Safe eye surgery: non-technical aspects

The traditional training of surgeons focused exclusively on developing knowledge, clinical expertise, and technical (surgical) skills. However, analyses of the reasons for adverse events in surgery have revealed that many underlying causes originate from behavioural or non-technical aspects of performance (eg, poor communication among members of the surgical team) rather than from a lack of surgical (ie, technical) skills. Therefore, technical skills appear to be necessary but not sufficient to ensure patient safety. Paying attention to non-technical skills, such as team working, leadership, situation awareness, decision making, and communication, will increase the likelihood of maintaining high levels of error-free performance. Identification and training of non-technical skills has been developed for high-risk careers, such as civil aviation and nuclear power. Only recently, training in non-technical skills has been adopted by the surgical world and anaesthetists. Non-technical skills need to be tailored to the environment where they are used, and eye surgery has some substantial differences compared with other surgical areas, for example, high volume of surgery, use of local anaesthetics, and very sophisticated equipment. This review highlights the need for identification of the non-technical skills relevant to eye surgeons and promotion of their use in the training of eye surgeons.

Surgical checklist for cataract surgery:progress with the initiative by the Royal College of Ophthalmologists to improve patient safety

PurposeThe World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012.Patients and methodsA survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate).ResultsRespondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college's bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist.ConclusionNinety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL.Eye advance online publication, 24 May 2013; doi:10.1038/eye.2013.101.

Clinical and technical factors associated with skin intrinsic fluorescence in subjects with type 1 diabetes from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications(EDIC) studies have established multiyear mean hemoglobin A1c (HbA1c) as predictive of microvascular complications in persons with type 1 diabetes. However, multiyear mean HbA1c is not always available in the clinical setting. Skin advanced glycation end products (AGEs) are thought to partially reflect effects of hyperglycemia over time, and measurement of skin AGEs might be a surrogate for multiyear mean HbA1c. As certain AGEs fluoresce and skin fluorescence has been demonstrated to correlate with the concentration of skin AGEs, noninvasive measurement by skin intrinsic fluorescence(SIF) facilitates the exploration of the association of mean HbA1c and other clinical/technical factors with SIF using the detailed phenotypic database available in DCCT/EDIC.

The Effects of the Catalytic Converter on Two-Stroke Engine Performance, SAE Technical Paper 972741

The two-stroke engine, by its nature is very dependent on the unsteady gas dynamics within an exhaust system. This is demonstrated by the tuning effects on two-stroke engines, which have been well documented. In consideration of current emissions legislation, a two-stroke engine can be fitted with a catalytic converter for the outboard, utility or automotive markets. The catalytic substrate represents a major obstruction to the flow of exhaust gas, which hinders the progression of the main exhausted pulse, and in turn effects the scavenging of the cylinder and ultimately the performance of the engine.

Rigorous Specification and Low-Latency Implementation of Technical Market Indicators

Technical market indicators are tools used by technical an- alysts to understand trends in trading markets. Technical (market) indicators are often calculated in real-time, as trading progresses. This paper presents a mathematically- founded framework for calculating technical indicators. Our framework consists of a domain specific language for the un- ambiguous specification of technical indicators, and a run- time system based on Click, for computing the indicators. We argue that our solution enhances the ease of program- ming due to aligning our domain-specific language to the mathematical description of technical indicators, and that it enables executing programs in kernel space for decreased latency, without exposing the system to users’ programming errors.

The Biospheric Project - Manchester International Festival 2013:Technical food systems

The Biospheric Project is a nested multi-scalar urban agriculture project that aims to develop sustainable food systems in disadvantaged communities, though not only physical interventions, such as the urban masterplan and neighbourhood design to the building and its roof and façade, but also through social and commercial interventions, such as community involvement, businesses and a distribution system.

The project is focused around the Biospheric Foundation, a community interest company and research think-tank whose aim is to hasten our transition to a closed cycle, low-carbon economy. Its home is Irwell house, that houses a large-scale aquaponic-based food production system, which is directly linked to a whole-food shop (78 Steps, named after the distance from the productive system) and a whole food distribution system (the Whole Box). The building sits within a post-industrial landscape which is being developed into a new productive landscape, utilizing the the technologies developed by the Biospheric Foundation and Prof Greg Keeffe of Queens University Belfast. The collaboration links designer, academics and activists across the disciplines of Urban design, Architecture, Permaculture, landscape design, environmental science and business and community.

Measuring math anxiety in Italian college and high school students: Validity, reliability and gender invariance of the Abbreviated Math Anxiety Scale (AMAS)

Given that the ability to manage numbers is essential in a modern society, mathematics anxiety – which has been demonstrated to have unfortunate consequences in terms of mastery of math – has become a subject of increasing interest, and the need to accurately measure it has arisen. One of the widely employed scales to measure math anxiety is the Abbreviated Math Anxiety Scale (AMAS) (Hopko, Mahadevan, Bare & Hunt, 2003). The first aim of the present paper was to confirm the factor structure of the AMAS when administered to Italian high school and college students, and to test the invariance of the scale across educational levels. Additionally, we assessed the reliability and validity of the Italian version of the scale. Finally, we tested the invariance of the AMAS across genders. The overall findings provide evidence for the validity and reliability of the AMAS when administered to Italian students.