Abstract
The role of social media (SoMe) in surgical education is emerging as a tool that augments and complements traditional learning. As SoMe usage has steadily increased in our personal and ...professional lives, it is no surprise that it has permeated into surgical education. Different SoMe sites offer distinct platforms from which knowledge can be transmitted, while catering to various learning styles. The purpose of this review is to outline the various SoMe platforms and their use in surgical education. Moreover, it will discuss their effectiveness in teaching and learning surgical knowledge and skills as well as other potential roles SoMe has to offer to improve surgical education.
This review of the literature on small bowel carcinoma associated with Crohn’s disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also ...reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn’s disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn’s disease.
This paper investigates the energy and economic performance of several energy schemes that could potentially be applied to agricultural and zootechnical communities contributing to the international ...objectives of sustainable development. The proposed energy schemes involve integrated energy efficiency technologies and novel system layouts aiming at reaching the zero-energy goal at a community level, by considering collective energy actions with provision of benefits for members and stakeholders. The proposed scenarios include different innovative technologies, such as anaerobic digestion, cogeneration, biogas upgrading, solar, district heating and cooling. These layouts are modelled in TRNSYS simulation environment to perform dynamic simulations and parametric analyses of the pivotal system parameters. Such analyses are conducted to find out the best scenario and the size of its system components which optimize different energy and economic objective functions. To assess the feasibility of all proposed scenarios and energy schemes, as well as to investigate the potential of the developed models, proposed scenarios are studied for an existing community. This existing agricultural community named “La Bellotta”, is served through different technologies, including a gas fuelled co-generator and an anaerobic biodigester. Simulation results show that the investigated scenarios allow for achieving very high self consumption ratios of energy produced on-site (from 57 to 100%), high economic performance (measured by the profitability index up to 1.35 for the best investigated scenario) and environmental benefits. The case study provides examples of energy schemes in which citizens and communities have a major benefit to invest in projects including renewables technologies, energy efficiency, and positive energy services.
•Achieve zero-energy community goals for livestock farms.•Dynamic simulation to improve energy performance.•Multi-objective energy optimization for different layout configurations.•Model flexibility to enhance universal applicability.•Advanced economic analysis to prove the feasibility of investments.
Hair is an ideal tissue for tracing the human health conditions. It can be cut easily and painlessly, and the relative clinical results can give an indication of mineral status and toxic metal ...accumulation following long-term or even acute exposure. Different authors have found outdoor pollution phenomena, such as the levels, significantly alter metal and metalloid hair contents. This paper investigates the element concentration variability in hair samples collected from a not-exposed teenager, neither environmentally nor professionally. The sampling was carried out for one week, and the samples were collected from different locations on the scalp. A nuclear analytical methodology, i.e., the Instrumental Neutron Activation Analysis, is used for determining about 30 elements. Some differences have been found among the samplings as well as between the proximal and distal sections. A deep comparison with other similar studies worldwide present in the literature has been performed for evidencing the relationships and the differences due to different ethnical origins, lifestyles, diets, and climates among the different young populations.
Abstract Background The Script Concordance test (SCT) assesses clinical judgment. The purpose of this study was to determine whether a specialty-specific scoring key improves the validity of the SCT. ...Methods Thirty experts from 6 general surgery disciplines answered questions pertaining to their area of expertise. We created a scoring key of 5 amalgamated expert panel members. The answers of 227 general surgery residents were analyzed. Results The optimized test had a reliability level (Cronbach α) of .81. Scores increased progressively throughout all levels of training, with R5s scoring higher than R4s (R1, 42.7 ± 7.1; R2, 47.6 ± 7.5; R3, 48.7 ± 6.7; R4, 49.8 ± 7.7; R5, 52.9 ± 9.3). The average score of juniors (R1s + R2s, 45.1 ± 7.6) was significantly lower ( P < .001) than seniors (R3s + R4s + R5s, 50.4 ± 8.0). Conclusions We showed that specialty-specific experts must be used to develop the scoring key. This has important implications in the application of the SCT on a wider level.
Atmospheric pollution is an important task in life sciences and, in particular, inorganic fraction characterization is considered as an important issue in this field. For many years, researchers have ...focused their attention on the particulate matter fraction below 10 μm: in this case, our attention was also focused on PM2.5 (i.e., particles with a size fraction smaller than 2.5 μm) and PM1 (below 1 μm). This paper would like to investigate whether the element accumulation in different granulometric fractions is similar, or whether there are behavior dissimilarities. Among the different analytical techniques, the instrumental neutron activation analysis, an instrumental nuclear method, was used for its peculiarity of investigating the sample without performing any chemical-physical treatment. Forty-two daily samples using the reference method were collected, 15 filters for PM10, 18 for PM2.5, and 12 for PM1; the filters, along with primary standards and appropriate standard reference materials, were irradiated at the National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) R.C.-Casaccia’s Triga MARK II reactor. The irradiations carried out in the Rabbit and Lazy Susan channels allowed for the investigation of 36 elements and the relative Pearson’s correlations between elements and PM-fractions (PM10 vs. PM2.5 was good, whereas PM10 vs. PM1 was the worst). The Enrichment Factors were studied for the three fractions to show how anthropogenic sources have affected the element content. A comparison between these data and element levels determined worldwide showed that our concentrations were lower than those determined in similar scenarios. Furthermore, a statistical approach (source discrimination, hierarchical cluster analysis, principal component analysis) has allowed us to identify similarities between the samples: the airborne filters can be divided in two main groups (i.e., one made of PM10 and PM2.5 filters and one only of PM1 filters), meaning a different element contribution to this fraction coming from other sources present at the site.
An anomalous effect in the near field of crossing microwave beams, which consists of an unexpected transfer of modulation from one beam to the other, has found a plausible interpretation within the ...framework of a locally broken Lorentz invariance. A theoretical approach of this kind deserves to be reconsidered also in the light of further experimental work, including a counter-check of the phenomenon.
•ANN model coupled to an EMS for predictive-oriented control of energy community.•An optimization routine allows for the penetration of RES at community level.•Minimization of economic imbursement ...for customers at building level.•Rewarding is evaluated for the individual load management.•The developed control shows a significant energy and peak reduction in DR events.
This paper proposes an innovative algorithm for community energy management control, able to involve customers in energy trading by exploiting their potential energy flexibility. The main innovation relies on a matrix-based control system where the strategy considers individual and community priorities simultaneously. Through the individual energy flexibility and the community energy pool, the aggregated network energy supply is controlled and shaped. The presented model presents a generalized structure based on control volumes, and it can be universally applied to energy communities of different sizes, number of participants, energy carriers, penetration of photovoltaics, and electric vehicles. The predictive system is conceived from a recurrent neural network, which performs a real-time prediction on energy demands in buildings. Suitable energy flows optimization is also presented with different implications for economic and energy savings. Finally, to show the potential of the developed model, a suitable case study analysis is presented. Important results include the achievement of a typical win-win condition, where both the distribution system operator and final customers benefit from this strategy. Specifically, a reduction of energy demand during demand response events of about 21% is achieved, whereas the interaction with the electricity network decreases of about 15%.
Introduction
Exercise is beneficial to learning. The purpose of this research was to determine whether an episode of aerobic exercise prior to practice improves the acquisition and retention of ...laparoscopic skills in the fundamentals of laparoscopic surgery (FLS) simulator.
Methods
Baseline maximal physical fitness (VO2 max), performance on peg transfer (PT), pattern cut (PC), and intracorporeal suture (ICS) were measured for FLS naïve undergraduates. 2 Weeks later, participants were randomized into exercise (
E
) and control (
C
) groups.
C
did unrelated work for 40 min and then practiced PT and PC for 10 min, and ICS for 15 min. Final scores were recorded. In
E
, participants ran on a treadmill for 20 min at 60 % of their VO2 max. After a 15 min cool down, they engaged in identical FLS simulator training as group
C
. Both groups completed the NASA task load index (TLX) to assess workload. Retention was recorded 2 months after the training session. Groups were compared using
t
tests, χ
2
and Wilcoxon rank tests.
p
< 0.05 was considered significant.
Results
There were 52 participants (22 in
C
; 30 in
E
) with high physical fitness at baseline. Demographics between the groups were similar at baseline. There were no differences in VO2 max and scores on the three tasks at baseline (all
p
values NS). There was no statistical significance between the scores of the
C
and
E
groups at the training session and retention, except for higher PT scores in the
E
group after the training session.
Conclusion
In physically fit, surgically naïve students, one bout of aerobic exercise enhanced immediate learning of simple FLS skills but did not have an impact on more complex skills or on retention. The use of exercise in the surgical curriculum, or as a learning tool, warrants further investigation regarding how best to apply it.
Objectives Despite evidence supporting the value of the Fundamentals of Laparoscopic Surgery (FLS) curriculum, surgical educators still find it challenging to motivate residents to practice. Wiggio ...is an online networking and collaboration tool that allows learners to track performance, see what their peers are doing, and send and receive updates. The purpose of this study was to assess whether using Wiggio increases practice and improves performance of the FLS manual skills. Design After baseline FLS testing, residents were randomized into control (C) and Wiggio (W) groups. The practice events, time spent practicing, and best scores were recorded. Residents in the W group interacted with each other via the Wiggio website. The website moderator sent motivational messages, calendar reminders, and FLS-related articles. The best times and progress graphs for each resident were also posted online. After 4 weeks, all residents underwent final FLS testing and filled out a questionnaire. Setting The study was performed in a tertiary care center, at the Steinberg-Bernstein Centre for Minimally Invasive Surgery at the Montreal General Hospital. Participants Postgraduate year-1 and postgraduate year-2 general surgery residents with no or minimal FLS simulator experience were included. Results Of the 15 eligible residents, 14 participated, with 7 residents in each group. The FLS scores were similar at baseline (C = 56.9 ±14.2, W = 57. 6 ±14.7; p = 0.93). During the study period, twice as many residents in the W group practiced compared with those in the C group (4 vs 2); W-group residents reported more practice events than the C-group residents did (14 vs 4) and spent more time practicing in the laboratory (1035 vs 480 minutes). These results did not reach statistical significance. During practice sessions, proficiency scores were achieved for 40% of the tasks in the W group compared with 8.6% in the C group; however, this difference was also not significant. There was no difference in the FLS scores in both groups at the end of the study. The moderator spent an average of 6.5 minutes per day sending messages and managing the Wiggio website. Conclusions Participation in Wiggio seems to increase practice events and time spent training on FLS. Social networking may play a role in surgical education and learner motivation; however, the optimal use of Web 2.0 tools in resident education is not yet fully understood.
PDF
