Non-robotic thoracoscopic internal mammary artery preparation in the pig. A training model

Notwithstanding non-robotic, thoracoscopic preparation of the internal mammary artery (IMA) is a difficult surgical task, an appropriate experimental training model is lacking. We evaluated the young domestic pig for this purpose. Four domestic female pigs (30-40 kg body weight) were used for this study. Bilateral thoracoscopic preparation of the IMA was carried out under continuous, pressure controlled CO(2) insufflation. A 30 degrees rigid thoracoscope was inserted through a 10-mm port in the 5th/6th intercostal space (ICS) dorsally to the posterior axillary line. The dissection instrument (Ultracision Harmonic Scalpel) was inserted (5-mm port) in the 7th ICS at the posterior axillary line and the endo-forceps (5-mm port) in the 5th ICS at the posterior axillary line. Thoracoscopic IMA preparation in pig resulted more difficult than in man. A total of seven IMAs were prepared in their full intrathoracic length. A change in the preparation technique (lateral detachment of the endothoracic muscle) improved the safety of the procedure, allowing all four respective IMAs to be prepared safely, while the initial technique ensued an injury for 2 out of 3 vessels. The described young domestic pig model is suitable for experimental training of bilateral thoracoscopic IMA preparation.

A Hybrid Model for Multimodal Brain Tumor Segmentation

We present a fully automatic segmentation method for multi-modal brain tumor segmentation. The proposed generative-discriminative hybrid model generates initial tissue probabilities, which are used subsequently for enhancing the classi�cation and spatial regularization. The model has been evaluated on the BRATS2013 training set, which includes multimodal MRI images from patients with high- and low-grade gliomas. Our method is capable of segmenting the image into healthy (GM, WM, CSF) and pathological tissue (necrotic, enhancing and non-enhancing tumor, edema). We achieved state-of-the-art performance (Dice mean values of 0.69 and 0.8 for tumor subcompartments and complete tumor respectively) within a reasonable timeframe (4 to 15 minutes).

Social Support at the Workplace, Motivation to Transfer, and Training Transfer: A Multi-Level Indirect Effects Model

Supervisor support, peer support and transfer motivation have been identified as important predictors for training transfer. Transfer motivation is supposed to mediate the support–training transfer relationship. Especially after team training interventions that include all team members (i.e., intact-team training), individual perception of these factors might be shared among team members. However, an integration of the team level in the training transfer process is rare, yet still needed. Analyzing 194 employees from 34 teams in the context of intact-team training interventions, we found similar relationships and processes at both levels of analysis: Social support enhances transfer motivation at the individual and team levels. Furthermore, motivation to transfer increases training transfer and serves as a connecting mechanism in the social support–training transfer link. The results underline the importance of (1) considering multiple levels in theories and research about the training transfer process and (2) ensuring the practice of individual-directed support and a shared, supportive climate within teams.

Lamb Temporal Bone as a Surgical Training Model of Round Window Cochlear Implant Electrode Insertion

OBJECTIVE The preservation of residual hearing in cochlear implantation opens the door for optimal functional results. This atraumatic surgical technique requires training; however, the traditional human cadaveric temporal bones have become less available or unattainable in some institutions. This study investigates the suitability of an alternative model, using cadaveric lamb temporal bone, for surgical training of atraumatic round window electrode insertion. INTERVENTION A total of 14 lamb temporal bones were dissected for cochlear implantation by four surgeons. After mastoidectomy, visualization, and drilling of the round window niche, an atraumatic round window insertion of a Medel Flex24 electrode was performed. Electrode insertion depth and position were verified by computed tomography scans. MAIN OUTCOME MEASURE All cochleas were successfully implanted using the atraumatic round window approach; however, surgical access through the mastoid was substantially different when compared human anatomy. The mean number of intracochlear electrode contacts was 6.5 (range, 4-11) and the mean insertion depth 10.4 mm (range, 4-20 mm), which corresponds to a mean angular perimodiolar insertion depth of 229 degrees (range 67-540°). Full insertion of the electrode was not possible because of the smaller size of the lamb cochlea in comparison to that of the human. CONCLUSION The lamb temporal bone model is well suited as a training model for atraumatic cochlear implantation at the level of the round window. The minimally pneumatized mastoid as well as the smaller cochlea can help prepare a surgeon for difficult cochlear implantations. Because of substantial differences to human anatomy, it is not an adequate training model for other surgical techniques such as mastoidectomy and posterior tympanotomy as well as full electrode insertion.

Improving residency training with the help of multisource feedback: Generation of a model of influencing factors

Background: Feedback is considered to be one of the most important drivers of learning. One form of structured feedback used in medical settings is multisource feedback (MSF). This feedback technique provides the opportunity to gain a differentiated view on a doctor’s performance from several perspectives using a questionnaire and a facilitating conversation, in which learning goals are formulated. While many studies have been conducted on the validity, reliability and feasibility of the instrument, little is known about the impact of factors that might influence the effects of MSF on clinical performance. Summary of Work: To study under which circumstances MSF is most effective, we performed a literature review on Google Scholar with focus on MSF and feedback in general. Main key-words were: MSF, multi-source-feedback, multi source feedback, and feedback each combined with influencing/ hindering/ facilitating factors, effective, effectiveness, doctors-intraining, and surgery. Summary of Results: Based on the literature, we developed a preliminary model of facilitating factors. This model includes five main factors influencing MSF: questionnaire, doctor-in-training, group of raters, facilitating supervisor, and facilitating conversation. Discussion and Conclusions: Especially the following points that might influence MSF have not yet been sufficiently studied: facilitating conversation with the supervisor, individual aspects of doctors-in-training, and the causal relations between influencing factors. Overall there are only very few studies focusing on the impact of MSF on actual and long-term performance. We developed a preliminary model of hindering and facilitating factors on MSF. Further studies are needed to better understand under which circumstances MSF is most effective. Take-home messages: The preliminary model might help to guide further studies on how to implement MSF to use it at its full potential.

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

A model of career training in international contexts

Este artículo describe un modelo para la capacitación de practicantes de orientación ocupacional en contextos internacionales. Este modelo utiliza un enfoque de "compromiso activo" y se fundamenta en los siguientes factores: 1. Relativos a Competencia/Habilidad; 2. Aprendizaje Experimental; 3. Desafío de Fortaleza; 4. Pensamiento Crítico; 5. Intervenciones y Procesos Dinámicos; y 6. Aprendizaje e Innovación Integradas. También se incluye un debate sobre otras cuestiones prácticas relativas a la capacitación.

Visualization of a student predictive model for 3D virtual environments driven to procedural training

This document presents theimplementation ofa Student Behavior Predictor Viewer(SBPV)for a student predictive model. The student predictive model is part of an intelligent tutoring system, and is built from logs of students’ behaviors in the “Virtual Laboratory of Agroforestry Biotechnology”implemented in a previous work.The SBPVis a tool for visualizing a 2D graphical representationof the extended automaton associated with any of the clusters ofthe student predictive model. Apart from visualizing the extended automaton, the SBPV supports the navigation across the automaton by means of desktop devices. More precisely, the SBPV allows user to move through the automaton, to zoom in/out the graphic or to locate a given state. In addition, the SBPV also allows user to modify the default layout of the automaton on the screen by changing the position of the states by means of the mouse. To developthe SBPV, a web applicationwas designedand implementedrelying on HTML5, JavaScript and C#.

Effects of exercise training on intrauterine growth restriction in an animal model

Résumé Selon l'OMS, la retard de croissance intra-utérine (RCIU; 10% en dessous du poids normal pendant la grossesse) affecte 5-10% des grossesses et est une cause principale de la morbidité et de la mortalité périnatales. Dans notre étude précédente sur un modèle de souris transgénique de prééclampsie (R+A+), nous avons constaté que l’entraînement physique (ExT) avant et pendant la grossesse réduisait la pression artérielle maternelle et empêchait la RCIU en améliorant le développement placentaire. Dans le cadre de mon projet, nous avons confirmé les bénifices de l’ExT dans un modèle de RCIU (souris déficiente en p57Kip2 (p57-/+). Ainsi, nous avons observé la présence de RCIU, d’une masse placentaire réduite, d’une augmentation de la pathologie placentaire ainsi qu’une plus petite taille des portées chez les souris p57-/+ sédentaire. L’ExT prévient la RCIU ainsi que tous les paramètres mentionnés ci-haut. Nous avons observé que l'expression du facteur de croissance de l’endothélium vasculaire, un régulateur clé de l'angiogenèse lors de la croissance placentaire, était réduite dans le placenta des souris p57-/+ et normalisée par l’ExT. Nous avons également trouvé que l'expression en ARN dans le placenta de 2 facteurs inflammatoires (interleukine-1β et MCP-1) était augmenté chez les souris sédentaires p57-/+ alors que ceci n’était pas présent chez les souris entraînées, ce qui suggère que l'inflammation placentaire peut contribuer à la pathologie placentaire. Toutefois, contrairement aux souris R+A+, le système rénine-angiotensine placentaire chez les souris p57-/+ était normale et aucun effet de l’ExT a été observé. Ces résultats suggèrent que l’ExT prévient la RCIU en normalisant la pathologie placentaire, l’angiogenèse et l’inflammation placentaire.

Model curriculum for training motorcoach drivers: study guide.

Mode of access: Internet.

Illinois model pilot early childhood parental training programs : FY 90 summary report.

"April, 1991."

An outline of the general regulations and methods of teaching in the male national model schools, for the use of the teachers in training.

Cover title.

The Work crew performance model : a method for evaluating training and performance in the mining industry /

Includes bibliographical references.