanced and complex healthcare settings. One of the environments in which the level of preparation and expertise required of nurses is most adaptable is the operating room, where the variety of surgical approaches and the use of sometimes complex equipment at times requires a long learning curve. One of the specialties most affected in this regard is urology, with several techniques having emerged in recent years, particularly in the field of endoscopic treatment of benign prostatic hyperplasia (BPH). Understanding how the expertise of the surgical nurse may be influenced by the learning of new surgical procedures allows us to grasp how different the learning curve may differ between experienced and less experienced nurses in dealing with new surgical approaches. A total of 36 patients diagnosed with BPH and eligible for endoscopic treatments were enrolled (9 candidates for TURP, 9 for Holmium laser enucleation of the prostate (HoLEP), 9 for REZUM water vapour therapy, and 9 for UROLIFT). The nursing expertise was divided into three levels: novice (endoscopic room experience <6 months), competent (>1 year and 6 months of experience), and expert (experience >6 years). Objectively measurable data were collected regarding the instrumentation required to perform procedures, the setup time of the operating room and surgical devices, and the transition time between procedures in the same operating room. Surgical nurses were also asked to provide subjective commentary on the perceived difficulty in dealing with the four types of procedures. Regarding the learning curve of the surgical nurse, minimally invasive procedures were found to be more accessible to less experienced nurses. In particular, REZUM showed the most significant impact on reducing skill assimilation time. The impact of experience gained was notable for the endoscopic approaches of TURP and HoLEP: experienced surgical nurses were faster in acquiring new skills and setting up the materials needed for the surgical procedure. Considering nursing staff expertise and learning needs in the urologic endoscopy operating room is necessary and desirable because it allows easier and faster learning of new surgical approaches, especially in more complex techniques. Relying on experienced nursing staff is also desirable because it has an impact on overall operating time. [ABSTRACT FROM AUTHOR]

Background: Though laparoscopic gastrectomy (LG) has become the gold standard for gastric cancer treatment according to the Japanese treatment guidelines, its learning curve remains steep. Decreasing numbers of surgeons and transitions in the work environment have changed LG training recently. We analyzed LG training over the last decade to identify factors affecting the learning curve. Study Design: Laparoscopic distal and pylorus‐preserving gastrectomies conducted between 2010 and 2020 were included. We assessed learning curves based on the standard operation time (SOT) defined by analysis of covariance. Then we divided the trainees into two groups based on the length of the learning curve and examined the factors affecting the learning curve with linear regression analysis. Results: Among 2335 LGs, 960 cases treated by 27 trainees and 1301 cases treated by six attending surgeons were analyzed. The operation time was prolonged (p = 0.009) and postoperative morbidity rates were lower (p = 0.0003) for cases treated by trainees. Trainees experienced 38 (range, 9–81) cases as scopists and nine (range, 0–41) cases as first assistants to the first operator. The learning curve was approximately 30 cases. The SOT was calculated based on gender, body mass index, tumor location, reconstruction, and lymph node dissection. Trainees who had shorter learning curves had more experience (51–100 cases) with any laparoscopic surgery before LG training than the others (11–50 cases, p = 0.017). Conclusion: Sufficient experience with laparoscopic surgery before starting LG training might contribute to the efficiency of LG training and shorten the learning curve. [ABSTRACT FROM AUTHOR]

Objective: To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency. Materials and Methods: All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non‐risk‐adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection. Results: Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases. Conclusions: A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain. [ABSTRACT FROM AUTHOR]

Background: Several guidelines exist for minimally invasive pancreatoduodenectomy (MIPD) regarding its prerequisites and learning curve. However, these guidelines are based on the experience of the pioneers of MIPD; minimal data exist on the experience of the next generation of surgeons. The aim of this study was to compare the two surgeon types (veteran and junior) for MIPD in terms of immediate postoperative outcomes. Methods: The postoperative outcomes of 22 patients who underwent robot‐assisted pancreatoduodenectomy (RAPD) by a junior surgeon from July 2021 to December 2022 were retrospectively reviewed. The outcomes were compared with the initial postoperative outcomes and the contemporary postoperative outcomes of RAPD by a veteran surgeon. Results: In comparing the initial outcomes between the two surgeon types, the veteran surgeons showed a shorter operation time (junior surgeon vs. veteran surgeon: 606 ± 89 vs. 467 ± 77 min, p < 0.001). However, there was no significant difference in terms of postoperative outcomes, such as blood loss (300 [200–600] ml. vs. 200 [100–500] ml, p = 0.208), major complications (≥CDC IIIa: 4 (18.2%) vs. 4 (18.2%), p = 1.000), postoperative pancreatic fistula (POPF; ≥ISGPF Grade B: 2 (9.1%) vs. 3 (13.6%), p > 0.999), and length of hospital stay (18.0 ± 8.9 days vs. 18.3 ± 7.9 days, p = 0.915), between the two surgeon types. In addition, in a comparison of the contemporary outcomes, there was no significant difference in terms of postoperative outcome (complications: 4 (18.2%) vs 11 (11.1%), p = 0.580; POPF: 2 (9.1%) vs. 3 (3.0%), p = 0.484; length of hospital stay: 18.0 ± 8.9 vs. 15.0 ± 6.5 days, p = 0.065). Conclusion: The initial outcomes of MIPD by a well‐trained junior surgeon were found to be comparable to those of MIPD by a veteran surgeon. [ABSTRACT FROM AUTHOR]

The article discusses the use of fast approximate random forests using subsampling (rfsrc.fast) in determining sample sizes for random survival forests. The authors question the methodology used to tune and fit random survival forest models, suggesting that the subsampling strategy may disadvantage the model's performance compared to other models. They propose alternative tuning strategies, such as sampling with replacement, to improve model accuracy. The study emphasizes the importance of sharing open code to facilitate scientific research and collaboration. [Extracted from the article]

The article in the journal "Pediatric Anesthesia" discusses the use of Cumulative Sum (CUSUM) analysis to evaluate the performance of anesthesia residents in conducting caudal blocks during pediatric anesthesia rotations. The study aimed to determine the number of caudal blocks needed for residents to achieve competency and acceptable failure rates. The analysis found that five out of 17 residents achieved competency, with the minimum number of repetitions for caudal blocks ranging from 6 to 20 procedures. The study acknowledges limitations such as a small sample size and inconsistent data collection, but highlights the potential of CUSUM analysis in assessing residents' technical skills and learning curves. [Extracted from the article]

Introduction: Near‐infrared autofluorescence imaging (NIFI) can be used to identify parathyroid gland (PG) during surgery. The purpose of the study is to establish a new model, help surgeons better identify, and protect PGs. Methods: Five hundred and twenty three NIFI images were selected. The PGs were recorded by NIFI and marked with artificial intelligence (AI) model. The recognition rate for PGs was calculated. Analyze the differences between surgeons of different years of experience and AI recognition, and evaluate the diagnostic and therapeutic efficacy of AI model. Results: Our model achieved 83.5% precision and 57.8% recall in the internal validation set. The visual recognition rate of AI model was 85.2% and 82.4% on internal and external sets. The PG recognition rate of AI model is higher than that of junior surgeons (p < 0.05). Conclusions: This AI model will help surgeons identify PGs, and develop their learning ability and self‐confidence. [ABSTRACT FROM AUTHOR]

This research surveys current knowledge about forgetting curves and their application in production, aiming to identify the main characteristics and tendencies and research gaps on this topic. Faced with the need to improve tools that allow production planners to predict programmed batches with greater precision, it was found that there are still gaps to be filled that allow the application of learning and forgetting techniques in the production process. To compose the scope of this research, a systematization of the existing literature was carried out, using the keywords 'forgetting curves', 'total forgetting', 'learning and forgetting curve' and 'forgetting effects', in the databases of Science Direct, Scielo, Scopus, Web of Science and Google Academics, which allowed classifying and organizing the developed models into 3 groups: Deterministic models, Statistical models and Functional models. This systematic process consisted of selecting databases, filtering publications, reviewing information, and analysing models, providing a detailed analysis on a topic that, despite being promising, is poorly explored in the industry, demonstrating and indicating gaps in research and application. To be filled. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic gastric bypass (LGB) is an increasingly utilized approach to bariatric surgery in Australia. A high proportion of those procedures are revisional due to Australia's legacy of laparoscopic adjustable gastric banding (LAGB), which is not the case internationally. The aim of this study was to compare post‐operative outcomes in an Australian general foregut surgery unit against benchmarks published in the literature. Methods: This is retrospective cohort study of morbidly obese patients undergoing primary or revisional laparoscopic Roux‐en‐Y gastric bypass (RYGB) or laparoscopic one anastomosis gastric bypass (OAGB) with the two senior authors between 5 May 2015 and 27 June 2019. Perioperative data for the unit's first 100 cases were collected prospectively, stored on a unit database and analysed. Post‐operative complications at 30 days, 90 days, mortality, length of hospital stay, and Defined Adverse Events were chosen as indicators of the perioperative outcome (as defined in the Monash Bariatric Surgery Registry). Results: In this cohort, 35% of procedures were RYGB and 65% were OAGB. The majority (58%) were revisional procedures. Most patients (74%) were female. The median age was 50. The comorbidity profile of the population was similar to those published internationally. The median hospital stay was 4 days. There was no mortality. Early complications occurred in 9% of patients, with 3% occurring late. Conclusion: Outcomes of our first 100 cases are comparable with those recorded in the literature, notwithstanding a much higher proportion of revisional cases. LGB can be safely introduced in Australian general foregut surgery units by experienced laparoscopic surgeons. [ABSTRACT FROM AUTHOR]

Objective: Despite the increasing popularity of Endoscopic Ear Surgery (EES), there is a lack of evidence to guide trainees as they introduce EES into practice. This review aims to evaluate training in EES including the optimal introductory procedures, methods of training, the learning curve, and the determination of competency in EES. In addition, this review seeks to identify any areas falling within these themes requiring further clarification. Data Sources: A database search of Pubmed, Embase and the Cochrane Library was conducted in June 2022. Original articles, systematic reviews, and meta‐analyses reporting on training in EES, introduction into practice, learning curves, and competency assessment were included. Review Methods: A scoping review was carried out in accordance with the Joanna Briggs Institute guidelines and reported according to PRISMA guidelines for scoping reviews. A qualitative assessment of results grouped thematically was performed. Results: Twenty‐eight studies met the inclusion criteria, with 24 rating as "fair" or "good" on quality assessment. Surgical simulation was the most frequently described method of training as utilized in 11 studies. The most suggested introductory procedure was tympanoplasty which was advocated for in five studies. Heterogeneity existed in the outcomes and methodologies used to measure EES learning curves, with an overreliance on surgical times. No robust definition of competency in EES procedures exists at present. Conclusions: Surgical simulation appears to be a beneficial training methodology for EES. However, there is a marked lack of objective data to describe the optimal introductory procedures or assessment of competency in EES. Laryngoscope, 133:3269–3278, 2023 [ABSTRACT FROM AUTHOR]

In 2012 the European Medicines Agency approved a pineapple stem‐derived Bromelain‐based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013–2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta‐Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain‐based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non‐surgical eschar removal treatment modality. The benefits of Bromelain‐based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain‐based debridement are expanding to cover "off‐label" cases with significant benefits to the global healthcare economy. [ABSTRACT FROM AUTHOR]

Objective: We introduced learning curves on a detailed step protocol and ergonomic aspect to determine key surgical points in transumbilical single‐port laparoscopic hysterectomy (TSPLH) and to popularize both technical and cognitive methodology on laparoendoscopic single‐site surgery (LESS). Materials and Methods: A retrospective analysis of 87 TSPLH procedures was conducted by a single surgeon in three learning stages. Technical, ergonomic, and cognitive steps were introduced, and surgical outcomes were analyzed. Results: Key production points in TSPLH include developing a clear retroperitoneal space, maintaining appropriate strength and direction with a vaginal manipulator, coagulating the uterine artery, and applying an improved vaginal stump suturing method. Technical factors included instrument domination, hand–eye coordination, and alternating hand functions. Ergonomic techniques focused on shoulder, elbow, arm, wrist, and finger movements, range of motion, muscle power, continuous forces, and flexibility. Improved cognitive factors such as confidence, decision‐making, and communication were also observed. Conclusions: The study aimed to form methodological education on TSPLH and LESS and benefit more surgeons. The detailed production and key ergonomic points will help guide self‐learning and education. Synopsis: The study improves transumbilical single‐port laparoscopic hysterectomy by introducing learning curves on technical, ergonomic, and cognitive aspects, benefiting more surgeons. [ABSTRACT FROM AUTHOR]

Background: Intensity‐modulated radiotherapy (IMRT) has been increasingly used for patients with locally advanced non‐small cell lung cancer (LA‐NSCLC). However, there are some barriers to implementing IMRT for LA‐NSCLC, including the complexity of treatment plan optimization. This study aimed to evaluate the learning curve of lung dose optimization in IMRT for LA‐NSCLC and identify the factors that affect the degree of achievement of lung dose optimization. Methods: We retrospectively evaluated 40 consecutive patients with LA‐NSCLC who received concurrent chemoradiotherapy at our institution. These 40 patients were divided into two groups: 20 initially treated patients (earlier group) and 20 subsequently treated patients (later group). Patient and tumor characteristics were compared between the two groups. The dose‐volume parameter ratio between the actually delivered IMRT plan and the simulated three‐dimensional conformal radiotherapy plan was also compared between the two groups to determine the learning curve of lung dose optimization. Results: The dose‐volume parameter ratio for lung volume to receive more than 5 Gy (lung V5) and mean lung dose (MLD) significantly decreased in later groups. The spread of the beam path and insufficient optimization of dose coverage of planning target volume (PTV) might cause poor control of lung V5, MLD. Conclusions: A learning curve for lung dose optimization was observed with the accumulation of experience. Appropriate techniques, such as restricting the beam path and ensuring dose coverage of PTV during the optimization process, are essential to control lung dose in IMRT for LA‐NSCLC. [ABSTRACT FROM AUTHOR]