Evaluation of Medical Students’ Attitudes and Performance of Basic Surgery Skills in a Training Program Using Fresh Human skin, Excised During Body Contouring Surgeries

BACKGROUND: Learning surgical skills in the operating room may be a challenge for medical students. Therefore, more approaches using simulation to enable students to develop their practical skills are required. OBJECTIVES: We hypothesized that (1) there would be a need for additional surgical training for medical students in the pre-final year, and (2) our basic surgery skills training program using fresh human skin would improve medical students' surgical skills. DESIGN: We conducted a preliminary survey of medical students to clarify the need for further training in basic surgery procedures. A new approach using simulation to teach surgical skills on human skin was set up. The procedural skills of 15 randomly selected students were assessed in the operating room before and after participation in the simulation, using Objective Structured Assessment of Technical Skills. Furthermore, subjective assessment was performed based on students' self-evaluation. The data were analyzed using SPSS, version 21 (SPSS, Inc., Chicago, IL). SETTING: The study took place at the Inselspital, Bern University Hospital. PARTICIPANTS: A total of 186 pre-final-year medical students were enrolled into the preliminary survey; 15 randomly selected medical students participated in the basic surgical skills training course on the fresh human skin operating room. RESULTS: The preliminary survey revealed the need for a surgical skills curriculum. The simulation approach we developed showed significant (p < 0.001) improvement for all 12 surgical skills, with mean cumulative precourse and postcourse values of 31.25 ± 5.013 and 45.38 ± 3.557, respectively. The self-evaluation contained positive feedback as well. CONCLUSION: Simulation of surgery using human tissue samples could help medical students become more proficient in handling surgical instruments before stepping into a real surgical situation. We suggest further studies evaluating our proposed teaching method and the possibility of integrating this simulation approach into the medical school curriculum.

Perceptions of work engagement of nurses in Taiwan

Purpose. The purpose of this study was to determine the perceptions of work engagement of Taiwanese nurses with 3 specific aims: (1) understand Taiwanese nurses' perceptions of work engagement; (2) explore the factors influencing work engagement, and (3) examine how work engagement impacts nursing care for patients. ^ Design. The study used an ethnographic approach with participant observation and semi-structured interviews with RNs. ^ Setting. The study was conducted in the highest and lowest nurse turnover medical surgical units at a regional teaching hospital in southwestern Taiwan. ^ Sample. Purposive sampling resulted in 28 formal interviews with RNs who provided direct patient care, had at least 3 months experience in nursing, and were full-time employees. ^ Methods. Descriptive data were collected through participant observation in each unit. Observations were made while attending meetings, continuing education sessions, and informal conversations with RNs. Field notes and audio recorded semi-structured interviews were analyzed using qualitative thematic analytic techniques. ^ Findings. Findings revealed perceptions of work engagement spanned four domains: patients ("wholehearted care"), work (positive attitude), self (fulfillment and happiness), and others (relationships with colleagues). Providing "wholehearted care" toward patients was the foundation of work engagement for nurses in Taiwan. Engaged nurses felt fulfilled, happy, and found "meaning" through the process of patient care. The study revealed five factors that influenced work engagement: personal, organizational, social, patient, and professional. The impact of work engagement on nurse and patient outcomes are confirmed. ^ Conclusions. Taiwanese nurses connect work engagement with patients, the job, oneself, and colleagues. "Wholehearted patient care" is the core manifestation of work engagement among these nurses. In contrast, studies in western business only focused on work attitudes. Losing interest and "heart" lead to work routines which can lead to individual unhappiness. Findings from this study validate the multiple factors contributing to work engagement of nurses. Job demands and resources can only partially explain what hinders work engagement. Work disengagement and burnout share some commonality but should be measured differently. An understanding of RNs' perceptions of work engagement may provide direction for strategies that improve work engagement leading to decreased RN turnover. ^

Domain-Specific Multi-Modeling of Security Concerns in Service-Oriented Architectures

As a common reference for many in-development standards and execution frameworks, special attention is being paid to Service-Oriented Architectures. SOAs modeling, however, is an area in which a consensus has not being achieved. Currently, standardization organizations are defining proposals to offer a solution to this problem. Nevertheless, until very recently, non-functional aspects of services have not been considered for standardization processes. In particular, there exists a lack of a design solution that permits an independent development of the functional and non-functional concerns of SOAs, allowing that each concern be addressed in a convenient manner in early stages of the development, in a way that could guarantee the quality of this type of systems. This paper, leveraging on previous work, presents an approach to integrate security-related non-functional aspects (such as confidentiality, integrity, and access control) in the development of services.

Mapping urban shrinkage in Europe. Training School Final Report. EU-COST Action TU0803

In the context of the European COST Action ‘Cities Regrowing Smaller’ (CIRES) a training was held in Dortmund, Germany from November 14th to 18th in 2011. The training school ‘Mapping Urban Shrinkage’ aimed to get young researchers and scholars from different European countries together to deal with questions of how to measure and illustrate shrinkage

Constraint-based runtime prediction of SLA violations in service orchestrations

Service compositions put together loosely-coupled component services to perform more complex, higher level, or cross-organizational tasks in a platform-independent manner. Quality-of-Service (QoS) properties, such as execution time, availability, or cost, are critical for their usability, and permissible boundaries for their values are defined in Service Level Agreements (SLAs). We propose a method whereby constraints that model SLA conformance and violation are derived at any given point of the execution of a service composition. These constraints are generated using the structure of the composition and properties of the component services, which can be either known or empirically measured. Violation of these constraints means that the corresponding scenario is unfeasible, while satisfaction gives values for the constrained variables (start / end times for activities, or number of loop iterations) which make the scenario possible. These results can be used to perform optimized service matching or trigger preventive adaptation or healing.

A constraint-based approach to quality assurance in service choreographies.

Knowledge about the quality characteristics (QoS) of service com- positions is crucial for determining their usability and economic value. Ser- vice quality is usually regulated using Service Level Agreements (SLA). While end-to-end SLAs are well suited for request-reply interactions, more complex, decentralized, multiparticipant compositions (service choreographies) typ- ically involve multiple message exchanges between stateful parties and the corresponding SLAs thus encompass several cooperating parties with interde- pendent QoS. The usual approaches to determining QoS ranges structurally (which are by construction easily composable) are not applicable in this sce- nario. Additionally, the intervening SLAs may depend on the exchanged data. We present an approach to data-aware QoS assurance in choreographies through the automatic derivation of composable QoS models from partici- pant descriptions. Such models are based on a message typing system with size constraints and are derived using abstract interpretation. The models ob- tained have multiple uses including run-time prediction, adaptive participant selection, or design-time compliance checking. We also present an experimen- tal evaluation and discuss the benefits of the proposed approach.

A sharing-based approach to supporting adaptation in service compositions

Data-related properties of the activities involved in a service composition can be used to facilitate several design-time and run-time adaptation tasks, such as service evolution, distributed enactment, and instance-level adaptation. A number of these properties can be expressed using a notion of sharing. We present an approach for automated inference of data properties based on sharing analysis, which is able to handle service compositions with complex control structures, involving loops and sub-workflows. The properties inferred can include data dependencies, information content, domain-defined attributes, privacy or confidentiality levels, among others. The analysis produces characterizations of the data and the activities in the composition in terms of minimal and maximal sharing, which can then be used to verify compliance of potential adaptation actions, or as supporting information in their generation. This sharing analysis approach can be used both at design time and at run time. In the latter case, the results of analysis can be refined using the composition traces (execution logs) at the point of execution, in order to support run-time adaptation.

Injuries in strength training: review and practical application

Purpose: This systematic review examines what is known about injuries in strength training. Methods: A systematic search was performed in PubMed and SportDiscus. Studies were included if they examined powerlifters, weightlifters, strongman athletes, bodybuilding athletes, individuals who undertook recreational weight training or weight training to complement athletic performance. Exposure variables were incidence, severity and body part injury. Results: After examining 1214 titles and abstracts, 62 articles were identified as potentially relevant. Finally, 11 were included in this systematic review. Conflicting results were reported on the relationships between injury definition and incidence or severity recorded. The lower back followed by the shoulder and knee are the most frequently affected areas in strength sports. Conclusion: Strength training is safe. However, the variety of injury definitions has makes it difficult to compare different studies in this field. New styles of reporting injuries have appeared, and could make increases these ratios. If methodological limitations in measuring incidence rate and severity injuries can be resolved, more work can be conducted to define the real incidence rate, compare it with others sports, and explore cause and effect relationships in randomized controlled trials. Key Words: strength training, injuries, specific strength sports, severity

Validation of an instrument for injury data collection in strength training

Purpose: To provide for the basis for collecting strength training data using a rigorously validated injury report form. Methods: A group of specialist designed a questionnaire of 45 item grouped into 4 dimensions. Six stages were used to assess face, content, and criterion validity of the weight training injury report form. A 13 members panel assessed the form for face validity, and an expert panel assessed it for content and criterion validity. Panel members were consulted until consensus was reached. A yardstick developed by an expert panel using Intraclass correlation technique was used to assess the reability of the form. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC).The strength training injury report form was developed, and the face, content, and criterion validity successfully assessed. A six step protocol to create a yardstick was also developed to assist in the validation process. Both inter-rater and intra rater reliability results indicated a 98% agreement. Inter-rater reliability agreement of 98% for three injuries. Results: The Cronbach?s alpha of the questionnaire was 0.944 (pmenor que0.01) and the ICC of the entire questionnaire was 0.894 (pmenor que0.01). Conclusion: The questionnaire gathers together enough psychometric properties to be considered a valid and reliable tool for register injury data in strength training, and providing researchers with a basis for future studies in this area. Key Words: data collection; validation; injury prevention; strength training

Quality of experience of adaptive video streaming: investigation in service parameters and subjective quality assessment methodology

The usage of HTTP adaptive streaming (HAS) has become widely spread in multimedia services. Because it allows the service providers to improve the network resource utilization and user׳s Quality of Experience (QoE). Using this technology, the video playback interruption is reduced since the network and server status in addition to capability of user device, all are taken into account by HAS client to adapt the quality to the current condition. Adaptation can be done using different strategies. In order to provide optimal QoE, the perceptual impact of adaptation strategies from point of view of the user should be studied. However, the time-varying video quality due to the adaptation which usually takes place in a long interval introduces a new type of impairment making the subjective evaluation of adaptive streaming system challenging. The contribution of this paper is two-fold: first, it investigates the testing methodology to evaluate HAS QoE by comparing the subjective experimental outcomes obtained from ACR standardized method and a semi-continuous method developed to evaluate the long sequences. In addition, influence of using audiovisual stimuli to evaluate the video-related impairment is inquired. Second, impact of some of the adaptation technical factors including the quality switching amplitude and chunk size in combination with high range of commercial content type is investigated. The results of this study provide a good insight toward achieving appropriate testing method to evaluate HAS QoE, in addition to designing switching strategies with optimal visual quality.

Justice and emotions in service recovery: a complaint in B2C e-commerce

This study proposes a marketing approach to service recovery (SR) models to explain what factors affect cumulative satisfaction, loyalty and word-of-mouth (WOM) following complaint behaviour. The model has its base on the definition of perceived justice and its influence on satisfaction with service recovery (SSR) and on emotions (positive and negative). Trust acts as a central construct in the model, receiving influence from the affective and cognitive aspect. The sample for this study consists of 303 Spanish business-to-consumer e-commerce (B2C-EC) users who made a complaint after an electronic transaction. Results from the analysis show the influence of perceived justice ? mainly interactional justice and procedural justice ? on SSR and the relevance of positive emotions as a key factor in SSR processes, in contrast to the major role that negative emotions have traditionally played in these models.

Integrating Evidence-Based Practice in the Training Programme Bachelor’s Degree in Nursing, University Jaume I

The Evidence-Based Practice (EBP) aims to combine a form methodological process of professional experience in health with the most current information on the clinical situation. The professional novice can make better decisions despite lacking sufficient years in clinical practice. We then train the student in correct habits within the methodological process by which you can strengthen both their knowledge and their attitude and ability, allowing secure customs, where all of your work is based on PBE.

Spontaneous Abortions and Shift Work in a Cohort of Nurses in Norway

Background: An association between spontaneous abortions and shift work has been suggested, but present research results are conflicting. The aim of the study is to evaluate the relationship between spontaneous abortions among nurses, shift schedules, and nights worked. Methods: This is a longitudinal study where we identified 914 females from a cohort of nurses in Norway who had worked the same type of shift schedule 2008-2010; either permanent day shift, three-shift rotation or permanent night shift. Information on age, work and life-style factors, as well as spontaneous abortions during lifetime and the past three years (2008-2010) was obtained by annual questionnaires. Results: A higher prevalence of experienced spontaneous abortions before study start (2008) was found among nurses working permanent night shift compared to other nurses. In a linear regression analysis, a risk of 1.3 was found for experienced spontaneous abortions before study start among permanent night shift nurses, with day shift as reference, when adjusting for age, smoking, caffeine and job strain, but the finding was not statistical significant (95 per cent confidence interval 0.8-2.1). Permanent night shift workers had a risk of 1.5 experiencing spontaneous abortions in 2008-2010 compared to day shift nurses, although not statistical significant (95 per cent confidence interval 0.7-3.5). The number of night shifts the past three years was not associated with experiencing spontaneous abortions 2008-2010, but associated with a reduced risk of experiencing spontaneous abortions during lifetime. The results must be interpreted in the light of a possible selection bias; both selections into the occupation of nursing and into the different shift types of the more healthy persons may have occurred in this population. Conclusion: No significant increased risk of spontaneous abortion among permanent night shift nurses compared to day-time nurses was found in this study, and no association was found between spontaneous abortions and the number of worked night shifts.

Internalization of quality management in service organizations

Purpose – The purpose of this paper is to analyze the internalization of quality management (QM) on the basis of quality certifiable standards – also referred to as meta-standards – in service organizations. More specifically, the paper analyzes the case of the internalization of a quality standard in the Spanish hotel industry. Design/methodology/approach – The paper examines the relationships between the measures of internalization, benefit, QM tools and motivation, using partial least squares in the framework of the structural equation modeling technique. Findings – The results show that the hotels that have internalized the standard to a greater extent are more likely to be driven by internal motivation, develop more QM tools and achieve greater benefits than the hotels with a lower degree of internalization. Originality/value – As previous studies have examined these issues in relation to the internalization of ISO standards, the present study adds to this important stream of research and contributes by advancing the understanding of these issues through the case of a specific standard for the hotel industry.