Suturing is an expected skill for students graduating from health professions programs. Previous studies investigated student experience with teaching sessions utilizing constructive feedback versus ...compliments but did not investigate the combination of both.
In this parallel, randomized controlled trial, participants were divided into three groups: feedback (F), compliments (C), or feedback and compliments (FC). Participants received standardized instruction on simple interrupted suturing and two-handed knot-tying, and were videotaped performing this skill before and after the intervention. Performance was evaluated using a validated Objective Structured Assessment of Technical Skills (OSATS) instrument. Participants completed a preintervention and postintervention survey rating their task enjoyment and self-assessment of performance. Analysis was performed to determine differences between and within the groups using Kruskal–Wallis, Wilcoxon rank-sum, and Mann–Whitney U tests.
A total of 31 students participated: 11 in C, 10 in F, and 10 in FC. The groups had similar preintervention OSATS scores. The F and FC groups demonstrated significant improvement in OSATS score after intervention, group C was not significantly different: F median of 11.25-19.75 points (P = 0.002); FC median of 11.75-21 points (P = 0.002); C median of 13-14 points (P = 0.2266). Between the groups FC and F both had significant performance improvement compared with C (P < 0.001 and P = 0.001 respectively). The FC group had a significantly higher rating of their enjoyment of the task on the postintervention survey compared with both the C and F groups with a median rating of 10 compared with 8 and 8 (P = 0.0052 and P = 0.0126, respectively).
The combination of feedback and compliments was associated with improvement in performance on suturing and knot-tying similar to the feedback-only group. The FC group rated a higher level of enjoyment of the activity compared to feedback or compliments alone.
360° virtual reality (VR) video is an exciting and evolving field. Current technology promotes a totally immersive, 3-dimensional (3D), 360° experience anywhere in the world using simply a smart ...phone and virtual reality headset. The potential for its application in the field of surgical education is enormous. The aim of this study was to determine knot tying skills taught with a 360-degree VR video compared to conventional 2D video teaching.
This trial was a prospective, randomised controlled study. 40 foundation year doctors (first year postgraduate) were randomised to either the 360-degree VR video (n = 20) or 2D video teaching (n = 20). Participants were given 15 min to watch their allocated video. Ability to tie a single handed reef knot was then assessed against a marking criteria developed for the Royal College of Surgeons, England, (RCSeng) Basic Surgical Skills (BSS) course, by a blinded assessor competent in knot tying. Each candidate then underwent further teaching using Peyton's four step model. Knot tying technique was then re-assessed.
Knot tying scores were significantly better in the VR video teaching arm when compared with conventional (median knot score 5.0 vs 4.0 p = 0.04). When used in combination with face to face skills teaching this difference persisted (median knot score 9.5 vs 9.0 p = 0.01). More people in the VR arm constructed a complete reef knot than in the 2D arm following face to face teaching (17/20 vs 12/20). No difference between the groups existed in the time taken to construct a reef knot following video and teaching (median time 31.0s vs 30.5s p = 0.89).
This study shows there is significant merit in the application of 360-degree VR video technology in surgical training, both as an independent teaching aid and when used as an adjunct to traditional face to face teaching.
•To determine knot tying skills taught with a 360-degree Virtual Reality video compared to 2- Dimensional video teaching.•Using video teaching alone, knot tying scores were significantly better in the 360-degree Virtual Reality video arm.•More people in the 360-degree Virtual Reality video arm constructed a complete reef knot than in the 2-Dimensional arm.
•Novel horizontal tying force method for robustness design of building structures.•Method anchored within rational framework considering sudden member/support loss.•Consideration of ductility limit, ...dynamic amplification and surrounding structure.•Treatment of beam/floor tying, different sources of tying and load combinations.•Verified effectiveness and simplicity as a replacement for prescriptive tying rules.
This paper presents a rational method for the horizontal tying of multi-storey building structures aimed at robustness design and the mitigation of progressive collapse. Unlike current prescriptive tying force approaches, the new method benefits from i) a rational association with local damage scenarios consisting of the sudden loss of a column or a load-bearing wall, ii) the explicit consideration of the system ductility limit and dynamic amplification, iii) the systematic combination of various types of loading and sources of tying, and iv) supplementary methods for assessing the interaction of the affected floor system with the surrounding structure. Importantly, these relative benefits are still realised within a practical application framework that is comparable in simplicity to prescriptive tying rules, making the proposed tying method suitable for codification and as a replacement for prescriptive tying force requirements in the next generation of robustness design codes. Following a detailed exposition of the method formulation and parameters, the paper presents several studies which demonstrate the effectiveness of the proposed tying force method, concluding with an example that illustrates its application to a typical reinforced concrete floor system.
Tying is usually defined as the dominant company selling one product since the buyer must also purchase a different product or agree not to purchase the bonded product from other suppliers. This ...paper analyzes requirements imposed by the reported business actor on other parties deemed to have violated the tying and bundling under competition law in Indonesia, the U.S., and the European Union. Also, it discusses the application of the Rule of Reason by the competition commission in these three region. This study uses a comparative law approach. The results of the analysis show that a tying agreement is an agreement that requires the recipient of the supply to buy other products that are not necessarily needed. Usually, these agreements are entered into by two affiliated companies or at least cooperating partners, one of which occupies a dominant position to prevent competitors from entering the relevant market. Not all tying agreements have a negative impact. Therefore, an impact analysis is needed through a rule of reason approach, especially in digital-based industries.
Here we present a new method for coupled linear elasticity problems whose finite element discretization may lead to spatially non-coincident discretized interfaces. Our approach combines the ...classical Dirichlet–Neumann coupling formulation with a new set of discretized interface conditions obtained through Taylor series expansions. We show that these conditions ensure linear consistency of the coupled finite element solution. We then formulate an iterative solution method for the coupled discrete system and apply the new coupling approach to two representative settings for which we also provide several numerical illustrations. The first setting is a mesh-tying problem in which both coupled structures have the same Lamé parameters whereas the second setting is an interface problem for which the Lamé parameters in the two coupled structures are different.
We present a new method for coupled linear elasticity problems whose finite element discretization may lead to spatially non-coincident discretized interfaces. Our approach combines the classical ...Dirichlet–Neumann coupling formulation with a new set of discretized interface conditions obtained through Taylor series expansions. We show that these conditions ensure linear consistency of the coupled finite element solution. We then formulate an iterative solution method for the coupled discrete system and apply the new coupling approach to two representative settings for which we also provide several numerical illustrations. The first setting is a mesh-tying problem in which both coupled structures have the same Lamé parameters whereas the second setting is an interface problem for which the Lamé parameters in the two coupled structures are different.
Recently, the hybrid convolutional neural network hidden Markov model (CNN-HMM) has been introduced for offline handwritten Chinese text recognition (HCTR) and has achieved state-of-the-art ...performance. However, modeling each of the large vocabulary of Chinese characters with a uniform and fixed number of hidden states requires high memory and computational costs and makes the tens of thousands of HMM state classes confusing. Another key issue of CNN-HMM for HCTR is the diversified writing style, which leads to model strain and a significant performance decline for specific writers. To address these issues, we propose a writer-aware CNN based on parsimonious HMM (WCNN-PHMM). First, PHMM is designed using a data-driven state-tying algorithm to greatly reduce the total number of HMM states, which not only yields a compact CNN by state sharing of the same or similar radicals among different Chinese characters but also improves the recognition accuracy due to the more accurate modeling of tied states and the lower confusion among them. Second, WCNN integrates each convolutional layer with one adaptive layer fed by a writer-dependent vector, namely, the writer code, to extract the irrelevant variability in writer information to improve recognition performance. The parameters of writer-adaptive layers are jointly optimized with other network parameters in the training stage, while a multiple-pass decoding strategy is adopted to learn the writer code and generate recognition results. Validated on the ICDAR 2013 competition of CASIA-HWDB database, the more compact WCNN-PHMM of a 7360-class vocabulary can achieve a relative character error rate (CER) reduction of 16.6% over the conventional CNN-HMM without considering language modeling. By adopting a powerful hybrid language model (N-gram language model and recurrent neural network language model), the CER of WCNN-PHMM is reduced to 3.17%. Moreover, the state-tying results of PHMM explicitly show the information sharing among similar characters and the confusion reduction of tied state classes. Finally, we visualize the learned writer codes and demonstrate the strong relationship with the writing styles of different writers. To the best of our knowledge, WCNN-PHMM yields the best results on the ICDAR 2013 competition set, demonstrating its power when enlarging the size of the character vocabulary.
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