Access to a simulator is not enough: the benefits of virtual reality training based on peer-group-derived benchmarks--a randomized controlled trial.

BACKGROUND: Virtual reality (VR) simulators are widely used to familiarize surgical novices with laparoscopy, but VR training methods differ in efficacy. In the present trial, self-controlled basic VR training (SC-training) was tested against training based on peer-group-derived benchmarks (PGD-training). METHODS: First, novice laparoscopic residents were randomized into a SC group (n = 34), and a group using PGD-benchmarks (n = 34) for basic laparoscopic training. After completing basic training, both groups performed 60 VR laparoscopic cholecystectomies for performance analysis. Primary endpoints were simulator metrics; secondary endpoints were program adherence, trainee motivation, and training efficacy. RESULTS: Altogether, 66 residents completed basic training, and 3,837 of 3,960 (96.8 %) cholecystectomies were available for analysis. Course adherence was good, with only two dropouts, both in the SC-group. The PGD-group spent more time and repetitions in basic training until the benchmarks were reached and subsequently showed better performance in the readout cholecystectomies: Median time (gallbladder extraction) showed significant differences of 520 s (IQR 354-738 s) in SC-training versus 390 s (IQR 278-536 s) in the PGD-group (p < 0.001) and 215 s (IQR 175-276 s) in experts, respectively. Path length of the right instrument also showed significant differences, again with the PGD-training group being more efficient. CONCLUSIONS: Basic VR laparoscopic training based on PGD benchmarks with external assessment is superior to SC training, resulting in higher trainee motivation and better performance in simulated laparoscopic cholecystectomies. We recommend such a basic course based on PGD benchmarks before advancing to more elaborate VR training.

Socio-economic benefits of using space technologies to monitor and respond to earthquakes

Earthquakes represent a major hazard for populations around the world, causing frequent loss of life,human suffering and enormous damage to homes, other buildings and infrastructure. The Technology Resources forEarthquake Monitoring and Response (TREMOR) Team of 36 space professionals analysed this problem over thecourse of the International Space University Summer Session Program and published their recommendations in the formof a report. The TREMOR Team proposes a series of space- and ground-based systems to provide improved capabilityto manage earthquakes. The first proposed system is a prototype earthquake early-warning system that improves theexisting knowledge of earthquake precursors and addresses the potential of these phenomena. Thus, the system willat first enable the definitive assessment of whether reliable earthquake early warning is possible through precursormonitoring. Should the answer be affirmative, the system itself would then form the basis of an operational earlywarningsystem. To achieve these goals, the authors propose a multi-variable approach in which the system will combine,integrate and process precursor data from space- and ground-based seismic monitoring systems (already existing andnew proposed systems) and data from a variety of related sources (e.g. historical databases, space weather data, faultmaps). The second proposed system, the prototype earthquake simulation and response system, coordinates the maincomponents of the response phase to reduce the time delays of response operations, increase the level of precisionin the data collected, facilitate communication amongst teams, enhance rescue and aid capabilities and so forth. It isbased in part on an earthquake simulator that will provide pre-event (if early warning is proven feasible) and post-eventdamage assessment and detailed data of the affected areas to corresponding disaster management actors by means of ageographic information system (GIS) interface. This is coupled with proposed mobile satellite communication hubs toprovide links between response teams. Business- and policy-based implementation strategies for these proposals, suchas the establishment of a non-governmental organisation to develop and operate the systems, are included.

Disabilities Benefits for Special Services Disability, July 2008

IPERS provides the security you need through guaranteed benefits. With IPERS, unlike other retirement plans, benefits aren’t tied to the performance of the stock market and you don’t need to be an experienced investor to make your retirement dreams a reality. Your IPERS benefits are only one part of your overall retirement savings. Your total retirement income will come from a combination of your IPERS benefits, social security, personal savings, and any other retirement plan benefits.

Disabilities Benefits for Special Services Disability, July 2008

IPERS provides the security you need through guaranteed benefits. With IPERS, unlike other retirement plans, benefits aren’t tied to the performance of the stock market and you don’t need to be an experienced investor to make your retirement dreams a reality. Your IPERS benefits are only one part of your overall retirement savings. Your total retirement income will come from a combination of your IPERS benefits, social security, personal savings, and any other retirement plan benefits.

Uses and Benefits of Aviation in Iowa: Executive Summary, 2009

Air transportation is a key contributor to Iowa’s economy. The Iowa Department of Transportation’s Office of Aviation developed this 2009 report to evaluate and analyze the uses and benefits of aviation in Iowa. The statewide economic impact study shows how aviation serves as an economic engine, documents various ways air transportation is used in Iowa, and discusses other benefits that air transportation supports. Aviation related economic benefits measured in this study fall into two categories. In one category, benefits are measured in terms of jobs, payroll, and annual economic activity that various aviation and air transportation groups support. In the other category, added efficiency that businesses realize from their use of aviation is estimated in terms of increased productivity. Many of the economic benefits identified in this study are associated with commercial and general aviation airports that serve communities throughout Iowa. Beyond the boundaries of the airports are other aviation related activities that also add significant value to Iowa’s economy. Both types of economic benefit are discussed in this summary report.

Insurance and Welfare Benefits Education Report 2007

The following report is a summary of the insurance and welfare benefits education activities in 2007. 2007 was the first full year that DAS-HRE had a full-time health and welfare benefits educator.

Equilibrium Unemployment and the Duration of Unemployment Benefits

This paper uses microdata to evaluate the impact on the steady-state unemployment rate of an increase in maximum benefit duration. We evaluate a policy change in Austria that extended maximum benefit duration and use this policy change to estimate the causal impact of benefit duration on labor market flows. We find that the policy change leads to a significant increase in the steady-state unemployment rate and, surprisingly, most of this increase is due to an increase in the inflow into rather than the outflow from unemployment.

Q&A: Furloughs, bumping, and IPERS Benefits 2010-2011, June 20, 2010

An 4 page report about what happens to your IPERS during furloughs.

Q&A: Furloughs, Bumping, and IPERS Benefits 2010-2012, June 20, 2010

The new law makes the following changes: (a) Reduces IPERS benefits not yet earned by regular members and raises contributions for them above the rate set in current law. (b) Raises the limit on how much contributions for regular members can change each year from 0.5 percentage point to 1.0 percentage point. (c) Extends a provision for restoring wage credits for mandatory unpaid time and extends it to union bumping. Other changes are limited in scope and will not affect most members; some changes are merely technical.

Proto-South-East Asia as a trigger of early angiosperm diversification

Darwin described as an 'abominable mystery' the abrupt origin of angiosperms in the mid-Cretaceous and the high diversification rates in their early history. The father of evolutionary theory could not fathom this rapid diversification and rather invoked that 'there was during long ages a small isolated continent in the S. hemisphere, which served as the birthplace of the higher plants'. In this essay, we comment on the spatial origin of angiosperms, but focus primarily on understanding the abiotic factors that promoted the early diversification of angiosperms by reviewing palaeobotanical, palaeogeographical, phylogenetics and biogeographical evidence. We argue that islands located in the region today occupied by South-East Asia played a major role in angiosperm diversification during the Late Jurassic and Early Cretaceous.

A review of relocation benefits of state agencies and regent institutions for the period July 1, 2005 through June 30, 2009

A review of relocation benefits of state agencies and regent institutions for the period July 1, 2005 through June 30, 2009

Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures.

Vertebral fracture (VF) is the most common osteoporotic fracture and is associated with high morbidity and mortality. Conservative treatment combining antalgic agents and rest is usually recommended for symptomatic VFs. The aim of this paper is to review the randomized controlled trials comparing the efficacy and safety of percutaneous vertebroplasty (VP) and percutaneous balloon kyphoplasty (KP) versus conservative treatment. VP and KP procedures are associated with an acceptable general safety. Although the case series investigating VP/KP have all shown an outstanding analgesic benefit, randomized controlled studies are rare and have yielded contradictory results. In several of these studies, a short-term analgesic benefit was observed, except in the prospective randomized sham-controlled studies. A long-term analgesic and functional benefit has rarely been noted. Several recent studies have shown that both VP and KP are associated with an increased risk of new VFs. These fractures are mostly VFs adjacent to the procedure, and they occur within a shorter time period than VFs in other locations. The main risk factors include the number of preexisting VFs, the number of VPs/KPs performed, age, decreased bone mineral density, and intradiscal cement leakage. It is therefore important to involve the patients to whom VP/KP is being proposed in the decision-making process. It is also essential to rapidly initiate a specific osteoporosis therapy when a VF occurs (ideally a bone anabolic treatment) so as to reduce the risk of fracture. Randomized controlled studies are necessary in order to better define the profile of patients who likely benefit the most from VP/KP.