2D versus 3D Endoscopy: Head-to-Head Comparison in a Simulated Model of Endoscopic Endonasal Dural Suturing

Objective Endonasal dural suturing (EDS) has been reported to decrease the incidence of cerebrospinal fluid fistula. This technique requires handling of single-shaft instrumentation in the narrow endonasal corridor. It has been proposed that three-dimensional (3D) endoscopes were associated with improved depth perception. In this study, we sought to perform a comparison of two-dimensional (2D) versus 3D endoscopy by assessing surgical proficiency in a simulated model of EDS. Materials and Methods Twenty-six participants subdivided into groups based on previous endoscopic experience were asked to pass barbed sutures through preset targets with either 2D (Storz Hopkins II) or 3D (Storz TIPCAM) endoscopes on 3D-printed simulation model. Surgical precision and procedural time were measured. All participants completed a Likert scale questionnaire. Results Novice, intermediate, and expert groups took 11.0, 8.7, and 5.7 minutes with 2D endoscopy and 10.9, 9.0, and 7.6 minutes with 3D endoscopy, respectively. The average deviation for novice, intermediate, and expert groups (mm) was 5.5, 4.4, and 4.3 with 2D and 6.6, 4.6, and 3.0 with 3D, respectively. No significant difference in procedural time or accuracy was found in 2D versus 3D endoscopy. 2D endoscopic visualization was preferred by the majority of expert/intermediate participants, while 3D endoscopic visualization by the novice group. Conclusion In this pilot study, there was no statistical difference in procedural time or accuracy when utilizing 2D versus 3D endoscopes. While it is possible that widespread familiarity with 2D endoscopic equipment has biased this study, preliminary analysis suggests that 3D endoscopy offers no definitive advantage over 2D endoscopy in this simulated model of EDS.

Determining Whether Tai Chi Chuan is Related to the Updating Function in Older Adults: Differences Between Experts and Novices

Background: Tai Chi Chuan (TCC) is one effective method used to delay cognitive decline in older adults. However, the relationship between the long-term practice of TCC and the crucial working memory updating function of the brain in the elderly has not been comprehensively researched.Objective: This cross-sectional study explores how behavioral performance in a laboratory setting is related to long term practice of TCC on the updating function in older people using reaction times (RTs) of N-back tasks. Methods: 26 healthy elderly people participated in this experiment. According to the length of time TCC was practiced, 13 subjects in the TCC group had more than 5 years’ experience of TCC exercise, and 13 elderly subjects who had not been systematically exposed to mind-body exercise were assigned to the novice group. The N-back task was administered to every participant to evaluate the updating function. Results: The TCC group had faster RTs compared to the novice group (p<0.05); For the 1-back task, the TCC group showed faster RTs than the novice group. For the 2-back task, the novice group exhibited faster RTs than the TCC group. Conclusions: TCC experts exhibit greater updating function as compared to TCC novices. Long-term TCC appears to be positive associated with the updating function of older adults, making it an effective exercise to maintain cognitive function in the elderly.

Twelve-Weeks of Virtual and In-Person Exercise Training Improve Static and Dynamic Balance in Female Cancer Patients

Background: Balance is important for maintaining activities of daily living and functional independence. Whether balance is improved in cancer patients after fitness training is unclear. The purpose of this study was to determine if 12-weeks of exercise improves balance and posture in female cancer patients. Methods: Thirty-eight female cancer patients were enrolled. Of the 16 patients who completed the program (mean age±SD: 65±10 years), 12 participants were novice and 4 were experienced exercisers. Six-weeks of exercise sessions were provided in-person and the remaining sessions were virtually delivered. The American College of Sports Medicine’s exercise recommendations were followed. Novice exercises received 36, 90-minute exercise sessions (3x/week) and experienced exercisers had 24, 90-minute sessions (2x/week). Posture was measured using the plumb line method and overhead squat test; balance was measured using the unipedal single leg stance and limits of stability (LOS). Body composition, cardiorespiratory fitness, muscular strength, and flexibility were also measured. Two-way repeated measures ANOVAs and Bonferroni’s multiple comparison tests were used to determine significant differences. Results: Balance on the left leg (eyes closed) and LOS with leftward excursion were significantly improved in experienced exercisers (P=0.0029), but not in the novice group (P=0.0013). Qualitative data showed that experienced exercisers had improved static and dynamic postural alignment of the lower body. Conclusions: While cardiorespiratory and muscular fitness significantly improved in the novice group, these patients did not show balance and postural improvements. Only the experienced exercisers had significant improvements in static and dynamic balance and lower body posture.

An Analysis of Heterogeneity in German Speaking Birdwatchers Reveals Three Distinct Clusters and Gender Differences

The purpose of this study was to segment birdwatchers into clusters. Members from a wide range of bird related organizations, from highly specialized birders as well as Facebook bird group members were studied to provide a diverse dataset (n = 2766; 50.5% men). Birding specialization was measured with a battery of questionnaires. Birding specialization encompassed the three constructs of skill/competence, behavior, personal and behavioral commitment. Additionally, involvement, measured by centrality to lifestyle, attraction, social bonding, and identity, was used. The NbClust analyses showed that a three-cluster solution was the optimal solution. Then, k-means cluster analysis was applied on three groups: casual/novice, intermediate, and specialist/advanced birdwatchers. More men than women were in the specialist/advanced group and more women than men in the casual/novice group. As a conclusion, this study confirms a three-cluster solution for segmenting German birdwatchers based on a large and diverse sample and a broad conceptualization of the construct birding specialization. These data can be used to address different target audiences (novices, advanced birders) with different programs, e.g., in nature conservation.

Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy

Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.

Research and development of a mixed reality and haptic-based dental simulator for tooth preparation and its preliminary evaluation (Preprint)

BACKGROUND Dental simulator is used in preclinical skills training and virtual reality is the main technology of it. With the development of XR technology, mixed reality appeared and it has significant advantage over virtual reality. OBJECTIVE This study intended to research and develop a mixed reality (MR) and haptic-based dental simulator for tooth preparation and preliminarily evaluate its face validity. METHODS A prototype of MR dental simulator for tooth preparation was innovatively developed by integrating the head-mounted display (HMD), special force feedback handles, foot pedal, computer hardware, and software program. Thirty-four participants were recruited and were divided into Novice group (N=17) and Skilled group (N=17) based on their clinical experience. All participants prepared a maxillary right central incisor for all ceramic crown in the dental simulator, and completed a questionnaire after the preparation to investigate their experience and evaluation toward the dental simulator in aspects of the hardware and software. RESULTS A prototype of MR dental simulator for tooth preparation (Unidental MR Simulator) was newly developed. 73.53% of the participants were satisfied with the overall experience in using Unidental MR Simulator. Over 90% of the participants agreed with that Unidental MR Simulator can stimulate their interest in learning and over 80 % of them were willing to use dental simulator Unidental MR Simulator for skills training in the future. The differences in the experience of the HMD, simulation of the dental instruments, realism of the force feedback of teeth, simulation of the tooth preparation process, overall experience of the simulator and attitudes toward the simulator between Novice group and Skilled group were not statistically significant (P>0.05). Novice group were more satisfied with the ease of use of the simulator. (P<0.05). The resolution of the HMD and the simulation of the preparation process had significant positive correlations with the overall using experience of the simulator (P<0.05). CONCLUSIONS The newly developed dental simulator for tooth preparation, Unidental MR simulator, has a good face validity. It can achieve a higher degree of similarity to the real clinical treatment environment by achieving position adjustment of patients, allowing users to have a better dental skill training experience.

Effects of decision-making on indoor bouldering performances: A multi-experimental study approach

The purpose of this study was to investigate whether novice, intermediate, and advanced bouldering athletes would differ in their decision-making abilities and to what extent distinct problem-solving tactics would affect the athletes’ bouldering performances. Seventy-seven male bouldering athletes participated in a multi-experimental study with the conceptual replication of three bouldering tasks. Participants were allocated according to their ability levels to the novice group (NOV with n = 18), the intermediate group (INT with n = 18), or the advanced group (ADV with n = 41). The data collected for movement analysis via video consisted of the pre-ascent decision-making times, the number of movement deviations from the best solution, the number of movement mistakes, the average gripping times, the bouldering times to the top, the number of successful ascents, and the number of attempts to complete the tasks. Results among all three experiments revealed shorter decision-making times, fewer movement mistakes, and shorter average gripping and bouldering times to the top in the ADV group than in the NOV group and the INT group. Furthermore, participants from the ADV group demonstrated fewer movement deviations than participants from the NOV group (in all three experiments) and the INT group (Experiment 1 and Experiment 2). Moreover, participants from the ADV group and the INT group were characterized, in all three experiments, by a higher number of successful ascents and a lower number of attempts to complete the tasks than participants from the NOV group. In total, these findings emphasize that accomplished decision-making abilities consist of a key determinant in successful indoor bouldering performances.

845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

Validation of a Virtual Reality Simulator for Percutaneous Pedicle Screw Insertion

Introduction: Working-hour restrictions, rota gaps and an increasing drive for theatre efficiency have resulted in challenges to surgical training. As a result, Virtual Reality (VR) has emerged as a popular tool to augment this training. Our aim was to evaluate the validity of a VR simulator for performing percutaneous pedicle screw guidewire insertion. Materials and Methods: Twenty-four participants were divided into three equal groups depending on prior surgical experience: a novice group (<10 procedures), an intermediate group (10-50 procedures) and an expert group (>50 procedures). All subjects performed four guidewire insertions on a TraumaVision® simulator (Swemac Innovation AB, Linköping, Sweden) in a set order. Six outcome measures were recorded; total score, time, fluoroscopy exposure, wire depth, zone of placement and wall violations. Results: There were statistically significant differences between the groups for time taken (p<0.001) and fluoroscopy exposure (p<0.001). The novice group performed the worst, and the expert group outperformed both intermediates and novices in both categories. Other outcome results were good and less variable. There was an observed learning effect in the novice and intermediate groups between each of the attempts for both time taken and fluoroscopy exposure. Conclusions: The study contributes constructive evidence to support the validity of the TraumaVision® simulator as a training tool for pedicle screw guidewire insertion. The simulator is less suitable as an assessment tool. The learning effect was evident in the less experienced groups, suggesting that VR may offer a greater benefit in the early stages of training. Further work is required to assess transferability to the clinical setting.

Effect of Music on the Efficiency of Performing a Microsurgical Arterial Anastomosis: A Prospective Randomized Study

Introduction Music is commonly played in operating rooms. Because microsurgery demands utmost concentration and precise motor control, we conducted the present study to investigate a potentially beneficial impact of music on performing a microsurgical anastomosis. Materials and Methods We included a novice group (15 inexperienced medical students) and a professional group (15 experienced microsurgeons) in our study. Simple randomization was performed to allocate participants to the music-playing first or music-playing second cohort. Each participant performed two end-to-end anastomoses on a chicken thigh model. Participant demographics, their subjective preference for work environment (music/no music), and time to completion were noted. The performance of the participants was assessed using the Stanford Microsurgery and Resident Training (SMaRT) scale by an independent examiner, and the final anastomoses were evaluated according to the anastomosis lapse index. Results Listening to music had no significant effect on time to completion, SMaRT scale, and anastomosis lapse index scores in both novice and professional cohorts. However, the subjective preference to work while listening to music correlated with high SMaRT scale scores within the professional cohort (p = 0.044). Conclusion Playing their preferred music in the operating room improves the performance scores of surgeons, but only if they subjectively appreciate working with background music.