Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology.

PubMed

Brunckhorst, Oliver; Volpe, Alessandro; van der Poel, Henk; Mottrie, Alexander; Ahmed, Kamran

2016-04-01

Urology is at the forefront of minimally invasive surgery to a great extent. These procedures produce additional learning challenges and possess a steep initial learning curve. Training and assessment methods in surgical specialties such as urology are known to lack clear structure and often rely on differing operative flow experienced by individuals and institutions. This article aims to assess current urology training modalities, to identify the role of simulation within urology, to define and identify the learning curves for various urologic procedures, and to discuss ways to decrease complications in the context of training. A narrative review of the literature was conducted through December 2015 using the PubMed/Medline, Embase, and Cochrane Library databases. Evidence of the validity of training methods in urology includes observation of a procedure, mentorship and fellowship, e-learning, and simulation-based training. Learning curves for various urologic procedures have been recommended based on the available literature. The importance of structured training pathways is highlighted, with integration of modular training to ensure patient safety. Valid training pathways are available in urology. The aim in urology training should be to combine all of the available evidence to produce procedure-specific curricula that utilise the vast array of training methods available to ensure that we continue to improve patient outcomes and reduce complications. The current evidence for different training methods available in urology, including simulation-based training, was reviewed, and the learning curves for various urologic procedures were critically analysed. Based on the evidence, future pathways for urology curricula have been suggested to ensure that patient safety is improved. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Mentorship, learning curves, and balance.

PubMed

Cohen, Meryl S; Jacobs, Jeffrey P; Quintessenza, James A; Chai, Paul J; Lindberg, Harald L; Dickey, Jamie; Ungerleider, Ross M

2007-09-01

Professionals working in the arena of health care face a variety of challenges as their careers evolve and develop. In this review, we analyze the role of mentorship, learning curves, and balance in overcoming challenges that all such professionals are likely to encounter. These challenges can exist both in professional and personal life. As any professional involved in health care matures, complex professional skills must be mastered, and new professional skills must be acquired. These skills are both technical and judgmental. In most circumstances, these skills must be learned. In 2007, despite the continued need for obtaining new knowledge and learning new skills, the professional and public tolerance for a "learning curve" is much less than in previous decades. Mentorship is the key to success in these endeavours. The success of mentorship is two-sided, with responsibilities for both the mentor and the mentee. The benefits of this relationship must be bidirectional. It is the responsibility of both the student and the mentor to assure this bidirectional exchange of benefit. This relationship requires time, patience, dedication, and to some degree selflessness. This mentorship will ultimately be the best tool for mastering complex professional skills and maturing through various learning curves. Professional mentorship also requires that mentors identify and explicitly teach their mentees the relational skills and abilities inherent in learning the management of the triad of self, relationships with others, and professional responsibilities.Up to two decades ago, a learning curve was tolerated, and even expected, while professionals involved in healthcare developed the techniques that allowed for the treatment of previously untreatable diseases. Outcomes have now improved to the point that this type of learning curve is no longer acceptable to the public. Still, professionals must learn to perform and develop independence and confidence. The responsibility to meet this challenge without a painful learning curve belongs to both the younger professionals, who must progress through the learning curve, and the more mature professionals who must create an appropriate environment for learning. In addition to mentorship, the detailed tracking of outcomes is an essential tool for mastering any learning curve. It is crucial to utilize a detailed database to track outcomes, to learn, and to protect both yourself and your patients. It is our professional responsibility to engage in self-evaluation, in part employing voluntary sharing of data. For cardiac surgical subspecialties, the databases now existing for The European Association for CardioThoracic Surgery and The Society of Thoracic Surgeons represent the ideal tool for monitoring outcomes. Evolving initiatives in the fields of paediatric cardiology, paediatric critical care, and paediatric cardiac anaesthesia will play similar roles.A variety of professional and personal challenges must be met by all those working in health care. The acquisition of learned skills, and the use of special tools, will facilitate the process of conquering these challenges. Choosing appropriate role models and mentors can help progression through any learning curve in a controlled and protected fashion. Professional and personal satisfaction are both necessities. Finding the satisfactory balance between work and home life is difficult, but possible with the right tools, organization skills, and support system at work and at home. The concepts of mentorship, learning curves and balance cannot be underappreciated.

Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice.

PubMed

Andersen, Steven Arild Wuyts; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2015-10-01

Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. A prospective trial with a 2 × 2 design was conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. Performance was assessed using a modified Welling Scale for final product analysis by 2 blinded senior otologists. Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95% CI) of 15.7 (14.4-17.0) in distributed practice vs. 13.0 (11.9-14.1) with massed practice (P = .002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs. 13.4 (12.8-14.0) for corresponding nontutored sessions (P < .01) but at the cost of a drop in performance once tutoring ceased. The performance drop was less with distributed practice, suggesting a protective effect when acquired skills were consolidated over time. The mean performance of the nontutored participants in the distributed practice group plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.

Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience.

PubMed

Lv, Houning; Zhao, Ningning; Zheng, Zhongqing; Wang, Tao; Yang, Fang; Jiang, Xihui; Lin, Lin; Sun, Chao; Wang, Bangmao

2017-05-01

Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum (CUSUM) methods were used to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. This single-center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases. © 2016 Japan Gastroenterological Endoscopy Society.

29 CFR 525.12 - Terms and conditions of special minimum wage certificates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... provide them with an opportunity to overcome the initial learning curve. The persons observed shall be... of machines are not available, a second work measurement should be conducted. (i) Each worker with a...

29 CFR 525.12 - Terms and conditions of special minimum wage certificates.

Code of Federal Regulations, 2012 CFR

2012-07-01

... provide them with an opportunity to overcome the initial learning curve. The persons observed shall be... of machines are not available, a second work measurement should be conducted. (i) Each worker with a...

29 CFR 525.12 - Terms and conditions of special minimum wage certificates.

Code of Federal Regulations, 2014 CFR

2014-07-01

... provide them with an opportunity to overcome the initial learning curve. The persons observed shall be... of machines are not available, a second work measurement should be conducted. (i) Each worker with a...

29 CFR 525.12 - Terms and conditions of special minimum wage certificates.

Code of Federal Regulations, 2013 CFR

2013-07-01

... provide them with an opportunity to overcome the initial learning curve. The persons observed shall be... of machines are not available, a second work measurement should be conducted. (i) Each worker with a...

Totally laparoscopic aortic surgery: comparison of the apron and retrocolic techniques in a porcine model.

PubMed

Huynh, Hai; Elkouri, Stephane; Beaudoin, Nathalie; Bruneau, Luc; Guimond, Cathie; Daniel, Véronique; Blair, Jean-François

2007-01-01

This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time required, laparoscopic anastomosis quality, and learning curve. The first 3 interventions required an open conversion. The last 7 were done without complications. Mean dissection time was significantly higher with the apron approach compared with the retrocolic approach. The total times for operation, clamping, and arteriotomy time were similar. All laparoscopic anastomoses were patent and without stenosis. The initial learning curve for laparoscopic anastomosis was relatively short for a second-year surgery resident. Both techniques resulted in satisfactory exposure of the aorta and similar mean operative and clamping time. Training on an ex vivo laparoscopic box trainer and on an animal model seems to be complementary to decrease laparoscopic anastomosis completion time.

Applications of Adaptive Learning Controller to Synthetic Aperture Radar.

DTIC Science & Technology

1985-02-01

FIGURE 37. Location of Two Sub- Phase Histories to be Utilized in Estimating Misfocus Coefficients A and C . . . A8 FIGURES 38.-94. ALC Learning Curves ...FIGURES (Concl uded) FIGURE 23. ALC Learning Curve .... .................. ... 45 .- " FIGURE 24. ALC Learning Curve ......... ................. 47 FIGURE...25. ALC Learning Curve .... .................. ... 48 FIGURE 26. ALC Learning Curve ....... .... ... .... 50 FIGURE 27. ALC Learning Curve

Soft tissue balancing in total knee arthroplasty using sensor-guided assessment: is there a learning curve?

PubMed

Gharaibeh, Monther A; Chen, Darren B; MacDessi, Samuel J

2018-05-01

Sensor-guided assessment for soft tissue balance in total knee arthroplasty (TKA) has been reported to improve patient satisfaction and self-reported outcome scores. As more surgeons adopt this technology in TKA, we performed this study to identify if there is a learning curve with its use. Analysis of a total of 90 consecutive cases was performed in this study. Initial and final intercompartmental pressure differences were recorded before and after knee ligament balancing. The first 45 patients (group 1) were compared to the last 45 patients (group 2) in terms of operative time and the final state of knee balance. A balanced knee was defined as pressure difference between medial and lateral compartments of ≤15 pounds. Group 1 had 10 unbalanced knees in the final pressure difference assessment, while all cases in group 2 were balanced (P < 0.001). There was no statistically significant difference in mean operative time between the two groups. A scatter plot of intercompartmental pressure difference identified that after 30 cases, the capacity to achieve knee ligament balance improved. This study suggests that there is a learning curve with the use of sensor-guided assessment in TKA in achieving knee balance; however, the differences noted between initial and final groups were small and may not be of clinical significance. © 2018 Royal Australasian College of Surgeons.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis.

PubMed

Park, Yoonah; Yong, Yuen Geng; Yun, Seong Hyeon; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-05-01

This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model: An analysis of 150 consecutive patients.

PubMed

Han, Hyung Joon; Choi, Sae Byeol; Park, Man Sik; Lee, Jin Suk; Kim, Wan Bae; Song, Tae Jin; Choi, Sang Yong

2011-07-01

Single port laparoscopic surgery has come to the forefront of minimally invasive surgery. For those familiar with conventional techniques, however, this type of operation demands a different type of eye/hand coordination and involves unfamiliar working instruments. Herein, the authors describe the learning curve and the clinical outcomes of single port laparoscopic cholecystectomy for 150 consecutive patients with benign gallbladder disease. All patients underwent single port laparoscopic cholecystectomy using a homemade glove port by one of five operators with different levels of experiences of laparoscopic surgery. The learning curve for each operator was fitted using the non-linear ordinary least squares method based on a non-linear regression model. Mean operating time was 77.6 ± 28.5 min. Fourteen patients (6.0%) were converted to conventional laparoscopic cholecystectomy. Complications occurred in 15 patients (10.0%), as follows: bile duct injury (n = 2), surgical site infection (n = 8), seroma (n = 2), and wound pain (n = 3). One operator achieved a learning curve plateau at 61.4 min per procedure after 8.5 cases and his time improved by 95.3 min as compared with initial operation time. Younger surgeons showed significant decreases in mean operation time and achieved stable mean operation times. In particular, younger surgeons showed significant decreases in operation times after 20 cases. Experienced laparoscopic surgeons can safely perform single port laparoscopic cholecystectomy using conventional or angled laparoscopic instruments. The present study shows that an operator can overcome the single port laparoscopic cholecystectomy learning curve in about eight cases.

Understanding and Taking Control of Surgical Learning Curves.

PubMed

Gofton, Wade T; Papp, Steven R; Gofton, Tyson; Beaulé, Paul E

2016-01-01

As surgical techniques continue to evolve, surgeons will have to integrate new skills into their practice. A learning curve is associated with the integration of any new procedure; therefore, it is important for surgeons who are incorporating a new technique into their practice to understand what the reported learning curve might mean for them and their patients. A learning curve should not be perceived as negative because it can indicate progress; however, surgeons need to understand how to optimize the learning curve to ensure progress with minimal patient risk. It is essential for surgeons who are implementing new procedures or skills to define potential learning curves, examine how a reported learning curve may relate to an individual surgeon's in-practice learning and performance, and suggest methods in which an individual surgeon can modify his or her specific learning curve in order to optimize surgical outcomes and patient safety. A defined personal learning contract may be a practical method for surgeons to proactively manage their individual learning curve and provide evidence of their efforts to safely improve surgical practice.

Commercialising Comparison: Pearson Puts the TLC in Soft Capitalism

ERIC Educational Resources Information Center

Hogan, Anna; Sellar, Sam; Lingard, Bob

2016-01-01

This paper provides a critical policy analysis of "The Learning Curve" (TLC) (2012), an initiative developed by the multinational edu-business, Pearson, in conjunction with the Economist Intelligence Unit. "TLC" exemplifies the commercialising of comparison and the efforts of edu-businesses to strategically position themselves…

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

PubMed Central

Park, Yoonah; Yong, Yuen Geng; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-01-01

Purpose This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). Methods This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Results Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). Conclusion The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase. PMID:25960990

Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada.

PubMed

Drevet, Gabrielle; Ugalde Figueroa, Paula

2016-03-01

Video-assisted thoracoscopic surgery (VATS) using a single incision (uniportal) may result in better pain control, earlier mobilization and shorter hospital stays. Here, we review the safety and efficiency of our initial experience with uniportal VATS and evaluate our learning curve. We conducted a retrospective review of uniportal VATS using a prospectively maintained departmental database and analyzed patients who had undergone a lung anatomic resection separately from patients who underwent other resections. To assess the learning curve, we compared the first 10 months of the study period with the second 10 months. From January 2014 to August 2015, 250 patients underwent intended uniportal VATS, including 180 lung anatomic resections (72%) and 70 other resections (28%). Lung anatomic resection was successfully completed using uniportal VATS in 153 patients (85%), which comprised all the anatomic segmentectomies (29 patients), 80% (4 of 5) of the pneumonectomies and 82% (120 of 146) of the lobectomies attempted. The majority of lung anatomic resections that required conversion to thoracotomy occurred in the first half of our study period. Seventy patients underwent other uniportal VATS resections. Wedge resections were the most common of these procedures (25 patients, 35.7%). Although 24 of the 70 patients (34%) required the placement of additional ports, none required conversion to thoracotomy. Uniportal VATS was safe and feasible for both standard and complex pulmonary resections. However, when used for pulmonary anatomic resections, uniportal VATS entails a steep learning curve.

Guidelines for application of learning/cost improvement curves

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1975-01-01

The differences between the terms learning curve and improvement curve are noted, as well as the differences between the Wright system and the Crawford system. Learning curve computational techniques were reviewed along with a method to arrive at a composite learning curve for a system given detail curves either by the functional techniques classification or simply categorized by subsystem. Techniques are discussed for determination of the theoretical first unit (TFU) cost using several of the currently accepted methods. Sometimes TFU cost is referred to as simply number one cost. A tabular presentation of the various learning curve slope values is given. A discussion of the various trends in the application of learning/improvement curves and an outlook for the future are presented.

Learning curves in health professions education.

PubMed

Pusic, Martin V; Boutis, Kathy; Hatala, Rose; Cook, David A

2015-08-01

Learning curves, which graphically show the relationship between learning effort and achievement, are common in published education research but are not often used in day-to-day educational activities. The purpose of this article is to describe the generation and analysis of learning curves and their applicability to health professions education. The authors argue that the time is right for a closer look at using learning curves-given their desirable properties-to inform both self-directed instruction by individuals and education management by instructors.A typical learning curve is made up of a measure of learning (y-axis), a measure of effort (x-axis), and a mathematical linking function. At the individual level, learning curves make manifest a single person's progress towards competence including his/her rate of learning, the inflection point where learning becomes more effortful, and the remaining distance to mastery attainment. At the group level, overlaid learning curves show the full variation of a group of learners' paths through a given learning domain. Specifically, they make overt the difference between time-based and competency-based approaches to instruction. Additionally, instructors can use learning curve information to more accurately target educational resources to those who most require them.The learning curve approach requires a fine-grained collection of data that will not be possible in all educational settings; however, the increased use of an assessment paradigm that explicitly includes effort and its link to individual achievement could result in increased learner engagement and more effective instructional design.

Brief periods of NREM sleep do not promote early offline gains but subsequent on-task performance in motor skill learning.

PubMed

Maier, Jonathan G; Piosczyk, Hannah; Holz, Johannes; Landmann, Nina; Deschler, Christoph; Frase, Lukas; Kuhn, Marion; Klöppel, Stefan; Spiegelhalder, Kai; Sterr, Annette; Riemann, Dieter; Feige, Bernd; Voderholzer, Ulrich; Nissen, Christoph

2017-11-01

Sleep modulates motor learning, but its detailed impact on performance curves remains to be fully characterized. This study aimed to further determine the impact of brief daytime periods of NREM sleep on 'offline' (task discontinuation after initial training) and 'on-task' (performance within the test session) changes in motor skill performance (finger tapping task). In a mixed design (combined parallel group and repeated measures) sleep laboratory study (n=17 'active' wake vs. sleep, n=19 'passive' wake vs. sleep), performance curves were assessed prior to and after a 90min period containing either sleep, active or passive wakefulness. We observed a highly significant, but state- (that is, sleep/wake)-independent early offline gain and improved on-task performance after sleep in comparison to wakefulness. Exploratory curve fitting suggested that the observed sleep effect most likely emerged from an interaction of training-induced improvement and detrimental 'time-on-task' processes, such as fatigue. Our results indicate that brief periods of NREM sleep do not promote early offline gains but subsequent on-task performance in motor skill learning. Copyright © 2017 Elsevier Inc. All rights reserved.

Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations.

PubMed

Soto-Mesa, D; Amorín-Díaz, M; Pérez-Arviza, L; Fernández-Pello Montes, S; Martín-Huéscar, A

2015-11-01

Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience.

PubMed

Cho, Chak-Lam; Ho, Kwan-Lun; Chan, Wayne Kwun-Wai; Chu, Ringo Wing-Hong; Law, In-Chak

2017-01-01

Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct. Copyright® by the International Brazilian Journal of Urology.

Accelerating Success: A Design Guide for Starting a New School Incubator

ERIC Educational Resources Information Center

Lake, Robin; Rainey, Lydia

2004-01-01

Incubators are organizations that aim to decrease the learning curve for new schools and increase the likelihood that promising school plans will succeed. Incubators offer communities an innovative new way to support locally-initiated school designs. This design guide is intended to help people who are interested in starting a school incubator…

Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health.

PubMed

Mirheydar, Hossein S; Parsons, J Kellogg

2013-06-01

Robotic technology disseminated into urological practice without robust comparative effectiveness data. To review the diffusion of robotic surgery into urological practice. We performed a comprehensive literature review focusing on diffusion patterns, patient safety, learning curves, and comparative costs for robotic radical prostatectomy, partial nephrectomy, and radical cystectomy. Robotic urologic surgery diffused in patterns typical of novel technology spreading among practicing surgeons. Robust evidence-based data comparing outcomes of robotic to open surgery were sparse. Although initial Level 3 evidence for robotic prostatectomy observed complication outcomes similar to open prostatectomy, subsequent population-based Level 2 evidence noted an increased prevalence of adverse patient safety events and genitourinary complications among robotic patients during the early years of diffusion. Level 2 evidence indicated comparable to improved patient safety outcomes for robotic compared to open partial nephrectomy and cystectomy. Learning curve recommendations for robotic urologic surgery have drawn exclusively on Level 4 evidence and subjective, non-validated metrics. The minimum number of cases required to achieve competency for robotic prostatectomy has increased to unrealistically high levels. Most comparative cost-analyses have demonstrated that robotic surgery is significantly more expensive than open or laparoscopic surgery. Evidence-based data are limited but suggest an increased prevalence of adverse patient safety events for robotic prostatectomy early in the national diffusion period. Learning curves for robotic urologic surgery are subjective and based on non-validated metrics. The urological community should develop rigorous, evidence-based processes by which future technological innovations may diffuse in an organized and safe manner.

Verbal learning changes in older adults across 18 months.

PubMed

Zimprich, Daniel; Rast, Philippe

2009-07-01

The major aim of this study was to investigate individual changes in verbal learning across a period of 18 months. Individual differences in verbal learning have largely been neglected in the last years and, even more so, individual differences in change in verbal learning. The sample for this study comes from the Zurich Longitudinal Study on Cognitive Aging (ZULU; Zimprich et al., 2008a) and comprised 336 older adults in the age range of 65-80 years at first measurement occasion. In order to address change in verbal learning we used a latent change model of structured latent growth curves to account for the non-linearity of the verbal learning data. The individual learning trajectories were captured by a hyperbolic function which yielded three psychologically distinct parameters: initial performance, learning rate, and asymptotic performance. We found that average performance increased with respect to initial performance, but not in learning rate or in asymptotic performance. Further, variances and covariances remained stable across both measurement occasions, indicating that the amount of individual differences in the three parameters remained stable, as did the relationships among them. Moreover, older adults differed reliably in their amount of change in initial performance and asymptotic performance. Eventually, changes in asymptotic performance and learning rate were strongly negatively correlated. It thus appears as if change in verbal learning in old age is a constrained process: an increase in total learning capacity implies that it takes longer to learn. Together, these results point to the significance of individual differences in change of verbal learning in the elderly.

Learning curves for urological procedures: a systematic review.

PubMed

Abboudi, Hamid; Khan, Mohammed Shamim; Guru, Khurshid A; Froghi, Saied; de Win, Gunter; Van Poppel, Hendrik; Dasgupta, Prokar; Ahmed, Kamran

2014-10-01

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures. © 2013 The Authors. BJU International © 2013 BJU International.

Virtual reality cataract surgery training: learning curves and concurrent validity.

PubMed

Selvander, Madeleine; Åsman, Peter

2012-08-01

To investigate initial learning curves on a virtual reality (VR) eye surgery simulator and whether achieved skills are transferable between tasks. Thirty-five medical students were randomized to complete ten iterations on either the VR Caspulorhexis module (group A) or the Cataract navigation training module (group B) and then two iterations on the other module. Learning curves were compared between groups. The second Capsulorhexis video was saved and evaluated with the performance rating tool Objective Structured Assessment of Cataract Surgical Skill (OSACSS). The students' stereoacuity was examined. Both groups demonstrated significant improvements in performance over the 10 iterations: group A for all parameters analysed including score (p < 0.0001), time (p < 0.0001) and corneal damage (p = 0.0003), group B for time (p < 0.0001), corneal damage (p < 0.0001) but not for score (p = 0.752). Training on one module did not improve performance on the other. Capsulorhexis score correlated significantly with evaluation of the videos using the OSACSS performance rating tool. For stereoacuity < and ≥120 seconds of arc, sum of both modules' second iteration score was 73.5 and 41.0, respectively (p = 0.062). An initial rapid improvement in performance on a simulator with repeated practice was shown. For capsulorhexis, 10 iterations with only simulator feedback are not enough to reach a plateau for overall score. Skills transfer between modules was not found suggesting benefits from training on both modules. Stereoacuity may be of importance in the recruitment and training of new cataract surgeons. Additional studies are needed to investigate this further. Concurrent validity was found for Capsulorhexis module. © 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.

Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective.

PubMed

Stefanidis, Dimitrios; Hope, William W; Korndorffer, James R; Markley, Sarah; Scott, Daniel J

2010-04-01

Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum. Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test. Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee. Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Implementation Learning and Forgetting Curve to Scheduling in Garment Industry

NASA Astrophysics Data System (ADS)

Muhamad Badri, Huda; Deros, Baba Md; Syahri, M.; Saleh, Chairul; Fitria, Aninda

2016-02-01

The learning curve shows the relationship between time and the cumulative number of units produced which using the mathematical description on the performance of workers in performing repetitive works. The problems of this study is level differences in the labors performance before and after the break which affects the company's production scheduling. The study was conducted in the garment industry, which the aims is to predict the company production scheduling using the learning curve and forgetting curve. By implementing the learning curve and forgetting curve, this paper contributes in improving the labors performance that is in line with the increase in maximum output 3 hours productive before the break are 15 unit product with learning curve percentage in the company is 93.24%. Meanwhile, the forgetting curve improving maximum output 3 hours productive after the break are 11 unit product with the percentage of forgetting curve in the company is 92.96%. Then, the obtained 26 units product on the productive hours one working day is used as the basic for production scheduling.

Defining the learning curve of laparoendoscopic single-site Heller myotomy.

PubMed

Ross, Sharona B; Luberice, Kenneth; Kurian, Tony J; Paul, Harold; Rosemurgy, Alexander S

2013-08-01

Initial outcomes suggest laparoendoscopic single-site (LESS) Heller myotomy with anterior fundoplication provides safe, efficacious, and cosmetically superior outcomes relative to conventional laparoscopy. This study was undertaken to define the learning curve of LESS Heller myotomy with anterior fundoplication. One hundred patients underwent LESS Heller myotomy with anterior fundoplication. Symptom frequency and severity were scored using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Symptom resolution, additional trocars, and complications were compared among patient quartiles. Median data are presented. Preoperative frequency/severity scores were: dysphagia = 10/8 and regurgitation = 8/7. Additional trocars were placed in 12 patients (10%), of whom all were in the first two quartiles. Esophagotomy/gastrotomy occurred in three patients. Postoperative complications occurred in 9 per cent. No conversions to "open" operations occurred. Length of stay was 1 day. Postoperative frequency/severity scores were: dysphagia = 2/0 and regurgitation = 0/0; scores were less than before myotomy (P < 0.001). There were no apparent scars, except where additional trocars were placed. LESS Heller myotomy with anterior fundoplication well palliates symptoms of achalasia with no apparent scar. Placement of additional trocars only occurred early in the experience. For surgeons proficient with the conventional laparoscopic approach, the learning curve of LESS Heller myotomy with anterior fundoplication is short and safe, because proficiency is quickly attained.

Using distance technology to learn across borders: a virtual travel course in nursing.

PubMed

Gallagher-Lepak, Susan; Block, Derryl; Rojas, Yrene Esperanza Urbina; Birkholz, Lorri; Melgar Morán, Carlos Christian

2011-08-01

A 6-week online course was developed and delivered to nursing students and instructors at universities in two countries. The course exposed students and faculty to nursing and health concerns in both countries. All course communications were conducted in both English and Spanish, with support from online translation software as needed. Course content covered professional nursing, global health issues, and nursing interventions used with clinical problems. Although students were initially intimidated by the course language requirements, students valued the opportunity to learn about cultural and health issues. Faculty experienced a learning curve as well and enjoyed this international experience. Copyright 2011, SLACK Incorporated.

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

PubMed Central

Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Seryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-01-01

Purpose Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Methods Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve. Results We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646). Conclusion Learning curve seems to complete after performing 16 cases. PMID:28686640

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.

PubMed

Yano, Fumiaki; Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Seryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-01-01

Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve. We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646). Learning curve seems to complete after performing 16 cases.

Analysis of Laparoscopic Sleeve Gastrectomy Learning Curve and Its Influence on Procedure Safety and Perioperative Complications.

PubMed

Major, Piotr; Wysocki, Michał; Dworak, Jadwiga; Pędziwiatr, Michał; Pisarska, Magdalena; Wierdak, Mateusz; Zub-Pokrowiecka, Anna; Natkaniec, Michał; Małczak, Piotr; Nowakowski, Michał; Budzyński, Andrzej

2018-06-01

Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol. Primary endpoint was determining the LSG learning curve's stabilization point, using operative time, intraoperative difficulties, intraoperative adverse events (IAE), and number of stapler firings. Secondary endpoints: influence on perioperative complications and reoperations. Five hundred patients were included (330 females, median age of 40 (33-49) years). Operative time in G1-G2 differed significantly from G3-G5. Stabilization point was the 200th procedure using operative time. Intraoperative difficulties of G1 differed significantly from G2-G5, with stabilization after the 100th procedure. IAE and number of stapler firings could not be used as predictor. Based on perioperative morbidity, the learning curve was stabilized at the 100th procedure. The morbidity rates in the groups were G1, 13%; G2, 4%; G3, 5%; G4, 5%; and G5, 2%. The reoperation rate in G1 was 3%; G2, 2%; G3, 2%; G4, 1%; and G5, 0%. The institutional learning process stabilization point for LSG in a newly established bariatric center is between the 100th and 200th operation. Initially, the morbidity rate is high, which should concern surgeons who are willing to perform bariatric surgery.

Digital tomosynthesis for evaluating metastatic lung nodules: nodule visibility, learning curves, and reading times.

PubMed

Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyungjin; Song, Yong Sub; Hwang, Eui Jin

2015-01-01

To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, ≤ 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis.

PubMed

Harrysson, Iliana J; Cook, Jonathan; Sirimanna, Pramudith; Feldman, Liane S; Darzi, Ara; Aggarwal, Rajesh

2014-07-01

To determine how minimally invasive surgical learning curves are assessed and define an ideal framework for this assessment. Learning curves have implications for training and adoption of new procedures and devices. In 2000, a review of the learning curve literature was done by Ramsay et al and it called for improved reporting and statistical evaluation of learning curves. Since then, a body of literature is emerging on learning curves but the presentation and analysis vary. A systematic search was performed of MEDLINE, EMBASE, ISI Web of Science, ERIC, and the Cochrane Library from 1985 to August 2012. The inclusion criteria are minimally invasive abdominal surgery formally analyzing the learning curve and English language. 592 (11.1%) of the identified studies met the selection criteria. Time is the most commonly used proxy for the learning curve (508, 86%). Intraoperative outcomes were used in 316 (53%) of the articles, postoperative outcomes in 306 (52%), technical skills in 102 (17%), and patient-oriented outcomes in 38 (6%) articles. Over time, there was evidence of an increase in the relative amount of laparoscopic and robotic studies (P < 0.001) without statistical evidence of a change in the complexity of analysis (P = 0.121). Assessment of learning curves is needed to inform surgical training and evaluate new clinical procedures. An ideal analysis would account for the degree of complexity of individual cases and the inherent differences between surgeons. There is no single proxy that best represents the success of surgery, and hence multiple outcomes should be collected.

On the necessity of U-shaped learning.

PubMed

Carlucci, Lorenzo; Case, John

2013-01-01

A U-shaped curve in a cognitive-developmental trajectory refers to a three-step process: good performance followed by bad performance followed by good performance once again. U-shaped curves have been observed in a wide variety of cognitive-developmental and learning contexts. U-shaped learning seems to contradict the idea that learning is a monotonic, cumulative process and thus constitutes a challenge for competing theories of cognitive development and learning. U-shaped behavior in language learning (in particular in learning English past tense) has become a central topic in the Cognitive Science debate about learning models. Antagonist models (e.g., connectionism versus nativism) are often judged on their ability of modeling or accounting for U-shaped behavior. The prior literature is mostly occupied with explaining how U-shaped behavior occurs. Instead, we are interested in the necessity of this kind of apparently inefficient strategy. We present and discuss a body of results in the abstract mathematical setting of (extensions of) Gold-style computational learning theory addressing a mathematically precise version of the following question: Are there learning tasks that require U-shaped behavior? All notions considered are learning in the limit from positive data. We present results about the necessity of U-shaped learning in classical models of learning as well as in models with bounds on the memory of the learner. The pattern emerges that, for parameterized, cognitively relevant learning criteria, beyond very few initial parameter values, U-shapes are necessary for full learning power! We discuss the possible relevance of the above results for the Cognitive Science debate about learning models as well as directions for future research. Copyright © 2013 Cognitive Science Society, Inc.

Retroperitoneoscopic living donor nephrectomy: initial experience with a unique hand-assisted approach.

PubMed

Capolicchio, J-P; Feifer, A; Plante, M K; Tchervenkov, J

2011-01-01

The retroperitoneoscopic (RP) approach to live donor nephrectomy (LDN) may be advantageous for the donor because it avoids mobilization of peritoneal organs and provides direct access to the renal vessels. Notwithstanding, this approach is not popular, likely because of the steeper learning curve. We feel that hand-assistance (HA) can reduce the learning curve and in this study, we present our experience with a novel hand-assist approach to retroperitoneoscopic live donor nephrectomy (HARP-LDN). Over a one-yr period, 10 consecutive patients underwent left HARP-LDN with a mean body mass index of 29 and three with prior left abdomen surgery. The surgical technique utilizes a 7 cm, muscle-sparing incision for the hand-port with two endoscopic ports. Operative time was an average of 155 min., with no open conversions. Mean blood loss was 68 mL, and warm ischemia time was 2.5 min. Hospital stay averaged 2.7 d with postoperative complications limited to one urinary retention. Our modified HARP approach to left LDN is safe, effective and can be performed expeditiously. Our promising initial results require a larger patient cohort to confirm the advantages of the hand-assisted retroperitoneal technique. © 2010 John Wiley & Sons A/S.

Learning curves in health care.

PubMed

Waldman, J Deane; Yourstone, Steven A; Smith, Howard L

2003-01-01

This article explores the uses of learning curve theory in medicine. Though effective application of learning curve theory in health care can result in higher quality and lower cost, it is seldom methodically applied in clinical practice. Fundamental changes are necessary in the corporate culture of medicine in order to capitalize maximally on the benefits of learning.

Manufacturing complexity analysis

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1977-01-01

The analysis of the complexity of a typical system is presented. Starting with the subsystems of an example system, the step-by-step procedure for analysis of the complexity of an overall system is given. The learning curves for the various subsystems are determined as well as the concurrent numbers of relevant design parameters. Then trend curves are plotted for the learning curve slopes versus the various design-oriented parameters, e.g. number of parts versus slope of learning curve, or number of fasteners versus slope of learning curve, etc. Representative cuts are taken from each trend curve, and a figure-of-merit analysis is made for each of the subsystems. Based on these values, a characteristic curve is plotted which is indicative of the complexity of the particular subsystem. Each such characteristic curve is based on a universe of trend curve data taken from data points observed for the subsystem in question. Thus, a characteristic curve is developed for each of the subsystems in the overall system.

Learning Factors Transfer Analysis: Using Learning Curve Analysis to Automatically Generate Domain Models

ERIC Educational Resources Information Center

Pavlik, Philip I. Jr.; Cen, Hao; Koedinger, Kenneth R.

2009-01-01

This paper describes a novel method to create a quantitative model of an educational content domain of related practice item-types using learning curves. By using a pairwise test to search for the relationships between learning curves for these item-types, we show how the test results in a set of pairwise transfer relationships that can be…

R for fledglings

USGS Publications Warehouse

Donovan, Therese; Brown, Michelle; Katz, Jonathan

2015-01-01

We’ve been asked to provide a short introduction to R and its utility in natural resource management. In this short introduction, we can guarantee one thing: you won’t learn R in a few days. That would be like learning to speak French in a few days. To actually learn R, you need to practice….Bode Miller didn’t win his Olympic medals without hours and hours of practice. However, in this short introduction, you can gain an appreciation for what R can do, be introduced to some key functions that you will likely use over and over again, and learn some strategies for creating scripts for automating your work. There are several excellent R books that provide much more information than this short introduction….. R has a steep learning curve, and our hope is to cover some basics to get you over the initial hump.

An introduction to scripting in Ruby for biologists.

PubMed

Aerts, Jan; Law, Andy

2009-07-16

The Ruby programming language has a lot to offer to any scientist with electronic data to process. Not only is the initial learning curve very shallow, but its reflection and meta-programming capabilities allow for the rapid creation of relatively complex applications while still keeping the code short and readable. This paper provides a gentle introduction to this scripting language for researchers without formal informatics training such as many wet-lab scientists. We hope this will provide such researchers an idea of how powerful a tool Ruby can be for their data management tasks and encourage them to learn more about it.

Identifying Learning Patterns of Children at Risk for Specific Reading Disability

PubMed Central

Barbot, Baptiste; Krivulskaya, Suzanna; Hein, Sascha; Reich, Jodi; Thuma, Philip E.; Grigorenko, Elena L.

2016-01-01

Differences in learning patterns of vocabulary acquisition in children at risk (+SRD) and not at risk (SRD) for Specific Reading Disability (SRD) were examined using a microdevelopmental paradigm applied to the multi-trial Foreign Language Learning Task (FLLT; Baddeley et al., 1995). The FLLT was administered to 905 children from rural Chitonga-speaking Zambia. A multi-group Latent Growth Curve Model (LGCM) was implemented to study interindividual differences in intraindividual change across trials. Results showed that the +SRD group recalled fewer words correctly in the first trial, learned at a slower rate during the subsequent trials, and demonstrated a more linear learning pattern compared to the SRD group. This study illustrates the promise of LGCM applied to multi-trial learning tasks, by isolating three components of the learning process (initial recall, rate of learning, and functional pattern of learning). Implications of this microdevelopmental approach to SRD research in low-to-middle income countries are discussed. PMID:26037654

Identifying learning patterns of children at risk for Specific Reading Disability.

PubMed

Barbot, Baptiste; Krivulskaya, Suzanna; Hein, Sascha; Reich, Jodi; Thuma, Philip E; Grigorenko, Elena L

2016-05-01

Differences in learning patterns of vocabulary acquisition in children at risk (+SRD) and not at risk (-SRD) for Specific Reading Disability (SRD) were examined using a microdevelopmental paradigm applied to the multi-trial Foreign Language Learning Task (FLLT; Baddeley et al., 1995). The FLLT was administered to 905 children from rural Chitonga-speaking Zambia. A multi-group Latent Growth Curve Model (LGCM) was implemented to study interindividual differences in intraindividual change across trials. Results showed that the +SRD group recalled fewer words correctly in the first trial, learned at a slower rate during the subsequent trials, and demonstrated a more linear learning pattern compared to the -SRD group. This study illustrates the promise of LGCM applied to multi-trial learning tasks, by isolating three components of the learning process (initial recall, rate of learning, and functional pattern of learning). Implications of this microdevelopmental approach to SRD research in low-to-middle income countries are discussed. © 2015 John Wiley & Sons Ltd.

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

PubMed

Ferrarese, Alessia; Gentile, Valentina; Bindi, Marco; Rivelli, Matteo; Cumbo, Jacopo; Solej, Mario; Enrico, Stefano; Martino, Valter

2016-01-01

A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms "surgeon", "specialized surgeon", and "specialist surgeon"; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee's progress. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor's ability, the trainee's own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

Measuring student learning using initial and final concept test in an STEM course

NASA Astrophysics Data System (ADS)

Kaw, Autar; Yalcin, Ali

2012-06-01

Effective assessment is a cornerstone in measuring student learning in higher education. For a course in Numerical Methods, a concept test was used as an assessment tool to measure student learning and its improvement during the course. The concept test comprised 16 multiple choice questions and was given in the beginning and end of the class for three semesters. Hake's gain index, a measure of learning gains from pre- to post-tests, of 0.36 to 0.41 were recorded. The validity and reliability of the concept test was checked via standard measures such as Cronbach's alpha, content and criterion-related validity, item characteristic curves and difficulty and discrimination indices. The performance of various subgroups such as pre-requisite grades, transfer students, gender and age were also studied.

The learning curve of robot-assisted laparoscopic fundoplication in children: a prospective evaluation and CUSUM analysis.

PubMed

Cundy, Thomas P; Rowland, Simon P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

2015-06-01

Fundoplication is a leading application of robotic surgery in children, yet the learning curve for this procedure (RF) remains ill-defined. This study aims to identify various learning curve transition points, using cumulative summation (CUSUM) analysis. A prospective database was examined to identify RF cases undertaken during 2006-2014. Time-based surgical process outcomes were evaluated, as well as clinical outcomes. A total of 57 RF cases were included. Statistically significant transitions beyond the learning phase were observed at cases 42, 34 and 37 for docking, console and total operating room times, respectively. A steep early learning phase for docking time was overcome after 12 cases. There were three Clavien-Dindo grade ≥ 3 complications, with two patients requiring redo fundoplication. We identified numerous well-defined learning curve trends to affirm that experience confers significant temporal improvements. Our findings highlight the value of the CUSUM method for learning curve evaluation. Copyright © 2014 John Wiley & Sons, Ltd.

TOWARD CHARACTERIZATION OF THE TYPE IIP SUPERNOVA PROGENITOR POPULATION: A STATISTICAL SAMPLE OF LIGHT CURVES FROM Pan-STARRS1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanders, N. E.; Soderberg, A. M.; Chornock, R.

2015-02-01

In recent years, wide-field sky surveys providing deep multiband imaging have presented a new path for indirectly characterizing the progenitor populations of core-collapse supernovae (SNe): systematic light-curve studies. We assemble a set of 76 grizy-band Type IIP SN light curves from Pan-STARRS1, obtained over a constant survey program of 4 yr and classified using both spectroscopy and machine-learning-based photometric techniques. We develop and apply a new Bayesian model for the full multiband evolution of each light curve in the sample. We find no evidence of a subpopulation of fast-declining explosions (historically referred to as ''Type IIL'' SNe). However, we identify a highly significantmore » relation between the plateau phase decay rate and peak luminosity among our SNe IIP. These results argue in favor of a single parameter, likely determined by initial stellar mass, predominantly controlling the explosions of red supergiants. This relation could also be applied for SN cosmology, offering a standardizable candle good to an intrinsic scatter of ≲ 0.2 mag. We compare each light curve to physical models from hydrodynamic simulations to estimate progenitor initial masses and other properties of the Pan-STARRS1 Type IIP SN sample. We show that correction of systematic discrepancies between modeled and observed SN IIP light-curve properties and an expanded grid of progenitor properties are needed to enable robust progenitor inferences from multiband light-curve samples of this kind. This work will serve as a pathfinder for photometric studies of core-collapse SNe to be conducted through future wide-field transient searches.« less

Taking the brakes off the learning curve.

PubMed

Gheysen, Freja; Lasne, Gabriel; Pélégrini-Issac, Mélanie; Albouy, Genevieve; Meunier, Sabine; Benali, Habib; Doyon, Julien; Popa, Traian

2017-03-01

Motor learning is characterized by patterns of cerebello-striato-cortical activations shifting in time, yet the early dynamic and function of these activations remains unclear. Five groups of subjects underwent either continuous or intermittent theta-burst stimulation of one cerebellar hemisphere, or no stimulation just before learning a new motor sequence during fMRI scanning. We identified three phases during initial learning: one rapid, one slow, and one quasi-asymptotic performance phase. These phases were not changed by left cerebellar stimulation. Right cerebellar inhibition, however, accelerated learning and enhanced brain activation in critical motor learning-related areas during the first phase, continuing with reduced brain activation but high-performance in late phase. Right cerebellar excitation did not affect the early learning process, but slowed learning significantly in late phase, along with increased brain activation. We conclude that the right cerebellum is a key factor coordinating other neuronal loops in the early acquisition of an explicit motor sequential skill. Hum Brain Mapp 38:1676-1691, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

An appraisal of the learning curve in robotic general surgery.

PubMed

Pernar, Luise I M; Robertson, Faith C; Tavakkoli, Ali; Sheu, Eric G; Brooks, David C; Smink, Douglas S

2017-11-01

Robotic-assisted surgery is used with increasing frequency in general surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic general surgery to inform adopters of the technology. PubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on general surgery operations, and with explicit statistical methods. Twenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19-128 cases for colorectal, 8-95 for foregut/bariatric, 20-48 for biliary, and 10-80 for solid organ surgery. Although robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.

Playing off the curve - testing quantitative predictions of skill acquisition theories in development of chess performance.

PubMed

Gaschler, Robert; Progscha, Johanna; Smallbone, Kieran; Ram, Nilam; Bilalić, Merim

2014-01-01

Learning curves have been proposed as an adequate description of learning processes, no matter whether the processes manifest within minutes or across years. Different mechanisms underlying skill acquisition can lead to differences in the shape of learning curves. In the current study, we analyze the tournament performance data of 1383 chess players who begin competing at young age and play tournaments for at least 10 years. We analyze the performance development with the goal to test the adequacy of learning curves, and the skill acquisition theories they are based on, for describing and predicting expertise acquisition. On the one hand, we show that the skill acquisition theories implying a negative exponential learning curve do a better job in both describing early performance gains and predicting later trajectories of chess performance than those theories implying a power function learning curve. On the other hand, the learning curves of a large proportion of players show systematic qualitative deviations from the predictions of either type of skill acquisition theory. While skill acquisition theories predict larger performance gains in early years and smaller gains in later years, a substantial number of players begin to show substantial improvements with a delay of several years (and no improvement in the first years), deviations not fully accounted for by quantity of practice. The current work adds to the debate on how learning processes on a small time scale combine to large-scale changes.

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study.

PubMed

Paschold, M; Huber, T; Maedge, S; Zeissig, S R; Lang, H; Kneist, W

2017-04-01

Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. The study subjects were operating room nurses, medical students, and first year residents. Participants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. Nurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). The included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Teaching Learning Curves in an Undergraduate Economics or Operations Management Course

ERIC Educational Resources Information Center

Naidu, Jaideep T.; Sanford, John F.

2012-01-01

Learning Curves has its roots in economics and behavioral psychology. Learning Curves theory has several business applications and is widely used in the industry. As faculty of Operations Management courses, we cover this topic in some depth in the classroom. In this paper, we present some of our teaching methods and material that have helped us…

Learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer.

PubMed

Lendínez-Cano, G; Osman García, I; Congregado Ruiz, C B; Conde Sánchez, J M; Medina López, R A

2018-03-07

To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Learning curves for transapical transcatheter aortic valve replacement in the PARTNER-I trial: Technical performance, success, and safety.

PubMed

Suri, Rakesh M; Minha, Sa'ar; Alli, Oluseun; Waksman, Ron; Rihal, Charanjit S; Satler, Lowell P; Greason, Kevin L; Torguson, Rebecca; Pichard, Augusto D; Mack, Michael; Svensson, Lars G; Rajeswaran, Jeevanantham; Lowry, Ashley M; Ehrlinger, John; Mick, Stephanie L; Tuzcu, E Murat; Thourani, Vinod H; Makkar, Raj; Holmes, David; Leon, Martin B; Blackstone, Eugene H

2016-09-01

Introduction of hybrid techniques, such as transapical transcatheter aortic valve replacement (TA-TAVR), requires skills that a heart team must master to achieve technical efficiency: the technical performance learning curve. To date, the learning curve for TA-TAVR remains unknown. We therefore evaluated the rate at which technical performance improved, assessed change in occurrence of adverse events in relation to technical performance, and determined whether adverse events after TA-TAVR were linked to acquiring technical performance efficiency (the learning curve). From April 2007 to February 2012, 1100 patients, average age 85.0 ± 6.4 years, underwent TA-TAVR in the PARTNER-I trial. Learning curves were defined by institution-specific patient sequence number using nonlinear mixed modeling. Mean procedure time decreased from 131 to 116 minutes within 30 cases (P = .06) and device success increased to 90% by case 45 (P = .0007). Within 30 days, 354 patients experienced a major adverse event (stroke in 29, death in 96), with possibly decreased complications over time (P ∼ .08). Although longer procedure time was associated with more adverse events (P < .0001), these events were associated with change in patient risk profile, not the technical performance learning curve (P = .8). The learning curve for TA-TAVR was 30 to 45 procedures performed, and technical efficiency was achieved without compromising patient safety. Although fewer patients are now undergoing TAVR via nontransfemoral access, understanding TA-TAVR learning curves and their relationship with outcomes is important as the field moves toward next-generation devices, such as those to replace the mitral valve, delivered via the left ventricular apex. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Learning micro incision surgery without the learning curve

PubMed Central

Navin, Shoba; Parikh, Rajul

2008-01-01

We describe a method of learning micro incision cataract surgery painlessly with the minimum of learning curves. A large-bore or standard anterior chamber maintainer (ACM) facilitates learning without change of machine or preferred surgical technique. Experience with the use of an ACM during phacoemulsification is desirable. PMID:18292624

Comparison of Learning Curves for Major and Minor Laparoscopic Liver Resection.

PubMed

Lee, Woohyung; Woo, Jung-Woo; Lee, Jin-Kwon; Park, Ji-Ho; Kim, Ju-Yeon; Kwag, Seung-Jin; Park, Taejin; Jeong, Sang-Ho; Ju, Young-Tae; Jeong, Eun-Jung; Lee, Young-Joon; Choi, Sang-Kyung; Hong, Soon-Chan; Jeong, Chi-Young

2016-06-01

Because laparoscopic liver resection (LLR) has a steep learning curve, analyzing experience is important for trainees. Several authors have described the learning curve of LLR, without comparing the learning curves between major and minor LLR. Perioperative data were retrieved from the medical records of 170 consecutive patients who underwent LLR by a single surgeon at a tertiary hospital. Learning curves were generated and compared between major and minor LLR using cumulative sum control charts and the moving average. Major and minor LLR was performed in 96 and 74 patients, respectively. The learning curves showed a steady state after case 50 for major LLR. Because of discordant results in minor LLR, subgroup analyses were performed, showing competency in LLR after cases 25 and 35 for left lateral sectionectomy and tumorectomy, respectively. Transfused red blood cell volume (0.6 versus 2.2 packs, P < .001) decreased after achievement of competence in major LLR. Blood loss exceeding 500 mL (odds ratio 2.395, 95% confidence interval 1.096-5.233, P = .028) was independently associated with LLR failure. The number of cases required to accomplish LLR differed according to the extent of resection. Extensive blood loss was independently associated with LLR failure.

Learning Curve of the Application of Huang Three-Step Maneuver in a Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy for Advanced Gastric Cancer

PubMed Central

Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-long; Lin, Mi; Tu, Ru-Hong

2016-01-01

Abstract To investigate the learning curve of the application of Huang 3-step maneuver, which was summarized and proposed by our center for the treatment of advanced upper gastric cancer. From April 2012 to March 2013, 130 consecutive patients who underwent a laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) by a single surgeon who performed Huang 3-step maneuver were retrospectively analyzed. The learning curve was analyzed based on the moving average (MA) method and the cumulative sum method (CUSUM). Surgical outcomes, short-term outcomes, and follow-up results before and after learning curve were contrastively analyzed. A stepwise multivariate logistic regression was used for a multivariable analysis to determine the factors that affect the operative time using Huang 3-step maneuver. Based on the CUSUM, the learning curve for Huang 3-step maneuver was divided into phase 1 (cases 1–40) and phase 2 (cases 41–130). The dissection time (DT) (P < 0.001), blood loss (BL) (P < 0.001), and number of vessels injured in phase 2 were significantly less than those in phase 1. There were no significant differences in the clinicopathological characteristics, short-term outcomes, or major postoperative complications between the learning curve phases. Univariate and multivariate analyses revealed that body mass index (BMI), short gastric vessels (SGVs), splenic hilar artery (SpA) type, and learning curve phase were significantly associated with DT. In the entire group, 124 patients were followed for a median time of 23.0 months (range, 3–30 months). There was no significant difference in the survival curve between phases. AUGC patients with a BMI less than 25 kg/m2, a small number of SGVs, and a concentrated type of SpA are ideal candidates for surgeons who are in phase 1 of the learning curve. PMID:27043698

Retention of sequential drug discriminations under fixed-interval schedules for long time periods without training.

PubMed

Li, Mi; McMillan, Donald E

2003-08-22

The experiments showed that sequential drug discriminations can be learned and retained under a fixed-interval (FI) schedule for more than 18 months without additional training under a complex three-choice procedure. Pigeons were trained to discriminate among 5 mg/kg pentobarbital, 2 mg/kg D-amphetamine, and saline. After responding stabilized, dose-response curves were determined for other drugs. Subsequently, pentobarbital was replaced with 5 mg/kg morphine as a training drug, and D-amphetamine was replaced with 30 mg/kg caffeine. After the pigeons learned these new discriminations, dose-response curves were redetermined. Initially, chlordiazepoxide substituted for pentobarbital, cocaine substituted for D-amphetamine, and nicotine partially substituted for D-amphetamine. Morphine, Delta9-tetrahydrocannabinol, and caffeine did not substitute for either drug. After retraining with morphine and caffeine, responding occurred on the pentobarbital/morphine key after pentobarbital, chlordiazepoxide and morphine and on the D-amphetamine/caffeine key after D-amphetamine, cocaine and caffeine. After nicotine and Delta9-tetrahyrdocannabinol, responding occurred on the saline key. These data show that drug discriminations learned under fixed-interval schedules are retained for long time periods, even when discrimination training with other drugs occurs during the retention period.

An introduction to scripting in Ruby for biologists

PubMed Central

Aerts, Jan; Law, Andy

2009-01-01

The Ruby programming language has a lot to offer to any scientist with electronic data to process. Not only is the initial learning curve very shallow, but its reflection and meta-programming capabilities allow for the rapid creation of relatively complex applications while still keeping the code short and readable. This paper provides a gentle introduction to this scripting language for researchers without formal informatics training such as many wet-lab scientists. We hope this will provide such researchers an idea of how powerful a tool Ruby can be for their data management tasks and encourage them to learn more about it. PMID:19607723

Laparoscopic varicocelectomy: virtual reality training and learning curve.

PubMed

Wang, Zheng; Ni, Yuhua; Zhang, Yinan; Jin, Xunbo; Xia, Qinghua; Wang, Hanbo

2014-01-01

To explore the role that virtual reality training might play in the learning curve of laparoscopic varicocelectomy. A total of 1326 laparoscopic varicocelectomy cases performed by 16 participants from July 2005 to June 2012 were retrospectively analyzed. The participants were divided into 2 groups: group A was trained by laparoscopic trainer boxes; group B was trained by a virtual reality training course preoperatively. The operation time curves were drafted, and the learning, improving, and platform stages were divided and statistically confirmed. The operation time and number of cases in the learning and improving stages of both groups were compared. Testicular artery sparing failure and postoperative hydroceles rate were statistically analyzed for the confirmation of the learning curve. The learning curve of laparoscopic varicocelectomy was 15 cases, and with 14 cases more, it came into the platform stage. The number of cases for the learning stages of both groups showed no statistical difference (P=.49), but the operation time of group B for the learning stage was less than that of group A (P<.00001). The number of cases of group B for the improving stage was significantly less than that of group A (P=.005), but the operation time of both groups in the improving stage showed no difference (P=.30). The difference of testicular artery sparing failure rates among these 3 stages was proved significant (P<.0001), the postoperative hydroceles rate showed no statistical difference (P=.60). The virtual reality training shortened the operation time in the learning stage and hastened the trainees' steps in the improving stage, but did not shorten the learning curve as expected to.

Trainee competence in thoracoscopic esophagectomy in the prone position: evaluation using cumulative sum techniques.

PubMed

Oshikiri, Taro; Yasuda, Takashi; Yamamoto, Masashi; Kanaji, Shingo; Yamashita, Kimihiro; Matsuda, Takeru; Sumi, Yasuo; Nakamura, Tetsu; Fujino, Yasuhiro; Tominaga, Masahiro; Suzuki, Satoshi; Kakeji, Yoshihiro

2016-09-01

Minimally invasive esophagectomy (MIE) has less morbidity than the open approach. In particular, thoracoscopic esophagectomy in the prone position (TEP) has been performed worldwide. Using the cumulative sum control chart (CUSUM) method, this study aimed to confirm whether a trainee surgeon who learned established standards would become skilled in TEP with a shorter learning curve than that of the mentoring surgeon. Surgeon A performed TEP in 100 patients; the first 22 patients comprised period 1. His learning curve, defined based on the operation time (OT) of the thoracic procedure, was evaluated using the CUSUM method, and short-term outcomes were assessed. Another 22 patients underwent TEP performed by surgeon B, with outcomes compared to those of surgeon A's period 1. Using the CUSUM chart, the peak point of the thoracic procedure OT occurred at the 44th case in surgeon A's experience of 100 cases. With surgeon A's first 22 cases (period 1), the peak point of the thoracic procedure OT could not be confirmed and graph is expanding soaring at CUSUM chart. The CUSUM chart of surgeon B's experience of 22 cases clearly indicated that the peak point of the thoracic procedure OT occurred at the 17th case. The rate of recurrent laryngeal nerve palsy for surgeon B (9 %) was significantly lower than for surgeon A in period 1 (36 %) (p = 0.0266). There is some possibility for a trainee surgeon to attain the required basic skills to perform TEP in a relatively short period of time using a standardized procedure developed by a mentoring surgeon. The CUSUM method should be useful in evaluating trainee competence during an initial series of procedures, by assessing the learning curve defined by OT.

Comparison of the Operative Outcomes and Learning Curves between Laparoscopic and Robotic Gastrectomy for Gastric Cancer

PubMed Central

Huang, Kuo-Hung; Lan, Yuan-Tzu; Fang, Wen-Liang; Chen, Jen-Hao; Lo, Su-Shun; Li, Anna Fen-Yau; Chiou, Shih-Hwa; Wu, Chew-Wun; Shyr, Yi-Ming

2014-01-01

Background Minimally invasive surgery, including laparoscopic and robotic gastrectomy, has become more popular in the treatment of gastric cancer. However, few studies have compared the learning curves between laparoscopic and robotic gastrectomy for gastric cancer. Methods Data were prospectively collected between July 2008 and Aug 2014. A total of 145 patients underwent minimally invasive gastrectomy for gastric cancer by a single surgeon, including 73 laparoscopic and 72 robotic gastrectomies. The clinicopathologic characteristics, operative outcomes and learning curves were compared between the two groups. Results Compared with the laparoscopic group, the robotic group was associated with less blood loss and longer operative time. After the surgeon learning curves were overcome for each technique, the operative outcomes became similar between the two groups except longer operative time in the robotic group. After accumulating more cases of robotic gastrectomy, the operative time in the laparoscopic group decreased dramatically. Conclusions After overcoming the learning curves, the operative outcomes became similar between laparoscopic and robotic gastrectomy. The experience of robotic gastrectomy could affect the learning process of laparoscopic gastrectomy. PMID:25360767

Improving Accuracy and Temporal Resolution of Learning Curve Estimation for within- and across-Session Analysis

PubMed Central

Tabelow, Karsten; König, Reinhard; Polzehl, Jörg

2016-01-01

Estimation of learning curves is ubiquitously based on proportions of correct responses within moving trial windows. Thereby, it is tacitly assumed that learning performance is constant within the moving windows, which, however, is often not the case. In the present study we demonstrate that violations of this assumption lead to systematic errors in the analysis of learning curves, and we explored the dependency of these errors on window size, different statistical models, and learning phase. To reduce these errors in the analysis of single-subject data as well as on the population level, we propose adequate statistical methods for the estimation of learning curves and the construction of confidence intervals, trial by trial. Applied to data from an avoidance learning experiment with rodents, these methods revealed performance changes occurring at multiple time scales within and across training sessions which were otherwise obscured in the conventional analysis. Our work shows that the proper assessment of the behavioral dynamics of learning at high temporal resolution can shed new light on specific learning processes, and, thus, allows to refine existing learning concepts. It further disambiguates the interpretation of neurophysiological signal changes recorded during training in relation to learning. PMID:27303809

Hysteroscopic sterilization using a virtual reality simulator: assessment of learning curve.

PubMed

Janse, Juliënne A; Goedegebuure, Ruben S A; Veersema, Sebastiaan; Broekmans, Frank J M; Schreuder, Henk W R

2013-01-01

To assess the learning curve using a virtual reality simulator for hysteroscopic sterilization with the Essure method. Prospective multicenter study (Canadian Task Force classification II-2). University and teaching hospital in the Netherlands. Thirty novices (medical students) and five experts (gynecologists who had performed >150 Essure sterilization procedures). All participants performed nine repetitions of bilateral Essure placement on the simulator. Novices returned after 2 weeks and performed a second series of five repetitions to assess retention of skills. Structured observations on performance using the Global Rating Scale and parameters derived from the simulator provided measurements for analysis. The learning curve is represented by improvement per procedure. Two-way repeated-measures analysis of variance was used to analyze learning curves. Effect size (ES) was calculated to express the practical significance of the results (ES ≥ 0.50 indicates a large learning effect). For all parameters, significant improvements were found in novice performance within nine repetitions. Large learning effects were established for six of eight parameters (p < .001; ES, 0.50-0.96). Novices approached expert level within 9 to 14 repetitions. The learning curve established in this study endorses future implementation of the simulator in curricula on hysteroscopic skill acquisition for clinicians who are interested in learning this sterilization technique. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

PubMed

Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

2015-08-01

The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=<0.001-0.01). No significant difference was observed between case experience and frequency of post-operative complications (P=0.125), although the CUSUM chart demonstrated a directional change in slope for the last 12 cases in which there were high proportions of re-do cases and patients <6 months of age. The CUSUM method has a valuable role for learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition points. Copyright © 2015 Elsevier Inc. All rights reserved.

The 25 kW power module evolution study. Part 3: Conceptual designs for power module evolutions. Volume 3: Cost estimates

NASA Technical Reports Server (NTRS)

1979-01-01

Cost data generated for the evolutionary power module concepts selected are reported. The initial acquisition costs (design, development, and protoflight unit test costs) were defined and modeled for the baseline 25 kW power module configurations. By building a parametric model of this initial building block, the cost of the 50 kW and the 100 kW power modules were derived by defining only their configuration and programmatic differences from the 25 kW baseline module. Variations in cost for the quantities needed to fulfill the mission scenarios were derived by applying appropriate learning curves.

Learner Characteristic Based Learning Effort Curve Mode: The Core Mechanism on Developing Personalized Adaptive E-Learning Platform

ERIC Educational Resources Information Center

Hsu, Pi-Shan

2012-01-01

This study aims to develop the core mechanism for realizing the development of personalized adaptive e-learning platform, which is based on the previous learning effort curve research and takes into account the learner characteristics of learning style and self-efficacy. 125 university students from Taiwan are classified into 16 groups according…

Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization

DTIC Science & Technology

2014-05-01

1 Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization David N. Ford...2014 4. TITLE AND SUBTITLE Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization 5a...Manufacturing ( 3D printing ) 2 Research Context Problem: Learning curve savings forecasted in SHIPMAIN maintenance initiative have not materialized

Learning curve for intracranial angioplasty and stenting in single center.

PubMed

Cai, Qiankun; Li, Yongkun; Xu, Gelin; Sun, Wen; Xiong, Yunyun; Sun, Wenshan; Bao, Yuanfei; Huang, Xianjun; Zhang, Yao; Zhou, Lulu; Zhu, Wusheng; Liu, Xinfeng

2014-01-01

To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications. Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect. The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases. Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases. Copyright © 2013 Wiley Periodicals, Inc.

Acquisition Challenge: The Importance of Incompressibility in Comparing Learning Curve Models

DTIC Science & Technology

2015-10-01

parameters for all four learning mod- els used in the study . The learning rate factor, b, is the slope of the linear regression line, which in this case is...incorporated within the DoD acquisition environment. This study tested three alternative learning models (the Stanford-B model, DeJong’s learning formula...appropriate tools to calculate accurate and reliable predictions. However, conventional learning curve methodology has been in practice since the pre

A Primer on the Statistical Modelling of Learning Curves in Health Professions Education

ERIC Educational Resources Information Center

Pusic, Martin V.; Boutis, Kathy; Pecaric, Martin R.; Savenkov, Oleksander; Beckstead, Jason W.; Jaber, Mohamad Y.

2017-01-01

Learning curves are a useful way of representing the rate of learning over time. Features include an index of baseline performance (y-intercept), the efficiency of learning over time (slope parameter) and the maximal theoretical performance achievable (upper asymptote). Each of these parameters can be statistically modelled on an individual and…

Learning curve in robotic rectal cancer surgery: current state of affairs.

PubMed

Jiménez-Rodríguez, Rosa M; Rubio-Dorado-Manzanares, Mercedes; Díaz-Pavón, José Manuel; Reyes-Díaz, M Luisa; Vazquez-Monchul, Jorge Manuel; Garcia-Cabrera, Ana M; Padillo, Javier; De la Portilla, Fernando

2016-12-01

Robotic-assisted rectal cancer surgery offers multiple advantages for surgeons, and it seems to yield the same clinical outcomes as regards the short-time follow-up of patients compared to conventional laparoscopy. This surgical approach emerges as a technique aiming at overcoming the limitations posed by rectal cancer and other surgical fields of difficult access, in order to obtain better outcomes and a shorter learning curve. A systematic review of the literature of robot-assisted rectal surgery was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in October 2015 in PubMed, MEDLINE and the Cochrane Central Register of Controlled Trials, for articles published in the last 10 years and pertaining the learning curve of robotic surgery for colorectal cancer. It consisted of the following key words: "rectal cancer/learning curve/robotic-assisted laparoscopic surgery". A total of 34 references were identified, but only 9 full texts specifically addressed the analysis of the learning curve in robot-assisted rectal cancer surgery, 7 were case series and 2 were non-randomised case-comparison series. Eight papers used the cumulative sum (CUSUM) method, and only one author divided the series into two groups to compare both. The mean number of cases for phase I of the learning curve was calculated to be 29.7 patients; phase II corresponds to a mean number 37.4 patients. The mean number of cases required for the surgeon to be classed as an expert in robotic surgery was calculated to be 39 patients. Robotic advantages could have an impact on learning curve for rectal cancer and lower the number of cases that are necessary for rectal resections.

Effects on CO2 Reduction Potential of the Accelerated Introduction of Plug-in Hybrid Electric Vehicle in the Market

NASA Astrophysics Data System (ADS)

Shinoda, Yukio; Yabe, Kuniaki; Tanaka, Hideo; Akisawa, Atsushi; Kashiwagi, Takao

In this paper we consider that there are two economical social behaviors when new technologies are introduced. One is on the short-term economic basis, the other one is on the long-tem economic basis. If we consider a learning curve on the technology, it is more economical than short-term behavior to accelerate the introduction of the technology much wider in the earlier term than that on short-term economic basis. The costs in the accelerated term are higher, but the introduction costs in the later terms are cheaper by learning curve. This paper focuses on the plug-in hybrid electric vehicles (PHEVs). The ways to derive the results on short-term economic basis and the results on long-term economic basis are shown. The result of short-term behaviors can be derived by using the iteration method in which the battery costs in every term are adjusted to the learning curve. The result of long-term behaviors can be derived by seeking to the way where the amount of battery capacity is increased. We also estimate that how much subsidy does it need to get close to results on the long-term economic basis when social behavior is on the short-term economic basis. We assume subsidy for PHEV's initial costs, which can be financed by charging fee on petroleum consumption. In that case, there is no additional cost in the system. We show that the greater the total amount of money to that subsidy is, the less the amount of both CO2 emissions and system costs.

The Oxford unicompartmental knee fails at a high rate in a high-volume knee practice.

PubMed

Schroer, William C; Barnes, C Lowry; Diesfeld, Paul; LeMarr, Angela; Ingrassia, Rachel; Morton, Diane J; Reedy, Mary

2013-11-01

The Oxford knee is a unicompartmental implant featuring a mobile-bearing polyethylene component with excellent long-term survivorship results reported by the implant developers and early adopters. By contrast, other studies have reported higher revision rates in large academic practices and in national registries. Registry data have shown increased failure with this implant especially by lower-volume surgeons and institutions. In the setting of a high-volume knee arthroplasty practice, we sought to determine (1) the failure rate of the Oxford unicompartmental knee implant using a failure definition for aseptic loosening that combined clinical features, plain radiographs, and scintigraphy, and (2) whether increased experience with this implant would decrease failure rate, if there is a learning curve effect. Eighty-three Oxford knee prostheses were implanted between September 2005 and July 2008 by the principal investigator. Radiographic and clinical data were available for review for all cases. A failed knee was defined as having recurrent pain after an earlier period of recovery from surgery, progressive radiolucent lines compared with initial postoperative radiographs, and a bone scan showing an isolated area of uptake limited to the area of the replaced compartment. Eleven knees in this series failed (13%); Kaplan-Meier survivorship was 86.5% (95% CI, 78.0%-95.0%) at 5 years. Failure occurrences were distributed evenly over the course of the study period. No learning curve effect was identified. Based on these findings, including a high failure rate of the Oxford knee implant and the absence of any discernible learning curve effect, the principal investigator no longer uses this implant.

Safety, efficiency and learning curves in robotic surgery: a human factors analysis.

PubMed

Catchpole, Ken; Perkins, Colby; Bresee, Catherine; Solnik, M Jonathon; Sherman, Benjamin; Fritch, John; Gross, Bruno; Jagannathan, Samantha; Hakami-Majd, Niv; Avenido, Raymund; Anger, Jennifer T

2016-09-01

Expense, efficiency of use, learning curves, workflow integration and an increased prevalence of serious incidents can all be barriers to adoption. We explored an observational approach and initial diagnostics to enhance total system performance in robotic surgery. Eighty-nine robotic surgical cases were observed in multiple operating rooms using two different surgical robots (the S and Si), across several specialties (Urology, Gynecology, and Cardiac Surgery). The main measures were operative duration and rate of flow disruptions-described as 'deviations from the natural progression of an operation thereby potentially compromising safety or efficiency.' Contextual parameters collected were surgeon experience level and training, type of surgery, the model of robot and patient factors. Observations were conducted across four operative phases (operating room pre-incision; robot docking; main surgical intervention; post-console). A mean of 9.62 flow disruptions per hour (95 % CI 8.78-10.46) were predominantly caused by coordination, communication, equipment and training problems. Operative duration and flow disruption rate varied with surgeon experience (p = 0.039; p < 0.001, respectively), training cases (p = 0.012; p = 0.007) and surgical type (both p < 0.001). Flow disruption rates in some phases were also sensitive to the robot model and patient characteristics. Flow disruption rate is sensitive to system context and generates improvement diagnostics. Complex surgical robotic equipment increases opportunities for technological failures, increases communication requirements for the whole team, and can reduce the ability to maintain vision in the operative field. These data suggest specific opportunities to reduce the training costs and the learning curve.

The Da Vinci Xi and robotic radical prostatectomy-an evolution in learning and technique.

PubMed

Goonewardene, S S; Cahill, D

2017-06-01

The da Vinci Xi robot has been introduced as the successor to the Si platform. The promise of the Xi is to open the door to new surgical procedures. For robotic-assisted radical prostatectomy (RARP)/pelvic surgery, the potential is better vision and longer instruments. How has the Xi impacted on operative and pathological parameters as indicators of surgical performance? This is a comparison of an initial series of 42 RARPs with the Xi system in 2015 with a series using the Si system immediately before Xi uptake in the same calendar year, and an Si series by the same surgeon synchronously as the Xi series using operative time, blood loss, and positive margins as surrogates of surgical performance. Subjectively and objectively, there is a learning curve to Xi uptake in longer operative times but no impact on T2 positive margins which are the most reflective single measure of RARP outcomes. Subjectively, the vision of the Xi is inferior to the Si system, and the integrated diathermy system and automated setup are quirky. All require experience to overcome. There is a learning curve to progress from the Si to Xi da Vinci surgical platforms, but this does not negatively impact the outcome.

Establishing the Learning Curve of Robotic Sacral Colpopexy in a Start-up Robotics Program.

PubMed

Sharma, Shefali; Calixte, Rose; Finamore, Peter S

2016-01-01

To determine the learning curve of the following segments of a robotic sacral colpopexy: preoperative setup, operative time, postoperative transition, and room turnover. A retrospective cohort study to determine the number of cases needed to reach points of efficiency in the various segments of a robotic sacral colpopexy (Canadian Task Force II-2). A university-affiliated community hospital. Women who underwent robotic sacral colpopexy at our institution from 2009 to 2013 comprise the study population. Patient characteristics and operative reports were extracted from a patient database that has been maintained since the inception of the robotics program at Winthrop University Hospital and electronic medical records. Based on additional procedures performed, 4 groups of patients were created (A-D). Learning curves for each of the segment times of interest were created using penalized basis spline (B-spline) regression. Operative time was further analyzed using an inverse curve and sequential grouping. A total of 176 patients were eligible. Nonparametric tests detected no difference in procedure times between the 4 groups (A-D) of patients. The preoperative and postoperative points of efficiency were 108 and 118 cases, respectively. The operative points of proficiency and efficiency were 25 and 36 cases, respectively. Operative time was further analyzed using an inverse curve that revealed that after 11 cases the surgeon had reached 90% of the learning plateau. Sequential grouping revealed no significant improvement in operative time after 60 cases. Turnover time could not be assessed because of incomplete data. There is a difference in the operative time learning curve for robotic sacral colpopexy depending on the statistical analysis used. The learning curve of the operative segment showed an improvement in operative time between 25 and 36 cases when using B-spline regression. When the data for operative time was fit to an inverse curve, a learning rate of 11 cases was appreciated. Using sequential grouping to describe the data, no improvement in operative time was seen after 60 cases. Ultimately, we believe that efficiency in operative time is attained after 30 to 60 cases when performing robotic sacral colpopexy. The learning curve for preoperative setup and postoperative transition, which is reflective of anesthesia and nursing staff, was approximately 110 cases. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Dynamics of Hippocampal Protein Expression During Long-term Spatial Memory Formation*

PubMed Central

Borovok, Natalia; Nesher, Elimelech; Levin, Yishai; Reichenstein, Michal; Pinhasov, Albert

2016-01-01

Spatial memory depends on the hippocampus, which is particularly vulnerable to aging. This vulnerability has implications for the impairment of navigation capacities in older people, who may show a marked drop in performance of spatial tasks with advancing age. Contemporary understanding of long-term memory formation relies on molecular mechanisms underlying long-term synaptic plasticity. With memory acquisition, activity-dependent changes occurring in synapses initiate multiple signal transduction pathways enhancing protein turnover. This enhancement facilitates de novo synthesis of plasticity related proteins, crucial factors for establishing persistent long-term synaptic plasticity and forming memory engrams. Extensive studies have been performed to elucidate molecular mechanisms of memory traces formation; however, the identity of plasticity related proteins is still evasive. In this study, we investigated protein turnover in mouse hippocampus during long-term spatial memory formation using the reference memory version of radial arm maze (RAM) paradigm. We identified 1592 proteins, which exhibited a complex picture of expression changes during spatial memory formation. Variable linear decomposition reduced significantly data dimensionality and enriched three principal factors responsible for variance of memory-related protein levels at (1) the initial phase of memory acquisition (165 proteins), (2) during the steep learning improvement (148 proteins), and (3) the final phase of the learning curve (123 proteins). Gene ontology and signaling pathways analysis revealed a clear correlation between memory improvement and learning phase-curbed expression profiles of proteins belonging to specific functional categories. We found differential enrichment of (1) neurotrophic factors signaling pathways, proteins regulating synaptic transmission, and actin microfilament during the first day of the learning curve; (2) transcription and translation machinery, protein trafficking, enhancement of metabolic activity, and Wnt signaling pathway during the steep phase of memory formation; and (3) cytoskeleton organization proteins. Taken together, this study clearly demonstrates dynamic assembly and disassembly of protein-protein interaction networks depending on the stage of memory formation engrams. PMID:26598641

Learning Curve for Seawater Reverse Osmosis Desalination Plants: Capital Cost Trend of the Past, Present, and Future

NASA Astrophysics Data System (ADS)

Caldera, Upeksha; Breyer, Christian

2017-12-01

Seawater reverse osmosis (SWRO) desalination is expected to play a pivotal role in helping to secure future global water supply. While the global reliance on SWRO plants for water security increases, there is no consensus on how the capital costs of SWRO plants will vary in the future. The aim of this paper is to analyze the past trends of the SWRO capital expenditures (capex) as the historic global cumulative online SWRO capacity increases, based on the learning curve concept. The SWRO capex learning curve is found based on 4,237 plants that came online from 1977 to 2015. A learning rate of 15% is determined, implying that the SWRO capex reduced by 15% when the cumulative capacity was doubled. Based on SWRO capacity annual growth rates of 10% and 20%, by 2030, the global average capex of SWRO plants is found to fall to 1,580 USD/(m3/d) and 1,340 USD/(m3/d), respectively. A learning curve for SWRO capital costs has not been presented previously. This research highlights the potential for decrease in SWRO capex with the increase in installation of SWRO plants and the value of the learning curve approach to estimate future SWRO capex.

Defining the learning curve in laparoscopic paraesophageal hernia repair: a CUSUM analysis.

PubMed

Okrainec, Allan; Ferri, Lorenzo E; Feldman, Liane S; Fried, Gerald M

2011-04-01

There are numerous reports in the literature documenting high recurrence rates after laparoscopic paraesophageal hernia repair. The purpose of this study was to determine the learning curve for this procedure using the Cumulative Summation (CUSUM) technique. Forty-six consecutive patients with paraesophageal hernia were evaluated prospectively after laparoscopic paraesophageal hernia repair. Upper GI series was performed 3 months postoperatively to look for recurrence. Patients were stratified based on the surgeon's early (first 20 cases) and late experience (>20 cases). The CUSUM method was then used to further analyze the learning curve. Nine patients (21%) had anatomic recurrence. There was a trend toward a higher recurrence rate during the first 20 cases, although this did not achieve statistical significance (33% vs. 13%, p = 0.10). However, using a CUSUM analysis to plot the learning curve, we found that the recurrence rate diminishes after 18 cases and reaches an acceptable rate after 26 cases. Surgeon experience is an important predictor of recurrence after laparoscopic paraesophageal hernia repair. CUSUM analysis revealed there is a significant learning curve to become proficient at this procedure, with approximately 20 cases required before a consistent decrease in hernia recurrence rate is observed.

Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy.

PubMed

Kim, H-I; Park, M S; Song, K J; Woo, Y; Hyung, W J

2014-10-01

The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success. We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality. Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success. The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory. Copyright © 2013 Elsevier Ltd. All rights reserved.

Brighter Smiles Africa--translation of a Canadian community-based health-promoting school program to Uganda.

PubMed

Macnab, A J; Radziminski, N; Budden, H; Kasangaki, A; Zavuga, R; Gagnon, F A; Mbabali, M

2010-08-01

PROJECT GOAL: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. MUK identified rural communities where hospitals could provide dental students with community-based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care delivery.

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease.

PubMed

Gutierrez, Ana Luiza; Binda, Márcia Luisa Montalvão Appel; Ramos, José Geraldo Lopes

2016-09-01

Objectives  To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. Methods  A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. Results  The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI ( r  = 0.670; p  = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI ( r  = 0.468; p  = 0.037). A learning curve was observed during docking and undocking times. Conclusion  Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways. Thieme Publicações Ltda Rio de Janeiro, Brazil.

The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China

PubMed Central

Ou, Yen-Chuan; Yang, Chun-Kuang; Chang, Kuangh-Si; Wang, John; Hung, Siu-Wan; Tung, Min-Che; Tewari, Ashutosh K; Patel, Vipul R

2014-01-01

To analyze the learning curve for cancer control from an initial 250 cases (Group I) and subsequent 250 cases (Group II) of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin (PSM) and biochemical recurrence (BCR) were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I (22.2% vs 14.2%, respectively, with Gleason score 8–10, P= 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P= 0.017). The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group II. A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle (NVB) preservation was significantly influenced by the PSM in high-risk patients (84.1% in the preservation group vs 43.9% in the nonpreservation group). The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM. PMID:24830691

Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy.

PubMed

Ku, Ja Yoon; Ha, Hong Koo

2015-04-01

Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.

Robotic partial nephrectomy shortens warm ischemia time, reducing suturing time kinetics even for an experienced laparoscopic surgeon: a comparative analysis.

PubMed

Faria, Eliney F; Caputo, Peter A; Wood, Christopher G; Karam, Jose A; Nogueras-González, Graciela M; Matin, Surena F

2014-02-01

Laparoscopic and robotic partial nephrectomy (LPN and RPN) are strongly related to influence of tumor complexity and learning curve. We analyzed a consecutive experience between RPN and LPN to discern if warm ischemia time (WIT) is in fact improved while accounting for these two confounding variables and if so by which particular aspect of WIT. This is a retrospective analysis of consecutive procedures performed by a single surgeon between 2002-2008 (LPN) and 2008-2012 (RPN). Specifically, individual steps, including tumor excision, suturing of intrarenal defect, and parenchyma, were recorded at the time of surgery. Multivariate and univariate analyzes were used to evaluate influence of learning curve, tumor complexity, and time kinetics of individual steps during WIT, to determine their influence in WIT. Additionally, we considered the effect of RPN on the learning curve. A total of 146 LPNs and 137 RPNs were included. Considering renal function, WIT, suturing time, renorrhaphy time were found statistically significant differences in favor of RPN (p < 0.05). In the univariate analysis, surgical procedure, learning curve, clinical tumor size, and RENAL nephrometry score were statistically significant predictors for WIT (p < 0.05). RPN decreased the WIT on average by approximately 7 min compared to LPN even when adjusting for learning curve, tumor complexity, and both together (p < 0.001). We found RPN was associated with a shorter WIT when controlling for influence of the learning curve and tumor complexity. The time required for tumor excision was not shortened but the time required for suturing steps was significantly shortened.

Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve.

PubMed

Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Cao, Shiqi; Cao, Yongke

2017-07-01

Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes. We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups. According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case. Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.

Predicting long-term growth in students' mathematics achievement: the unique contributions of motivation and cognitive strategies.

PubMed

Murayama, Kou; Pekrun, Reinhard; Lichtenfeld, Stephanie; Vom Hofe, Rudolf

2013-01-01

This research examined how motivation (perceived control, intrinsic motivation, and extrinsic motivation), cognitive learning strategies (deep and surface strategies), and intelligence jointly predict long-term growth in students' mathematics achievement over 5 years. Using longitudinal data from six annual waves (Grades 5 through 10; Mage  = 11.7 years at baseline; N = 3,530), latent growth curve modeling was employed to analyze growth in achievement. Results showed that the initial level of achievement was strongly related to intelligence, with motivation and cognitive strategies explaining additional variance. In contrast, intelligence had no relation with the growth of achievement over years, whereas motivation and learning strategies were predictors of growth. These findings highlight the importance of motivation and learning strategies in facilitating adolescents' development of mathematical competencies. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method.

PubMed

Yamaguchi, Tomohiro; Kinugasa, Yusuke; Shiomi, Akio; Sato, Sumito; Yamakawa, Yushi; Kagawa, Hiroyasu; Tomioka, Hiroyuki; Mori, Keita

2015-07-01

Few data are available to assess the learning curve for robotic-assisted surgery for rectal cancer. The aim of the present study was to evaluate the learning curve for robotic-assisted surgery for rectal cancer by a surgeon at a single institute. From December 2011 to August 2013, a total of 80 consecutive patients who underwent robotic-assisted surgery for rectal cancer performed by the same surgeon were included in this study. The learning curve was analyzed using the cumulative sum method. This method was used for all 80 cases, taking into account operative time. Operative procedures included anterior resections in 6 patients, low anterior resections in 46 patients, intersphincteric resections in 22 patients, and abdominoperineal resections in 6 patients. Lateral lymph node dissection was performed in 28 patients. Median operative time was 280 min (range 135-683 min), and median blood loss was 17 mL (range 0-690 mL). No postoperative complications of Clavien-Dindo classification Grade III or IV were encountered. We arranged operative times and calculated cumulative sum values, allowing differentiation of three phases: phase I, Cases 1-25; phase II, Cases 26-50; and phase III, Cases 51-80. Our data suggested three phases of the learning curve in robotic-assisted surgery for rectal cancer. The first 25 cases formed the learning phase.

Facilitating students' application of the integral and the area under the curve concepts in physics problems

NASA Astrophysics Data System (ADS)

Nguyen, Dong-Hai

This research project investigates the difficulties students encounter when solving physics problems involving the integral and the area under the curve concepts and the strategies to facilitate students learning to solve those types of problems. The research contexts of this project are calculus-based physics courses covering mechanics and electromagnetism. In phase I of the project, individual teaching/learning interviews were conducted with 20 students in mechanics and 15 students from the same cohort in electromagnetism. The students were asked to solve problems on several topics of mechanics and electromagnetism. These problems involved calculating physical quantities (e.g. velocity, acceleration, work, electric field, electric resistance, electric current) by integrating or finding the area under the curve of functions of related quantities (e.g. position, velocity, force, charge density, resistivity, current density). Verbal hints were provided when students made an error or were unable to proceed. A total number of 140 one-hour interviews were conducted in this phase, which provided insights into students' difficulties when solving the problems involving the integral and the area under the curve concepts and the hints to help students overcome those difficulties. In phase II of the project, tutorials were created to facilitate students' learning to solve physics problems involving the integral and the area under the curve concepts. Each tutorial consisted of a set of exercises and a protocol that incorporated the helpful hints to target the difficulties that students expressed in phase I of the project. Focus group learning interviews were conducted to test the effectiveness of the tutorials in comparison with standard learning materials (i.e. textbook problems and solutions). Overall results indicated that students learning with our tutorials outperformed students learning with standard materials in applying the integral and the area under the curve concepts to physics problems. The results of this project provide broader and deeper insights into students' problem solving with the integral and the area under the curve concepts and suggest strategies to facilitate students' learning to apply these concepts to physics problems. This study also has significant implications for further research, curriculum development and instruction.

An Exploratory Analysis of Personality, Attitudes, and Study Skills on the Learning Curve within a Team-based Learning Environment

PubMed Central

Henry, Teague; Campbell, Ashley

2015-01-01

Objective. To examine factors that determine the interindividual variability of learning within a team-based learning environment. Methods. Students in a pharmacokinetics course were given 4 interim, low-stakes cumulative assessments throughout the semester and a cumulative final examination. Students’ Myers-Briggs personality type was assessed, as well as their study skills, motivations, and attitudes towards team-learning. A latent curve model (LCM) was applied and various covariates were assessed to improve the regression model. Results. A quadratic LCM was applied for the first 4 assessments to predict final examination performance. None of the covariates examined significantly impacted the regression model fit except metacognitive self-regulation, which explained some of the variability in the rate of learning. There were some correlations between personality type and attitudes towards team learning, with introverts having a lower opinion of team-learning than extroverts. Conclusion. The LCM could readily describe the learning curve. Extroverted and introverted personality types had the same learning performance even though preference for team-learning was lower in introverts. Other personality traits, study skills, or practice did not significantly contribute to the learning variability in this course. PMID:25861101

An exploratory analysis of personality, attitudes, and study skills on the learning curve within a team-based learning environment.

PubMed

Persky, Adam M; Henry, Teague; Campbell, Ashley

2015-03-25

To examine factors that determine the interindividual variability of learning within a team-based learning environment. Students in a pharmacokinetics course were given 4 interim, low-stakes cumulative assessments throughout the semester and a cumulative final examination. Students' Myers-Briggs personality type was assessed, as well as their study skills, motivations, and attitudes towards team-learning. A latent curve model (LCM) was applied and various covariates were assessed to improve the regression model. A quadratic LCM was applied for the first 4 assessments to predict final examination performance. None of the covariates examined significantly impacted the regression model fit except metacognitive self-regulation, which explained some of the variability in the rate of learning. There were some correlations between personality type and attitudes towards team learning, with introverts having a lower opinion of team-learning than extroverts. The LCM could readily describe the learning curve. Extroverted and introverted personality types had the same learning performance even though preference for team-learning was lower in introverts. Other personality traits, study skills, or practice did not significantly contribute to the learning variability in this course.

What is the learning curve for the anterior approach for total hip arthroplasty?

PubMed

de Steiger, Richard Noel; Lorimer, Michelle; Solomon, Michael

2015-12-01

There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon's individual learning curve when using this approach. (1) What was the revision rate for all surgeons adopting the anterior approach for placement of a particular implant? (2) What was the revision rate for surgeons who performed > 100 cases in this fashion? (3) Is there a minimum number of cases required to complete a learning curve for this procedure? The Australian Orthopaedic Association National Joint Replacement Registry prospectively collects data on all primary and revision joint arthroplasty surgery. We analyzed all conventional THAs performed up to December 31, 2013, with a primary diagnosis of osteoarthritis using a specific implant combination and secondarily those associated with surgeons performing more than 100 procedures. Ninety-five percent of these procedures were performed through the direct anterior approach. Procedures using this combination were ordered from earliest (first procedure date) to latest (last procedure date) for each individual surgeon. Using the order number for each surgeon, five operation groups were defined: one to 15 operations, 16 to 30 operations, 31 to 50 operations, 51 to 100 operations, and > 100 operations. The primary outcome measure was time to first revision using Kaplan-Meier estimates of survivorship. Sixty-eight surgeons performed 5499 THAs using the specified implant combination. The cumulative percent revision at 4 years for all 68 surgeons was 3% (95% confidence interval [CI], 2.5-3.8). For surgeons who had performed over 100 operations, the cumulative revision rate was 3% (95% CI, 2.0-3.5). It was not until surgeons had performed over 50 operations that there was no difference in the cumulative percent revision compared with over 100 operations. The cumulative percent revision for surgeons performing 51 to 100 operations at 4 years was 3% (95% CI, 1.5-5.4) and over 100 operations 2% (95% CI, 1.2-2.7; hazard ratio, 1.40 [95% CI, 0.7-2.7]; p = 0.33). There is a learning curve for the anterior approach for THA even when using a prosthesis combination specifically marketed for that approach. We found that 50 or more procedures need to be performed by a surgeon before the rate of revision is no different from performing 100 or more procedures. Surgeons should be aware of this initial higher rate of revision when deciding which approach delivers the best outcome for their patients.

The learning curve: Implications of a quantitative analysis

PubMed Central

Gallistel, Charles R.; Fairhurst, Stephen; Balsam, Peter

2004-01-01

The negatively accelerated, gradually increasing learning curve is an artifact of group averaging in several commonly used basic learning paradigms (pigeon autoshaping, delay- and trace-eye-blink conditioning in the rabbit and rat, autoshaped hopper entry in the rat, plus maze performance in the rat, and water maze performance in the mouse). The learning curves for individual subjects show an abrupt, often step-like increase from the untrained level of responding to the level seen in the well trained subject. The rise is at least as abrupt as that commonly seen in psychometric functions in stimulus detection experiments. It may indicate that the appearance of conditioned behavior is mediated by an evidence-based decision process, as in stimulus detection experiments. If the appearance of conditioned behavior is taken instead to reflect the increase in an underlying associative strength, then a negligible portion of the function relating associative strength to amount of experience is behaviorally visible. Consequently, rate of learning cannot be estimated from the group-average curve; the best measure is latency to the onset of responding, determined for each subject individually. PMID:15331782

The learning curve: implications of a quantitative analysis.

PubMed

Gallistel, Charles R; Fairhurst, Stephen; Balsam, Peter

2004-09-07

The negatively accelerated, gradually increasing learning curve is an artifact of group averaging in several commonly used basic learning paradigms (pigeon autoshaping, delay- and trace-eye-blink conditioning in the rabbit and rat, autoshaped hopper entry in the rat, plus maze performance in the rat, and water maze performance in the mouse). The learning curves for individual subjects show an abrupt, often step-like increase from the untrained level of responding to the level seen in the well trained subject. The rise is at least as abrupt as that commonly seen in psychometric functions in stimulus detection experiments. It may indicate that the appearance of conditioned behavior is mediated by an evidence-based decision process, as in stimulus detection experiments. If the appearance of conditioned behavior is taken instead to reflect the increase in an underlying associative strength, then a negligible portion of the function relating associative strength to amount of experience is behaviorally visible. Consequently, rate of learning cannot be estimated from the group-average curve; the best measure is latency to the onset of responding, determined for each subject individually.

Autoshaped head poking in the mouse: a quantitative analysis of the learning curve.

PubMed

Papachristos, Efstathios B; Gallistel, C R

2006-05-01

In autoshaping experiments, we quantified the acquisition of anticipatory head poking in individual mice, using an algorithm that finds changes in the slope of a cumulative record. In most mice, upward changes in the amount of anticipatory poking per trial were abrupt, and tended to occur at session boundaries, suggesting that the session is as significant a unit of experience as the trial. There were large individual differences in the latency to the onset of vigorous responding. "Asymptotic" performance was unstable; large, bidirectional, and relatively enduring changes were common. Given the characteristics of the individual learning curves, it is unlikely that physiologically meaningful estimates of rate of learning can be extracted from group-average learning curves.

Autoshaped Head Poking in the Mouse: A Quantitative Analysis of the Learning Curve

PubMed Central

Papachristos, Efstathios B; Gallistel, C.R

2006-01-01

In autoshaping experiments, we quantified the acquisition of anticipatory head poking in individual mice, using an algorithm that finds changes in the slope of a cumulative record. In most mice, upward changes in the amount of anticipatory poking per trial were abrupt, and tended to occur at session boundaries, suggesting that the session is as significant a unit of experience as the trial. There were large individual differences in the latency to the onset of vigorous responding. “Asymptotic” performance was unstable; large, bidirectional, and relatively enduring changes were common. Given the characteristics of the individual learning curves, it is unlikely that physiologically meaningful estimates of rate of learning can be extracted from group-average learning curves. PMID:16776053

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon.

PubMed

Kedikoglou, Simos; Syrigos, Konstantinos; Skalkidis, Yannis; Ploiarchopoulou, Fani; Dessypris, Nick; Petridou, Eleni

2005-08-01

The quality improvement effort in clinical practice has focused mostly on 'performance quality', i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the 'conformance quality', i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A 'learning curve' phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

Learning curve of speech recognition.

PubMed

Kauppinen, Tomi A; Kaipio, Johanna; Koivikko, Mika P

2013-12-01

Speech recognition (SR) speeds patient care processes by reducing report turnaround times. However, concerns have emerged about prolonged training and an added secretarial burden for radiologists. We assessed how much proofing radiologists who have years of experience with SR and radiologists new to SR must perform, and estimated how quickly the new users become as skilled as the experienced users. We studied SR log entries for 0.25 million reports from 154 radiologists and after careful exclusions, defined a group of 11 experienced radiologists and 71 radiologists new to SR (24,833 and 122,093 reports, respectively). Data were analyzed for sound file and report lengths, character-based error rates, and words unknown to the SR's dictionary. Experienced radiologists corrected 6 characters for each report and for new users, 11. Some users presented a very unfavorable learning curve, with error rates not declining as expected. New users' reports were longer, and data for the experienced users indicates that their reports, initially equally lengthy, shortened over a period of several years. For most radiologists, only minor corrections of dictated reports were necessary. While new users adopted SR quickly, with a subset outperforming experienced users from the start, identification of users struggling with SR will help facilitate troubleshooting and support.

Existing reporting guidelines for clinical trials are not completely relevant for implantable medical devices: a systematic review.

PubMed

Motte, Anne-France; Diallo, Stéphanie; van den Brink, Hélène; Châteauvieux, Constance; Serrano, Carole; Naud, Carole; Steelandt, Julie; Alsac, Jean-Marc; Aubry, Pierre; Cour, Florence; Pellerin, Olivier; Pineau, Judith; Prognon, Patrice; Borget, Isabelle; Bonan, Brigitte; Martelli, Nicolas

2017-11-01

The aim of this study was to determine relevant items for reporting clinical trials on implantable medical devices (IMDs) and to identify reporting guidelines which include these items. A panel of experts identified the most relevant items for evaluating IMDs from an initial list based on reference papers. We then conducted a systematic review of articles indexed in MEDLINE. We retrieved reporting guidelines from the EQUATOR network's library for health research reporting. Finally, we screened these reporting guidelines to find those using our set of reporting items. Seven relevant reporting items were selected that related to four topics: randomization, learning curve, surgical setting, and device information. A total of 348 reporting guidelines were identified, among which 26 met our inclusion criteria. However, none of the 26 reporting guidelines presented all seven items together. The most frequently reported item was timing of randomization (65%). On the contrary, device information and learning curve effects were poorly specified. To our knowledge, this study is the first to identify specific items related to IMDs in reporting guidelines for clinical trials. We have shown that no existing reporting guideline is totally suitable for these devices. Copyright © 2017 Elsevier Inc. All rights reserved.

Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis.

PubMed

Wani, Sachin; Hall, Matthew; Wang, Andrew Y; DiMaio, Christopher J; Muthusamy, V Raman; Keswani, Rajesh N; Brauer, Brian C; Easler, Jeffrey J; Yen, Roy D; El Hajj, Ihab; Fukami, Norio; Ghassemi, Kourosh F; Gonzalez, Susana; Hosford, Lindsay; Hollander, Thomas G; Wilson, Robert; Kushnir, Vladimir M; Ahmad, Jawad; Murad, Faris; Prabhu, Anoop; Watson, Rabindra R; Strand, Daniel S; Amateau, Stuart K; Attwell, Augustin; Shah, Raj J; Early, Dayna; Edmundowicz, Steven A; Mullady, Daniel

2016-04-01

There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon.

PubMed

Zorn, Kevin C; Orvieto, Marcelo A; Gong, Edward M; Mikhail, Albert A; Gofrit, Ofer N; Zagaja, Gregory P; Shalhav, Arieh L

2007-04-01

Several experienced practitioners of open surgery with limited or no laparoscopic background have adopted robot-assisted laparoscopic radical prostatectomy (RLRP) as an alternative to open radical prostatectomy (RRP), demonstrating outcomes comparable to those in large RRP and laparoscopic prostatectomy series. Thus, the significance of prior laparoscopic skills seems unclear. The learning curve, with respect to operative time and complications, in the hands of a devoted laparoscopic surgeon has not been critically assessed. We evaluated the learning curve of a highly experienced laparoscopic surgeon in achieving expertise with RLRP. We prospectively evaluated 150 consecutive patients undergoing RLRP by a single surgeon between March 2003 and September 2005. The first 25 cases were performed with the assistance of a surgeon experienced in open RRP. Data were compared for the first, second, and third groups of 50 cases. Demographic data were similar for the three groups. Urinary and sexual function data were evaluated subjectively and objectively using the RAND-36v2 Survey and the UCLA PCI preoperatively and at 3, 6, and 12 months postoperatively. The mean operative time, blood loss, and conversion rate decreased significantly with increasing experience. All open conversions occurred during the first 25 cases. Intraoperative and postoperative complication rates were similar among groups. Although the differences were not significant, urinary and sexual function recovery improved with experience. The RLRP learning curve for a fellowship-trained laparoscopic surgeon seems to be similar to that of laparoscopically naive yet experienced practitioners of open RRP. The RLRP is safe and reproducible and even during the learning curve can produce results similar to those reported in large RRP series. The importance of assistance by an experienced open RRP surgeon during the learning curve cannot be overemphasized.

The learning curve in robotic distal pancreatectomy.

PubMed

Napoli, Niccolò; Kauffmann, Emanuele F; Perrone, Vittorio Grazio; Miccoli, Mario; Brozzetti, Stefania; Boggi, Ugo

2015-09-01

No data are available on the learning curve in robotic distal pancreatectomy (RADP). The learning curve in RADP was assessed in 55 consecutive patients using the cumulative sum method, based on operative time. Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of surgery. No operation was converted to laparoscopic or open surgery and no patient died. Post-operative complications occurred in 34 patients (61.8%), being of Clavien-Dindo grade I-II in 32 patients (58.1%), including pancreatic fistula in 29 patients (52.7%). No grade C pancreatic fistula occurred. Four patients received blood transfusions (7.2%), three were readmitted (5.4%) and one required repeat surgery (1.8%). Based on the reduction of operative times (421.1 ± 20.5 vs 248.9 ± 9.3 min; p < 0.0001), completion of the learning curve was achieved after ten operations. Operative time of the first 10 operations was associated with a positive slope (0.47 + 1.78* case number; R (2) 0.97; p < 0.0001*), while that of the following 45 procedures showed a negative slope (23.52 - 0.39* case number; R (2) 0.97; p < 0.0001*). After completion of the learning curve, more patients had a malignant histology (0 vs 35.6%; p = 0.002), accounting for both higher lymph node yields (11.1 ± 12.2 vs 20.9 ± 18.5) (p = 0.04) and lower rate of spleen preservation (90 vs 55.6%) (p = 0.04). RADP was safely feasible in selected patients and the learning curve was completed after ten operations. Improvement in clinical outcome was not demonstrated, probably because of the limited occurrence of outcome comparators.

Robotic partial nephrectomy - Evaluation of the impact of case mix on the procedural learning curve.

PubMed

Roman, A; Ahmed, K; Challacombe, B

2016-05-01

Although Robotic partial nephrectomy (RPN) is an emerging technique for the management of small renal masses, this approach is technically demanding. To date, there is limited data on the nature and progression of the learning curve in RPN. To analyse the impact of case mix on the RPN LC and to model the learning curve. The records of the first 100 RPN performed, were analysed at our institution that were carried out by a single surgeon (B.C) (June 2010-December 2013). Cases were split based on their Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score into the following groups: 6-7, 8-9 and >10. Using a split group (20 patients in each group) and incremental analysis, the mean, the curve of best fit and R(2) values were calculated for each group. Of 100 patients (F:28, M:72), the mean age was 56.4 ± 11.9 years. The number of patients in each PADUA score groups: 6-7, 8-9 and >10 were 61, 32 and 7 respectively. An increase in incidence of more complex cases throughout the cohort was evident within the 8-9 group (2010: 1 case, 2013: 16 cases). The learning process did not significantly affect the proxies used to assess surgical proficiency in this study (operative time and warm ischaemia time). Case difficulty is an important parameter that should be considered when evaluating procedural learning curves. There is not one well fitting model that can be used to model the learning curve. With increasing experience, clinicians tend to operate on more difficult cases. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

PubMed Central

2017-01-01

Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p = 0.009, p = 0.000, p = 0.030, and p = 0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p > 0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert's proficiency level is achieved at around 18 cases. PMID:28503572

Estimating the cost of production stoppage

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1979-01-01

Estimation model considers learning curve quantities, and time of break to forecast losses due to break in production schedule. Major parameters capable of predicting costs are number of units made prior to production sequence, length of production break, and slope of learning curve produced prior to break.

Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi.

PubMed

Fan, Tianyong; Xian, Peng; Yang, Lu; Liu, Yong; Wei, Qiang; Li, Hong

2009-11-01

To summarize our experience and evaluate the learning curve of retroperitoneal laparoscopic ureterolithotomy of the upper ureter. Between May 2004 and May 2007, 40 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. We divided the first and last 20 patients into group I and group II. There was no statistical difference in stone size between groups. Operative time and complications were measured as a basis for the assessment of the learning curve. In group I, the complication rate was 15% (3/20), including two patients whose procedure was converted to open surgery because of intraoperative bleeding, and one patient who experienced urine leakage because of a displaced Double-J ureteral stent. In group II, no postoperative complications occurred, while the mean operative time was significantly shorter compared with the earlier operations (65 vs 120 min). Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.

[Pancreatoduodenectomy: learning curve within single multi-field center].

PubMed

Kaprin, A D; Kostin, A A; Nikiforov, P V; Egorov, V I; Grishin, N A; Lozhkin, M V; Petrov, L O; Bykasov, S A; Sidorov, D V

2018-01-01

To analyze learning curve by using of immediate results of pancreatoduodenectomy at multi-field oncology institute. For the period 2010-2016 at Abdominal Oncology Department of Herzen Moscow Oncology Research Institute 120 pancreatoduodenal resections were consistently performed. All patients were divided into two groups: the first 60 procedures (group A) and subsequent 60 operations (group B). Herewith, first 60 operations were performed within the first 4.5 years of study period, the next 60 operations - within remaining 2.5 years. Learning curves showed significantly variable intraoperative blood loss (1100 ml and 725 ml), surgery time (589 min and 513 min) and postoperative hospital-stay (15 days and 13 days) in group A followed by gradual improvement of these values in group B. Incidence of negative resection margin (R0) was also significantly improved in the last 60 operations (70 and 92%, respectively). Despite pancreatoduodenectomy is one of the most difficult surgical interventions in abdominal surgery learning curve will differ from one surgeon to another.

Automated Blazar Light Curves Using Machine Learning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Spencer James

2017-07-27

This presentation describes a problem and methodology pertaining to automated blazar light curves. Namely, optical variability patterns for blazars require the construction of light curves and in order to generate the light curves, data must be filtered before processing to ensure quality.

Using learning curves on energy-efficient technologies to estimate future energy savings and emission reduction potentials in the U.S. iron and steel industry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karali, Nihan; Park, Won Young; McNeil, Michael A.

Increasing concerns on non-sustainable energy use and climate change spur a growing research interest in energy efficiency potentials in various critical areas such as industrial production. This paper focuses on learning curve aspects of energy efficiency measures in the U.S iron and steel sector. A number of early-stage efficient technologies (i.e., emerging or demonstration technologies) are technically feasible and have the potential to make a significant contribution to energy saving and CO 2 emissions reduction, but fall short economically to be included. However, they may also have the cost effective potential for significant cost reduction and/or performance improvement in themore » future under learning effects such as ‘learning-by-doing’. The investigation is carried out using ISEEM, a technology oriented, linear optimization model. We investigated how steel demand is balanced with/without the availability learning curve, compared to a Reference scenario. The retrofit (or investment in some cases) costs of energy efficient technologies decline in the scenario where learning curve is applied. The analysis also addresses market penetration of energy efficient technologies, energy saving, and CO 2 emissions in the U.S. iron and steel sector with/without learning impact. Accordingly, the study helps those who use energy models better manage the price barriers preventing unrealistic diffusion of energy-efficiency technologies, better understand the market and learning system involved, predict future achievable learning rates more accurately, and project future savings via energy-efficiency technologies with presence of learning. We conclude from our analysis that, most of the existing energy efficiency technologies that are currently used in the U.S. iron and steel sector are cost effective. Penetration levels increases through the years, even though there is no price reduction. However, demonstration technologies are not economically feasible in the U.S. iron and steel sector with the current cost structure. In contrast, some of the demonstration technologies are adapted in the mid-term and their penetration levels increase as the prices go down with learning curve. We also observe large penetration of 225kg pulverized coal injection with the presence of learning.« less

Methods for Performing Survival Curve Quality-of-Life Assessments.

PubMed

Sumner, Walton; Ding, Eric; Fischer, Irene D; Hagen, Michael D

2014-08-01

Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions. Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival. An algorithm was developed to generate relative discount rate-utility (DRU) functions from a standard survival curve and health state and an equally attractive alternative curve and state. A least means squared distance algorithm was developed to describe how nearly 3 or more DRU functions intersect. These techniques were implemented in a program called X-Trade and tested. SQLA scenarios can portray realistic treatment choices. A side effect scenario portrays one prototypical choice, to extend life while experiencing some loss, such as an amputation. A risky treatment scenario portrays procedures with an initial mortality risk. A time trade scenario mimics conventional time tradeoffs. Each SQLA scenario yields DRU functions with distinctive shapes, such as sigmoid curves or vertical lines. One SQLA can imply a discount rate or utility if the other value is known and both values are temporally stable. Two SQLA exercises imply a unique discount rate and utility if the inferred DRU functions intersect. Three or more SQLA results can quantify uncertainty or inconsistency in discount rate and utility estimates. Pilot studies suggested that many subjects could learn to interpret survival curves and do SQLA. SQLA confuse some people. Compared with SQLA, standard gambles quantify very low utilities more easily, and time tradeoffs are simpler for high utilities. When discount rates approach zero, time tradeoffs are as informative and easier to do than SQLA. SQLA may complement conventional utility assessment methods. © The Author(s) 2014.

Narrowed indications improve outcomes for hip resurfacing arthroplasty.

PubMed

Johnson, Aaron J; Zywiel, Michael G; Hooper, Hassan; Mont, Michael A

2011-01-01

Hip resurfacing arthroplasty has had excellent clinical outcomes from multiple centers. However, controversy exists regarding the most appropriate patient selection criteria. Many proponents of hip resurfacing believe that narrowing the patient indications with strict inclusion and exclusion criteria may lead to improved outcomes and decreased complication rates. The purpose of this study was to review the results of resurfacing performed by an experienced surgeon to determine if implant survival and complication rates were different between subgroups of patients with different demographic factors. We evaluated 311 patients who had a hip resurfacing arthroplasty performed after the initial learning curve and who had a minimum follow-up of 5 years (mean, 93 months). These patients were compared to a group of 93 patients (96 hips) who underwent resurfacings, with newer selection criteria based on the findings of the first cohort. Overall, there were 10 failures in the first patient cohort (97% survivorship), compared to no failures in the second cohort. Higher revision rates were associated with patients who had osteonecrosis or rheumatoid arthritis. Patients who had femoral component sizes larger than 50 millimeters had lower revision rates. There were no revisions in patients who were under 50 years of age, had head sizes greater than 50 millimeters, and who had a primary diagnosis of osteoarthritis. After evaluating our initial experience after the learning curve, the ideal patient selection criteria was determined to be young males who have femoral head sizes greater than 50 millimeters. The early results are encouraging in that, although resurfacing may not be appropriate for all patients, it can provide predictable, excellent survivorship in these patients.

Evaluating Spatiotemporal Image Correlation Technology as a Tool for Training Nonexpert Sonographers to Perform Examinations of the Fetal Heart.

PubMed

Avnet, Hagai; Mazaaki, Eyal; Shen, Ori; Cohen, Sarah; Yagel, Simcha

2016-01-01

We aimed to evaluate the use of spatiotemporal image correlation (STIC) as a tool for training nonexpert examiners to perform screening examinations of the fetal heart by acquiring and examining STIC volumes according to a standardized questionnaire based on the 5 transverse planes of the fetal heart. We conducted a prospective study at 2 tertiary care centers. Two sonographers without formal training in fetal echocardiography received theoretical instruction on the 5 fetal echocardiographic transverse planes, as well as STIC technology. Only women with conditions allowing 4-dimensional STIC volume acquisitions (grayscale and Doppler) were included in the study. Acquired volumes were evaluated offline according to a standardized protocol that required the trainee to mark 30 specified structures on 5 required axial planes. Volumes were then reviewed by an expert examiner for quality of acquisition and correct identification of specified structures. Ninety-six of 112 pregnant women examined entered the study. Patients had singleton pregnancies between 20 and 32 weeks' gestation. After an initial learning curve of 20 examinations, trainees succeeded in identifying 97% to 98% of structures, with a highly significant degree of agreement with the expert's analysis (P < .001). A median of 2 STIC volumes for each examination was necessary for maximal structure identification. Acquisition quality scores were high (8.6-8.7 of a maximal score of 10) and were found to correlate with identification rates (P = .017). After an initial learning curve and under expert guidance, STIC is an excellent tool for trainees to master extended screening examinations of the fetal heart.

Early Australian experience in robotic sleeve gastrectomy: a single site series.

PubMed

Silverman, Candice D; Ghusn, Michael A

2017-05-01

The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice. © 2016 Royal Australasian College of Surgeons.

Enhancing ASTRO101 Student Engagement Using Student-Created ScienceSKETCHES

NASA Astrophysics Data System (ADS)

Slater, Timothy F.; Slater, Stephanie

2016-01-01

As astronomy teaching faculty are changing their teaching strategies from those less desirable approaches that allow students to passively listen to professor-centered, information-lectures to more desirable, active-student engagement classrooms characterized by active learning, ASTRO 101 professors are looking for more ways to help students learn to participate in authentic scientific practices. This is consistent with notion advocated by the NRC that students should practice scientific thinking, scientific discourse, and scientific practices while learning science. Noticing that much informal scientific discussion is mediated by sketches—such as those occasionally lively discussions held after hours during scientific conferences—scholars at the CAPER Center for Astronomy & Physics Education Research have been piloting a series of active learning tasks where students are challenged to create scientific drawings to illustrate their understanding of astronomical phenomena or structures. Known informally as ScienceSKETCHES, examples of these tasks challenge students to illustrate: the spectral curve differences between high and low mass stars; the differences among galaxy shapes; the distribution of stars for the Andromeda Galaxy in terms of luminosity versus temperature; old and young planetary surfaces; or the relationships between distances and speeds of orbiting objects. Although our initial testing has focused on predominately on paper and pencil tasks, with the occasional cell phone picture of a ScienceSKETCH being texted to the professor, the electronic-based teaching world is nearly ready to support these sorts of drawing tasks. Already, the ability to complete and submit scientific sketches is becoming commonplace across electronic learning platforms, including shared white-boarding in many desktop videoconferencing systems, and handheld device learning systems for interactive classrooms, like those from Learning Catalytics, among many others. Our initial results suggest that this strategy is worthwhile line of research and development for a wide range of astronomy education researchers and curriculum developers.

Impact of online visual feedback on motor acquisition and retention when learning to reach in a force field.

PubMed

Batcho, C S; Gagné, M; Bouyer, L J; Roy, J S; Mercier, C

2016-11-19

When subjects learn a novel motor task, several sources of feedback (proprioceptive, visual or auditory) contribute to the performance. Over the past few years, several studies have investigated the role of visual feedback in motor learning, yet evidence remains conflicting. The aim of this study was therefore to investigate the role of online visual feedback (VFb) on the acquisition and retention stages of motor learning associated with training in a reaching task. Thirty healthy subjects made ballistic reaching movements with their dominant arm toward two targets, on 2 consecutive days using a robotized exoskeleton (KINARM). They were randomly assigned to a group with (VFb) or without (NoVFb) VFb of index position during movement. On day 1, the task was performed before (baseline) and during the application of a velocity-dependent resistive force field (adaptation). To assess retention, participants repeated the task with the force field on day 2. Motor learning was characterized by: (1) the final endpoint error (movement accuracy) and (2) the initial angle (iANG) of deviation (motor planning). Even though both groups showed motor adaptation, the NoVFb-group exhibited slower learning and higher final endpoint error than the VFb-group. In some condition, subjects trained without visual feedback used more curved initial trajectories to anticipate for the perturbation. This observation suggests that learning to reach targets in a velocity-dependent resistive force field is possible even when feedback is limited. However, the absence of VFb leads to different strategies that were only apparent when reaching toward the most challenging target. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The 1974 AVCR Young Scholar Paper: An Open-System Model of Learning

ERIC Educational Resources Information Center

Winn, William

1975-01-01

Rejecting the cybernetic model of the learner, the author offers an open-system model based on von Bertalanffy's equation for growth of the living organism. The model produces four learning curves, not just the logarithmic curve produced by the successive approximations of the cybernetic model. (Editor)

A learning curve for solar thermal power

NASA Astrophysics Data System (ADS)

Platzer, Werner J.; Dinter, Frank

2016-05-01

Photovoltaics started its success story by predicting the cost degression depending on cumulated installed capacity. This so-called learning curve was published and used for predictions for PV modules first, then predictions of system cost decrease also were developed. This approach is less sensitive to political decisions and changing market situations than predictions on the time axis. Cost degression due to innovation, use of scaling effects, improved project management, standardised procedures including the search for better sites and optimization of project size are learning effects which can only be utilised when projects are developed. Therefore a presentation of CAPEX versus cumulated installed capacity is proposed in order to show the possible future advancement of the technology to politics and market. However from a wide range of publications on cost for CSP it is difficult to derive a learning curve. A logical cost structure for direct and indirect capital expenditure is needed as the basis for further analysis. Using derived reference cost for typical power plant configurations predictions of future cost have been derived. Only on the basis of that cost structure and the learning curve levelised cost of electricity for solar thermal power plants should be calculated for individual projects with different capacity factors in various locations.

Axisymmetric indentation of curved elastic membranes by a convex rigid indenter

PubMed Central

Pearce, S.P.; King, J.R.; Holdsworth, M.J.

2011-01-01

Motivated by applications to seed germination, we consider the transverse deflection that results from the axisymmetric indentation of an elastic membrane by a rigid body. The elastic membrane is fixed around its boundary, with or without an initial pre-stretch, and may be initially curved prior to indentation. General indenter shapes are considered, and the load–indentation curves that result for a range of spheroidal tips are obtained for both flat and curved membranes. Wrinkling may occur when the membrane is initially curved, and a relaxed strain-energy function is used to calculate the deformed profile in this case. Applications to experiments designed to measure the mechanical properties of seed endosperms are discussed. PMID:22298913

Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

PubMed

Pocha, Christine

2010-01-01

Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.

Statistical assessment of the learning curves of health technologies.

PubMed

Ramsay, C R; Grant, A M; Wallace, S A; Garthwaite, P H; Monk, A F; Russell, I T

2001-01-01

(1) To describe systematically studies that directly assessed the learning curve effect of health technologies. (2) Systematically to identify 'novel' statistical techniques applied to learning curve data in other fields, such as psychology and manufacturing. (3) To test these statistical techniques in data sets from studies of varying designs to assess health technologies in which learning curve effects are known to exist. METHODS - STUDY SELECTION (HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW): For a study to be included, it had to include a formal analysis of the learning curve of a health technology using a graphical, tabular or statistical technique. METHODS - STUDY SELECTION (NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH): For a study to be included, it had to include a formal assessment of a learning curve using a statistical technique that had not been identified in the previous search. METHODS - DATA SOURCES: Six clinical and 16 non-clinical biomedical databases were searched. A limited amount of handsearching and scanning of reference lists was also undertaken. METHODS - DATA EXTRACTION (HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW): A number of study characteristics were abstracted from the papers such as study design, study size, number of operators and the statistical method used. METHODS - DATA EXTRACTION (NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH): The new statistical techniques identified were categorised into four subgroups of increasing complexity: exploratory data analysis; simple series data analysis; complex data structure analysis, generic techniques. METHODS - TESTING OF STATISTICAL METHODS: Some of the statistical methods identified in the systematic searches for single (simple) operator series data and for multiple (complex) operator series data were illustrated and explored using three data sets. The first was a case series of 190 consecutive laparoscopic fundoplication procedures performed by a single surgeon; the second was a case series of consecutive laparoscopic cholecystectomy procedures performed by ten surgeons; the third was randomised trial data derived from the laparoscopic procedure arm of a multicentre trial of groin hernia repair, supplemented by data from non-randomised operations performed during the trial. RESULTS - HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW: Of 4571 abstracts identified, 272 (6%) were later included in the study after review of the full paper. Some 51% of studies assessed a surgical minimal access technique and 95% were case series. The statistical method used most often (60%) was splitting the data into consecutive parts (such as halves or thirds), with only 14% attempting a more formal statistical analysis. The reporting of the studies was poor, with 31% giving no details of data collection methods. RESULTS - NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH: Of 9431 abstracts assessed, 115 (1%) were deemed appropriate for further investigation and, of these, 18 were included in the study. All of the methods for complex data sets were identified in the non-clinical literature. These were discriminant analysis, two-stage estimation of learning rates, generalised estimating equations, multilevel models, latent curve models, time series models and stochastic parameter models. In addition, eight new shapes of learning curves were identified. RESULTS - TESTING OF STATISTICAL METHODS: No one particular shape of learning curve performed significantly better than another. The performance of 'operation time' as a proxy for learning differed between the three procedures. Multilevel modelling using the laparoscopic cholecystectomy data demonstrated and measured surgeon-specific and confounding effects. The inclusion of non-randomised cases, despite the possible limitations of the method, enhanced the interpretation of learning effects. CONCLUSIONS - HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW: The statistical methods used for assessing learning effects in health technology assessment have been crude and the reporting of studies poor. CONCLUSIONS - NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH: A number of statistical methods for assessing learning effects were identified that had not hitherto been used in health technology assessment. There was a hierarchy of methods for the identification and measurement of learning, and the more sophisticated methods for both have had little if any use in health technology assessment. This demonstrated the value of considering fields outside clinical research when addressing methodological issues in health technology assessment. CONCLUSIONS - TESTING OF STATISTICAL METHODS: It has been demonstrated that the portfolio of techniques identified can enhance investigations of learning curve effects. (ABSTRACT TRUNCATED)

Huang's three-step maneuver shortens the learning curve of laparoscopic spleen-preserving splenic hilar lymphadenectomy.

PubMed

Huang, Chang-Ming; Huang, Ze-Ning; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Jun, Lu; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong

2017-12-01

The goal of this study was to investigate the difference between the learning curves of different maneuvers in laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced upper gastric cancer. From January 2010 to April 2014, 53 consecutive patients who underwent laparoscopic spleen-preserving splenic hilar lymphadenectomy via the traditional-step maneuver (group A) and 53 consecutive patients via Huang's three-step maneuver (group B) were retrospectively analyzed. No significant difference in patient characteristics were found between the two groups. The learning curves of groups A and B were divided into phase 1 (1-43 cases and 1-30 cases, respectively) and phase 2 (44-53 cases and 31-53 cases, respectively). Compared with group A, the dissection time, bleeding loss and vascular injury were significantly decreased in group B. No significant differences in short-term outcomes were found between the two maneuvers. The multivariate analysis indicated that the body mass index, short gastric vessels, splenic artery type and maneuver were significantly associated with the dissection time in group B. No significant difference in the survival curve was found between the maneuvers. The learning curve of Huang's three-step maneuver was shorter than that of the traditional-step maneuver, and the former represents an ideal maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy.To shorten the learning curve at the beginning of laparoscopic spleen-preserving splenic hilar lymphadenectomy, beginners should beneficially use Huang's three-step maneuver and select patients with advanced upper gastric cancer with a body mass index of less than 25 kg/m 2 and the concentrated type of splenic artery. Copyright © 2017. Published by Elsevier Ltd.

Dynamic Hebbian Cross-Correlation Learning Resolves the Spike Timing Dependent Plasticity Conundrum.

PubMed

Olde Scheper, Tjeerd V; Meredith, Rhiannon M; Mansvelder, Huibert D; van Pelt, Jaap; van Ooyen, Arjen

2017-01-01

Spike Timing-Dependent Plasticity has been found to assume many different forms. The classic STDP curve, with one potentiating and one depressing window, is only one of many possible curves that describe synaptic learning using the STDP mechanism. It has been shown experimentally that STDP curves may contain multiple LTP and LTD windows of variable width, and even inverted windows. The underlying STDP mechanism that is capable of producing such an extensive, and apparently incompatible, range of learning curves is still under investigation. In this paper, it is shown that STDP originates from a combination of two dynamic Hebbian cross-correlations of local activity at the synapse. The correlation of the presynaptic activity with the local postsynaptic activity is a robust and reliable indicator of the discrepancy between the presynaptic neuron and the postsynaptic neuron's activity. The second correlation is between the local postsynaptic activity with dendritic activity which is a good indicator of matching local synaptic and dendritic activity. We show that this simple time-independent learning rule can give rise to many forms of the STDP learning curve. The rule regulates synaptic strength without the need for spike matching or other supervisory learning mechanisms. Local differences in dendritic activity at the synapse greatly affect the cross-correlation difference which determines the relative contributions of different neural activity sources. Dendritic activity due to nearby synapses, action potentials, both forward and back-propagating, as well as inhibitory synapses will dynamically modify the local activity at the synapse, and the resulting STDP learning rule. The dynamic Hebbian learning rule ensures furthermore, that the resulting synaptic strength is dynamically stable, and that interactions between synapses do not result in local instabilities. The rule clearly demonstrates that synapses function as independent localized computational entities, each contributing to the global activity, not in a simply linear fashion, but in a manner that is appropriate to achieve local and global stability of the neuron and the entire dendritic structure.

Evaluation of the learning curve for external cephalic version using cumulative sum analysis.

PubMed

Kim, So Yun; Han, Jung Yeol; Chang, Eun Hye; Kwak, Dong Wook; Ahn, Hyun Kyung; Ryu, Hyun Mi; Kim, Moon Young

2017-07-01

We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R 2 values. The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. 'H' value, that the actual failure rate does not differ from the acceptable failure rate, was -3.27 and -1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV.

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

PubMed

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

Insights from Hydrogen Refueling Station Manufacturing Competitiveness Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mayyas, Ahmad

2015-12-18

In work for the Clean Energy Manufacturing Analysis Center (CEMAC), NREL is currently collaborating with Great Lakes Wind Network in conducting a comprehensive hydrogen refueling stations manufacturing competitiveness and supply chain analyses. In this project, CEMAC will be looking at several metrics that will facilitate understanding of the interactions between and within the HRS supply chain, such metrics include innovation potential, intellectual properties, learning curves, related industries and clustering, existing supply chains, ease of doing business, and regulations and safety. This presentation to Fuel Cell Seminar and Energy Exposition 2015 highlights initial findings from CEMAC's analysis.

Tactile perceptual learning: learning curves and transfer to the contralateral finger.

PubMed

Kaas, Amanda L; van de Ven, Vincent; Reithler, Joel; Goebel, Rainer

2013-02-01

Tactile perceptual learning has been shown to improve performance on tactile tasks, but there is no agreement about the extent of transfer to untrained skin locations. The lack of such transfer is often seen as a behavioral index of the contribution of early somatosensory brain regions. Moreover, the time course of improvements has never been described explicitly. Sixteen subjects were trained on the Ludvigh task (a tactile vernier task) on four subsequent days. On the fifth day, transfer of learning to the non-trained contralateral hand was tested. In five subjects, we explored to what extent training effects were retained approximately 1.5 years after the final training session, expecting to find long-term retention of learning effects after training. Results showed that tactile perceptual learning mainly occurred offline, between sessions. Training effects did not transfer initially, but became fully available to the untrained contralateral hand after a few additional training runs. After 1.5 years, training effects were not fully washed out and could be recuperated within a single training session. Interpreted in the light of theories of visual perceptual learning, these results suggest that tactile perceptual learning is not fundamentally different from visual perceptual learning, but might proceed at a slower pace due to procedural and task differences, thus explaining the apparent divergence in the amount of transfer and long-term retention.

Learning Curve for Teaching Constellations in a Planetarium

NASA Astrophysics Data System (ADS)

Hintz, Eric G.; Smith, N.; Moody, J. W.; Stephens, D. C.; Joner, M. D.; Hintz, M.; Lawler, J.; Jones, M.; Bench, N.

2014-01-01

As part of a larger project we have examined how students learn constellations in a planetarium environment. Students in our introductory descriptive astronomy class were given a 50 object quiz before any instruction. This quiz includes 30 constellations, 17 bright stars, two star clusters, and the Orion Nebula. In addition we gathered a small set of demographic information. After the initial quiz we tracked student scores through the semester to see how long it took for them to learn all 50 objects. We also plan to give a follow-up constellation quiz to students who have previously taken the quiz to test for retention. This will cover a time line for 6 months up to 4 years. We will present our early results from this study. This data will also be used as a baseline for a study of Head Mounted Displays to teach a deaf audience in a planetarium. This work is partially supported by funding from the National Science Foundation grant IIS-1124548 and the Sorenson Foundation.

A hybrid gene selection approach for microarray data classification using cellular learning automata and ant colony optimization.

PubMed

Vafaee Sharbaf, Fatemeh; Mosafer, Sara; Moattar, Mohammad Hossein

2016-06-01

This paper proposes an approach for gene selection in microarray data. The proposed approach consists of a primary filter approach using Fisher criterion which reduces the initial genes and hence the search space and time complexity. Then, a wrapper approach which is based on cellular learning automata (CLA) optimized with ant colony method (ACO) is used to find the set of features which improve the classification accuracy. CLA is applied due to its capability to learn and model complicated relationships. The selected features from the last phase are evaluated using ROC curve and the most effective while smallest feature subset is determined. The classifiers which are evaluated in the proposed framework are K-nearest neighbor; support vector machine and naïve Bayes. The proposed approach is evaluated on 4 microarray datasets. The evaluations confirm that the proposed approach can find the smallest subset of genes while approaching the maximum accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

An initial experience with hip resurfacing versus cementless total hip arthroplasty.

PubMed

Arndt, Justin Michael; Wera, Glenn D; Goldberg, Victor M

2013-07-01

Hip resurfacing is an alternative to total hip arthroplasty. We aimed to compare an experienced hip surgeon's initial clinical results of hip resurfacing with a new cementless total hip arthroplasty (THA). The first 55 consecutive hip resurfacing arthroplasties were compared to 100 consecutive cementless THAs using a cylindrical tapered femoral stem. The learning curve between the two procedures was compared utilizing the incidence of reoperation, complications, Harris Hip Scores (HHS), and implant survivorship. The reoperation rate was significantly higher (p = 0.019) for hip resurfacing (14.5%) versus THA (4%). The overall complication rate between the two groups was not significantly different (p = 0.398). Preoperative HHS were similar between the two groups (p = 0.2). The final mean HHS was similar in both the resurfacing and THA groups (96 vs. 98.3, respectively, p < 0.65). Kaplan-Meier survival analysis with an endpoint of reoperation suggests complications occurred earlier in the resurfacing group versus the THA group (log-rank test, p = 0.007). In comparison to our initial experience with a cementless THA stem, operative complications occur earlier and more often after hip resurfacing during the learning period. The clinical outcomes in both groups however are similar at 5 year follow-up.

From the ground up: building a minimally invasive aortic valve surgery program

PubMed Central

Lamelas, Joseph

2015-01-01

Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a “virtual lobby” for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority. PMID:25870815

From the ground up: building a minimally invasive aortic valve surgery program.

PubMed

Nguyen, Tom C; Lamelas, Joseph

2015-03-01

Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority.

The learning curves in living donor hemiliver graft procurement using small upper midline incision.

PubMed

Ikegami, Toru; Harimoto, Norifumi; Shimokawa, Masahiro; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Itoh, Shinji; Okabe, Norihisa; Sakata, Kazuhito; Nagatsu, Akihisa; Soejima, Yuji; Maehara, Yoshihiko

2016-12-01

The learning curve for performing living donor hemiliver procurement (LDHP) via small upper midline incision (UMI) has not been determined. Living donors (n=101) who underwent LDHP via UMI were included to investigate the learning curve using cumulative sum analysis. The cumulative sum analysis showed that nine cases for right lobe (case #23) and 19 cases for left lobe (case #32 in the whole series) are needed for stable and acceptable surgical outcomes in LDHP via UMI. The established phase (n=69, since case #33) had a significantly shorter operative time, a smaller incision size, and less blood loss than the previous learning phase (n=32, serial case number up to the last 19th left lobe case). Multivariate analysis showed that the learning phase, high body mass index ≥25 kg/m 2 , and left lobe graft procurement are the factors associated with surgical events including operative blood loss ≥400 mL, operative time ≥300 minutes, or surgical complications ≥Clavien-Dindo grade II. There is an obvious learning curve in performing LDHP via UMI, and 32 cases including both 19 cases for left lobe and nine cases for right lobe are needed for having stable and acceptable surgical outcomes. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Using Dragon Curves To Learn about Length and Area.

ERIC Educational Resources Information Center

Smith, Lyle R.

1999-01-01

Utilizes dragon curves which are made with three tiles and can be used to create fascinating patterns to help students understand the concepts of length, area, and perimeter of regions as defined by dragon curves. (ASK)

Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies.

PubMed

Zorn, Kevin C; Wille, Mark A; Thong, Alan E; Katz, Mark H; Shikanov, Sergey A; Razmaria, Aria; Gofrit, Ofer N; Zagaja, Gregory P; Shalhav, Arieh L

2009-08-01

Several robot-assisted radical prostatectomy (RARP) series have reviewed the impact of the initial learning curve on perioperative outcomes. However, little is known about the impact of experience on urinary and sexual outcomes. Herein, we review the perioperative, pathological and functional outcomes of our initial 700 consecutive procedures with at least 1 year follow up. From 2003-2006, 700 consecutive men underwent RARP at a single, academic institution. Perioperative data and pathologic outcomes were prospectively collected. Validated, UCLA-PCI-SF36v2 quality-of-life questionnaires were also obtained at 1, 3, 6 and 12 months following surgery. Outcomes between groups (cases 1-300, 301-500, and 501-700) were compared. Mean operative time (OT) and blood loss significantly decreased during the experience (286, 198, 190 min; p or=7 in 24%, 40%, 44%; p

Non-Constant Learning Rates in Retrospective Experience Curve Analyses and their Correlation to Deployment Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wei, Max; Smith, Sarah J.; Sohn, Michael D.

2015-07-16

A key challenge for policy-makers and technology market forecasters is to estimate future technology costs and in particular the rate of cost reduction versus production volume. A related, critical question is what role should state and federal governments have in advancing energy efficient and renewable energy technologies? This work provides retrospective experience curves and learning rates for several energy-related technologies, each of which have a known history of federal and state deployment programs. We derive learning rates for eight technologies including energy efficient lighting technologies, stationary fuel cell systems, and residential solar photovoltaics, and provide an overview and timeline ofmore » historical deployment programs such as state and federal standards and state and national incentive programs for each technology. Piecewise linear regimes are observed in a range of technology experience curves, and public investments or deployment programs are found to be strongly correlated to an increase in learning rate across multiple technologies. A downward bend in the experience curve is found in 5 out of the 8 energy-related technologies presented here (electronic ballasts, magnetic ballasts, compact fluorescent lighting, general service fluorescent lighting, and the installed cost of solar PV). In each of the five downward-bending experience curves, we believe that an increase in the learning rate can be linked to deployment programs to some degree. This work sheds light on the endogenous versus exogenous contributions to technological innovation and highlights the impact of exogenous government sponsored deployment programs. This work can inform future policy investment direction and can shed light on market transformation and technology learning behavior.« less

Using Technology in Teacher Preparation: Two Mature Teacher Educators Negotiate the Steep Learning Curve

ERIC Educational Resources Information Center

Monroe, Eula; Tolman, Marvin

2004-01-01

This paper chronicles the ventures of two mature faculty members who continue to negotiate their own steep learning curves in helping teacher education students use current technology. It describes the scaffolding provided within the university setting for the faculty members' growth. Included are elements supported by a PT3 grant that have…

The Birmingham Interlocking Pelvic Osteotomy for acetabular dysplasia: 13- to 21-year survival outcomes.

PubMed

Mei-Dan, O; Jewell, D; Garabekyan, T; Brockwell, J; Young, D A; McBryde, C W; O'Hara, J N

2017-06-01

The aim of this study was to evaluate the long-term clinical and radiographic outcomes of the Birmingham Interlocking Pelvic Osteotomy (BIPO). In this prospective study, we report the mid- to long-term clinical outcomes of the first 100 consecutive patients (116 hips; 88 in women, 28 in men) undergoing BIPO, reflecting the surgeon's learning curve. Failure was defined as conversion to hip arthroplasty. The mean age at operation was 31 years (7 to 57). Three patients (three hips) were lost to follow-up. Survivorship was 76% at ten years and 57% at a mean of 17 years. Younger patients (< 20 years) had the best survivorship (20 hips at risk; 90% at 17 years; 95% confidence interval 65 to 97). Post-operative complications occurred after 12 operations (10.4%) over the duration of the study. Increasing patient age and hip arthritis grade were primary determinants of surgical failure. BIPO provides good to excellent survivorship in appropriately selected patients, with a relatively low rate of complications. Our results are comparable with other established methods of periacetabular osteotomy (PAO), such as the Bernese PAO, even during the surgeon's initial learning curve. Cite this article: Bone Joint J 2017;99-B:724-31. ©2017 The British Editorial Society of Bone & Joint Surgery.

Use of a Machine-learning Method for Predicting Highly Cited Articles Within General Radiology Journals.

PubMed

Rosenkrantz, Andrew B; Doshi, Ankur M; Ginocchio, Luke A; Aphinyanaphongs, Yindalon

2016-12-01

This study aimed to assess the performance of a text classification machine-learning model in predicting highly cited articles within the recent radiological literature and to identify the model's most influential article features. We downloaded from PubMed the title, abstract, and medical subject heading terms for 10,065 articles published in 25 general radiology journals in 2012 and 2013. Three machine-learning models were applied to predict the top 10% of included articles in terms of the number of citations to the article in 2014 (reflecting the 2-year time window in conventional impact factor calculations). The model having the highest area under the curve was selected to derive a list of article features (words) predicting high citation volume, which was iteratively reduced to identify the smallest possible core feature list maintaining predictive power. Overall themes were qualitatively assigned to the core features. The regularized logistic regression (Bayesian binary regression) model had highest performance, achieving an area under the curve of 0.814 in predicting articles in the top 10% of citation volume. We reduced the initial 14,083 features to 210 features that maintain predictivity. These features corresponded with topics relating to various imaging techniques (eg, diffusion-weighted magnetic resonance imaging, hyperpolarized magnetic resonance imaging, dual-energy computed tomography, computed tomography reconstruction algorithms, tomosynthesis, elastography, and computer-aided diagnosis), particular pathologies (prostate cancer; thyroid nodules; hepatic adenoma, hepatocellular carcinoma, non-alcoholic fatty liver disease), and other topics (radiation dose, electroporation, education, general oncology, gadolinium, statistics). Machine learning can be successfully applied to create specific feature-based models for predicting articles likely to achieve high influence within the radiological literature. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared with Open-Surgery Controls from the Premier Perspective Database

PubMed Central

Kreaden, Usha S.; Gabbert, Jessica; Thomas, Raju

2014-01-01

Abstract Introduction: The primary aims of this study were to assess the learning curve effect of robot-assisted radical prostatectomy (RARP) in a large administrative database consisting of multiple U.S. hospitals and surgeons, and to compare the results of RARP with open radical prostatectomy (ORP) from the same settings. Materials and Methods: The patient population of study was from the Premier Perspective Database (Premier, Inc., Charlotte, NC) and consisted of 71,312 radical prostatectomies performed at more than 300 U.S. hospitals by up to 3739 surgeons by open or robotic techniques from 2004 to 2010. The key endpoints were surgery time, inpatient length of stay, and overall complications. We compared open versus robotic, results by year of procedures, results by case volume of specific surgeons, and results of open surgery in hospitals with and without a robotic system. Results: The mean surgery time was longer for RARP (4.4 hours, standard deviation [SD] 1.7) compared with ORP (3.4 hours, SD 1.5) in the same hospitals (p<0.0001). Inpatient stay was shorter for RARP (2.2 days, SD 1.9) compared with ORP (3.2 days, SD 2.7) in the same hospitals (p<0.0001). The overall complications were less for RARP (10.6%) compared with ORP (15.8%) in the same hospitals, as were transfusion rates. ORP results in hospitals without a robot were not better than ORP with a robot, and pretreatment co-morbidity profiles were similar in all cohorts. Trending of results by year of procedure showed no differences in the three cohorts, but trending of RARP results by surgeon experience showed improvements in surgery time, hospital stay, conversion rates, and complication rates. Conclusions: During the initial 7 years of RARP development, outcomes showed decreased hospital stay, complications, and transfusion rates. Learning curve trends for RARP were evident for these endpoints when grouped by surgeon experience, but not by year of surgery. PMID:24350787

Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country.

PubMed

De-la-Peña, Joaquín; Calderón, Ángel; Esteban, José Miguel; López-Rosés, Leopoldo; Martínez-Ares, David; Nogales, Óscar; Orive-Calzada, Aitor; Rodríguez, Sarbelio; Sánchez-Hernández, Eloy; Vila, Juan; Fernández-Esparrach, Gloria

2014-02-01

Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.

Evaluating the Bias of Alternative Cost Progress Models: Tests Using Aerospace Industry Acquisition Programs

DTIC Science & Technology

1992-12-01

suspect :mat, -n2 extent predict:.on cas jas ccsiziveiv crrei:=e amonc e v:arious models, :he fandom *.;aik, learn ha r ur e, i;<ea- variable and Bemis...Functions, Production Rate Adjustment Model, Learning Curve Model. Random Walk Model. Bemis Model. Evaluating Model Bias, Cost Prediction Bias. Cost...of four cost progress models--a random walk model, the tradiuonai learning curve model, a production rate model Ifixed-variable model). and a model

The implications of renewable energy research and development: Policy scenario analysis with experience and learning effects

NASA Astrophysics Data System (ADS)

Kobos, Peter Holmes

This dissertation analyzes the current and potential future costs of renewable energy technology from an institutional perspective. The central hypothesis is that reliable technology cost forecasting can be achieved through standard and modified experience curves implemented in a dynamic simulation model. Additionally, drawing upon region-specific institutional lessons highlights the role of market, social, and political institutions throughout an economy. Socio-political influences and government policy pathways drive resource allocation decisions that may be predominately influenced by factors other than those considered in a traditional market-driven, mechanistic approach. Learning in economic systems as a research topic is an attractive complement to the notion of institutional pathways. The economic implications of learning by doing, as first outlined by Arrow (1962), highlight decreasing production costs as individuals, or more generally the firm, become more familiar with a production process. The standard approach in the literature has been to employ a common experience curve where cumulative production is the only independent variable affecting costs. This dissertation develops a two factor experience curve, adding research, development and demonstration (RD&D) expenditures as a second variable. To illustrate the concept in the context of energy planning, two factor experience curves are developed for wind energy technology and solar photovoltaic (PV) modules under different assumptions on learning rates for cumulative capacity and the knowledge stock (a function of past RD&D efforts). Additionally, a one factor experience curve and cost trajectory scenarios are developed for concentrated solar power and geothermal energy technology, respectively. Cost forecasts are then developed for all four of these technologies in a dynamic simulation model. Combining the theoretical framework of learning by doing with the fields of organizational learning and institutional economics, this dissertation argues that the current state of renewable energy technology costs is largely due to the past production efforts (learning by doing) and RD&D efforts (learning by searching) in these global industries. This cost pathway, however, may be altered through several policy process feedback mechanisms including targeted RD&D expenditures, maintenance of RD&D to promote learning effects, and financial incentive programs that support energy production from renewable energy technologies.

Biomimetic molecular design tools that learn, evolve, and adapt.

PubMed

Winkler, David A

2017-01-01

A dominant hallmark of living systems is their ability to adapt to changes in the environment by learning and evolving. Nature does this so superbly that intensive research efforts are now attempting to mimic biological processes. Initially this biomimicry involved developing synthetic methods to generate complex bioactive natural products. Recent work is attempting to understand how molecular machines operate so their principles can be copied, and learning how to employ biomimetic evolution and learning methods to solve complex problems in science, medicine and engineering. Automation, robotics, artificial intelligence, and evolutionary algorithms are now converging to generate what might broadly be called in silico-based adaptive evolution of materials. These methods are being applied to organic chemistry to systematize reactions, create synthesis robots to carry out unit operations, and to devise closed loop flow self-optimizing chemical synthesis systems. Most scientific innovations and technologies pass through the well-known "S curve", with slow beginning, an almost exponential growth in capability, and a stable applications period. Adaptive, evolving, machine learning-based molecular design and optimization methods are approaching the period of very rapid growth and their impact is already being described as potentially disruptive. This paper describes new developments in biomimetic adaptive, evolving, learning computational molecular design methods and their potential impacts in chemistry, engineering, and medicine.

An interplay of fusiform gyrus and hippocampus enables prototype- and exemplar-based category learning.

PubMed

Lech, Robert K; Güntürkün, Onur; Suchan, Boris

2016-09-15

The aim of the present study was to examine the contributions of different brain structures to prototype- and exemplar-based category learning using functional magnetic resonance imaging (fMRI). Twenty-eight subjects performed a categorization task in which they had to assign prototypes and exceptions to two different families. This test procedure usually produces different learning curves for prototype and exception stimuli. Our behavioral data replicated these previous findings by showing an initially superior performance for prototypes and typical stimuli and a switch from a prototype-based to an exemplar-based categorization for exceptions in the later learning phases. Since performance varied, we divided participants into learners and non-learners. Analysis of the functional imaging data revealed that the interaction of group (learners vs. non-learners) and block (Block 5 vs. Block 1) yielded an activation of the left fusiform gyrus for the processing of prototypes, and an activation of the right hippocampus for exceptions after learning the categories. Thus, successful prototype- and exemplar-based category learning is associated with activations of complementary neural substrates that constitute object-based processes of the ventral visual stream and their interaction with unique-cue representations, possibly based on sparse coding within the hippocampus. Copyright © 2016 Elsevier B.V. All rights reserved.

Motor learning induces plastic changes in Purkinje cell dendritic spines in the rat cerebellum.

PubMed

González-Tapia, D; González-Ramírez, M M; Vázquez-Hernández, N; González-Burgos, I

2017-12-14

The paramedian lobule of the cerebellum is involved in learning to correctly perform motor skills through practice. Dendritic spines are dynamic structures that regulate excitatory synaptic stimulation. We studied plastic changes occurring in the dendritic spines of Purkinje cells from the paramedian lobule of rats during motor learning. Adult male rats were trained over a 6-day period using an acrobatic motor learning paradigm; the density and type of dendritic spines were determined every day during the study period using a modified version of the Golgi method. The learning curve reflected a considerable decrease in the number of errors made by rats as the training period progressed. We observed more dendritic spines on days 2 and 6, particularly more thin spines on days 1, 3, and 6, fewer mushroom spines on day 3, fewer stubby spines on day 1, and more thick spines on days 4 and 6. The initial stage of motor learning may be associated with fast processing of the underlying synaptic information combined with an apparent "silencing" of memory consolidation processes, based on the regulation of the neuronal excitability. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm.

PubMed

Schulz, A; Perbix, W; Shoham, Y; Daali, S; Charalampaki, C; Fuchs, P C; Schiefer, J

2017-03-01

Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid ® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands. We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described. EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel ® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28. EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Evaluation of ultrasound-guided vascular access in dogs.

PubMed

Chamberlin, Scott C; Sullivan, Lauren A; Morley, Paul S; Boscan, Pedro

2013-01-01

To describe the technique and determine the feasibility, success rate, perceived difficulty, and time to vascular access using ultrasound guidance for jugular vein catheterization in a cardiac arrest dog model. Prospective descriptive study. University teaching hospital. Nine Walker hounds. A total of 27 jugular catheterizations were performed postcardiac arrest using ultrasound guidance. Catheterizations were recorded based on the order in which they were performed and presence/absence of a hematoma around the vein. Time (minutes) until successful vascular access and perceived difficulty in achieving vascular access (scale of 1 = easy to 10 = difficult) were recorded for each catheterization. Mean time to vascular access was 1.9 minutes (95% confidence interval, 1.1-3.4 min) for catheterizations without hematoma, versus 4.3 minutes (1.8-10.1 min) for catheterizations with hematoma (P = 0.1). Median perceived difficulty was 2 of 10 (range 1-7) for catheterizations without hematoma, versus 2 of 10 (range 1-8) for catheterizations with hematoma (P = 0.3). A learning curve was evaluated by comparing mean time to vascular access and perceived difficulty in initial versus subsequent catheterizations. Mean time to vascular access was 2.5 minutes (1.0-6.4 min) in the initial 13 catheterizations versus 3.3 minutes (1.5-7.5 min) in the subsequent 14 catheterizations (P = 0.6). Median perceived difficulty in the first 13 catheterizations (3, range 1-8) was significantly greater (P = 0.049) than median perceived difficulty in the subsequent 14 catheterizations (2, range 1-6). Ultrasound-guided jugular catheterization is associated with a learning curve but is successful in obtaining rapid vascular access in dogs. Further prospective studies are warranted to confirm the utility of this technique in a clinical setting. © Veterinary Emergency and Critical Care Society 2013.

Per-oral Endoscopic Myotomy (POEM) After the Learning Curve: Durable Long-term Results With a Low Complication Rate.

PubMed

Hungness, Eric S; Sternbach, Joel M; Teitelbaum, Ezra N; Kahrilas, Peter J; Pandolfino, John E; Soper, Nathaniel J

2016-09-01

We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included. Treatment success was defined as an Eckardt score ≤3 without reintervention. Gastroesophageal reflux was defined by abnormal pH-testing or reflux esophagitis >Los Angeles grade A. Between January 2012 and March 2015, 115 patients underwent POEM at a single, high-volume center. Operative time was 101 ± 29 minutes, with 95% (109/115) of patients discharged on postoperative day 1. Clavien-Dindo grade III complications occurred in 2.7%, one of which required diagnostic laparoscopy to rule out Veress needle injury to the gall bladder. The rate of grade I complications was 15.2%. At an average of 2.4 years post-POEM (range 12-52 months), the overall success rate was 92%. Objective evidence of reflux was present in 40% for all patients and 33% for patients with a body mass index <35 kg/m and no hiatal hernia. POEM performed by experienced surgeons provided durable symptomatic relief in 94% of patients with nonspastic achalasia and 90% of patients with type 3 achalasia/spastic esophageal motility disorders, with a low rate of complications. The rate of gastroesophageal reflux was comparable with prior studies of both POEM and laparoscopic Heller myotomy.

The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings.

PubMed

Madsen, Mette E; Nørgaard, Lone N; Tabor, Ann; Konge, Lars; Ringsted, Charlotte; Tolsgaard, Martin G

2017-01-01

The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. Twenty midwives completed a simulation-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established validity evidence, and they advanced to the next level only after attaining predefined levels of performance. The number of repetitions and time needed to achieve predefined performance levels were recorded along with the performance scores in each setting. Finally, the outcomes were correlated across settings. A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P < .001). Performance scores on the VR simulator correlated well to the clinical performance scores (Pearson correlation coefficient .81; P = .049). No significant correlations were found between numbers of attempts needed to reach proficiency across the 3 different settings. A post hoc analysis found that the 50% fastest trainees at reaching proficiency during simulation-based training received higher clinical performance scores compared to trainees with scores placing them among the 50% slowest (P = .025). Performances during simulation-based sonography training may predict performance in related tasks and subsequent clinical learning curves. © 2016 by the American Institute of Ultrasound in Medicine.

Evaluation of the learning curve for external cephalic version using cumulative sum analysis

PubMed Central

Kim, So Yun; Chang, Eun Hye; Kwak, Dong Wook; Ahn, Hyun Kyung; Ryu, Hyun Mi; Kim, Moon Young

2017-01-01

Objective We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. Methods This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R2 values. Results The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. ‘H’ value, that the actual failure rate does not differ from the acceptable failure rate, was −3.27 and −1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. Conclusion Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV. PMID:28791265

An object location memory paradigm for older adults with and without mild cognitive impairment.

PubMed

Külzow, Nadine; Kerti, Lucia; Witte, Veronica A; Kopp, Ute; Breitenstein, Caterina; Flöel, Agnes

2014-11-30

Object-location memory is critical in every-day life and known to deteriorate early in the course of neurodegenerative disease. We adapted the previously established learning paradigm "LOCATO" for use in healthy older adults and patients with mild cognitive impairment (MCI). Pictures of real-life buildings were associated with positions on a two-dimensional street map by repetitions of "correct" object-location pairings over the course of five training blocks, followed by a recall task. Correct/incorrect associations were indicated by button presses. The original two 45-item sets were reduced to 15 item-sets, and tested in healthy older adults and MCI for learning curve, recall, and re-test effects. The two 15-item versions showed comparable learning curves and recall scores within each group. While learning curves increased linearly in both groups, MCI patients performed significantly worse on learning and recall compared to healthy controls. Re-testing after 6 month showed small practice effects only. LOCATO is a simple standardized task that overcomes several limitation of previously employed visuospatial task by using real-life stimuli, minimizing verbal encoding, avoiding fine motor responses, combining explicit and implicit statistical learning, and allowing to assess learning curve in addition to recall. Results show that the shortened version of LOCATO meets the requirements for a robust and ecologically meaningful assessment of object-location memory in older adults with and without MCI. It can now be used to systematically assess acquisition of object-location memory and its modulation through adjuvant therapies like pharmacological or non-invasive brain stimulation. Copyright © 2014 Elsevier B.V. All rights reserved.

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis

PubMed Central

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

Background The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. Methods and finding We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755–0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691–0.783) and 0.742 (0.698–0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. Conclusions According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction. PMID:28060903

Cognitive Machine-Learning Algorithm for Cardiac Imaging: A Pilot Study for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy.

PubMed

Sengupta, Partho P; Huang, Yen-Min; Bansal, Manish; Ashrafi, Ali; Fisher, Matt; Shameer, Khader; Gall, Walt; Dudley, Joel T

2016-06-01

Associating a patient's profile with the memories of prototypical patients built through previous repeat clinical experience is a key process in clinical judgment. We hypothesized that a similar process using a cognitive computing tool would be well suited for learning and recalling multidimensional attributes of speckle tracking echocardiography data sets derived from patients with known constrictive pericarditis and restrictive cardiomyopathy. Clinical and echocardiographic data of 50 patients with constrictive pericarditis and 44 with restrictive cardiomyopathy were used for developing an associative memory classifier-based machine-learning algorithm. The speckle tracking echocardiography data were normalized in reference to 47 controls with no structural heart disease, and the diagnostic area under the receiver operating characteristic curve of the associative memory classifier was evaluated for differentiating constrictive pericarditis from restrictive cardiomyopathy. Using only speckle tracking echocardiography variables, associative memory classifier achieved a diagnostic area under the curve of 89.2%, which improved to 96.2% with addition of 4 echocardiographic variables. In comparison, the area under the curve of early diastolic mitral annular velocity and left ventricular longitudinal strain were 82.1% and 63.7%, respectively. Furthermore, the associative memory classifier demonstrated greater accuracy and shorter learning curves than other machine-learning approaches, with accuracy asymptotically approaching 90% after a training fraction of 0.3 and remaining flat at higher training fractions. This study demonstrates feasibility of a cognitive machine-learning approach for learning and recalling patterns observed during echocardiographic evaluations. Incorporation of machine-learning algorithms in cardiac imaging may aid standardized assessments and support the quality of interpretations, particularly for novice readers with limited experience. © 2016 American Heart Association, Inc.

[Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

PubMed

Rasner, P I; Pushkar', D Iu; Kolontarev, K B; Kotenkov, D V

2014-01-01

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

Learning curve for new technology?: a nationwide register-based study of 46,363 total knee arthroplasties.

PubMed

Peltola, Mikko; Malmivaara, Antti; Paavola, Mika

2013-12-04

The risk of early revision is increased for the first patients operatively treated with a newly introduced knee prosthesis. In this study, we explored the learning curves associated with ten knee implant models to determine their effect on early revision risk. We studied register data from all seventy-five surgical units that performed knee arthroplasty in Finland from 1998 to 2007. Of 54,925 patients (66,098 knees), 39,528 patients (46,363 knees) underwent arthroplasty for osteoarthritis of the knee with the ten most common total knee implants and were followed with complete data until December 31, 2010, or the time of death. We used a Cox proportional-hazards regression model for calculating the hazard ratios for early revision for the first fifteen arthroplasties and subsequent increments of numbers of arthroplasties. We found large differences among knee implants at the introduction with regard to the risk of early revision, as well as for the overall risk of early revision. A learning curve was found for four implant models, while six models did not show a learning effect on the risk of early revision. The survivorship of the studied prostheses showed substantial differences. Knee implants have model-specific learning curves and early revision risks. Some models are more difficult to implement than others. The manufacturers should consider the learning effect when designing implants and instrumentation. The surgeons should thoroughly familiarize themselves with the new knee implants before use.

The SBRT database initiative of the German Society for Radiation Oncology (DEGRO): patterns of care and outcome analysis of stereotactic body radiotherapy (SBRT) for liver oligometastases in 474 patients with 623 metastases.

PubMed

Andratschke, N; Alheid, H; Allgäuer, M; Becker, G; Blanck, O; Boda-Heggemann, J; Brunner, T; Duma, M; Gerum, S; Guckenberger, M; Hildebrandt, G; Klement, R J; Lewitzki, V; Ostheimer, C; Papachristofilou, A; Petersen, C; Schneider, T; Semrau, R; Wachter, S; Habermehl, D

2018-03-13

The intent of this pooled analysis as part of the German society for radiation oncology (DEGRO) stereotactic body radiotherapy (SBRT) initiative was to analyze the patterns of care of SBRT for liver oligometastases and to derive factors influencing treated metastases control and overall survival in a large patient cohort. From 17 German and Swiss centers, data on all patients treated for liver oligometastases with SBRT since its introduction in 1997 has been collected and entered into a centralized database. In addition to patient and tumor characteristics, data on immobilization, image guidance and motion management as well as dose prescription and fractionation has been gathered. Besides dose response and survival statistics, time trends of the aforementioned variables have been investigated. In total, 474 patients with 623 liver oligometastases (median 1 lesion/patient; range 1–4) have been collected from 1997 until 2015. Predominant histologies were colorectal cancer (n = 213 pts.; 300 lesions) and breast cancer (n = 57; 81 lesions). All centers employed an SBRT specific setup. Initially, stereotactic coordinates and CT simulation were used for treatment set-up (55%), but eventually were replaced by CBCT guidance (28%) or more recently robotic tracking (17%). High variance in fraction (fx) number (median 1 fx; range 1–13) and dose per fraction (median: 18.5 Gy; range 3–37.5 Gy) was observed, although median BED remained consistently high after an initial learning curve. Median follow-up time was 15 months; median overall survival after SBRT was 24 months. One- and 2-year treated metastases control rate of treated lesions was 77% and 64%; if maximum isocenter biological equivalent dose (BED) was greater than 150 Gy EQD2Gy, it increased to 83% and 70%, respectively. Besides radiation dose colorectal and breast histology and motion management methods were associated with improved treated metastases control. After an initial learning curve with regards to total cumulative doses, consistently high biologically effective doses have been employed translating into high local tumor control at 1 and 2 years. The true impact of histology and motion management method on treated metastases control deserve deeper analysis. Overall survival is mainly influenced by histology and metastatic tumor burden.

Comparison of angular dependence of magnetic Barkhausen noise of hysteresis and initial magnetization curve in API5L steel

NASA Astrophysics Data System (ADS)

Chávez-Gonzalez, A. F.; Martínez-Ortiz, P.; Pérez-Benítez, J. A.; Espina-Hernández, J. H.; Caleyo, F.

2018-01-01

This work analyzes the differences between the magnetic Barkhausen noise corresponding to the initial magnetization curve and Barkhausen noise corresponding to one branch of the hysteresis loop in API-5L steel. The outcomes show that the Barkhausen noise signal corresponding to the initial magnetization curve and that corresponding to the hysteresis are significantly different. This difference is due to the presence of different processes of the domain wall dynamics in both phenomena. To study the processes present in magnetization dynamics for an applied field of H > 0, research into the angular dependence of a Barkhausen signal using applied field bands has revealed that a Barkhausen signal corresponding to the initial magnetization curve is more suitable than a Barkhausen signal corresponding to the hysteresis loop.

Virtual reality simulation training of mastoidectomy - studies on novice performance.

PubMed

Andersen, Steven Arild Wuyts

2016-08-01

Virtual reality (VR) simulation-based training is increasingly used in surgical technical skills training including in temporal bone surgery. The potential of VR simulation in enabling high-quality surgical training is great and VR simulation allows high-stakes and complex procedures such as mastoidectomy to be trained repeatedly, independent of patients and surgical tutors, outside traditional learning environments such as the OR or the temporal bone lab, and with fewer of the constraints of traditional training. This thesis aims to increase the evidence-base of VR simulation training of mastoidectomy and, by studying the final-product performances of novices, investigates the transfer of skills to the current gold-standard training modality of cadaveric dissection, the effect of different practice conditions and simulator-integrated tutoring on performance and retention of skills, and the role of directed, self-regulated learning. Technical skills in mastoidectomy were transferable from the VR simulation environment to cadaveric dissection with significant improvement in performance after directed, self-regulated training in the VR temporal bone simulator. Distributed practice led to a better learning outcome and more consolidated skills than massed practice and also resulted in a more consistent performance after three months of non-practice. Simulator-integrated tutoring accelerated the initial learning curve but also caused over-reliance on tutoring, which resulted in a drop in performance when the simulator-integrated tutor-function was discontinued. The learning curves were highly individual but often plateaued early and at an inadequate level, which related to issues concerning both the procedure and the VR simulator, over-reliance on the tutor function and poor self-assessment skills. Future simulator-integrated automated assessment could potentially resolve some of these issues and provide trainees with both feedback during the procedure and immediate assessment following each procedure. Standard setting by establishing a proficiency level that can be used for mastery learning with deliberate practice could also further sophisticate directed, self-regulated learning in VR simulation-based training. VR simulation-based training should be embedded in a systematic and competency-based training curriculum for high-quality surgical skills training, ultimately leading to improved safety and patient care.

The computation of all plane/surface intersections for CAD/CAM applications

NASA Technical Reports Server (NTRS)

Hoitsma, D. H., Jr.; Roche, M.

1984-01-01

The problem of the computation and display of all intersections of a given plane with a rational bicubic surface patch for use on an interactive CAD/CAM system is examined. The general problem of calculating all intersections of a plane and a surface consisting of rational bicubic patches is reduced to the case of a single generic patch by applying a rejection algorithm which excludes all patches that do not intersect the plane. For each pertinent patch the algorithm presented computed the intersection curves by locating an initial point on each curve, and computes successive points on the curve using a tolerance step equation. A single cubic equation solver is used to compute the initial curve points lying on the boundary of a surface patch, and the method of resultants as applied to curve theory is used to determine critical points which, in turn, are used to locate initial points that lie on intersection curves which are in the interior of the patch. Examples are given to illustrate the ability of this algorithm to produce all intersection curves.

The Parallel Episodic Processing (PEP) model 2.0: A single computational model of stimulus-response binding, contingency learning, power curves, and mixing costs.

PubMed

Schmidt, James R; De Houwer, Jan; Rothermund, Klaus

2016-12-01

The current paper presents an extension of the Parallel Episodic Processing model. The model is developed for simulating behaviour in performance (i.e., speeded response time) tasks and learns to anticipate both how and when to respond based on retrieval of memories of previous trials. With one fixed parameter set, the model is shown to successfully simulate a wide range of different findings. These include: practice curves in the Stroop paradigm, contingency learning effects, learning acquisition curves, stimulus-response binding effects, mixing costs, and various findings from the attentional control domain. The results demonstrate several important points. First, the same retrieval mechanism parsimoniously explains stimulus-response binding, contingency learning, and practice effects. Second, as performance improves with practice, any effects will shrink with it. Third, a model of simple learning processes is sufficient to explain phenomena that are typically (but perhaps incorrectly) interpreted in terms of higher-order control processes. More generally, we argue that computational models with a fixed parameter set and wider breadth should be preferred over those that are restricted to a narrow set of phenomena. Copyright © 2016 Elsevier Inc. All rights reserved.

Transforaminal Lumbar Interbody Fusion with Rigid Interspinous Process Fixation: A Learning Curve Analysis of a Surgeon Team's First 74 Cases.

PubMed

Doherty, Patrick; Welch, Arthur; Tharpe, Jason; Moore, Camille; Ferry, Chris

2017-05-30

Studies have shown that a significant learning curve may be associated with adopting minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with bilateral pedicle screw fixation (BPSF). Accordingly, several hybrid TLIF techniques have been proposed as surrogates to the accepted BPSF technique, asserting that less/fewer fixation(s) or less disruptive fixation may decrease the learning curve while still maintaining the minimally disruptive benefits. TLIF with interspinous process fixation (ISPF) is one such surrogate procedure. However, despite perceived ease of adaptability given the favorable proximity of the spinous processes, no evidence exists demonstrating whether or not the technique may possess its own inherent learning curve. The purpose of this study was to determine whether an intraoperative learning curve for one- and two-level TLIF + ISPF may exist for a single lead surgeon. Seventy-four consecutive patients who received one- or two-Level TLIF with rigid ISPF by a single lead surgeon were retrospectively reviewed. It was the first TLIF + ISPF case series for the lead surgeon. Intraoperative blood loss (EBL), hospitalization length-of-stay (LOS), fluoroscopy time, and postoperative complications were collected. EBL, LOS, and fluoroscopy time were modeled as a function of case number using multiple linear regression methods. A change point was included in each model to allow the trajectory of the outcomes to change during the duration of the case series. These change points were determined using profile likelihood methods. Models were fit using the maximum likelihood estimates for the change points. Age, sex, body mass index (BMI), and the number of treated levels were included as covariates. EBL, LOS, and fluoroscopy time did not significantly differ by age, sex, or BMI (p ≥ 0.12). Only EBL differed significantly by the number of levels (p = 0.026). The case number was not a significant predictor of EBL, LOS, or fluoroscopy time (p ≥ 0.21). At the time of data collection (mean time from surgery: 13.3 months), six patients had undergone revision due to interbody migration. No ISPF device complications were observed. Study outcomes support the ideal that TLIF + ISPF can be a readily adopted procedure without a significant intraoperative learning curve. However, the authors emphasize that further assessment of long-term healing outcomes is essential in fully characterizing both the efficacy and the indication learning curve for the TLIF + ISPF technique.

Clinical and Radiographic Outcomes With Assessment of the Learning Curve in Arthroscopically Assisted Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Rotator Cuff Tears.

PubMed

Yamakado, Kotaro

2017-12-01

To evaluate the clinical results of an arthroscopy-assisted latissimus dorsi tendon transfer (aLD) for irreparable posterosuperior cuff tears as a primary surgery. The secondary aim of this study was to quantify the learning curve using the log-linear model. We hypothesized that aLD significantly improved shoulder function and that there was consistent reduction of the operative time in support of a learning-curve effect. After the arthroscopic partial repair was completed, the latissimus dorsi tendon was harvested via axillary mini-open incision and fixed with a knotless anchor arthroscopically. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) scoring system, active range of motion, and the visual analog scale (VAS) for pain. The operative time was recorded to quantify the learning curve using a log-linear model. Thirty patients with a mean age of 67.4 years who underwent aLD were included. At a mean of 34 months after an aLD, the mean UCLA score increased from 15.7 preoperatively to 28.8 postoperatively (P < .001). The mean active forward elevation increased from 105° preoperatively to 149° postoperatively (P < .001). The mean active external rotation increased from 22° preoperatively to 32° postoperatively (P < .001). The VAS improved from 58 mm to 18 mm (P < .001). In all but 2 cases (93%), the preoperative osteoarthritis grade was maintained. The mean operative time was 145 minutes. A significant linear correlation was observed between the operative time and cumulative volume of cases after performing a logarithmic transformation. The learning rate was calculated as 84%. Arthroscopy-assisted latissimus dorsi tendon transfer is a technically demanding procedure; however, it can lead to significant improvements in overall shoulder pain and function. This study also confirmed a learning-curve effect for the aLD. The learning rate was 84%, indicating the existence of a long learning period. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Overall Memory Impairment Identification with Mathematical Modeling of the CVLT-II Learning Curve in Multiple Sclerosis

PubMed Central

Stepanov, Igor I.; Abramson, Charles I.; Hoogs, Marietta; Benedict, Ralph H. B.

2012-01-01

The CVLT-II provides standardized scores for each of the List A five learning trials, so that the clinician can compare the patient's raw trials 1–5 scores with standardized ones. However, frequently, a patient's raw scores fluctuate making a proper interpretation difficult. The CVLT-II does not offer any other methods for classifying a patient's learning and memory status on the background of the learning curve. The main objective of this research is to illustrate that discriminant analysis provides an accurate assessment of the learning curve, if suitable predictor variables are selected. Normal controls were ninety-eight healthy volunteers (78 females and 20 males). A group of MS patients included 365 patients (266 females and 99 males) with clinically defined multiple sclerosis. We show that the best predictor variables are coefficients B3 and B4 of our mathematical model B3 ∗ exp(−B2  ∗  (X − 1)) + B4  ∗  (1 − exp(−B2  ∗  (X − 1))) because discriminant functions, calculated separately for B3 and B4, allow nearly 100% correct classification. These predictors allow identification of separate impairment of readiness to learn or ability to learn, or both. PMID:22745911

Overall Memory Impairment Identification with Mathematical Modeling of the CVLT-II Learning Curve in Multiple Sclerosis.

PubMed

Stepanov, Igor I; Abramson, Charles I; Hoogs, Marietta; Benedict, Ralph H B

2012-01-01

The CVLT-II provides standardized scores for each of the List A five learning trials, so that the clinician can compare the patient's raw trials 1-5 scores with standardized ones. However, frequently, a patient's raw scores fluctuate making a proper interpretation difficult. The CVLT-II does not offer any other methods for classifying a patient's learning and memory status on the background of the learning curve. The main objective of this research is to illustrate that discriminant analysis provides an accurate assessment of the learning curve, if suitable predictor variables are selected. Normal controls were ninety-eight healthy volunteers (78 females and 20 males). A group of MS patients included 365 patients (266 females and 99 males) with clinically defined multiple sclerosis. We show that the best predictor variables are coefficients B3 and B4 of our mathematical model B3 ∗ exp(-B2  ∗  (X - 1)) + B4  ∗  (1 - exp(-B2  ∗  (X - 1))) because discriminant functions, calculated separately for B3 and B4, allow nearly 100% correct classification. These predictors allow identification of separate impairment of readiness to learn or ability to learn, or both.

Using Machine Learning To Predict Which Light Curves Will Yield Stellar Rotation Periods

NASA Astrophysics Data System (ADS)

Agüeros, Marcel; Teachey, Alexander

2018-01-01

Using time-domain photometry to reliably measure a solar-type star's rotation period requires that its light curve have a number of favorable characteristics. The probability of recovering a period will be a non-linear function of these light curve features, which are either astrophysical in nature or set by the observations. We employ standard machine learning algorithms (artificial neural networks and random forests) to predict whether a given light curve will produce a robust rotation period measurement from its Lomb-Scargle periodogram. The algorithms are trained and validated using salient statistics extracted from both simulated light curves and their corresponding periodograms, and we apply these classifiers to the most recent Intermediate Palomar Transient Factory (iPTF) data release. With this pipeline, we anticipate measuring rotation periods for a significant fraction of the ∼4x108 stars in the iPTF footprint.

Amnesia in an actor: Learning and re-learning of play passages despite severe autobiographical amnesia.

PubMed

Kopelman, Michael D; Morton, John

2015-06-01

We describe the case of an accomplished actor, whom we term AB, who suffered severe amnesia following a cardiac arrest and hypoxic brain damage, affecting medial temporal and thalamic structures. His performance on standard episodic memory tests, and on measures of retrograde amnesia, including autobiographical memory, was severely impaired. When presented with passages from plays he had not appeared in, AB showed a severe impairment at the first learning trial, but thereafter showed a 'normal' learning curve for this semantically and syntactically complex material. On being presented with passages from plays he had performed in the past, AB did not show any recognition of them whatsoever, as one might expect from his severe episodic memory impairment. However, AB showed a striking benefit (savings score) in relearning passages he had previously performed, compared with new passages, despite not having any autobiographical recall of having performed the relearned passages before. Moreover, although his initial recall performance in learning these passages was impaired compared with healthy control actors of similar age and experience, AB demonstrated the same incremental learning rate on subsequent learning trials of the passages as did the controls. We conclude that, although severely impaired at the first learning trial (on both 'new' and 'old' passages), AB was able to employ his long-established semantic and procedural skills to attempt the task, and that thereafter he showed a 'normal' rate of incremental learning from a lower baseline. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Neural oscillatory mechanisms during novel grammar learning underlying language analytical abilities.

PubMed

Kepinska, Olga; Pereda, Ernesto; Caspers, Johanneke; Schiller, Niels O

2017-12-01

The goal of the present study was to investigate the initial phases of novel grammar learning on a neural level, concentrating on mechanisms responsible for individual variability between learners. Two groups of participants, one with high and one with average language analytical abilities, performed an Artificial Grammar Learning (AGL) task consisting of learning and test phases. During the task, EEG signals from 32 cap-mounted electrodes were recorded and epochs corresponding to the learning phases were analysed. We investigated spectral power modulations over time, and functional connectivity patterns by means of a bivariate, frequency-specific index of phase synchronization termed Phase Locking Value (PLV). Behavioural data showed learning effects in both groups, with a steeper learning curve and higher ultimate attainment for the highly skilled learners. Moreover, we established that cortical connectivity patterns and profiles of spectral power modulations over time differentiated L2 learners with various levels of language analytical abilities. Over the course of the task, the learning process seemed to be driven by whole-brain functional connectivity between neuronal assemblies achieved by means of communication in the beta band frequency. On a shorter time-scale, increasing proficiency on the AGL task appeared to be supported by stronger local synchronisation within the right hemisphere regions. Finally, we observed that the highly skilled learners might have exerted less mental effort, or reduced attention for the task at hand once the learning was achieved, as evidenced by the higher alpha band power. Copyright © 2017 Elsevier Inc. All rights reserved.

Why the Kantian ideal survives medical learning curves, and why it matters.

PubMed

Brecher, B

2006-09-01

The "Kantian ideal" is often misunderstood as invoking individual autonomy rather than rational self legislation. Le Morvan and Stock's otherwise insightful discussion of "Medical learning curves and the Kantian ideal"--for example--draws the mistaken inference that that ideal is inconsistent with the realities of medical practice. But it is not. Rationally to be a patient entails accepting its necessary conditions.

A Method for Writing Open-Ended Curved Arrow Notation Questions for Multiple-Choice Exams and Electronic-Response Systems

ERIC Educational Resources Information Center

Ruder, Suzanne M.; Straumanis, Andrei R.

2009-01-01

A critical stage in the process of developing a conceptual understanding of organic chemistry is learning to use curved arrow notation. From this stems the ability to predict reaction products and mechanisms beyond the realm of memorization. Since evaluation (i.e., testing) is known to be a key driver of student learning, it follows that a new…

Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon's experience.

PubMed

Wen, Zhe; Liang, Huiying; Liang, Jiankun; Liang, Qifeng; Xia, Huimin

2017-02-01

Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst (CDC) in children. However, the learning curve for this challenging laparoscopic procedure has not been addressed. The aim of this study is to determine the characteristics of the learning curve of this procedure. This may guide the training in institutions currently not using this technique. A prospectively collected database comprising all medical records of the first 104 consecutive patients undergoing laparoscopic CDC excision and Roux-en-Y hepaticojejunostomy performed by one surgeon was studied. Multifactorial linear/logistic regression analysis was performed to identify patient-, surgeon-, and procedure-related factors associated with operating times, rates of adverse event, and length of postoperative stay. Cumulative sum analysis demonstrated a learning curve for laparoscopic choledochal cyst excision of 37 cases. Comparing the early with the late experiences (37 vs. 67 cases), the surgeon-specific outcomes significantly improved in terms of operating times (352 vs. 240 min; P < 0.001), postoperative complication rate (13.5 vs. 1.5 %; P = 0.02), and the length of hospital stay (9.4 vs. 7.8 days; P = 0.01). After multivariate analyses, independent predictors of operating times included the completion of the learning curve (CLC) (OR 0.68, 95 % CI 0.63-0.73) and adhesion score (OR middle 1.25, 95 % CI 1.08-1.45; OR high 1.40, 95 % CI 1.20-1.62; compared with the low score); significant predictors of perioperative adverse outcomes were CLC (OR 0.07, 95 % CI 0.02-0.34) and comorbidities prior to the surgery (OR 30.65, 95 % CI 1.71-549.63). The independent predictors of length of postoperative stay included CLC, preoperative comorbidities, and perioperative adverse events. CLC for laparoscopic choledochal cyst excision is 37 cases. After CLC, not only the operative time is reduced, the complications, adverse results, and the length of hospital stay all decreased significantly. The learning curve can be used as the basis for performance guiding the training.

Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases.

PubMed

Cabalag, Miguel S; Mann, G Bruce; Gorelik, Alexandra; Miller, Julie A

2015-06-01

Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative approach to minimally invasive adrenalectomy, potentially offering less pain and faster recovery compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their first 50 cases. Data were prospectively collected for 50 consecutive PRAs performed by the same surgeon. Patient demographics, tumour characteristics, analgesia use, operative and preparation time, length of stay, and complications were recorded. Fifty adrenalectomies were performed in 49 patients. The median (range) age was 58.5 years (30-83) and the majority of patients were female (n = 33, 66.0%). The median (interquartile range (IQR)) preparation time was 35.5 (28.5-50.0) and median operation time was 70.5 (54-85) min, which decreased during the study period. After a learning curve of 15 cases, median operative time reached 61 min. PRA patients required minimal post-operative analgesia, with a median (IQR) of 0 (0-5) mg of intravenous morphine equivalent used. The median (IQR) length of stay was 1 (1-1) day, with 8 (16.0%) same-day discharges. There were four complications: one blood pressure lability from a phaeochromocytoma, one reintubation, one self-limited bleed and one temporary subcostal neuropraxia. There were no conversions to open surgery or deaths. Our results support previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in minimal post-operative analgesia use and short length of hospital stay. © 2014 Royal Australasian College of Surgeons.

Twelve tips for postgraduate or undergraduate medics building a basic microsurgery simulation training course.

PubMed

Mason, Katrina A; Theodorakopoulou, Evgenia; Pafitanis, Georgios; Ghanem, Ali M; Myers, Simon R

2016-09-01

Microsurgery is used in a variety of surgical specialties, including Plastic Surgery, Maxillofacial Surgery, Ophthalmic Surgery, Otolaryngology and Neurosurgery. It is considered one of the most technically challenging fields of surgery. Microsurgical skills demand fine, precise and controlled movements, and microsurgical skill acquisition has a steep initial learning curve. Microsurgical simulation provides a safe environment for skill acquisition before operating clinically. The traditional starting point for anyone wanting to pursue microsurgery is a basic simulation training course. We present twelve tips for postgraduate and undergraduate medics on how to set up and run a basic ex-vivo microsurgery simulation training course suitable for their peers.

Crowdsourced validation of a machine-learning classification system for autism and ADHD.

PubMed

Duda, M; Haber, N; Daniels, J; Wall, D P

2017-05-16

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) together affect >10% of the children in the United States, but considerable behavioral overlaps between the two disorders can often complicate differential diagnosis. Currently, there is no screening test designed to differentiate between the two disorders, and with waiting times from initial suspicion to diagnosis upwards of a year, methods to quickly and accurately assess risk for these and other developmental disorders are desperately needed. In a previous study, we found that four machine-learning algorithms were able to accurately (area under the curve (AUC)>0.96) distinguish ASD from ADHD using only a small subset of items from the Social Responsiveness Scale (SRS). Here, we expand upon our prior work by including a novel crowdsourced data set of responses to our predefined top 15 SRS-derived questions from parents of children with ASD (n=248) or ADHD (n=174) to improve our model's capability to generalize to new, 'real-world' data. By mixing these novel survey data with our initial archival sample (n=3417) and performing repeated cross-validation with subsampling, we created a classification algorithm that performs with AUC=0.89±0.01 using only 15 questions.

Prediction of Curve Progression in Idiopathic Scoliosis: Validation of the Sanders Skeletal Maturity Staging System.

PubMed

Sitoula, Prakash; Verma, Kushagra; Holmes, Laurens; Gabos, Peter G; Sanders, James O; Yorgova, Petya; Neiss, Geraldine; Rogers, Kenneth; Shah, Suken A

2015-07-01

Retrospective case series. This study aimed to validate the Sanders Skeletal Maturity Staging System and to assess its correlation to curve progression in idiopathic scoliosis. The Sanders Skeletal Maturity Staging System has been used to predict curve progression in idiopathic scoliosis. This study intended to validate that initial study with a larger sample size. We retrospectively reviewed 1100 consecutive patients with idiopathic scoliosis between 2005 and 2011. Girls aged 8 to 14 years (<2 yr postmenarche) and boys aged 10 to 16 years who had obtained at least 1 hand and spine radiograph on the same day for evaluation of skeletal age and scoliosis curve magnitude were followed to skeletal maturity (Risser stage 5 or fully capped Risser stage 4), curve progression to 50° or greater, or spinal fusion. Patients with nonidiopathic curves were excluded. There were 161 patients: 131 girls (12.3 ± 1.2 yr) and 30 boys (13.9 ± 1.1 yr). The distribution of patients within Sanders stage (SS) 1 through 7 was 7, 28, 41, 45, 7, 31, and 2 patients, respectively; modified Lenke curve types 1 to 6 were 26, 12, 63, 5, 38, and 17 patients, respectively. All patients in SS2 with initial Cobb angles of 25° or greater progressed, and patients in SS1 and SS3 with initial Cobb angles of 35° or greater progressed. Similarly, all patients with initial Cobb angles of 40° or greater progressed except those in SS7. Conversely, none of the patients with initial Cobb angles of 15° or less or those in SS5, SS6, and SS7 with initial Cobb angles of 30° or less progressed. Predictive progression of 67%, 50%, 43%, 27%, and 60% was observed for subgroups SS1/30°, SS2/20°, SS3/30°, SS4/30°, and SS6/35° respectively. This larger cohort shows a strong predictive correlation between SS and initial Cobb angle for probability of curve progression in idiopathic scoliosis. 3.

Analysis for water level data for Everglades National Park, Florida

USGS Publications Warehouse

Buchanan, T.J.; Hartwell, J.H.

1972-01-01

Stage-duration curves were developed for five gaging stations in Everglades National Park, Florida. Four of the five curves show similar characteristics with an increase in the slope when the water level is below land surface. Monthly stage-duration curves, developed for one of the stations, reflect the seasonal trends of the water level. Recession curves were prepared for the same five stations. These curves represent the average water-level decline during periods of little or no rainfall. They show the decline in level at the end of 10, 20, and 60 days for any given initial stage. A family of curves was also prepared to give the recession from various initial stages for any period up to 60 days.

Robotic Mitral Valve Repair: The Learning Curve.

PubMed

Goodman, Avi; Koprivanac, Marijan; Kelava, Marta; Mick, Stephanie L; Gillinov, A Marc; Rajeswaran, Jeevanantham; Brzezinski, Anna; Blackstone, Eugene H; Mihaljevic, Tomislav

Adoption of robotic mitral valve surgery has been slow, likely in part because of its perceived technical complexity and a poorly understood learning curve. We sought to correlate changes in technical performance and outcome with surgeon experience in the "learning curve" part of our series. From 2006 to 2011, two surgeons undertook robotically assisted mitral valve repair in 458 patients (intent-to-treat); 404 procedures were completed entirely robotically (as-treated). Learning curves were constructed by modeling surgical sequence number semiparametrically with flexible penalized spline smoothing best-fit curves. Operative efficiency, reflecting technical performance, improved for (1) operating room time for case 1 to cases 200 (early experience) and 400 (later experience), from 414 to 364 to 321 minutes (12% and 22% decrease, respectively), (2) cardiopulmonary bypass time, from 148 to 102 to 91 minutes (31% and 39% decrease), and (3) myocardial ischemic time, from 119 to 75 to 68 minutes (37% and 43% decrease). Composite postoperative complications, reflecting safety, decreased from 17% to 6% to 2% (63% and 85% decrease). Intensive care unit stay decreased from 32 to 28 to 24 hours (13% and 25% decrease). Postoperative stay fell from 5.2 to 4.5 to 3.8 days (13% and 27% decrease). There were no in-hospital deaths. Predischarge mitral regurgitation of less than 2+, reflecting effectiveness, was achieved in 395 (97.8%), without correlation to experience; return-to-work times did not change substantially with experience. Technical efficiency of robotic mitral valve repair improves with experience and permits its safe and effective conduct.

A specific implicit sequence learning deficit as an underlying cause of dyslexia? Investigating the role of attention in implicit learning tasks.

PubMed

Staels, Eva; Van den Broeck, Wim

2017-05-01

Recently, a general implicit sequence learning deficit was proposed as an underlying cause of dyslexia. This new hypothesis was investigated in the present study by including a number of methodological improvements, for example, the inclusion of appropriate control conditions. The second goal of the study was to explore the role of attentional functioning in implicit and explicit learning tasks. In a 2 × 2 within-subjects design 4 tasks were administered in 30 dyslexic and 38 control children: an implicit and explicit serial reaction time (RT) task and an implicit and explicit contextual cueing task. Attentional functioning was also administered. The entire learning curves of all tasks were analyzed using latent growth curve modeling in order to compare performances between groups and to examine the role of attentional functioning on the learning curves. The amount of implicit learning was similar for both groups. However, the dyslexic group showed slower RTs throughout the entire task. This group difference reduced and became nonsignificant after controlling for attentional functioning. Both implicit learning tasks, but none of the explicit learning tasks, were significantly affected by attentional functioning. Dyslexic children do not suffer from a specific implicit sequence learning deficit. The slower RTs of the dyslexic children throughout the entire implicit sequence learning process are caused by their comorbid attention problems and overall slowness. A key finding of the present study is that, in contrast to what was assumed for a long time, implicit learning relies on attentional resources, perhaps even more than explicit learning does. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Comparison of the learning curves of digital examination and transabdominal sonography for the determination of fetal head position during labor.

PubMed

Rozenberg, P; Porcher, R; Salomon, L J; Boirot, F; Morin, C; Ville, Y

2008-03-01

To evaluate the learning curve of transabdominal sonography for the determination of fetal head position in labor and to compare it with that of digital vaginal examination. A student midwife who had never performed digital vaginal examination or ultrasound examination was recruited for this study. Instructions on how to perform digital vaginal examination and ultrasound examination were given before and after completing the first vaginal and ultrasound examinations, and repeated for each subsequent examination for as long as necessary. Digital and ultrasound diagnoses of the fetal head position were always performed first by the student midwife, and repeated by an experienced midwife or physician. The learning curve for identification of the fetal head position by either one of the two methods was analyzed using the cumulative sums (CUSUM) method for measurement errors. One hundred patients underwent digital vaginal examination and 99 had transabdominal sonography for the determination of fetal head position. An error rate of around 50% for vaginal examination was nearly constant during the first 50 examinations. It decreased subsequently, to stabilize at a low level from the 82(nd) patient. Errors of +/- 180 degrees were the most frequent. The learning curve for ultrasound imaging stabilized earlier than that of vaginal examination, after the 32(nd) patient. The most frequent errors with ultrasound examination were the inability to conclude on a diagnosis, particularly at the beginning of training, followed by errors of +/- 45 degrees. Based on our findings for the student tested, learning and accuracy of the determination of fetal head position in labor were easier and higher, respectively, with transabdominal sonography than with digital examination. This should encourage physicians to introduce clinical ultrasound examination into their practice. CUSUM charts provide a reliable representation of the learning curve, by accumulating evidence of performance. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.

Time-Decayed User Profile for Second Language Vocabulary Learning System

ERIC Educational Resources Information Center

Li, Li; Wei, Xiao

2014-01-01

Vocabulary learning is the foundation of second language learning. Many E-learning systems have been developed to help learners to learn vocabulary efficiently. Most of these systems employ Ebbinghaus Forgetting Curve to make the review schedule for learners. However, learners are different in learning ability and the review schedule based on…

Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation.

PubMed

Anastasiadis, Kyriakos; Antonitsis, Polychronis; Asteriou, Christos; Argiriadou, Helena; Deliopoulos, Apostolos; Konstantinou, Dimitrios; Grosomanidis, Vassilios; Tossios, Paschalis

2017-07-01

Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P <0.001), peak troponin release (0.07 ± 0.02 vs. 0.1 ± 0.04 ng/mL, P < 0.01), peak creatinine levels (0.97 ± 0.24 vs. 1.2 ± 0.3 mg/dL, P < 0.001), duration of mechanical ventilation (14.1 ± 7.2 vs. 36.9 ± 59.8 h, P < 0.01) and ICU stay (2.1 ± 0.7 vs. 4.4 ± 6.4 days, P < 0.01). However, need for intraoperative blood transfusion showed a trend towards a gradual decrease as experience with MiECC system was accumulating (R 2  = 0.094, P = 0.007). Subsequently, operational learning applied to postoperative hematocrit and hemoglobin levels (R 2  = 0.098, P = 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Why the Kantian ideal survives medical learning curves, and why it matters

PubMed Central

Brecher, B

2006-01-01

The “Kantian ideal” is often misunderstood as invoking individual autonomy rather than rational self legislation. Le Morvan and Stock's otherwise insightful discussion of “Medical learning curves and the Kantian ideal”—for example—draws the mistaken inference that that ideal is inconsistent with the realities of medical practice. But it is not. Rationally to be a patient entails accepting its necessary conditions. PMID:16943330

The learning curve of laparoendoscopic single-Site (LESS) fundoplication: definable, short, and safe.

PubMed

Ross, Sharona B; Choung, Edward; Teta, Anthony F; Colibao, Lotiffa; Luberice, Kenneth; Paul, Harold; Rosemurgy, Alexander S

2013-01-01

This study of laparoendoscopic single-site (LESS) fundoplication for gastroesophageal reflux disease was undertaken to determine the "learning curve" for implementing LESS fundoplication. One hundred patients, 38% men, with a median age of 61 years and median body mass index of 26 kg/m(2) , underwent LESS fundoplications. The operative times, placement of additional trocars, conversions to "open" operations, and complications were compared among patient quartiles to establish a learning curve. Median data are reported. The median operative times and complications did not differ among 25-patient cohorts. Additional trocars were placed in 27% of patients, 67% of whom were in the first 25-patient cohort. Patients undergoing LESS fundoplication had a dramatic relief in the frequency and severity of all symptoms of reflux across all cohorts equally (P < .05), particularly for heartburn and regurgitation, without causing dysphagia. LESS fundoplication ameliorates symptoms of gastroesophageal reflux disease without apparent scarring. Notably, few operations required additional trocars after the first 25-patient cohort. Patient selection became more inclusive (eg, more "redo" fundoplications) with increasing experience, whereas operative times and complications remained relatively unchanged. The learning curve of LESS fundoplication is definable, short, and safe. We believe that patients will seek LESS fundoplication because of the efficacy and superior cosmetic outcomes; surgeons will need to meet this demand.

Prognostication of Learning Curve on Surgical Management of Vasculobiliary Injuries after Cholecystectomy

PubMed Central

Dar, Faisal Saud; Zia, Haseeb; Rafique, Muhammad Salman; Khan, Nusrat Yar; Salih, Mohammad; Hassan Shah, Najmul

2016-01-01

Background. Concomitant vascular injury might adversely impact outcomes after iatrogenic bile duct injury (IBDI). Whether a new HPB center should embark upon repair of complex biliary injuries with associated vascular injuries during learning curve is unknown. The objective of this study was to determine outcome of surgical management of IBDI with and without vascular injuries in a new HPB center during its learning curve. Methods. We retrospectively reviewed patients who underwent surgical management of IBDI at our center. A total of 39 patients were included. Patients without (Group 1) and with vascular injuries (Group 2) were compared. Outcome was defined as 90-day morbidity and mortality. Results. Median age was 39 (20–80) years. There were 10 (25.6%) vascular injuries. E2 injuries were associated significantly with high frequency of vascular injuries (66% versus 15.1%) (P = 0.01). Right hepatectomy was performed in three patients. Out of these, two had a right hepatic duct stricture and one patient had combined right arterial and portal venous injury. The number of patients who developed postoperative complications was not significantly different between the two groups (11.1% versus 23.4%) (P = 0.6). Conclusion. Learning curve is not a negative prognostic variable in the surgical management of iatrogenic vasculobiliary injuries after cholecystectomy. PMID:27525124

Does my high blood pressure improve your survival? Overall and subgroup learning curves in health.

PubMed

Van Gestel, Raf; Müller, Tobias; Bosmans, Johan

2017-09-01

Learning curves in health are of interest for a wide range of medical disciplines, healthcare providers, and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: economies of scale, learning from cumulative experience, and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics predicts provider performance. To soften collinearity problems, we explore the use of least absolute shrinkage and selection operator regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. We find that treating an additional TAVI patient is associated with an increase in the probability of 2-year survival by about 0.16%-points. For adverse events like renal failure and stroke, we find that an extra day between procedures is associated with an increase in the probability for these events by 0.12%-points and 0.07%-points, respectively. Furthermore, we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension, and the use of certain types of replacement valves during the TAVI procedure. Copyright © 2017 John Wiley & Sons, Ltd.

Machine Learning Techniques for Stellar Light Curve Classification

NASA Astrophysics Data System (ADS)

Hinners, Trisha A.; Tat, Kevin; Thorp, Rachel

2018-07-01

We apply machine learning techniques in an attempt to predict and classify stellar properties from noisy and sparse time-series data. We preprocessed over 94 GB of Kepler light curves from the Mikulski Archive for Space Telescopes (MAST) to classify according to 10 distinct physical properties using both representation learning and feature engineering approaches. Studies using machine learning in the field have been primarily done on simulated data, making our study one of the first to use real light-curve data for machine learning approaches. We tuned our data using previous work with simulated data as a template and achieved mixed results between the two approaches. Representation learning using a long short-term memory recurrent neural network produced no successful predictions, but our work with feature engineering was successful for both classification and regression. In particular, we were able to achieve values for stellar density, stellar radius, and effective temperature with low error (∼2%–4%) and good accuracy (∼75%) for classifying the number of transits for a given star. The results show promise for improvement for both approaches upon using larger data sets with a larger minority class. This work has the potential to provide a foundation for future tools and techniques to aid in the analysis of astrophysical data.

Effects of antiepileptic drugs on learning as assessed by a repeated acquisition of response sequences task in rats.

PubMed

Shannon, Harlan E; Love, Patrick L

2007-02-01

Patients with epilepsy can have impaired cognitive abilities. Antiepileptic drugs (AEDs) may contribute to the cognitive deficits observed in patients with epilepsy, and have been shown to induce cognitive impairments in healthy individuals. However, there are few systematic data on the effects of AEDs on specific cognitive domains. We have previously demonstrated that a number of AEDs can impair working memory and attention. The purpose of the present study was to evaluate the effects of AEDs on learning as measured by a repeated acquisition of response sequences task in nonepileptic rats. The GABA-related AEDs phenobarbital and chlordiazepoxide significantly disrupted performance by shifting the learning curve to the right and increasing errors, whereas tiagabine and valproate did not. The sodium channel blockers carbamazepine and phenytoin suppressed responding at higher doses, whereas lamotrigine shifted the learning curve to the right and increased errors, and topiramate was without significant effect. Levetiracetam also shifted the learning curve to the right and increased errors. The disruptions produced by triazolam, chlordiazepoxide, lamotrigine, and levetiracetam were qualitatively similar to the effects of the muscarinic cholinergic receptor antagonist scopolamine. The present results indicate that AEDs can impair learning, but there are differences among AEDs in the magnitude of the disruption in nonepileptic rats, with drugs that enhance GABA receptor function and some that block sodium channels producing the most consistent impairment of learning.

Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention.

PubMed

Kolozsvari, Nicoleta O; Kaneva, Pepa; Brace, Chantalle; Chartrand, Genevieve; Vaillancourt, Marilou; Cao, Jiguo; Banaszek, Daniel; Demyttenaere, Sebastian; Vassiliou, Melina C; Fried, Gerald M; Feldman, Liane S

2011-07-01

Little evidence exists to guide educators in the best way to implement simulation within surgical skills curricula. This study investigated whether practicing a basic Fundamentals of Laparoscopic Surgery (FLS) simulator task [peg transfer (PT)] facilitates learning a more complex skill [intracorporeal suturing (ICS)] and compared the effect of PT training to mastery with training to the passing level on PT retention and on learning ICS. For this study, 98 surgically naïve subjects were randomized to one of three PT training groups: control, standard training, and overtraining. All the participants then trained in ICS. The learning curves for ICS were analyzed by estimating the learning plateau and rate using nonlinear regression. Skill retention was assessed by retesting participants 1 month after training. The groups were compared using analysis of variance (ANOVA). Effectiveness of skill transfer was calculated using the transfer effectiveness ratio (TER). Data are presented as mean±standard deviation (p<0.05). The study was completed by 77 participants (28 control, 26 standard, and 23 overtrained subjects). The ICS learning plateau rose with increasing PT training (452±10 vs. 459±10 vs. 467±10; p<0.01). Increased PT training was associated with a trend toward higher initial ICS scores (128±107 vs. 127±110 vs. 183±106; p=0.13) and faster learning rates (15±4 vs. 14±4 vs. 13±4 trials; p=0.10). At retention, there were no differences in PT scores (p=0.5). The PT training took 20±10 min for standard training and 39±20 min for overtraining (p<0.01). Overtrained participants saved 11±5 min in ICS training compared with the control subjects (p=0.04). However, TER was 0.165 for the overtraining group and 0.160 for the standard training group, suggesting that PT overtraining took longer than the time saved on ICS training. For surgically naïve subjects, part-task training with PT alone was associated with slight improvements in the learning curve for ICS. However, overtraining with PT did not improve skill retention, and peg training alone was not an efficient strategy for learning ICS.

Towards Global Transdisciplinary Research: Lessons Learned from the Belmont Forum

NASA Astrophysics Data System (ADS)

Paillard, S. J.; Uhle, M. E.; van Jaarsveld, A. S.; Monfray, P.

2014-12-01

The Belmont Forum was initiated in 2009 by a sub group of the International Group of Funding Agencies for Global Change Research. The Belmont Challenge embodies the Forum's central goal: to deliver knowledge needed for societies to take action to mitigate and adapt to detrimental environmental change. This is fostered through collaboration among scientists across the globe and by stressing the importance of co-production of knowledge associated with coupled natural and social systems. The Belmont Challenge was clearly aligned with other collective thinking processes within the research community and key knowledge users from intergovernmental bodies. Convergence of these efforts gave rise to the S&T Alliance for Global Sustainability and its initiative - Future Earth. Collaborative Research Actions, consisting primarily of multilateral research calls to address topics relevant to Future Earth, have been the main tool developed to address the Belmont Challenge and some early lessons emerged. First, obstacles faced by the Belmont Forum are similar to those met by scientists collaborating across traditional boundaries. Building shared languages and interests between various disciplines and across global cultures, remains difficult; this results in a persistent underestimation of the transformation required to move knowledge creation towards a truly global inter- and transdisciplinary science. Second, the diversity of organizations, cultures and practices within the Belmont Forum is the main source of its creativity and its challenges. While some convergence is needed to build coherent strategies and work efficiently together, diversity is necessary to design actions suitable for all partners regardless of their national research system and science-policy priorities. Finding the right trade-offs is a learning process that Future Earth is also facing; thus both initiatives are not only linked through funding relations but also through strongly intertwined learning curves.

Results of Casting in Severe Curves in Infantile Scoliosis.

PubMed

Stasikelis, Peter J; Carpenter, Ashley M

2018-04-01

Previous work has demonstrated best results for casting in infantile scoliosis when the curves are small and the child begins casting under 2 years of age. This study examines if casting can delay the need for growth friendly instrumentation in severe curves (50 to 106 degrees) and how the comorbidities of syrinx or genetic syndromes affected outcomes. All children undergoing casting for scoliosis at a single institution over an 8-year period were examined. Inclusion criteria included initial curve at first casting of ≥50 degrees, age ≤3 years at the start of casting, and a minimum follow-up of 3 years. Of 148 children undergoing casting during this period, 44 met our inclusion criteria. All children underwent magnetic resonance imaging. Ten children with a syrinx were identified. Ten children had known genetic syndromes (2 who also had a syrinx). The 26 children without these comorbidities were considered idiopathic. Curve magnitude ranged from 50 to 106 degrees. Nine of the 26 (35%) children in the children with idiopathic curves demonstrated resolution of their curves, while only 3 of the remaining 18 (17%) did. Of the children that did not have resolution of their curves, 14 were maintained over the entire follow-up period to within 15 degrees of their initial curve and 13 were improved 15 degrees or more. Only 5 children had an increase of 15 degrees or more over the follow-up period and 4 of these have undergone growth friendly instrumentation after a mean delay from initial cast of 71 months (range, 18 to 100 mo). This study demonstrates that even in severe curves, casting was effective in delaying instrumentation in all cases, and led to curve resolution of the curves in 12 of 44 children. Level III-case control study.

Explicit and Implicit Processes Constitute the Fast and Slow Processes of Sensorimotor Learning.

PubMed

McDougle, Samuel D; Bond, Krista M; Taylor, Jordan A

2015-07-01

A popular model of human sensorimotor learning suggests that a fast process and a slow process work in parallel to produce the canonical learning curve (Smith et al., 2006). Recent evidence supports the subdivision of sensorimotor learning into explicit and implicit processes that simultaneously subserve task performance (Taylor et al., 2014). We set out to test whether these two accounts of learning processes are homologous. Using a recently developed method to assay explicit and implicit learning directly in a sensorimotor task, along with a computational modeling analysis, we show that the fast process closely resembles explicit learning and the slow process approximates implicit learning. In addition, we provide evidence for a subdivision of the slow/implicit process into distinct manifestations of motor memory. We conclude that the two-state model of motor learning is a close approximation of sensorimotor learning, but it is unable to describe adequately the various implicit learning operations that forge the learning curve. Our results suggest that a wider net be cast in the search for the putative psychological mechanisms and neural substrates underlying the multiplicity of processes involved in motor learning. Copyright © 2015 the authors 0270-6474/15/359568-12$15.00/0.

Explicit and Implicit Processes Constitute the Fast and Slow Processes of Sensorimotor Learning

PubMed Central

Bond, Krista M.; Taylor, Jordan A.

2015-01-01

A popular model of human sensorimotor learning suggests that a fast process and a slow process work in parallel to produce the canonical learning curve (Smith et al., 2006). Recent evidence supports the subdivision of sensorimotor learning into explicit and implicit processes that simultaneously subserve task performance (Taylor et al., 2014). We set out to test whether these two accounts of learning processes are homologous. Using a recently developed method to assay explicit and implicit learning directly in a sensorimotor task, along with a computational modeling analysis, we show that the fast process closely resembles explicit learning and the slow process approximates implicit learning. In addition, we provide evidence for a subdivision of the slow/implicit process into distinct manifestations of motor memory. We conclude that the two-state model of motor learning is a close approximation of sensorimotor learning, but it is unable to describe adequately the various implicit learning operations that forge the learning curve. Our results suggest that a wider net be cast in the search for the putative psychological mechanisms and neural substrates underlying the multiplicity of processes involved in motor learning. PMID:26134640

Robot-assisted partial nephrectomy: continued refinement of outcomes beyond the initial learning curve.

PubMed

Paulucci, David J; Abaza, Ronney; Eun, Daniel D; Hemal, Ashok K; Badani, Ketan K

2017-05-01

To evaluate trends in peri-operative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robot-assisted partial nephrectomy (RAPN) among multiple surgeons. A multi-institutional database was used to evaluate trends in patient demographics (e.g. age, gender, comorbidities), tumour characteristics (e.g. size, complexity) and peri-operative outcomes (e.g. warm ischaemia time [WIT], operating time, complications, estimated blood loss [EBL], trifecta achievement) in consecutive cases 50-300 (n = 960) from 2008 to 2016 among four experienced surgeons. Trends in outcomes were assessed using multivariable regression models adjusted for demographic and tumour-specific variables. Outcomes for cases 50-99 were compared with those for cases 250-300. In the study period RAPN was increasingly performed in patients with larger tumours (β = 0.001, P = 0.048), hypertension (odds ratio [OR] 1.003; P = 0.008) diabetes (OR 1.003; P = 0.025) and previous abdominal surgery (OR 1.003; P = 0.006). Surgeon experience was associated with more trifecta achievement (OR 1.006; P < 0.001), shorter WIT (β = -0.036, P < 0.001), less EBL (β = -0.154, P = 0.009), fewer blood transfusions (OR 0.989, P = 0.024) and a reduced length of hospital stay (β = -0.002, P = 0.002), but not with operating time (P = 0.243), complications (P = 0.587) or surgical margin status (P = 0.102). Tumour size and WIT in cases 50-99 vs 250-300 were 2.7 vs 3.2 cm (P = 0.001) and 21.4 vs 16.2 min (P < 0.001), respectively. Refinement of RAPN outcomes, concomitant with the treatment of a patient population with larger tumours and more comorbidities, occurs after the initial LC is reached. Although RAPN can consistently be performed safely with acceptable outcomes after a small number of cases, improvement in trifecta achievement, WIT, EBL, blood transfusions and a shorter hospitalization continues to occur up to 300 procedures. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Equifinality in empirical studies of cultural transmission.

PubMed

Barrett, Brendan J

2018-01-31

Cultural systems exhibit equifinal behavior - a single final state may be arrived at via different mechanisms and/or from different initial states. Potential for equifinality exists in all empirical studies of cultural transmission including controlled experiments, observational field research, and computational simulations. Acknowledging and anticipating the existence of equifinality is important in empirical studies of social learning and cultural evolution; it helps us understand the limitations of analytical approaches and can improve our ability to predict the dynamics of cultural transmission. Here, I illustrate and discuss examples of equifinality in studies of social learning, and how certain experimental designs might be prone to it. I then review examples of equifinality discussed in the social learning literature, namely the use of s-shaped diffusion curves to discern individual from social learning and operational definitions and analytical approaches used in studies of conformist transmission. While equifinality exists to some extent in all studies of social learning, I make suggestions for how to address instances of it, with an emphasis on using data simulation and methodological verification alongside modern statistical approaches that emphasize prediction and model comparison. In cases where evaluated learning mechanisms are equifinal due to non-methodological factors, I suggest that this is not always a problem if it helps us predict cultural change. In some cases, equifinal learning mechanisms might offer insight into how both individual learning, social learning strategies and other endogenous social factors might by important in structuring cultural dynamics and within- and between-group heterogeneity. Copyright © 2018 Elsevier B.V. All rights reserved.

Predicting Robust Learning with the Visual Form of the Moment-by-Moment Learning Curve

ERIC Educational Resources Information Center

Baker, Ryan S.; Hershkovitz, Arnon; Rossi, Lisa M.; Goldstein, Adam B.; Gowda, Sujith M.

2013-01-01

We present a new method for analyzing a student's learning over time for a specific skill: analysis of the graph of the student's moment-by-moment learning over time. Moment-by-moment learning is calculated using a data-mined model that assesses the probability that a student learned a skill or concept at a specific time during learning (Baker,…

Undergraduate Student Self-Efficacy and Perceptions of Virtual World Learning Experience

ERIC Educational Resources Information Center

Stanton, Lorraine May

2017-01-01

Virtual worlds are innovative teaching and learning methods that can provide immersive and engaging learning experiences (Lu, 2010). Though they have potential benefits, students sometimes experience a steep learning curve and discomfort with the technology (Warburton, 2009). This study explored how students in two American Studies classes using…

The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe.

PubMed

Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander

2010-11-01

The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Using Machine-Learned Bayesian Belief Networks to Predict Perioperative Risk of Clostridium Difficile Infection Following Colon Surgery

PubMed Central

Bilchik, Anton; Eberhardt, John; Kalina, Philip; Nissan, Aviram; Johnson, Eric; Avital, Itzhak; Stojadinovic, Alexander

2012-01-01

Background Clostridium difficile (C-Diff) infection following colorectal resection is an increasing source of morbidity and mortality. Objective We sought to determine if machine-learned Bayesian belief networks (ml-BBNs) could preoperatively provide clinicians with postoperative estimates of C-Diff risk. Methods We performed a retrospective modeling of the Nationwide Inpatient Sample (NIS) national registry dataset with independent set validation. The NIS registries for 2005 and 2006 were used for initial model training, and the data from 2007 were used for testing and validation. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to identify subjects undergoing colon resection and postoperative C-Diff development. The ml-BBNs were trained using a stepwise process. Receiver operating characteristic (ROC) curve analysis was conducted and area under the curve (AUC), positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results From over 24 million admissions, 170,363 undergoing colon resection met the inclusion criteria. Overall, 1.7% developed postoperative C-Diff. Using the ml-BBN to estimate C-Diff risk, model AUC is 0.75. Using only known a priori features, AUC is 0.74. The model has two configurations: a high sensitivity and a high specificity configuration. Sensitivity, specificity, PPV, and NPV are 81.0%, 50.1%, 2.6%, and 99.4% for high sensitivity and 55.4%, 81.3%, 3.5%, and 99.1% for high specificity. C-Diff has 4 first-degree associates that influence the probability of C-Diff development: weight loss, tumor metastases, inflammation/infections, and disease severity. Conclusions Machine-learned BBNs can produce robust estimates of postoperative C-Diff infection, allowing clinicians to identify high-risk patients and potentially implement measures to reduce its incidence or morbidity. PMID:23611947

Score card endoscopy: a multicenter study to evaluate learning curves in 1-week courses using the Erlangen Endo-Trainer.

PubMed

Neumann, M; Hahn, C; Horbach, T; Schneider, I; Meining, A; Heldwein, W; Rösch, T; Hohenberger, W

2003-06-01

The present study was carried out in the context of current discussions concerning ways in which simulation systems can be integrated sensibly and effectively into clinical educational structures, in order to shorten the training period for assistants and reduce potential risks for the patient. In our study, a number of centers used a standardized training approach, in 1 week courses, to investigate the learning curve improvement that can be achieved with a group of beginners in upper gastroduodenal endoscopy. The multicenter study used the Erlangen Endo-Trainer, with specially prepared biological specimens from pigs. Using this, the individual steps of diagnostic upper gastrointestinal endoscopy with biopsy can be carried out following a score-card system. After a theoretical introduction and a demonstration of the examination by an experienced endoscopist, an initial evaluation score for each participant was obtained on day 1. On the following days, the program consisted of 2 hours' training by a tutor, followed by a test run for each participant. On days 1, 2, 3, 4, and 5 the test run was directly followed by a self-assessment. In addition, on days 1, 3, and 5 the test run for each beginner was recorded on video, with each video assigned an encrypted code number. All the end of the study week, control assessments of these videos were carried out by an experienced endoscopist. Both the self-assessments and the control assessments showed significant improvements in the endoscopic parameters tested during the course (days 1-5; all parameters P < 0.001, Wilcoxon-test). However, it was found that the trainees tended to give themselves better marks than the marks given by experienced endoscopists. During 1 week of training, using the model and following the score card, a significant improvement in the learning curve was achieved in the beginners' group for the individual steps involved in diagnostic upper gastrointestinal endoscopy. When this approach is used with trainees who are also provided with the necessary theoretical background, this type of preparation may lead to a better, lower-risk start to supervised practical endoscopic examinations in patients.

Femtosecond laser-assisted cataract surgery with bimanual technique: learning curve for an experienced cataract surgeon.

PubMed

Cavallini, Gian Maria; Verdina, Tommaso; De Maria, Michele; Fornasari, Elisa; Volpini, Elisa; Campi, Luca

2017-11-29

To describe the intraoperative complications and the learning curve of microincision cataract surgery assisted by femtosecond laser (FLACS) with bimanual technique performed by an experienced surgeon. It is a prospective, observational, comparative case series. A total of 120 eyes which underwent bimanual FLACS by the same experienced surgeon during his first experience were included in the study; we considered the first 60 cases as Group A and the second 60 cases as Group B. In both groups, only nuclear sclerosis of grade 2 or 3 was included; an intraocular lens was implanted through a 1.4-mm incision. Best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), central corneal thickness and endothelial cell loss (ECL) were evaluated before and at 1 and 3 months after surgery. Intraoperative parameters, and intra- and post-operative complications were recorded. In Group A, we had femtosecond laser-related minor complications in 11 cases (18.3%) and post-operative complications in 2 cases (3.3%); in Group B, we recorded 2 cases (3.3%) of femtosecond laser-related minor complications with no post-operative complications. Mean effective phaco time (EPT) was 5.32 ± 3.68 s in Group A and 4.34 ± 2.39 s in Group B with a significant difference (p = 0.046). We recorded a significant mean BCVA improvement at 3 months in both groups (p < 0.05) and no significant SIA nor corneal pachymetry changes in the two groups during the follow-up (p > 0.05). Finally, we found significant ECL in both groups with a significant difference between the two groups (p = 0.042). FLACS with bimanual technique and low-energy LDV Z8 is associated with a necessary initial learning curve. After the first adjustments in the surgical technique, this technology seems to be safe and effective with rapid visual recovery and it helps surgeons to standardize the crucial steps of cataract surgery.

Utility of Interobserver Agreement Statistics in Establishing Radiology Resident Learning Curves During Self-directed Radiologic Anatomy Training.

PubMed

Tureli, Derya; Altas, Hilal; Cengic, Ismet; Ekinci, Gazanfer; Baltacioglu, Feyyaz

2015-10-01

The aim of the study was to ascertain the learning curves for the radiology residents when first introduced to an anatomic structure in magnetic resonance images (MRI) to which they have not been previously exposed to. The iliolumbar ligament is a good marker for testing learning curves of radiology residents because the ligament is not part of a routine lumbar MRI reporting and has high variability in detection. Four radiologists, three residents without previous training and one mentor, studied standard axial T1- and T2-weighted images of routine lumbar MRI examinations. Radiologists had to define iliolumbar ligament while blinded to each other's findings. Interobserver agreement analyses, namely Cohen and Fleiss κ statistics, were performed for groups of 20 cases to evaluate the self-learning curve of radiology residents. Mean κ values of resident-mentor pairs were 0.431, 0.608, 0.604, 0.826, and 0.963 in the analysis of successive groups (P < .001). The results indicate that the concordance between the experienced and inexperienced radiologists started as weak (κ <0.5) and gradually became very acceptable (κ >0.8). Therefore, a junior radiology resident can obtain enough experience in identifying a rather ambiguous anatomic structure in routine MRI after a brief instruction of a few minutes by a mentor and studying approximately 80 cases by oneself. Implementing this methodology will help radiology educators obtain more concrete ideas on the optimal time and effort required for supported self-directed visual learning processes in resident education. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Colorectal endoscopic submucosal dissection (ESD) in the West - when can satisfactory results be obtained? A single-operator learning curve analysis.

PubMed

Spychalski, Michał; Skulimowski, Aleksander; Dziki, Adam; Saito, Yutaka

2017-12-01

Up to date we lack a detailed description of the colorectal endoscopic submucosal dissection (ESD) learning curve, that would represent the experience of the Western center. The aim of this study was to define the critical points of the learning curve and to draw up lesions qualification guidelines tailored to the endoscopists experience. We have carried out a single center prospective study. Between June 2013 and December 2016, 228 primary colorectal lesions were managed by ESD procedure. In order to create a learning curve model and to carry out the analysis the cases were divided into six periods, each consisting of 38 cases. The overall en bloc resection rate was 79.39%. The lowest en bloc resection rate (52.36%) was observed in the first period. After completing 76 procedures, the resection rate surged to 86% and it was accompanied by the significant increase in the mean procedure speed of ≥9 cm 2 /h. Lesions localization and diameter had a signification impact on the outcomes. After 76 procedures, en bloc resection rate of 90.9 and 90.67% were achieved for the left side of colon and rectum, respectively. In the right side of colon statistically significant lower resection rate of 67.57% was observed. We have proved that in the setting of the Western center, colorectal ESD can yield excellent results. It seems that the key to the success during the learning period is 'tailoring' lesions qualification guidelines to the experience of the endoscopist, as lesions diameter and localization highly influence the outcomes.

Laparoscopic recurrent inguinal hernia repair during the learning curve: it can be done?

PubMed

Bracale, Umberto; Sciuto, Antonio; Andreuccetti, Jacopo; Merola, Giovanni; Pecchia, Leandro; Melillo, Paolo; Pignata, Giusto

2017-01-01

Trans-Abdominal Preperitoneal Patch (TAPP) repairs for Recurrent Hernia (RH) is a technically demanding procedure. It has to be performed only by surgeons with extensive experience in the laparoscopic approach. The purpose of this study is to evaluate the surgical safety and the efficacy of TAPP for RH performed in a tutoring program by surgeons in practice (SP). All TAPP repairs for RH performed by the same surgical team have been included in the study. We have evaluated the results of three SP during their learning curve in a tutoring program. Then these results have been compared to those of a highly experienced laparoscopic surgeon (Benchmark). A total of 530 TAPP repairs have been performed. Among these, 83 TAPP have been executed for RH, of which 43 by the Benchmark and 40 by the SP. When we have compared the outcomes of the Benchmark with those of SP, no significant difference has been observed about morbidity and recurrence while the operative time has been significantly longer for the SP. No intraoperative complications have occurred. International guidelines urge that TAPP repair for RH has to be performed only by surgeons with extensive experience in the laparoscopic approach. The results of the present study demonstrate that TAPP for RH could be performed also by surgeons in training during a learning program. We retain that an adequate tutoring program could lead a surgeon in practice to perform more complex hernia procedures without jeopardizing patient safety throughout the learning curve period. Laparoscopy, Learning Curve, Recurrent Hernia.

[Initiating a Robotic Program for Abdominal Surgery - Experiences from a Centre in Germany].

PubMed

Brunner, Maximilian; Matzel, Klaus; Aladashvili, Archil; Krautz, Christian; Grützmann, Robert; Croner, Roland

2018-05-18

Robotic systems are becoming increasingly important in abdominal surgery. We describe the implementation of a robotic program at a German centre for abdominal surgery, with focus on feasibility, safety, patient selection, learning curves, financial aspects and the lessons learned. This retrospective analysis covered data on patient demographics, intra- and postoperative parameters, oncological results and costs of all robotic-assisted abdominal operations performed at our institution between August 2012 to December 2016. It was also evaluated how possible factors for preoperative patient selection might influence intra- or postoperative outcome and learning parameters. 81 operations were performed - mostly colorectal resections (n = 35), ventral mesh rectopexy (n = 23) and liver resections (n = 18). The conversion rate was 7%. All oncological patients underwent R0 resection. Mean postoperative hospitalisation was 8.8 days; mean morbidity was 24%, with major complications (Clavien-Dindo > II) in 7%; mortality was 0%. BMI above 33.5 kg/m 2 was associated with significantly higher morbidity (p = 0.024) and rate of major complications (p = 0.046), as well as a significantly longer hospitalisation (p = 0.009). Patients older than 65 years had significantly higher morbidity (p = 0.025). With increasing numbers of operations, time of surgery decreased (p = 0.001). The average cost of a robot-assisted operation, including hospital stay, was 15,221 €. The costs of robotic sigmoid resections or liver resections were higher (compared to the open approach: 106.8 and 62.8% higher, respectively, compared to the laparoscopic approach 93.5 and 66.5% higher, respectively). Robotic surgery is a safe approach. A crucial factor in the successful and safe performance of robotic assisted operations is proper patient selection, especially during the implementation period. The inevitable learning curve and the higher costs compared to open and laparocopic surgery must be respected and specialisation of the whole team is necessary. Georg Thieme Verlag KG Stuttgart · New York.

Effect of advective flow in fractures and matrix diffusion on natural gas production

DOE PAGES

Karra, Satish; Makedonska, Nataliia; Viswanathan, Hari S.; ...

2015-10-12

Although hydraulic fracturing has been used for natural gas production for the past couple of decades, there are significant uncertainties about the underlying mechanisms behind the production curves that are seen in the field. A discrete fracture network based reservoir-scale work flow is used to identify the relative effect of flow of gas in fractures and matrix diffusion on the production curve. With realistic three dimensional representations of fracture network geometry and aperture variability, simulated production decline curves qualitatively resemble observed production decline curves. The high initial peak of the production curve is controlled by advective fracture flow of freemore » gas within the network and is sensitive to the fracture aperture variability. Matrix diffusion does not significantly affect the production decline curve in the first few years, but contributes to production after approximately 10 years. These results suggest that the initial flushing of gas-filled background fractures combined with highly heterogeneous flow paths to the production well are sufficient to explain observed initial production decline. Lastly, these results also suggest that matrix diffusion may support reduced production over longer time frames.« less

Stepwise kinetic equilibrium models of quantitative polymerase chain reaction.

PubMed

Cobbs, Gary

2012-08-16

Numerous models for use in interpreting quantitative PCR (qPCR) data are present in recent literature. The most commonly used models assume the amplification in qPCR is exponential and fit an exponential model with a constant rate of increase to a select part of the curve. Kinetic theory may be used to model the annealing phase and does not assume constant efficiency of amplification. Mechanistic models describing the annealing phase with kinetic theory offer the most potential for accurate interpretation of qPCR data. Even so, they have not been thoroughly investigated and are rarely used for interpretation of qPCR data. New results for kinetic modeling of qPCR are presented. Two models are presented in which the efficiency of amplification is based on equilibrium solutions for the annealing phase of the qPCR process. Model 1 assumes annealing of complementary targets strands and annealing of target and primers are both reversible reactions and reach a dynamic equilibrium. Model 2 assumes all annealing reactions are nonreversible and equilibrium is static. Both models include the effect of primer concentration during the annealing phase. Analytic formulae are given for the equilibrium values of all single and double stranded molecules at the end of the annealing step. The equilibrium values are then used in a stepwise method to describe the whole qPCR process. Rate constants of kinetic models are the same for solutions that are identical except for possibly having different initial target concentrations. Analysis of qPCR curves from such solutions are thus analyzed by simultaneous non-linear curve fitting with the same rate constant values applying to all curves and each curve having a unique value for initial target concentration. The models were fit to two data sets for which the true initial target concentrations are known. Both models give better fit to observed qPCR data than other kinetic models present in the literature. They also give better estimates of initial target concentration. Model 1 was found to be slightly more robust than model 2 giving better estimates of initial target concentration when estimation of parameters was done for qPCR curves with very different initial target concentration. Both models may be used to estimate the initial absolute concentration of target sequence when a standard curve is not available. It is argued that the kinetic approach to modeling and interpreting quantitative PCR data has the potential to give more precise estimates of the true initial target concentrations than other methods currently used for analysis of qPCR data. The two models presented here give a unified model of the qPCR process in that they explain the shape of the qPCR curve for a wide variety of initial target concentrations.

Reinforcement Learning of Linking and Tracing Contours in Recurrent Neural Networks

PubMed Central

Brosch, Tobias; Neumann, Heiko; Roelfsema, Pieter R.

2015-01-01

The processing of a visual stimulus can be subdivided into a number of stages. Upon stimulus presentation there is an early phase of feedforward processing where the visual information is propagated from lower to higher visual areas for the extraction of basic and complex stimulus features. This is followed by a later phase where horizontal connections within areas and feedback connections from higher areas back to lower areas come into play. In this later phase, image elements that are behaviorally relevant are grouped by Gestalt grouping rules and are labeled in the cortex with enhanced neuronal activity (object-based attention in psychology). Recent neurophysiological studies revealed that reward-based learning influences these recurrent grouping processes, but it is not well understood how rewards train recurrent circuits for perceptual organization. This paper examines the mechanisms for reward-based learning of new grouping rules. We derive a learning rule that can explain how rewards influence the information flow through feedforward, horizontal and feedback connections. We illustrate the efficiency with two tasks that have been used to study the neuronal correlates of perceptual organization in early visual cortex. The first task is called contour-integration and demands the integration of collinear contour elements into an elongated curve. We show how reward-based learning causes an enhancement of the representation of the to-be-grouped elements at early levels of a recurrent neural network, just as is observed in the visual cortex of monkeys. The second task is curve-tracing where the aim is to determine the endpoint of an elongated curve composed of connected image elements. If trained with the new learning rule, neural networks learn to propagate enhanced activity over the curve, in accordance with neurophysiological data. We close the paper with a number of model predictions that can be tested in future neurophysiological and computational studies. PMID:26496502

Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function.

PubMed

Alemozaffar, Mehrdad; Duclos, Antoine; Hevelone, Nathanael D; Lipsitz, Stuart R; Borza, Tudor; Yu, Hua-Yin; Kowalczyk, Keith J; Hu, Jim C

2012-06-01

While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes. Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP). We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction. Our approach to RARP has been described previously. A single-console robotic system was used for all cases. Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function. Greater surgeon experience was associated with better 5-mo sexual function (p = 0.007) and a trend for better 12-mo sexual function (p = 0.061), with improvement plateauing after 250-300 cases. Additionally, younger patient age (both p<0.02) and better preoperative sexual function (<0.001) were associated with better 5- and 12-mo sexual function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p=0.021), while unilateral nerve sparing/non-nerve sparing was associated with worse 5-mo sexual function (p = 0.009). Limitations include the retrospective single-surgeon design. With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The learning curve of laparoscopic liver resection after the Louisville statement 2008: Will it be more effective and smooth?

PubMed

Lin, Chung-Wei; Tsai, Tzu-Jung; Cheng, Tsung-Yen; Wei, Hung-Kuang; Hung, Chen-Fang; Chen, Yin-Yin; Chen, Chii-Ming

2016-07-01

Laparoscopic liver resection (LLR) has been proven to be feasible and safe. However, it is a difficult and complex procedure with a steep learning curve. The aim of this study was to evaluate the learning curve of LLR at our institutions since 2008. One hundred and twenty-six consecutive LLRs were included from May 2008 to December 2014. Patient characteristics, operative data, and surgical outcomes were collected prospectively and analyzed. The median tumor size was 25 mm (range 5-90 mm), and 96 % of the resected tumors were malignant. 41.3 % (52/126) of patients had pathologically proven liver cirrhosis. The median operation time was 216 min (range 40-602 min) with a median blood loss of 100 ml (range 20-2300 ml). The median length of hospital stay was 4 days (range 2-10 days). Six major postoperative complications occurred in this series, and there was no 90-day postoperative mortality. Regarding the incidence of major operative events including operation time longer than 300 min, perioperative blood loss above 500 ml, and major postoperative complications, the learning curve [as evaluated by the cumulative sum (CUSUM) technique] showed its first reverse after 22 cases. The indication of laparoscopic resection in this series extended after 60 cases to include tumors located in difficult locations (segments 4a, 7, 8) and major hepatectomy. CUSUM showed that the incidence of major operative events proceeded to increase again, and the second reverse was noted after an additional 40 cases of experience. Location of the tumor in a difficult area emerged as a significant predictor of major operative events. In carefully selected patients, CUSUM analysis showed 22 cases were needed to overcome the learning curve for minor LLR.

A study of active learning methods for named entity recognition in clinical text.

PubMed

Chen, Yukun; Lasko, Thomas A; Mei, Qiaozhu; Denny, Joshua C; Xu, Hua

2015-12-01

Named entity recognition (NER), a sequential labeling task, is one of the fundamental tasks for building clinical natural language processing (NLP) systems. Machine learning (ML) based approaches can achieve good performance, but they often require large amounts of annotated samples, which are expensive to build due to the requirement of domain experts in annotation. Active learning (AL), a sample selection approach integrated with supervised ML, aims to minimize the annotation cost while maximizing the performance of ML-based models. In this study, our goal was to develop and evaluate both existing and new AL methods for a clinical NER task to identify concepts of medical problems, treatments, and lab tests from the clinical notes. Using the annotated NER corpus from the 2010 i2b2/VA NLP challenge that contained 349 clinical documents with 20,423 unique sentences, we simulated AL experiments using a number of existing and novel algorithms in three different categories including uncertainty-based, diversity-based, and baseline sampling strategies. They were compared with the passive learning that uses random sampling. Learning curves that plot performance of the NER model against the estimated annotation cost (based on number of sentences or words in the training set) were generated to evaluate different active learning and the passive learning methods and the area under the learning curve (ALC) score was computed. Based on the learning curves of F-measure vs. number of sentences, uncertainty sampling algorithms outperformed all other methods in ALC. Most diversity-based methods also performed better than random sampling in ALC. To achieve an F-measure of 0.80, the best method based on uncertainty sampling could save 66% annotations in sentences, as compared to random sampling. For the learning curves of F-measure vs. number of words, uncertainty sampling methods again outperformed all other methods in ALC. To achieve 0.80 in F-measure, in comparison to random sampling, the best uncertainty based method saved 42% annotations in words. But the best diversity based method reduced only 7% annotation effort. In the simulated setting, AL methods, particularly uncertainty-sampling based approaches, seemed to significantly save annotation cost for the clinical NER task. The actual benefit of active learning in clinical NER should be further evaluated in a real-time setting. Copyright © 2015 Elsevier Inc. All rights reserved.

Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves.

PubMed

Harris, David M; Ryan, Kathleen; Rabuck, Cynthia

2012-09-01

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.

Crowdsourced validation of a machine-learning classification system for autism and ADHD

PubMed Central

Duda, M; Haber, N; Daniels, J; Wall, D P

2017-01-01

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) together affect >10% of the children in the United States, but considerable behavioral overlaps between the two disorders can often complicate differential diagnosis. Currently, there is no screening test designed to differentiate between the two disorders, and with waiting times from initial suspicion to diagnosis upwards of a year, methods to quickly and accurately assess risk for these and other developmental disorders are desperately needed. In a previous study, we found that four machine-learning algorithms were able to accurately (area under the curve (AUC)>0.96) distinguish ASD from ADHD using only a small subset of items from the Social Responsiveness Scale (SRS). Here, we expand upon our prior work by including a novel crowdsourced data set of responses to our predefined top 15 SRS-derived questions from parents of children with ASD (n=248) or ADHD (n=174) to improve our model’s capability to generalize to new, ‘real-world’ data. By mixing these novel survey data with our initial archival sample (n=3417) and performing repeated cross-validation with subsampling, we created a classification algorithm that performs with AUC=0.89±0.01 using only 15 questions. PMID:28509905

On the phenomenon of curved microcracks in /(S)/90n/s laminates - Their shapes, initiation angles and locations

NASA Technical Reports Server (NTRS)

Hu, Shoufeng; Bark, Jong S.; Nairn, John A.

1993-01-01

A variational analysis of the stress state in microcracked cross-ply laminates has been used to investigate the phenomenon of curved microcracking in /(S)/90n/s laminates. Previous investigators proposed that the initiation and orientation of curved microcracks are controlled by local maxima and stress trajectories of the principal stresses. We have implemented a principal stress model using a variational mechanics stress analysis and we were able to make predictions about curved microcracks. The predictions agree well with experimental observations and therefore support the assertion that the variational analysis gives an accurate stress state that is useful for modeling the microcracking properties of cross-ply laminates. An important prediction about curved microcracks is that they are a late stage of microcracking damage. They occur only when the crack density of straight microcracks exceeds the critical crack density for curved microcracking. The predicted critical crack density for curved microcracking agrees well with experimental observations.

V1 orientation plasticity is explained by broadly tuned feedforward inputs and intracortical sharpening.

PubMed

Teich, Andrew F; Qian, Ning

2010-03-01

Orientation adaptation and perceptual learning change orientation tuning curves of V1 cells. Adaptation shifts tuning curve peaks away from the adapted orientation, reduces tuning curve slopes near the adapted orientation, and increases the responses on the far flank of tuning curves. Learning an orientation discrimination task increases tuning curve slopes near the trained orientation. These changes have been explained previously in a recurrent model (RM) of orientation selectivity. However, the RM generates only complex cells when they are well tuned, so that there is currently no model of orientation plasticity for simple cells. In addition, some feedforward models, such as the modified feedforward model (MFM), also contain recurrent cortical excitation, and it is unknown whether they can explain plasticity. Here, we compare plasticity in the MFM, which simulates simple cells, and a recent modification of the RM (MRM), which displays a continuum of simple-to-complex characteristics. Both pre- and postsynaptic-based modifications of the recurrent and feedforward connections in the models are investigated. The MRM can account for all the learning- and adaptation-induced plasticity, for both simple and complex cells, while the MFM cannot. The key features from the MRM required for explaining plasticity are broadly tuned feedforward inputs and sharpening by a Mexican hat intracortical interaction profile. The mere presence of recurrent cortical interactions in feedforward models like the MFM is insufficient; such models have more rigid tuning curves. We predict that the plastic properties must be absent for cells whose orientation tuning arises from a feedforward mechanism.

A strategic systems perspective of organizational learning theory: models for a case study at the Jet Propulsion Laboratory

NASA Technical Reports Server (NTRS)

Neece, O.

2000-01-01

Organizational learning is an umbrella term that covers a variety of topics including; learning curves, productivity, organizational memory, organizational forgetting, knowledge transfer, knowledge sharing and knowledge creation. This treatise will review some of these theories in concert with a model of how organizations learn.

The Role of Cognitive Abilities in Laparoscopic Simulator Training

ERIC Educational Resources Information Center

Groenier, M.; Schraagen, J. M. C.; Miedema, H. A. T.; Broeders, I. A. J. M.

2014-01-01

Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general…

Cross-domain and multi-task transfer learning of deep convolutional neural network for breast cancer diagnosis in digital breast tomosynthesis

NASA Astrophysics Data System (ADS)

Samala, Ravi K.; Chan, Heang-Ping; Hadjiiski, Lubomir; Helvie, Mark A.; Richter, Caleb; Cha, Kenny

2018-02-01

We propose a cross-domain, multi-task transfer learning framework to transfer knowledge learned from non-medical images by a deep convolutional neural network (DCNN) to medical image recognition task while improving the generalization by multi-task learning of auxiliary tasks. A first stage cross-domain transfer learning was initiated from ImageNet trained DCNN to mammography trained DCNN. 19,632 regions-of-interest (ROI) from 2,454 mass lesions were collected from two imaging modalities: digitized-screen film mammography (SFM) and full-field digital mammography (DM), and split into training and test sets. In the multi-task transfer learning, the DCNN learned the mass classification task simultaneously from the training set of SFM and DM. The best transfer network for mammography was selected from three transfer networks with different number of convolutional layers frozen. The performance of single-task and multitask transfer learning on an independent SFM test set in terms of the area under the receiver operating characteristic curve (AUC) was 0.78+/-0.02 and 0.82+/-0.02, respectively. In the second stage cross-domain transfer learning, a set of 12,680 ROIs from 317 mass lesions on DBT were split into validation and independent test sets. We first studied the data requirements for the first stage mammography trained DCNN by varying the mammography training data from 1% to 100% and evaluated its learning on the DBT validation set in inference mode. We found that the entire available mammography set provided the best generalization. The DBT validation set was then used to train only the last four fully connected layers, resulting in an AUC of 0.90+/-0.04 on the independent DBT test set.

Concentrated photovoltaics system costs and learning curve analysis

NASA Astrophysics Data System (ADS)

Haysom, Joan E.; Jafarieh, Omid; Anis, Hanan; Hinzer, Karin

2013-09-01

An extensive set of costs in /W for the installed costs of CPV systems has been amassed from a range of public sources, including both individual company prices and market reports. Cost reductions over time are very evident, with current prices for 2012 in the range of 3.0 ± 0.7 /W and a predicted cost of 1.5 /W for 2020. Cost data is combined with deployment volumes in a learning curve analysis, providing a fitted learning rate of either 18.5% or 22.3% depending on the methodology. This learning rate is compared to that of PV modules and PV installed systems, and the influence of soft costs is discussed. Finally, if an annual growth rate of 39% is assumed for deployed volumes, then, using the learning rate of 20%, this would predict the achievement of a cost point of 1.5 /W by 2016.

A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying.

PubMed

Molinas, Carlos Roger; Binda, Maria Mercedes; Sisa, Cesar Manuel; Campo, Rudi

2017-01-01

Training of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1-G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test ( T 1 ) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again ( T 2 ) in the same manner than at T 1 . In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again ( T 3 ) in the same manner than at T 1 and T 2 . At each repetition, scoring was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points ( Y 0), the point after HEC training/before LICK training ( Y 1), the Plateau, and the rate constants ( K ) were calculated. All groups, except for G4, started from a similar point ( Y 0). At Y 1, G5 scored already better than the others (G1 p  = .004; G2 p  = .04; G3 p  < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p  < 0.0001; G2 p  < 0.0001; G3 p  < 0.0001; and G4 p  < 0.0001). Our data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.

Cauchy problem with general discontinuous initial data along a smooth curve for 2-d Euler system

NASA Astrophysics Data System (ADS)

Chen, Shuxing; Li, Dening

2014-09-01

We study the Cauchy problems for the isentropic 2-d Euler system with discontinuous initial data along a smooth curve. All three singularities are present in the solution: shock wave, rarefaction wave and contact discontinuity. We show that the usual restrictive high order compatibility conditions for the initial data are automatically satisfied. The local existence of piecewise smooth solution containing all three waves is established.

Precision Learning Assessment: An Alternative to Traditional Assessment Techniques.

ERIC Educational Resources Information Center

Caltagirone, Paul J.; Glover, Christopher E.

1985-01-01

A continuous and curriculum-based assessment method, Precision Learning Assessment (PLA), which integrates precision teaching and norm-referenced techniques, was applied to a math computation curriculum for 214 third graders. The resulting districtwide learning curves defining average annual progress through the computation curriculum provided…

Enhanced Night Vision Via a Combination of Poisson Interpolation and Machine Learning

DTIC Science & Technology

2006-02-01

of 0-255, they are mostly similar. The right plot shows a family of m(x, ψ) curves of ψ=2 (the most linear) through ψ=1024 (the most curved ...complicating low-light imaging. Nayar and Branzoi [04] later suggested a second variant using a DLP micromirror array to modulate the exposure, via time...255, they are mostly similar. The right plot shows a family of m(x, ψ) curves of ψ=2 (the most linear) through ψ=1024 (the most curved

Effect of discrete track support by sleepers on rail corrugation at a curved track

NASA Astrophysics Data System (ADS)

Jin, X. S.; Wen, Z. F.

2008-08-01

The paper investigates into the effect of discrete track support by sleepers on the initiation and development of rail corrugation at a curved track when a railway vehicle passes through using a numerical method. The numerical method considers a combination of Kalker's rolling contact theory with non-Hertzian form, a linear frictional work model and a dynamics model of a half railway vehicle coupled with the curved track. The half-vehicle has a two-axle bogie and doubled suspension systems. It is treated as a full dynamic rigid multi-body model. In the track model, an Euler beam is used to model the rail, and the discrete track support by sleepers moving backward with respect to the vehicle running direction is considered to simulate the effect of the discrete sleeper support on the wheels/rails in rolling contact when the vehicle moves on the track. The sleeper is treated as a rigid body and the ballast bed is replaced with equivalent mass bodies. The numerical analysis exams in detail the variations of wheel/rail normal loads, the creepages, and the rail wear volume along the curved track. Their variations are much concerned with the discrete track support. The numerical results show that the discrete track support causes the fluctuating of the normal loads and creepages at a few frequencies. These frequencies comprise the passing frequency of the sleepers and the excited track resonant frequencies, which are higher than the sleeper passing frequency. Consequently, rail corrugation with several wavelengths initiates and develops. Also the results show that the contact vibrating between the curved rails and the four wheels of the same bogie has different frequencies. In this way, the different key frequencies to be excited play an important role in the initiation and development of curved rail corrugation. Therefore, the corrugations caused by the four wheels of the same bogie present different wavelengths. The paper shows and discusses the depths of the initial corrugations caused by the four wheels of the same bogie, at the entering transition curve, the circle curve and the exit transition curve of the curved track, respectively.

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty.

PubMed

Schnurr, Christoph; Eysel, Peer; König, Dietmar Pierre

2011-01-01

The use of computer navigation in total knee arthroplasty (TKA) improves the implant alignment but increases the operation time. Studies have shown that the operation time is further prolonged due to the surgeon's learning curve, and longer operation times have been associated with higher morbidity risks. It has been our hypothesis that an improvement in the human-machine interface might reduce the time required during the learning curve. Accordingly, we asked whether the use of navigation devices with a display fixed on the surgical instruments would reduce the operation time in navigated TKAs performed by navigation beginners. Thirty medical students were randomized and used two navigation devices in rotation: these were the Kolibri® device with an external display and the Dash® device with a display that was fixed on the cutting blocks. The time for adjustment of the tibial and femoral cutting blocks on knee models while using these devices was measured. A significant time reduction was demonstration when the Dash® device was used: The time reduction was 21% for the tibial block (p = 0.007), 40% for the femoral block (p < 0.001), and 32% for the whole procedure (p < 0.001). The integrated display, fixed on surgical instruments in a manner similar to a spirit level, seems to be more user-friendly for navigation beginners. Hence, unproductive time losses during the learning curve may be diminished.

Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.

PubMed

Janse, Juliënne A; Pattij, Thyrza O S; Eijkemans, Marinus J C; Broekmans, Frank J; Veersema, Sebastiaan; Schreuder, Henk W R

2013-09-01

To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Prospective multicenter study (Canadian Task Force II-2). Ten community (teaching) hospitals in the Netherlands. A total of 631 women who underwent permanent sterilization by tubal microinserts. Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement. Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications. Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience. A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Learning curve and early clinical outcomes for a robotic surgery novice performing robotic single site cholecystectomy.

PubMed

Angus, Andrew A; Sahi, Saad L; McIntosh, Bruce B

2014-06-01

A rapid training protocol has been developed for robotic surgery novices to learn robotic single-incision techniques. This study assesses the learning curve and early clinical results for a robotic surgery novice starting single-site cholecystectomy. A chart review was performed on the surgeon's first 55 patients to undergo this procedure. Average patient age was 46.01 ± 4.25 (range 21-86) years and BMI was 26.57 ± 4.25 (range 19.4-36.6) kg/m(2) . The mean port placement with docking time was 11.34 ± 3.74 (range 7-23) min. Mean console time was 28.74 ± 11.04 (range 15-66) min. Average total OR time was 61.84 ± 14.66 (range 40-105) min. All procedures were successfully completed without conversion or added ports. Complications included several minor procedural gall bladder perforations and miscellaneous postoperative symptomatic complaints. Robotic single site cholecystectomy can be safely performed by a robotic novice within a minimal learning curve and have early clinical results that are comparable to the published data of robotic experts. Copyright © 2013 John Wiley & Sons, Ltd.

Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial.

PubMed

Palter, Vanessa N; Orzech, Neil; Reznick, Richard K; Grantcharov, Teodor P

2013-02-01

: To develop and validate an ex vivo comprehensive curriculum for a basic laparoscopic procedure. : Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Moreover, neither the effect of ex vivo training on learning curves in the operating room (OR), nor the effect on nontechnical proficiency has been investigated. : This randomized single-blinded prospective trial allocated 20 surgical trainees to a structured training and assessment curriculum (STAC) group or conventional residency training. The STAC consisted of case-based learning, proficiency-based virtual reality training, laparoscopic box training, and OR participation. After completion of the intervention, all participants performed 5 sequential laparoscopic cholecystectomies in the OR. The primary outcome measure was the difference in technical performance between the 2 groups during the first laparoscopic cholecystectomy. Secondary outcome measures included differences with respect to learning curves in the OR, technical proficiency of each sequential laparoscopic cholecystectomy, and nontechnical skills. : Residents in the STAC group outperformed residents in the conventional group in the first (P = 0.004), second (P = 0.036), third (P = 0.021), and fourth (P = 0.023) laparoscopic cholecystectomies. The conventional group demonstrated a significant learning curve in the OR (P = 0.015) in contrast to the STAC group (P = 0.032). Residents in the STAC group also had significantly higher nontechnical skills (P = 0.027). : Participating in the STAC shifted the learning curve for a basic laparoscopic procedure from the operating room into the simulation laboratory. STAC-trained residents had superior technical proficiency in the OR and nontechnical skills compared with conventionally trained residents. (The study registration ID is NCT01560494.).

Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

PubMed

Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

2015-01-01

This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease.

PubMed

Novotný, Tomáš; Dvorák, Martin; Staffa, Robert

2011-02-01

Since the end of the 20th century, robot-assisted surgery has been finding its role among other minimally invasive methods. Vascular surgery seems to be another specialty in which the benefits of this technology can be expected. Our objective was to assess the learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease in a group of 40 patients. Between May 2006 and January 2010, 40 patients (32 men, 8 women), who were a median age of 58 years (range, 48-75 years), underwent 40 robot-assisted laparoscopic aortofemoral reconstructions. Learning curve estimations were used for anastomosis, clamping, and operative time assessment. For conversion rate evaluation, the cumulative summation (CUSUM) technique was used. Statistical analysis comparing the first and second half of our group, and unilateral-to-bilateral reconstructions were performed. We created 21 aortofemoral and 19 aortobifemoral bypasses. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time was 60 minutes (range, 40-95 minutes), and median operative time was 295 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%, and no graft or wound infection or cardiopulmonary or hepatorenal complications were observed. During the median 18-month follow-up (range, 2-48 months), three early graft occlusions occurred (7%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for robotic proximal anastomosis creation with anastomosis and clamping time reduction. The operative time learning curve was flat, confirming the procedure's complexity. There were two conversions to open surgery. CUSUM analysis confirmed that an acceptable conversion rate set at 5% was achieved. Comparing the first and second half of our group, all recorded times showed statistically significant improvements. Differences between unilateral and bilateral reconstructions were not statistically significant. Our results show that the success rate of robot-assisted laparoscopic aortofemoral bypass grafting is high and the complication rate is low. Anastomosis creation, one of the main difficulties of laparoscopic bypass grafting, has been overcome using the robotic operating system and its learning curve is short. However, the endoscopic dissection of the aortoiliac segment remains the most difficult part of the operation and should be addressed in further development of the method to reduce the operative times. Long-term results and potential benefits of this minimally invasive method have to be verified by randomized controlled clinical trials. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Memory Impairment in Multiple Sclerosis is Due to a Core Deficit in Initial Learning

PubMed Central

DeLuca, John; Leavitt, Victoria M.; Chiaravalloti, Nancy; Wylie, Glenn

2013-01-01

Persons with multiple sclerosis (MS) suffer memory impairment, but research on the nature of MS-related memory problems is mixed. Some have argued for a core deficit in retrieval, while others have identified deficient initial learning as the core deficit. We used a selective reminding paradigm to determine whether deficient initial learning or delayed retrieval represents the primary memory deficit in 44 persons with MS. Brain atrophy was measured from high-resolution MRIs. Regression analyses examined the impact of brain atrophy on (a) initial learning and delayed retrieval separately, and then (b) delayed retrieval controlling for initial learning. Brain atrophy was negatively associated with both initial learning and delayed retrieval (ps < .01), but brain atrophy was unrelated to retrieval when controlling for initial learning (p > .05). In addition, brain atrophy was associated with inefficient learning across initial acquisition trials, and brain atrophy was unrelated to delayed recall among MS subjects who successfully acquired the word list (although such learning frequently required many exposures). Taken together, memory deficits in MS are a result of deficits in initial learning; moreover, initial learning mediates the relationship between brain atrophy and subsequent retrieval, thereby supporting the core learning-deficit hypothesis of memory impairment in MS. PMID:23832311

Event related potentials to digit learning: tracking neurophysiologic changes accompanying recall performance.

PubMed

Jongsma, Marijtje L A; Gerrits, Niels J H M; van Rijn, Clementina M; Quiroga, Rodrigo Quian; Maes, Joseph H R

2012-07-01

The aim of this study was to track recall performance and event-related potentials (ERPs) across multiple trials in a digit-learning task. When a sequence is practiced by repetition, the number of errors typically decreases and a learning curve emerges. Until now, almost all ERP learning and memory research has focused on effects after a single presentation and, therefore, fails to capture the dynamic changes that characterize a learning process. However, the current study used a free-recall task in which a sequence of ten auditory digits was presented repeatedly. Auditory sequences of ten digits were presented in a logical order (control sequences) or in a random order (experimental sequences). Each sequence was presented six times. Participants had to reproduce the sequence after each presentation. EEG recordings were made at the time of the digit presentations. Recall performance for the control sequences was close to asymptote right after the first learning trial, whereas performance for the experimental sequences initially displayed primacy and recency effects. However, these latter effects gradually disappeared over the six repetitions, resulting in near-asymptotic recall performance for all digits. The performance improvement for the middle items of the list was accompanied by an increase in P300 amplitude, implying a close correspondence between this ERP component and the behavioral data. These results, which were discussed in the framework of theories on the functional significance of the P300 amplitude, add to the scarce empirical data on the dynamics of ERP responses in the process of intentional learning. Copyright © 2011 Elsevier B.V. All rights reserved.

Photometric Supernova Classification with Machine Learning

NASA Astrophysics Data System (ADS)

Lochner, Michelle; McEwen, Jason D.; Peiris, Hiranya V.; Lahav, Ofer; Winter, Max K.

2016-08-01

Automated photometric supernova classification has become an active area of research in recent years in light of current and upcoming imaging surveys such as the Dark Energy Survey (DES) and the Large Synoptic Survey Telescope, given that spectroscopic confirmation of type for all supernovae discovered will be impossible. Here, we develop a multi-faceted classification pipeline, combining existing and new approaches. Our pipeline consists of two stages: extracting descriptive features from the light curves and classification using a machine learning algorithm. Our feature extraction methods vary from model-dependent techniques, namely SALT2 fits, to more independent techniques that fit parametric models to curves, to a completely model-independent wavelet approach. We cover a range of representative machine learning algorithms, including naive Bayes, k-nearest neighbors, support vector machines, artificial neural networks, and boosted decision trees (BDTs). We test the pipeline on simulated multi-band DES light curves from the Supernova Photometric Classification Challenge. Using the commonly used area under the curve (AUC) of the Receiver Operating Characteristic as a metric, we find that the SALT2 fits and the wavelet approach, with the BDTs algorithm, each achieve an AUC of 0.98, where 1 represents perfect classification. We find that a representative training set is essential for good classification, whatever the feature set or algorithm, with implications for spectroscopic follow-up. Importantly, we find that by using either the SALT2 or the wavelet feature sets with a BDT algorithm, accurate classification is possible purely from light curve data, without the need for any redshift information.

Modeling Heterogeneity of Latent Growth Depending on Initial Status

ERIC Educational Resources Information Center

Klein, Andreas G.; Muthen, Bengt O.

2006-01-01

In this article, a heterogeneous latent growth curve model for modeling heterogeneity of growth rates is proposed. The suggested model is an extension of a conventional growth curve model and a complementary tool to mixed growth modeling. It allows the modeling of heterogeneity of growth rates as a continuous function of latent initial status and…

Endoscopic sleeve gastroplasty: the learning curve.

PubMed

Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

2017-09-01

 Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

Acquisition of neural learning in cerebellum and cerebral cortex for smooth pursuit eye movements

PubMed Central

Li, Jennifer X.; Medina, Javier F.; Frank, Loren M.; Lisberger, Stephen G.

2011-01-01

We have evaluated the emergence of neural learning in the frontal eye fields (FEFSEM) and the floccular complex of the cerebellum while monkeys learned a precisely-timed change in the direction of pursuit eye movement. For each neuron, we measured the time course of changes in neural response across a learning session that comprised at least 100 repetitions of an instructive change in target direction. In both areas, the average population learning curves tracked the behavioral changes with high fidelity, consistent with possible roles in driving learning. However, the learning curves of individual neurons sometimes bore little relation to the smooth, monotonic progression of behavioral learning. In the FEFSEM, neural learning was episodic. For individual neurons, learning appeared at different times during the learning session and sometimes disappeared by the end of the session. Different FEFSEM neurons expressed maximal learning at different times relative to the acquisition of behavioral learning. In the floccular complex, many Purkinje cells acquired learned simple-spike responses according to the same time course as behavioral learning and retained their learned responses throughout the learning session. A minority of Purkinje cells acquired learned responses late in the learning session, after behavioral learning had reached an asymptote. We conclude that learning in single neurons can follow a very different time course from behavioral learning. Both the FEFSEM and the floccular complex contain representations of multiple temporal components of learning, with different neurons contributing to learning at different times during the acquisition of a learned movement. PMID:21900551

Learning curves of theta/beta neurofeedback in children with ADHD.

PubMed

Janssen, Tieme W P; Bink, Marleen; Weeda, Wouter D; Geladé, Katleen; van Mourik, Rosa; Maras, Athanasios; Oosterlaan, Jaap

2017-05-01

Neurofeedback is widely applied as non-pharmacological intervention aimed at reducing symptoms of ADHD, even though efficacy has not been unequivocally established. Neuronal changes during the neurofeedback intervention that resemble learning can provide crucial evidence for the feasibility and specificity of this intervention. A total of 38 children (aged between 7 and 13 years) with a DSM-IV-TR diagnosis of ADHD, completed on average 29 sessions of theta (4-8 Hz)/beta (13-20 Hz) neurofeedback training. Dependent variables included training-related measures as well as theta and beta power during baseline and training runs for each session. Learning effects were analyzed both within and between sessions. To further specify findings, individual learning curves were explored and correlated with behavioral changes in ADHD symptoms. Over the course of the training, there was a linear increase in participants' mean training level, highest obtained training level and the number of earned credits (range b = 0.059, -0.750, p < 0.001). Theta remained unchanged over the course of the training, while beta activity increased linearly within training sessions (b = 0.004, 95% CI = [0.0013-0.0067], p = 0.005) and over the course of the intervention (b = 0.0052, 95% CI = [0.0039-0.0065], p < 0.001). In contrast to the group analyses, significant individual learning curves were found for both theta and beta over the course of the intervention in 39 and 53%, respectively. Individual learning curves were not significantly correlated with behavioral changes. This study shows that children with ADHD can gain control over EEG states during neurofeedback, although a lack of behavioral correlates may indicate insufficient transfer to daily functioning, or to confounding reinforcement of electromyographic activity. This trial is registered at the US National Institutes of Health (ClinicalTrials.gov, ref. no: NCT01363544); https://clinicaltrials.gov/show/NCT01363544 .

Internalizing, social competence, and substance initiation: influence of gender moderation and a preventive intervention.

PubMed

Lillehoj, Catherine J; Trudeau, Linda; Spoth, Richard; Wickrama, K A S

2004-05-01

Using latent growth curve modeling, the current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency (i.e., social assertiveness) and the initiation of substance use (i.e., tobacco, alcohol, marijuana), as well as the effect of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment conducted in 1998. A latent growth curve comparison analysis found that internalizing was related inversely to initial levels of social assertiveness skill among girls; further, internalizing was related positively to substance use initiation growth trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance use initiation and a faster increase in social assertiveness. Gender moderation of the impact of internalizing and social assertiveness on substance use initiation and response to the intervention, as well as the utility of latent growth curve modeling in the study of longitudinal change, are discussed.

Assessing Teachers' Competencies to Read and Interpret Graphs from Learning Progress Assessment: Results from Tests and Interviews

ERIC Educational Resources Information Center

Zeuch, Nina; Förster, Natalie; Souvignier, Elmar

2017-01-01

Learning progress assessment (LPA) provides formative information about effectiveness of instructional decisions. Learning curves are usually presented as graphical illustrations. However, little is known about teachers understanding and interpreting of graphically presented information. An instrument to measure competencies in reading graphs from…

[How does a lawyer evaluate the introduction of a new treatment method (the so-called learning curve)].

PubMed

Ulsenheimer, K

2001-01-01

In the interest of our patients and advancement in medicine and with the guarantee by law of the freedom to select methods of treatment, we may and must try out new strategies even in the face of initially unknown risks, side effects, and consequences. Every innovation assumes, however, that the advantages and disadvantages, potential complications, and burden to the patient have been weighed against those of conventional methods. The risks that a pioneer takes must be justified and presented comprehensively and clearly to the patient. Otherwise the threat is posed of civil and criminal accusations of negligence in responsibility or in the obligation to fully inform patients. Patient protection and safety must always be the first priority.

Femtosecond laser cataract surgery: technology and clinical practice.

PubMed

Roberts, Timothy V; Lawless, Michael; Chan, Colin Ck; Jacobs, Mark; Ng, David; Bali, Shveta J; Hodge, Chris; Sutton, Gerard

2013-03-01

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Stochastic Gain in Population Dynamics

NASA Astrophysics Data System (ADS)

Traulsen, Arne; Röhl, Torsten; Schuster, Heinz Georg

2004-07-01

We introduce an extension of the usual replicator dynamics to adaptive learning rates. We show that a population with a dynamic learning rate can gain an increased average payoff in transient phases and can also exploit external noise, leading the system away from the Nash equilibrium, in a resonancelike fashion. The payoff versus noise curve resembles the signal to noise ratio curve in stochastic resonance. Seen in this broad context, we introduce another mechanism that exploits fluctuations in order to improve properties of the system. Such a mechanism could be of particular interest in economic systems.

An experimental approach to non - extensive statistical physics and Epidemic Type Aftershock Sequence (ETAS) modeling. The case of triaxially deformed sandstones using acoustic emissions.

NASA Astrophysics Data System (ADS)

Stavrianaki, K.; Vallianatos, F.; Sammonds, P. R.; Ross, G. J.

2014-12-01

Fracturing is the most prevalent deformation mechanism in rocks deformed in the laboratory under simulated upper crustal conditions. Fracturing produces acoustic emissions (AE) at the laboratory scale and earthquakes on a crustal scale. The AE technique provides a means to analyse microcracking activity inside the rock volume and since experiments can be performed under confining pressure to simulate depth of burial, AE can be used as a proxy for natural processes such as earthquakes. Experimental rock deformation provides us with several ways to investigate time-dependent brittle deformation. Two main types of experiments can be distinguished: (1) "constant strain rate" experiments in which stress varies as a result of deformation, and (2) "creep" experiments in which deformation and deformation rate vary over time as a result of an imposed constant stress. We conducted constant strain rate experiments on air-dried Darley Dale sandstone samples in a variety of confining pressures (30MPa, 50MPa, 80MPa) and in water saturated samples with 20 MPa initial pore fluid pressure. The results from these experiments used to determine the initial loading in the creep experiments. Non-extensive statistical physics approach was applied to the AE data in order to investigate the spatio-temporal pattern of cracks close to failure. A more detailed study was performed for the data from the creep experiments. When axial stress is plotted against time we obtain the trimodal creep curve. Calculation of Tsallis entropic index q is performed to each stage of the curve and the results are compared with the ones from the constant strain rate experiments. The Epidemic Type Aftershock Sequence model (ETAS) is also applied to each stage of the creep curve and the ETAS parameters are calculated. We investigate whether these parameters are constant across all stages of the curve, or whether there are interesting patterns of variation. This research has been co-funded by the European Union (European Social Fund) and Greek national resources under the framework of the "THALES Program: SEISMO FEAR HELLARC" project of the "Education & Lifelong Learning" Operational Programme.

Refinement of moisture calibration curves for nuclear gage : interim report no. 1.

DOT National Transportation Integrated Search

1972-01-01

This study was initiated to determine the correct moisture calibration curves for different nuclear gages. It was found that the Troxler Model 227 had a linear response between count ratio and moisture content. Also, the two calibration curves for th...

Analysis of the vitreoretinal surgery learning curve.

PubMed

Martín-Avià, J; Romero-Aroca, P

2017-06-01

To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Development of a Portable Motor Learning Laboratory (PoMLab)

PubMed Central

Shinya, Masahiro

2016-01-01

Most motor learning experiments have been conducted in a laboratory setting. In this type of setting, a huge and expensive manipulandum is frequently used, requiring a large budget and wide open space. Subjects also need to travel to the laboratory, which is a burden for them. This burden is particularly severe for patients with neurological disorders. Here, we describe the development of a novel application based on Unity3D and smart devices, e.g., smartphones or tablet devices, that can be used to conduct motor learning experiments at any time and in any place, without requiring a large budget and wide open space and without the burden of travel on subjects. We refer to our application as POrtable Motor learning LABoratory, or PoMLab. PoMLab is a multiplatform application that is available and sharable for free. We investigated whether PoMLab could be an alternative to the laboratory setting using a visuomotor rotation paradigm that causes sensory prediction error, enabling the investigation of how subjects minimize the error. In the first experiment, subjects could adapt to a constant visuomotor rotation that was abruptly applied at a specific trial. The learning curve for the first experiment could be modeled well using a state space model, a mathematical model that describes the motor leaning process. In the second experiment, subjects could adapt to a visuomotor rotation that gradually increased each trial. The subjects adapted to the gradually increasing visuomotor rotation without being aware of the visuomotor rotation. These experimental results have been reported for conventional experiments conducted in a laboratory setting, and our PoMLab application could reproduce these results. PoMLab can thus be considered an alternative to the laboratory setting. We also conducted follow-up experiments in university physical education classes. A state space model that was fit to the data obtained in the laboratory experiments could predict the learning curves obtained in the follow-up experiments. Further, we investigated the influence of vibration function, weight, and screen size on learning curves. Finally, we compared the learning curves obtained in the PoMLab experiments to those obtained in the conventional reaching experiments. The results of the in-class experiments show that PoMLab can be used to conduct motor learning experiments at any time and place. PMID:27348223

Development of a Portable Motor Learning Laboratory (PoMLab).

PubMed

Takiyama, Ken; Shinya, Masahiro

2016-01-01

Most motor learning experiments have been conducted in a laboratory setting. In this type of setting, a huge and expensive manipulandum is frequently used, requiring a large budget and wide open space. Subjects also need to travel to the laboratory, which is a burden for them. This burden is particularly severe for patients with neurological disorders. Here, we describe the development of a novel application based on Unity3D and smart devices, e.g., smartphones or tablet devices, that can be used to conduct motor learning experiments at any time and in any place, without requiring a large budget and wide open space and without the burden of travel on subjects. We refer to our application as POrtable Motor learning LABoratory, or PoMLab. PoMLab is a multiplatform application that is available and sharable for free. We investigated whether PoMLab could be an alternative to the laboratory setting using a visuomotor rotation paradigm that causes sensory prediction error, enabling the investigation of how subjects minimize the error. In the first experiment, subjects could adapt to a constant visuomotor rotation that was abruptly applied at a specific trial. The learning curve for the first experiment could be modeled well using a state space model, a mathematical model that describes the motor leaning process. In the second experiment, subjects could adapt to a visuomotor rotation that gradually increased each trial. The subjects adapted to the gradually increasing visuomotor rotation without being aware of the visuomotor rotation. These experimental results have been reported for conventional experiments conducted in a laboratory setting, and our PoMLab application could reproduce these results. PoMLab can thus be considered an alternative to the laboratory setting. We also conducted follow-up experiments in university physical education classes. A state space model that was fit to the data obtained in the laboratory experiments could predict the learning curves obtained in the follow-up experiments. Further, we investigated the influence of vibration function, weight, and screen size on learning curves. Finally, we compared the learning curves obtained in the PoMLab experiments to those obtained in the conventional reaching experiments. The results of the in-class experiments show that PoMLab can be used to conduct motor learning experiments at any time and place.

Rotation Periods and Photometric Amplitudes for Cool Stars with TESS

NASA Astrophysics Data System (ADS)

Andrews, Hannah; Dominguez, Zechariah; Johnson, Sara; Buzasi, Derek L.

2018-06-01

The original Kepler mission observed 200000 stars in the same field nearly continuously for over four years, generating an unparalleled set of stellar rotation curves and new insights into the correlation between rotation periods and photometric variability on the lower main sequence. The continuation of Kepler in the guise of K2 has allowed us to examine a stellar sample comparable in size to that observed with Kepler, but drawn from new stellar populations. However, K2 observed each field for at most three months, limiting the inferences that can be drawn, particularly for older, slower-rotating stars. The upcoming TESS spacecraft will provide light curves for perhaps two orders of magnitude more stars, but with time windows as short as 27 days. In this work, we resample Kepler light curves using the TESS observing window, and study what can be learned from high-precision light curves of such short lengths, and how to compare those results to what we have learned from Kepler.

A Growth Curve Analysis of Novel Word Learning by Sequential Bilingual Preschool Children

ERIC Educational Resources Information Center

Kan, Pui Fong; Kohnert, Kathryn

2012-01-01

Longitudinal word learning studies which control for experience can advance understanding of language learning and potential intra- and inter-language relationships in developing bilinguals. We examined novel word learning in both the first (L1) and the second (L2) languages of bilingual children. The rate and shape of change as well as the role…

Life Span as the Measure of Performance and Learning in a Business Gaming Simulation

ERIC Educational Resources Information Center

Thavikulwat, Precha

2012-01-01

This study applies the learning curve method of measuring learning to participants of a computer-assisted business gaming simulation that includes a multiple-life-cycle feature. The study involved 249 participants. It verified the workability of the feature and estimated the participants' rate of learning at 17.4% for every doubling of experience.…

Feedback-based probabilistic category learning is selectively impaired in attention/hyperactivity deficit disorder.

PubMed

Gabay, Yafit; Goldfarb, Liat

2017-07-01

Although Attention-Deficit Hyperactivity Disorder (ADHD) is closely linked to executive function deficits, it has recently been attributed to procedural learning impairments that are quite distinct from the former. These observations challenge the ability of the executive function framework solely to account for the diverse range of symptoms observed in ADHD. A recent neurocomputational model emphasizes the role of striatal dopamine (DA) in explaining ADHD's broad range of deficits, but the link between this model and procedural learning impairments remains unclear. Significantly, feedback-based procedural learning is hypothesized to be disrupted in ADHD because of the involvement of striatal DA in this type of learning. In order to test this assumption, we employed two variants of a probabilistic category learning task known from the neuropsychological literature. Feedback-based (FB) and paired associate-based (PA) probabilistic category learning were employed in a non-medicated sample of ADHD participants and neurotypical participants. In the FB task, participants learned associations between cues and outcomes initially by guessing and subsequently through feedback indicating the correctness of the response. In the PA learning task, participants viewed the cue and its associated outcome simultaneously without receiving an overt response or corrective feedback. In both tasks, participants were trained across 150 trials. Learning was assessed in a subsequent test without a presentation of the outcome or corrective feedback. Results revealed an interesting disassociation in which ADHD participants performed as well as control participants in the PA task, but were impaired compared with the controls in the FB task. The learning curve during FB training differed between the two groups. Taken together, these results suggest that the ability to incrementally learn by feedback is selectively disrupted in ADHD participants. These results are discussed in relation to both the ADHD dopaminergic dysfunction model and recent findings implicating procedural learning impairments in those with ADHD. Copyright © 2017 Elsevier Inc. All rights reserved.

Tools to Make Online Students and Community Partners in a Service Learning Project More "AT-EASE"--Evidence from a Finance Class

ERIC Educational Resources Information Center

Butchey, Deanne

2014-01-01

The impact of service learning as a pedagogy to ensure efficient and effective experiential learning is well recognized, but in business schools, there is a perception that a steep learning curve exists for the students, faculty, and community. We use a tool to motivate and build competence in participants of a service learning project undertaken…

Machine learning methods for the classification of gliomas: Initial results using features extracted from MR spectroscopy.

PubMed

Ranjith, G; Parvathy, R; Vikas, V; Chandrasekharan, Kesavadas; Nair, Suresh

2015-04-01

With the advent of new imaging modalities, radiologists are faced with handling increasing volumes of data for diagnosis and treatment planning. The use of automated and intelligent systems is becoming essential in such a scenario. Machine learning, a branch of artificial intelligence, is increasingly being used in medical image analysis applications such as image segmentation, registration and computer-aided diagnosis and detection. Histopathological analysis is currently the gold standard for classification of brain tumors. The use of machine learning algorithms along with extraction of relevant features from magnetic resonance imaging (MRI) holds promise of replacing conventional invasive methods of tumor classification. The aim of the study is to classify gliomas into benign and malignant types using MRI data. Retrospective data from 28 patients who were diagnosed with glioma were used for the analysis. WHO Grade II (low-grade astrocytoma) was classified as benign while Grade III (anaplastic astrocytoma) and Grade IV (glioblastoma multiforme) were classified as malignant. Features were extracted from MR spectroscopy. The classification was done using four machine learning algorithms: multilayer perceptrons, support vector machine, random forest and locally weighted learning. Three of the four machine learning algorithms gave an area under ROC curve in excess of 0.80. Random forest gave the best performance in terms of AUC (0.911) while sensitivity was best for locally weighted learning (86.1%). The performance of different machine learning algorithms in the classification of gliomas is promising. An even better performance may be expected by integrating features extracted from other MR sequences. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video.

PubMed

Dias-Silva, Diogo; Pimentel-Nunes, Pedro; Magalhães, Joana; Magalhães, Ricardo; Veloso, Nuno; Ferreira, Carlos; Figueiredo, Pedro; Moutinho, Pedro; Dinis-Ribeiro, Mário

2014-06-01

A simplified narrow-band imaging (NBI) endoscopy classification of gastric precancerous and cancerous lesions was derived and validated in a multicenter study. This classification comes with the need for dissemination through adequate training. To address the learning curve of this classification by endoscopists with differing expertise and to assess the feasibility of a YouTube-based learning program to disseminate it. Prospective study. Five centers. Six gastroenterologists (3 trainees, 3 fully trained endoscopists [FTs]). Twenty tests provided through a Web-based program containing 10 randomly ordered NBI videos of gastric mucosa were taken. Feedback was sent 7 days after every test submission. Measures of accuracy of the NBI classification throughout the time. From the first to the last 50 videos, a learning curve was observed with a 10% increase in global accuracy, for both trainees (from 64% to 74%) and FTs (from 56% to 65%). After 200 videos, sensitivity and specificity of 80% and higher for intestinal metaplasia were observed in half the participants, and a specificity for dysplasia greater than 95%, along with a relevant likelihood ratio for a positive result of 7 to 28 and likelihood ratio for a negative result of 0.21 to 0.82, were achieved by all of the participants. No constant learning curve was observed for the identification of Helicobacter pylori gastritis and sensitivity to dysplasia. The trainees had better results in all of the parameters, except specificity for dysplasia, compared with the FTs. Globally, participants agreed that the program's structure was adequate, except on the feedback, which should have consisted of a more detailed explanation of each answer. No formal sample size estimate. A Web-based learning program could be used to teach and disseminate classifications in the endoscopy field. In this study, an NBI classification for gastric mucosal features seems to be easily learned for the identification of gastric preneoplastic lesions. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Perceptual learning as improved probabilistic inference in early sensory areas.

PubMed

Bejjanki, Vikranth R; Beck, Jeffrey M; Lu, Zhong-Lin; Pouget, Alexandre

2011-05-01

Extensive training on simple tasks such as fine orientation discrimination results in large improvements in performance, a form of learning known as perceptual learning. Previous models have argued that perceptual learning is due to either sharpening and amplification of tuning curves in early visual areas or to improved probabilistic inference in later visual areas (at the decision stage). However, early theories are inconsistent with the conclusions of psychophysical experiments manipulating external noise, whereas late theories cannot explain the changes in neural responses that have been reported in cortical areas V1 and V4. Here we show that we can capture both the neurophysiological and behavioral aspects of perceptual learning by altering only the feedforward connectivity in a recurrent network of spiking neurons so as to improve probabilistic inference in early visual areas. The resulting network shows modest changes in tuning curves, in line with neurophysiological reports, along with a marked reduction in the amplitude of pairwise noise correlations.

Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator.

PubMed

Larsen, C R; Grantcharov, T; Aggarwal, R; Tully, A; Sørensen, J L; Dalsgaard, T; Ottesen, B

2006-09-01

Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopy. Virtual reality (VR) simulators may be useful tools for training and assessing basic and advanced surgical skills and procedures. This study aimed to investigate the construct validity of the LapSimGyn VR simulator, and to determine the learning curves of gynecologists with different levels of experience. For this study, 32 gynecologic trainees and consultants (juniors or seniors) were allocated into three groups: novices (0 advanced laparoscopic procedures), intermediate level (>20 and <60 procedures), and experts (>100 procedures). All performed 10 sets of simulations consisting of three basic skill tasks and an ectopic pregnancy program. The simulations were carried out on 3 days within a maximum period of 2 weeks. Assessment of skills was based on time, economy of movement, and error parameters measured by the simulator. The data showed that expert gynecologists performed significantly and consistently better than intermediate and novice gynecologists. The learning curves differed significantly between the groups, showing that experts start at a higher level and more rapidly reach the plateau of their learning curve than do intermediate and novice groups of surgeons. The LapSimGyn VR simulator package demonstrates construct validity on both the basic skills module and the procedural gynecologic module for ectopic pregnancy. Learning curves can be obtained, but to reach the maximum performance for the more complex tasks, 10 repetitions do not seem sufficient at the given task level and settings. LapSimGyn also seems to be flexible and widely accepted by the users.

Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases.

PubMed

Qiu, Zhengjun; Sun, Jing; Pu, Ying; Jiang, Tao; Cao, Jun; Wu, Weidong

2011-09-01

Transumbilical single incision laparoscopic surgery (SILS) is a new laparoscopic procedure in which only one transumbilical incision is made, demonstrated as a scarless procedure. Here we report a single-center preliminary experience of transumbilical single incision laparoscopic cholecystectomy (SILC) in the treatment of benign gallbladder diseases, defining a single surgeon's learning curve. A total of 80 patients underwent SILC successfully by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. Then the perioperative demographics were recorded and the operative time was used to define the learning curve. The study group included 27 male and 53 female patients with gallstones (56 cases), cholesterol polyps (16 cases), an adenomatous polyp (3 cases), adenomyomatosis (1 case), or complex diseases (4 cases), and all consented to undergo SILC. No patient was converted to normal LC or open surgery. There were no perioperative port-related or surgical complications. The average operative time was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. The learning curve of the SILC procedures for this series of selected patients confirmed that SILC is a feasible, safe, and effective approach to the treatment of benign gallbladder diseases. For experienced laparoscopic surgeons, SILC is an easy and safe procedure. Patients benefit from milder pain, a lower incidence of port-related complications, better cosmesis, and fast recovery. The SILC procedure may become another option for the treatment of benign gallbladder diseases for selected patients.

Balloon dilation of the eustachian tube in a cadaver model: technical considerations, learning curve, and potential barriers.

PubMed

McCoul, Edward D; Singh, Ameet; Anand, Vijay K; Tabaee, Abtin

2012-04-01

The surgical management options for eustachian tube dysfunction have historically been limited. The goal of the current study was to evaluate the technical considerations, learning curve, and potential barriers for balloon dilation of the eustachian tube (BDET) as an alternative treatment modality. Prospective preclinical trial of BDET in a cadaver model. A novel balloon catheter device was used for eustachian tube dilation. Twenty-four BDET procedures were performed by three independent rhinologists with no prior experience with the procedure (eight procedures per surgeon). The duration and number of attempts of the individual steps and overall procedure were recorded. Endoscopic examination of the eustachian tube was performed after each procedure, and the surgeon was asked to rate the subjective difficulty on a five-point scale. Successful completion of the procedure occurred in each case. The overall mean duration of the procedure was 284 seconds, and a mean number of 1.15 attempts were necessary to perform the individual steps. The mean subjective procedure difficulty was noted as somewhat easy. Statistically shorter duration and subjectively easier procedure were noted in the second compared to the first half of the series, indicating a favorable learning curve. Linear fissuring within the eustachian tube lumen without submucosal disruption (nine procedures, 37%) and with submucosal disruption (five procedures, 21%) were noted. The significance of these physical findings is unclear. Preclinical testing of BDET is associated with favorable duration, learning curve, and overall ease of completion. Clinical trials are necessary to evaluate safety and efficacy. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Venous Grafts Procured During the Learning Curve for Endoscopic Veins Harvesting Show Compromised Vascular Remodeling

PubMed Central

Kiani, Soroosh; Desai, Pranjal H.; Thirumvalavan, Nannan; Kurian, Dinesh John; Flynn, Mary Margaret; Zhao, XiaoQing

2011-01-01

BACKGROUND Endoscopic vein harvest (EVH) is the US standard of care for CABG but recent comparisons to open harvest suggest that conduit quality and outcomes may be compromised. To test the hypothesis that problems with EVH may relate to its learning curve and conduit quality, we analyzed the quality and early function of conduits procured by technicians with varying EVH experience. METHODS EVH was performed during CABG by “experienced” (>900 cases, n=55 patients) vs. “novice” (<100 cases, n=30 patients) technicians. Afterwards, conduits were and examined for vascular injury using optical coherence tomography (OCT), with segments identified as injured further examined for gene expression using a tissue injury array. Conduit diameter was measured intra- and postoperatively (day 5 and 6 months) using OCT and Computed-Tomography angiography. RESULTS EVH performed by novice harvesters resulted in increased number of discrete graft injuries and higher expression of tissue injury genes. Regression analysis revealed an association between shear stress and early dilation (positive remodeling) (R2 =0.48, p <0.01). Injured veins showed blunted positive remodeling at 5 days and a greater degree of late lumen loss at 6 months. CONCLUSION Under normal conditions, intraluminal shear stress leads vein grafts to develop positive remodeling over the first postoperative week. Injury to conduits, a frequent sequela of the learning curve for EVH, was a predictor of early graft failure, blunted positive remodeling and greater negative remodeling. Given the ongoing annual volume of EVH cases, rigorous monitoring of the learning curve represents an important and unrecognized public health issue. PMID:21996436

Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve.

PubMed

Koedam, T W A; Veltcamp Helbach, M; van de Ven, P M; Kruyt, Ph M; van Heek, N T; Bonjer, H J; Tuynman, J B; Sietses, C

2018-04-01

Transanal total mesorectal excision (TaTME) provides an excellent view of the resection margins for rectal cancer from below, but is challenging due to few anatomical landmarks. During implementation of this technique, patient safety and optimal outcomes need to be ensured. The aim of this study was to evaluate the learning curve of TaTME in patients with rectal cancer in order to optimize future training programs. All consecutive patients after TaTME for rectal cancer between February 2012 and January 2017 were included in a single-center database. Influence of surgical experience on major postoperative complications, leakage rate and operating time was evaluated using cumulative sum charts and the splitting model. Correction for potential case-mix differences was performed. Over a period of 60 months, a total of 138 patients were included in this study. Adjusted for case-mix, improvement in postoperative outcomes was clearly seen after the first 40 patients, showing a decrease in major postoperative complications from 47.5 to 17.5% and leakage rate from 27.5 to 5%. Mean operating time (42 min) and conversion rate (from 10% to zero) was lower after transition to a two-team approach, but neither endpoint decreased with experience. Readmission and reoperation rates were not influenced by surgical experience. The learning curve of TaTME affected major (surgical) postoperative complications for the first 40 patients. A two-team approach decreased operative time and conversion rate. When implementing this new technique, a thorough teaching and supervisory program is recommended to shorten the learning curve and improve the clinical outcomes of the first patients.

Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve?

PubMed

Kamara, Eli; Robinson, Jonathon; Bas, Marcel A; Rodriguez, Jose A; Hepinstall, Matthew S

2017-01-01

Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve. Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior [FA]) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior [RP]), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques. Component position was measured on plain radiographs. Radiographic measurements were taken by 2 blinded observers. The percentage of hips within the surgeons' "target zone" (inclination, 30°-50°; anteversion, 10°-30°) was calculated, along with the percentage within the "safe zone" of Lewinnek (inclination, 30°-50°; anteversion, 5°-25°) and Callanan (inclination, 30°-45°; anteversion, 5°-25°). Relative risk (RR) and absolute risk reduction (ARR) were calculated. Variances (square of the standard deviations) were used to describe the variability of cup position. Seventy-six percentage of MP THAs were within the surgeons' target zone compared with 84% of FA THAs and 97% of RP THAs. This difference was statistically significant, associated with a RR reduction of 87% (RR, 0.13 [0.04-0.40]; P < .01; ARR, 21%; number needed to treat, 5) for RP compared to MP THAs. Compared to FA THAs, RP THAs were associated with a RR reduction of 81% (RR, 0.19 [0.06-0.62]; P < .01; ARR, 13%; number needed to treat, 8). Variances were lower for acetabulum inclination and anteversion in RP THAs (14.0 and 19.5) as compared to the MP (37.5 and 56.3) and FA (24.5 and 54.6) groups. These differences were statistically significant (P < .01). Adoption of robotic techniques delivers significant and immediate improvement in the precision of acetabular component positioning during the learning curve. While fluoroscopy has been shown to be beneficial with experience, a learning curve exists before precision improves significantly. Copyright © 2016 Elsevier Inc. All rights reserved.

A Glance at Institutional Support for Faculty Teaching in an Online Learning Environment

ERIC Educational Resources Information Center

Lion, Robert W.; Stark, Gary

2010-01-01

With continued advances in web-based learning, colleges and universities strive to meet the needs and interests of students, faculty, and staff. New instructional technologies have at least one thing in common: the learning curve associated with users becoming adept. Mastery requires significant time and attention. Providing the best quality…

Curved Saccade Trajectories Reveal Conflicting Predictions in Associative Learning

ERIC Educational Resources Information Center

Koenig, Stephan; Lachnit, Harald

2011-01-01

We report how the trajectories of saccadic eye movements are affected by memory interference acquired during associative learning. Human participants learned to perform saccadic choice responses based on the presentation of arbitrary central cues A, B, AC, BC, AX, BY, X, and Y that were trained to predict the appearance of a peripheral target…

MILS in a general surgery unit: learning curve, indications, and limitations.

PubMed

Patriti, Alberto; Marano, Luigi; Casciola, Luciano

2015-06-01

Minimally invasive liver surgery (MILS) is going to be a method with a wide diffusion even in general surgery units. Organization, learning curve effect, and the environment are crucial issues to evaluate before starting a program of minimally invasive liver resections. Analysis of a consecutive series of 70 patients has been used to define advantages and limits of starting a program of MILS in a general surgery unit. Seventeen MILS have been calculated with the cumulative sum method as the number of cases to complete the learning curve. Operative times [270 (60-480) vs. 180 (15-550) min; p 0.01] and rate of conversion (6/17 vs. 5/53; p 0.018) decrease after this number of cases. More complex cases can be managed after a proper optimization of all steps of liver resection. When a high confidence of the medical and nurse staff with MILS is reached, economical and strategic issues should be evaluated in order to establish a multidisciplinary hepatobiliary unit independent from the general surgery unit to manage more complex cases.

Measuring the surgical 'learning curve': methods, variables and competency.

PubMed

Khan, Nuzhath; Abboudi, Hamid; Khan, Mohammed Shamim; Dasgupta, Prokar; Ahmed, Kamran

2014-03-01

To describe how learning curves are measured and what procedural variables are used to establish a 'learning curve' (LC). To assess whether LCs are a valuable measure of competency. A review of the surgical literature pertaining to LCs was conducted using the Medline and OVID databases. Variables should be fully defined and when possible, patient-specific variables should be used. Trainee's prior experience and level of supervision should be quantified; the case mix and complexity should ideally be constant. Logistic regression may be used to control for confounding variables. Ideally, a learning plateau should reach a predefined/expert-derived competency level, which should be fully defined. When the group splitting method is used, smaller cohorts should be used in order to narrow the range of the LC. Simulation technology and competence-based objective assessments may be used in training and assessment in LC studies. Measuring the surgical LC has potential benefits for patient safety and surgical education. However, standardisation in the methods and variables used to measure LCs is required. Confounding variables, such as participant's prior experience, case mix, difficulty of procedures and level of supervision, should be controlled. Competency and expert performance should be fully defined. © 2013 The Authors. BJU International © 2013 BJU International.

Modeling cascading diffusion of new energy technologies: case study of residential solid oxide fuel cells in the US and internationally.

PubMed

Herron, Seth; Williams, Eric

2013-08-06

Subsidy programs for new energy technologies are motivated by the experience curve: increased adoption of a technology leads to learning and economies of scale that lower costs. Geographic differences in fuel prices and climate lead to large variability in the economic performance of energy technologies. The notion of cascading diffusion is that regions with favorable economic conditions serve as the basis to build scale and reduce costs so that the technology becomes attractive in new regions. We develop a model of cascading diffusion and implement via a case study of residential solid oxide fuel cells (SOFCs) for combined heating and power. We consider diffusion paths within the U.S. and internationally. We construct market willingness-to-pay curves and estimate future manufacturing costs via an experience curve. Combining market and cost results, we find that for rapid cost reductions (learning rate = 25%), a modest public subsidy can make SOFC investment profitable for 20-160 million households. If cost reductions are slow however (learning rate = 15%), residential SOFCs may not become economically competitive. Due to higher energy prices in some countries, international diffusion is more favorable than domestic, mitigating much of the uncertainty in the learning rate.

PHOTOMETRIC SUPERNOVA CLASSIFICATION WITH MACHINE LEARNING

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lochner, Michelle; Peiris, Hiranya V.; Lahav, Ofer

Automated photometric supernova classification has become an active area of research in recent years in light of current and upcoming imaging surveys such as the Dark Energy Survey (DES) and the Large Synoptic Survey Telescope, given that spectroscopic confirmation of type for all supernovae discovered will be impossible. Here, we develop a multi-faceted classification pipeline, combining existing and new approaches. Our pipeline consists of two stages: extracting descriptive features from the light curves and classification using a machine learning algorithm. Our feature extraction methods vary from model-dependent techniques, namely SALT2 fits, to more independent techniques that fit parametric models tomore » curves, to a completely model-independent wavelet approach. We cover a range of representative machine learning algorithms, including naive Bayes, k -nearest neighbors, support vector machines, artificial neural networks, and boosted decision trees (BDTs). We test the pipeline on simulated multi-band DES light curves from the Supernova Photometric Classification Challenge. Using the commonly used area under the curve (AUC) of the Receiver Operating Characteristic as a metric, we find that the SALT2 fits and the wavelet approach, with the BDTs algorithm, each achieve an AUC of 0.98, where 1 represents perfect classification. We find that a representative training set is essential for good classification, whatever the feature set or algorithm, with implications for spectroscopic follow-up. Importantly, we find that by using either the SALT2 or the wavelet feature sets with a BDT algorithm, accurate classification is possible purely from light curve data, without the need for any redshift information.« less

How the manner of presentation of data influences older patients in determining their treatment preferences.

PubMed

Mazur, D J; Merz, J F

1993-03-01

To assess how the manner of presentation of graphic data to older patients influences their treatment preferences. Cross-sectional structured interviews with patients. A university-based Department of Veterans Affairs Medical Center. One hundred sixty-six consecutive patients (mean age = 64.8 years, range of ages 29-82) seen in a Department of Veterans Affairs general medicine clinic. Five pairs of 5-year survival curves were presented to patients. Each pair was composed of two survival curves for alternative unidentified treatments for an unidentified medical condition. Curve A (LT = better long-term, worse short-term survival) was fixed throughout all curve pairs. Curve B (ST = better short-term, worse long-term survival) changed in each curve pair, showing incrementally better chances of short-term survival across the five curve pairs. Patients were randomly assigned to view the curve pairs in forward (increasing short-term survival) or backward (decreasing short-term survival) order. Order is a significant predictor of patients' initial preferences for the short-term survival curve (P = 0.0004) as well as their willingness to shift preferences during presentation of the five curve pairs. Patients > or = 65 were more likely to initially choose the ST curve in forward order presentation than patients < 65. More educated patients generally were less likely to prefer the ST curve under both elicitation orders. The data indicate that the method of eliciting patients' preferences strongly influenced their expressed preferences, and that these preferences may have predictable relationships with demographic characteristics such as age.

Motor Learning: An Analysis of 100 Trials of a Ski Slalom Game in Children with and without Developmental Coordination Disorder

PubMed Central

Smits-Engelsman, Bouwien C. M.; Jelsma, Lemke Dorothee; Ferguson, Gillian D.; Geuze, Reint H.

2015-01-01

Objective Although Developmental Coordination Disorder (DCD) is often characterized as a skill acquisition deficit disorder, few studies have addressed the process of motor learning. This study examined learning of a novel motor task; the Wii Fit ski slalom game. The main objectives were to determine: 1) whether learning occurs over 100 trial runs of the game, 2) if the learning curve is different between children with and without DCD, 3) if learning is different in an easier or harder version of the task, 4) if learning transfers to other balance tasks. Method 17 children with DCD (6–10 years) and a matched control group of 17 typically developing (TD) children engaged in 20 minutes of gaming, twice a week for five weeks. Each training session comprised of alternating trial runs, with five runs at an easy level and five runs at a difficult level. Wii scores, which combine speed and accuracy per run, were recorded. Standardized balance tasks were used to measure transfer. Results Significant differences in initial performance were found between groups on the Wii score and balance tasks. Both groups improved their Wii score over the five weeks. Improvement in the easy and in the hard task did not differ between groups. Retention in the time between training sessions was not different between TD and DCD groups either. The DCD group improved significantly on all balance tasks. Conclusions The findings in this study give a fairly coherent picture of the learning process over a medium time scale (5 weeks) in children novice to active computer games; they learn, retain and there is evidence of transfer to other balance tasks. The rate of motor learning is similar for those with and without DCD. Our results raise a number of questions about motor learning that need to be addressed in future research. PMID:26466324

Summative Evaluation of the Learning Initiatives Program (LIP). Final Report

ERIC Educational Resources Information Center

Human Resources and Skills Development Canada, 2005

2005-01-01

The Learning Initiatives Program (LIP), formerly the Learning Initiatives Fund (LIF), is a contribution program which was established in 1994 to encourage and support initiatives that contribute to the development of a results-oriented, accessible, relevant and accountable learning system in Canada. Through this program, Human Resources and Skills…

Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load.

PubMed

Bilotta, Federico; Titi, Luca; Lanni, Fabiana; Stazi, Elisabetta; Rosa, Giovanni

2013-08-01

To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a "good-excellent" level of competence. Prospective study. Operating room of a university hospital. 7 volunteer residents in anesthesiology. Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual's ability was based on the resident's self-assessment score and the attending anesthesiologist's judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). Each task had a specific learning rate; the number of procedures necessary to achieve "good-excellent" ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides "good-excellent" ability. © 2013 Elsevier Inc. All rights reserved.

Assessing the Impact of Surgeon Experience on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy: Results of Four High-Volume Surgeons.

PubMed

Fossati, Nicola; Di Trapani, Ettore; Gandaglia, Giorgio; Dell'Oglio, Paolo; Umari, Paolo; Buffi, Nicolò Maria; Guazzoni, Giorgio; Mottrie, Alexander; Gaboardi, Franco; Montorsi, Francesco; Briganti, Alberto; Suardi, Nazareno

2017-09-01

To test the impact of surgeon experience on urinary continence (UC) recovery after robot-assisted radical prostatectomy (RARP). The study included 1477 consecutive patients treated with RARP by four surgeons between 2006 and 2014. UC recovery was defined as being completely dry over a 24-hour period at follow-up. Surgeon experience was coded as the total number of RARP performed by the surgeon before the patient's operation. Multivariable analysis tested the association between surgeon experience and UC recovery. Covariates consisted of patient age, Charlson comorbidity index, preoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), nerve-sparing surgery (none vs unilateral vs bilateral), and preoperative risk groups (low- vs intermediate- vs high risk). The number of cases performed by each surgeon was 541, 413, 411, and 112, respectively. Median follow-up was 24 months (inter-quartile range: 18, 40). The UC recovery rate at 1 year after surgery was 82%. At multivariable analyses, surgeon experience represented an independent predictor of UC recovery (hazard ratio: 1.02, p < 0.001). The surgical learning curve was similar among surgeons, moving linearly from ∼60% of UC rate at the initial cases to almost 90% after more than 400 procedures. In patients undergoing RARP, surgeon experience is a significant predictor of UC recovery. The surgical learning curve of UC recovery does not reach a plateau even after more than 100 cases, suggesting a continuous improvement of the surgical technique. These findings deserve attention for patient counseling and future comparative studies evaluating functional outcomes after RARP.

Performance of medical students on a virtual reality simulator for knee arthroscopy: an analysis of learning curves and predictors of performance.

PubMed

Rahm, Stefan; Wieser, Karl; Wicki, Ilhui; Holenstein, Livia; Fucentese, Sandro F; Gerber, Christian

2016-03-25

Ethical concerns for surgical training on patients, limited working hours with fewer cases per trainee and the potential to better select talented persons for arthroscopic surgery raise the interest in simulator training for arthroscopic surgery. It was the purpose of this study to analyze learning curves of novices using a knee arthroscopy simulator and to correlate their performance with potentially predictive factors. Twenty medical students completed visuospatial tests and were then subjected to a simulator training program of eight 30 min sessions. Their test results were quantitatively correlated with their simulator performance at initiation, during and at the end of the program. The mean arthroscopic performance score (z-score in points) at the eight test sessions were 1. -35 (range, -126 to -5) points, 2. -16 (range, -30 to -2), 3. -11 (range, -35 to 4), 4. -3 (range, -16 to 5), 5. -2 (range, -28 to 7), 6. 1 (range, -18 to 8), 7. 2 (range, -9 to 8), 8. 2 (range, -4 to 7). Scores improved significantly from sessions 1 to 2 (p = 0.001), 2 to 3 (p = 0.052) and 3 to 4 (p = 0.001) but not thereafter. None of the investigated parameters predicted performance or development of arthroscopic performance. Novices improve significantly within four 30 min test virtual arthroscopy knee simulator training but not thereafter within the setting studied. No factors, predicting talent or speed and magnitude of improvement of skills could be identified.

The opponent channel population code of sound location is an efficient representation of natural binaural sounds.

PubMed

Młynarski, Wiktor

2015-05-01

In mammalian auditory cortex, sound source position is represented by a population of broadly tuned neurons whose firing is modulated by sounds located at all positions surrounding the animal. Peaks of their tuning curves are concentrated at lateral position, while their slopes are steepest at the interaural midline, allowing for the maximum localization accuracy in that area. These experimental observations contradict initial assumptions that the auditory space is represented as a topographic cortical map. It has been suggested that a "panoramic" code has evolved to match specific demands of the sound localization task. This work provides evidence suggesting that properties of spatial auditory neurons identified experimentally follow from a general design principle- learning a sparse, efficient representation of natural stimuli. Natural binaural sounds were recorded and served as input to a hierarchical sparse-coding model. In the first layer, left and right ear sounds were separately encoded by a population of complex-valued basis functions which separated phase and amplitude. Both parameters are known to carry information relevant for spatial hearing. Monaural input converged in the second layer, which learned a joint representation of amplitude and interaural phase difference. Spatial selectivity of each second-layer unit was measured by exposing the model to natural sound sources recorded at different positions. Obtained tuning curves match well tuning characteristics of neurons in the mammalian auditory cortex. This study connects neuronal coding of the auditory space with natural stimulus statistics and generates new experimental predictions. Moreover, results presented here suggest that cortical regions with seemingly different functions may implement the same computational strategy-efficient coding.

The U-Curve of E-Learning: Course Website and Online Video Use in Blended and Distance Learning

ERIC Educational Resources Information Center

Geri, Nitza; Gafni, Ruti; Winer, Amir

2014-01-01

Procrastination is a common challenge for students. While course Websites and online video lectures enable studying anytime, anywhere, and expand learning opportunities, their availability may increase procrastination by making it easier for students to defer until tomorrow. This research used Google Analytics to examine temporal use patterns of…

What Is the Future of Learning in Canada?

ERIC Educational Resources Information Center

Canadian Council on Learning, 2011

2011-01-01

In its final report to Canadians, the Canadian Council on Learning (CCL) reveals that Canada is slipping down the international learning curve. The needs in this area are stark. The potential rewards are enormous. But Canada is falling behind competitor countries and economies. It is on the wrong road and must make a dramatic change in the course…

Learning Curve Analyses in Neurodevelopmental Disorders: Are Children with Autism Spectrum Disorder Truly Visual Learners?

ERIC Educational Resources Information Center

Erdodi, Laszlo; Lajiness-O'Neill, Renee; Schmitt, Thomas A.

2013-01-01

Visual and auditory verbal learning using a selective reminding format was studied in a mixed clinical sample of children with autism spectrum disorder (ASD) (n = 42), attention-deficit hyperactivity disorder (n = 83), velocardiofacial syndrome (n = 17) and neurotypicals (n = 38) using the Test of Memory and Learning to (1) more thoroughly…

Inter-Labeler and Intra-Labeler Variability of Condition Severity Classification Models Using Active and Passive Learning Methods

PubMed Central

Nissim, Nir; Shahar, Yuval; Boland, Mary Regina; Tatonetti, Nicholas P; Elovici, Yuval; Hripcsak, George; Moskovitch, Robert

2018-01-01

Background and Objectives Labeling instances by domain experts for classification is often time consuming and expensive. To reduce such labeling efforts, we had proposed the application of active learning (AL) methods, introduced our CAESAR-ALE framework for classifying the severity of clinical conditions, and shown its significant reduction of labeling efforts. The use of any of three AL methods (one well known [SVM-Margin], and two that we introduced [Exploitation and Combination_XA]) significantly reduced (by 48% to 64%) condition labeling efforts, compared to standard passive (random instance-selection) SVM learning. Furthermore, our new AL methods achieved maximal accuracy using 12% fewer labeled cases than the SVM-Margin AL method. However, because labelers have varying levels of expertise, a major issue associated with learning methods, and AL methods in particular, is how to best to use the labeling provided by a committee of labelers. First, we wanted to know, based on the labelers’ learning curves, whether using AL methods (versus standard passive learning methods) has an effect on the Intra-labeler variability (within the learning curve of each labeler) and inter-labeler variability (among the learning curves of different labelers). Then, we wanted to examine the effect of learning (either passively or actively) from the labels created by the majority consensus of a group of labelers. Methods We used our CAESAR-ALE framework for classifying the severity of clinical conditions, the three AL methods and the passive learning method, as mentioned above, to induce the classifications models. We used a dataset of 516 clinical conditions and their severity labeling, represented by features aggregated from the medical records of 1.9 million patients treated at Columbia University Medical Center. We analyzed the variance of the classification performance within (intra-labeler), and especially among (inter-labeler) the classification models that were induced by using the labels provided by seven labelers. We also compared the performance of the passive and active learning models when using the consensus label. Results The AL methods produced, for the models induced from each labeler, smoother Intra-labeler learning curves during the training phase, compared to the models produced when using the passive learning method. The mean standard deviation of the learning curves of the three AL methods over all labelers (mean: 0.0379; range: [0.0182 to 0.0496]), was significantly lower (p = 0.049) than the Intra-labeler standard deviation when using the passive learning method (mean: 0.0484; range: [0.0275 to 0.0724). Using the AL methods resulted in a lower mean Inter-labeler AUC standard deviation among the AUC values of the labelers’ different models during the training phase, compared to the variance of the induced models’ AUC values when using passive learning. The Inter-labeler AUC standard deviation, using the passive learning method (0.039), was almost twice as high as the Inter-labeler standard deviation using our two new AL methods (0.02 and 0.019, respectively). The SVM-Margin AL method resulted in an Inter-labeler standard deviation (0.029) that was higher by almost 50% than that of our two AL methods. The difference in the inter-labeler standard deviation between the passive learning method and the SVM-Margin learning method was significant (p = 0.042). The difference between the SVM-Margin and Exploitation method was insignificant (p = 0.29), as was the difference between the Combination_XA and Exploitation methods (p = 0.67). Finally, using the consensus label led to a learning curve that had a higher mean intra-labeler variance, but resulted eventually in an AUC that was at least as high as the AUC achieved using the gold standard label and that was always higher than the expected mean AUC of a randomly selected labeler, regardless of the choice of learning method (including a passive learning method). Using a paired t-test, the difference between the intra-labeler AUC standard deviation when using the consensus label, versus that value when using the other two labeling strategies, was significant only when using the passive learning method (p = 0.014), but not when using any of the three AL methods. Conclusions The use of AL methods, (a) reduces intra-labeler variability in the performance of the induced models during the training phase, and thus reduces the risk of halting the process at a local minimum that is significantly different in performance from the rest of the learned models; and (b) reduces Inter-labeler performance variance, and thus reduces the dependence on the use of a particular labeler. In addition, the use of a consensus label, agreed upon by a rather uneven group of labelers, might be at least as good as using the gold standard labeler, who might not be available, and certainly better than randomly selecting one of the group’s individual labelers. Finally, using the AL methods when provided by the consensus label reduced the intra-labeler AUC variance during the learning phase, compared to using passive learning. PMID:28456512

Inter-labeler and intra-labeler variability of condition severity classification models using active and passive learning methods.

PubMed

Nissim, Nir; Shahar, Yuval; Elovici, Yuval; Hripcsak, George; Moskovitch, Robert

2017-09-01

Labeling instances by domain experts for classification is often time consuming and expensive. To reduce such labeling efforts, we had proposed the application of active learning (AL) methods, introduced our CAESAR-ALE framework for classifying the severity of clinical conditions, and shown its significant reduction of labeling efforts. The use of any of three AL methods (one well known [SVM-Margin], and two that we introduced [Exploitation and Combination_XA]) significantly reduced (by 48% to 64%) condition labeling efforts, compared to standard passive (random instance-selection) SVM learning. Furthermore, our new AL methods achieved maximal accuracy using 12% fewer labeled cases than the SVM-Margin AL method. However, because labelers have varying levels of expertise, a major issue associated with learning methods, and AL methods in particular, is how to best to use the labeling provided by a committee of labelers. First, we wanted to know, based on the labelers' learning curves, whether using AL methods (versus standard passive learning methods) has an effect on the Intra-labeler variability (within the learning curve of each labeler) and inter-labeler variability (among the learning curves of different labelers). Then, we wanted to examine the effect of learning (either passively or actively) from the labels created by the majority consensus of a group of labelers. We used our CAESAR-ALE framework for classifying the severity of clinical conditions, the three AL methods and the passive learning method, as mentioned above, to induce the classifications models. We used a dataset of 516 clinical conditions and their severity labeling, represented by features aggregated from the medical records of 1.9 million patients treated at Columbia University Medical Center. We analyzed the variance of the classification performance within (intra-labeler), and especially among (inter-labeler) the classification models that were induced by using the labels provided by seven labelers. We also compared the performance of the passive and active learning models when using the consensus label. The AL methods: produced, for the models induced from each labeler, smoother Intra-labeler learning curves during the training phase, compared to the models produced when using the passive learning method. The mean standard deviation of the learning curves of the three AL methods over all labelers (mean: 0.0379; range: [0.0182 to 0.0496]), was significantly lower (p=0.049) than the Intra-labeler standard deviation when using the passive learning method (mean: 0.0484; range: [0.0275-0.0724). Using the AL methods resulted in a lower mean Inter-labeler AUC standard deviation among the AUC values of the labelers' different models during the training phase, compared to the variance of the induced models' AUC values when using passive learning. The Inter-labeler AUC standard deviation, using the passive learning method (0.039), was almost twice as high as the Inter-labeler standard deviation using our two new AL methods (0.02 and 0.019, respectively). The SVM-Margin AL method resulted in an Inter-labeler standard deviation (0.029) that was higher by almost 50% than that of our two AL methods The difference in the inter-labeler standard deviation between the passive learning method and the SVM-Margin learning method was significant (p=0.042). The difference between the SVM-Margin and Exploitation method was insignificant (p=0.29), as was the difference between the Combination_XA and Exploitation methods (p=0.67). Finally, using the consensus label led to a learning curve that had a higher mean intra-labeler variance, but resulted eventually in an AUC that was at least as high as the AUC achieved using the gold standard label and that was always higher than the expected mean AUC of a randomly selected labeler, regardless of the choice of learning method (including a passive learning method). Using a paired t-test, the difference between the intra-labeler AUC standard deviation when using the consensus label, versus that value when using the other two labeling strategies, was significant only when using the passive learning method (p=0.014), but not when using any of the three AL methods. The use of AL methods, (a) reduces intra-labeler variability in the performance of the induced models during the training phase, and thus reduces the risk of halting the process at a local minimum that is significantly different in performance from the rest of the learned models; and (b) reduces Inter-labeler performance variance, and thus reduces the dependence on the use of a particular labeler. In addition, the use of a consensus label, agreed upon by a rather uneven group of labelers, might be at least as good as using the gold standard labeler, who might not be available, and certainly better than randomly selecting one of the group's individual labelers. Finally, using the AL methods: when provided by the consensus label reduced the intra-labeler AUC variance during the learning phase, compared to using passive learning. Copyright © 2017 Elsevier B.V. All rights reserved.

Practically perfect: learning by doing at AVS congress.

PubMed

2017-02-18

It has been some time since Cambridge vet school last hosted the annual AVS congress, which meant that this year's congress committee faced a steep learning curve. However, as Gill Harris reports, it rose to the occasion. British Veterinary Association.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve.

PubMed

Duarte, Ricardo Jordão; Cury, José; Oliveira, Luis Carlos Neves; Srougi, Miguel

2013-01-01

Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.

Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills.

PubMed

Grantcharov, Teodor P; Bardram, Linda; Funch-Jensen, Peter; Rosenberg, Jacob

2003-02-01

The study was carried out to analyze the learning rate for laparoscopic skills on a virtual reality training system and to establish whether the simulator was able to differentiate between surgeons with different laparoscopic experience. Forty-one surgeons were divided into three groups according to their experience in laparoscopic surgery: masters (group 1, performed more than 100 cholecystectomies), intermediates (group 2, between 15 and 80 cholecystectomies), and beginners (group 3, fewer than 10 cholecystectomies) were included in the study. The participants were tested on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator. The learning curves regarding time reached plateau after the second repetition for group 1, the fifth repetition for group 2, and the seventh repetition for group 3 (Friedman's tests P <0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman's tests, P >0.2) indicating the absence of a learning curve for these parameters. Group 2 error scores reached plateau after the first repetition, and group 3 after the fifth repetition. Group 2 improved their economy of movement score up to the third repetition and group 3 up to the sixth repetition (Friedman's tests, P <0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P <0.05). Different learning curves existed for surgeons with different laparoscopic background. The familiarization rate on the simulator was proportional to the operative experience of the surgeons. Experienced surgeons demonstrated best laparoscopic performance on the simulator, followed by those with intermediate experience and the beginners. These differences indicate that the scoring system of MIST-VR is sensitive and specific to measuring skills relevant for laparoscopic surgery.

Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multisignal Vital Sign Monitoring Data.

PubMed

Chen, Lujie; Dubrawski, Artur; Wang, Donghan; Fiterau, Madalina; Guillame-Bert, Mathieu; Bose, Eliezer; Kaynar, Ata M; Wallace, David J; Guttendorf, Jane; Clermont, Gilles; Pinsky, Michael R; Hravnak, Marilyn

2016-07-01

The use of machine-learning algorithms to classify alerts as real or artifacts in online noninvasive vital sign data streams to reduce alarm fatigue and missed true instability. Observational cohort study. Twenty-four-bed trauma step-down unit. Two thousand one hundred fifty-three patients. Noninvasive vital sign monitoring data (heart rate, respiratory rate, peripheral oximetry) recorded on all admissions at 1/20 Hz, and noninvasive blood pressure less frequently, and partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were vital sign deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained machine-learning algorithms. The best model was evaluated on test set alerts to enact online alert classification over time. The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve performance of 0.79 (95% CI, 0.67-0.93) for peripheral oximetry at the instant the vital sign first crossed threshold and increased to 0.87 (95% CI, 0.71-0.95) at 3 minutes into the alerting period. Blood pressure area under the curve started at 0.77 (95% CI, 0.64-0.95) and increased to 0.87 (95% CI, 0.71-0.98), whereas respiratory rate area under the curve started at 0.85 (95% CI, 0.77-0.95) and increased to 0.97 (95% CI, 0.94-1.00). Heart rate alerts were too few for model development. Machine-learning models can discern clinically relevant peripheral oximetry, blood pressure, and respiratory rate alerts from artifacts in an online monitoring dataset (area under the curve > 0.87).

[Evaluation of the learning curve of residents in localizing a phantom target with ultrasonography].

PubMed

Dessieux, T; Estebe, J-P; Bloc, S; Mercadal, L; Ecoffey, C

2008-10-01

Few information are available regarding the learning curve in ultrasonography and even less for ultrasound-guided regional anesthesia. This study aimed to evaluate in a training program the learning curve on a phantom of 12 residents novice in ultrasonography. Twelve trainees inexperienced in ultrasonography were given introductory training consisting of didactic formation on the various components of the portable ultrasound machine (i.e. on/off button, gain, depth, resolution, and image storage). Then, students performed three trials, in two sets of increased difficulty, at executing these predefined tasks: adjustments of the machine, then localization of a small plastic piece introduced into roasting pork (3 cm below the surface). At the end of the evaluation, the residents were asked to insert a 22 G needle into an exact predetermined target (i.e. point of fascia intersection). The progression of the needle was continuously controlled by ultrasound visualization using injection of a small volume of water (needle perpendicular to the longitudinal plane of the ultrasound beam). Two groups of two different examiners evaluated for each three trials the skill of the residents (quality, time to perform the machine adjustments, to localize the plastic target, and to hydrolocalize, and volume used for hydrolocalization). After each trial, residents evaluated their performance using a difficulty scale (0: easy to 10: difficult). All residents performed the adjustments from the last trial of each set, with a learning curve observed in terms of duration. Localization of the plastic piece was achieved by all residents at the 6th trial, with a shorter duration of localization. Hydrolocalization was achieved after the 4th trial by all subjects. Difficulty scale was correlated to the number of trials. All these results were independent of the experience of residents in regional anesthesia. Four trials were necessary to adjust correctly the machine, to localize a target, and to complete hydrolocalization. Ultrasonography in regional anesthesia seems to be a fast-learning technique, using this kind of practical training.

Avoiding and managing vascular injury during robotic-assisted radical prostatectomy

PubMed Central

Nunez Bragayrac, Luciano A.; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A.

2015-01-01

There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented. PMID:25642293

The LARI Experience - Young Stellar Light Curves

NASA Astrophysics Data System (ADS)

Cook, Michael J.; Coveyl, Kevin; Heiland, Leo; Steffens, Gary W.

2015-05-01

The Lowell Observatory has had a long and rich history of professional-amateur (Pro-Am) collaborations beginning with the observatory's founder, Percival Lowell. The Lowell Amateur Research Initiative (LARI) was launched in 2012 to formally involve amateur astronomers in scientific research by bringing them to the attention of and helping professional astronomers with their research endeavours. One of the LARI projects is the BVRI photometric monitoring of Young Stellar Objects (YSOs), wherein amateurs obtain observations to search for new outburst events and characterize the colour evolution of previously identified outbursters. We summarize the scientific and organizational aspects of this LARI program, including its goals and science motivation, the process for getting involved with the project, the current team members and their equipment, our unique methods of collaboration, programme stars, preliminary findings, and lessons learned.

Learning Curves for Ultrasound Assessment of Lumbar Puncture Insertion Sites: When is Competency Established?

PubMed

Rankin, Jessica H; Elkhunovich, Marsha A; Rangarajan, Vijayeta; Chilstrom, Mikaela; Mailhot, Tom

2016-07-01

Ultrasound (US) can be used to improve lumbar puncture (LP) success. How to achieve competency in LP US has not been defined. Cumulative sum statistics (CUSUM) characterized competency acquisition in other skills. Identify the learning curve for 80% success rate in LP US insertion site (IS) identification among pediatric emergency medicine fellows. This prospective study took place in a single pediatric emergency department. Fellows with limited ultrasound experience received didactics, training, and three proctored examinations. Skills were evaluated in three 2-h sessions: using US, subjects identified LP ISs on a convenience sample of patients ages 0-20 years old. Subjects' IS markings were compared to markings by an expert, an emergency US fellowship-trained attending. Successful IS identification was defined as markings within 2 mm or 5 mm of the expert mark in infants and older children, respectively. A second expert marked 17 cases for interrater agreement. CUSUM was used to analyze individual learning curves. Five fellows evaluated 72 patients (mean age 11.4 years [SD = 4, range 3-20], mean body mass index 20.5 [SD = 4.4, range 13.1-37.7]) over a 3-month period. Mean number of attempts per fellow was 14.4 ± 3.1 (R 11-19); mean time to landmark identification was 72 ± 46 s (R 27-240). The two experts demonstrated 100% observed agreement. Aggregate success rate for all fellows was 75% (54/72). Four fellows showed learning curves that trended toward, but did not achieve, the acceptable success rate of 80%. Nineteen attempts are insufficient among fellows to achieve competency in US-guided LP IS identification. Copyright © 2016 Elsevier Inc. All rights reserved.

[HoLEP learning curve: Toward a standardised formation and a team strategy].

PubMed

Baron, M; Nouhaud, F-X; Delcourt, C; Grise, P; Pfister, C; Cornu, J-N; Sibert, L

2016-09-01

Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center. It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months). Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; P<0.0001 and 4.2 vs 3.37g/min, P=0.038, respectively) so as the prostatic volume (43.5 vs 68.1mL, P=0.0001). Percentage of enucleated tissue was higher in the second group, however, the difference was not significant (69.5% vs 80.4%, P=0.03). Per- and postoperative complications, hospital length of stay, urinary drainage length and functional results at 3 and 6months were not significantly different. The learning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Analysis of the learning curve for pre-cut corneal specimens in preparation for lamellar transplantation: a prospective, single-centre, consecutive case series prepared at the Lions New South Wales Eye Bank.

PubMed

Martin, Aifric Isabel; Devasahayam, Rajnesh; Hodge, Christopher; Cooper, Simon; Sutton, Gerard L

2017-09-01

This study is the first paper to establish a learning curve by a single technician. Preparation of pre-cut corneal endothelial grafts commenced at Lions New South Wales Eye Bank in December 2014. The primary objective of this study was to review the safety and reliability of the preparation method during the first year of production. This is a hospital-based, prospective case series. There were 234 consecutive donor corneal lenticules. Donor lenticules were prepared by a single operator using a linear cutting microkeratome. Immediately prior to cutting, central corneal thickness values were recorded. Measurements of the corneal bed were taken immediately following lenticule preparation. Outcomes were separated by blade sizes, and intended thickness was compared to actual thickness for each setting. Early specimens were compared to later ones to assess for a learning curve within the technique. The main parameter measured is the mean difference from intended lamellar cut thickness. The mean final cut thickness was 122.36 ± 20.35 μm, and the mean difference from intended cut was 30.17 ± 37.45 μm. No significant difference was found between results achieved with early specimens versus those achieved with later specimens (P = 0.425). Thin, reproducible endothelial grafts can routinely be produced by trained technicians at their respective eye banks without significant concerns for an extended learning curve. This service can reduce perioperative surgical complexity, required surgical paraphernalia and theatre times. The consistent preparation of single-pass, ultrathin pre-cut corneas may have additional advantages for surgeons seeking to introduce lamellar techniques. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Value of the cumulative sum test for the assessment of a learning curve: Application to the introduction of patient-specific instrumentation for total knee arthroplasty in an academic department.

PubMed

De Gori, Marco; Adamczewski, Benjamin; Jenny, Jean-Yves

2017-06-01

The purpose of the study was to use the cumulative summation (CUSUM) test to assess the learning curve during the introduction of a new surgical technique (patient-specific instrumentation) in total knee arthroplasty (TKA) in an academic department. The first 50TKAs operated on at an academic department using patient-specific templates (PSTs) were scheduled to enter the study. All patients had a preoperative computed tomography scan evaluation to plan bone resections. The PSTs were positioned intraoperatively according to the best-fit technique and their three-dimensional orientation was recorded by a navigation system. The position of the femur and tibia PST was compared to the planned position for four items for each component: coronal and sagittal orientation, medial and lateral height of resection. Items were summarized to obtain knee, femur and tibia PST scores, respectively. These scores were plotted according to chronological order and included in a CUSUM analysis. The tested hypothesis was that the PST process for TKA was immediately under control after its introduction. CUSUM test showed that positioning of the PST significantly differed from the target throughout the study. There was a significant difference between all scores and the maximal score. No case obtained the maximal score of eight points. The study was interrupted after 20 cases because of this negative evaluation. The CUSUM test is effective in monitoring the learning curve when introducing a new surgical procedure. Introducing PST for TKA in an academic department may be associated with a long-lasting learning curve. The study was registered on the clinical.gov website (Identifier NCT02429245). Copyright © 2017 Elsevier B.V. All rights reserved.

The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database.

PubMed

Ward, S T; Hancox, A; Mohammed, M A; Ismail, T; Griffiths, E A; Valori, R; Dunckley, P

2017-06-01

The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Three-Hand Endoscopic Endonasal Transsphenoidal Surgery: Experience With an Anatomy-Preserving Mononostril Approach Technique.

PubMed

Eseonu, Chikezie I; ReFaey, Karim; Pamias-Portalatin, Eva; Asensio, Javier; Garcia, Oscar; Boahene, Kofi D; Quiñones-Hinojosa, Alfredo

2018-02-01

Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. Prospective case series and retrospective data analysis of patients who were treated with the 3-hand transsphenoidal technique between January 2007 and May 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3 min, P = .001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P = .846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized. Copyright © 2017 by the Congress of Neurological Surgeons

Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy.

PubMed

Lee, Hee Jun; Kim, Ju Yeong; Kim, Seul Ki; Lee, Jung Ryeol; Suh, Chang Suk; Kim, Seok Hyun

2015-01-01

To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation. A retrospective study. A university-based hospital (Canadian Task Force classification II-2). The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included. None. We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p < .001). Proficiency, which is the point at which the slope of the learning curve became less steep, was evident after about 45 operations. Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Learning curve for peroral endoscopic myotomy

PubMed Central

El Zein, Mohamad; Kumbhari, Vivek; Ngamruengphong, Saowanee; Carson, Kathryn A.; Stein, Ellen; Tieu, Alan; Chaveze, Yamile; Ismail, Amr; Dhalla, Sameer; Clarke, John; Kalloo, Anthony; Canto, Marcia Irene; Khashab, Mouen A.

2016-01-01

Background and study aims: Although peroral endoscopic myotomy (POEM) is being performed more frequently, the learning curve for gastroenterologists performing the procedure has not been well studied. The aims of this study were to define the learning curve for POEM and determine which preoperative and intraoperative factors predict the time that will be taken to complete the procedure and its different steps. Patients and methods: Consecutive patients who underwent POEM performed by a single expert gastroenterologist for the treatment of achalasia or spastic esophageal disorders were included. The POEM procedure was divided into four steps: mucosal entry, submucosal tunneling, myotomy, and closure. Nonlinear regression was used to determine the POEM learning plateau and calculate the learning rate. Results: A total of 60 consecutive patients underwent POEM in an endoscopy suite. The median length of procedure (LOP) was 88 minutes (range 36 – 210), and the mean (± standard deviation [SD]) LOP per centimeter of myotomy was 9 ± 5 minutes. The total operative time decreased significantly as experience increased (P < 0.001), with a “learning plateau” at 102 minutes and a “learning rate” of 13 cases. The mucosal entry, tunneling, and closure times decreased significantly with experience (P < 0.001). The myotomy time showed no significant decrease with experience (P = 0.35). When the mean (± SD) total procedure times for the learning phase and the corresponding comparator groups were compared, a statistically significant difference was observed between procedures 11 – 15 and procedures 16 – 20 (15.5 ± 2.4 min/cm and 10.1 ± 2.7 min/cm, P = 0.01) but not thereafter. A higher case number was significantly associated with a decreased LOP (P < 0.001). Conclusion: In this single-center retrospective study, the minimum threshold number of cases required for an expert interventional endoscopist performing POEM to reach a plateau approached 13. PMID:27227118

Evaluation of horizontal curve design

DOT National Transportation Integrated Search

1980-08-01

This report documents an initial evaluation of horizontal curve design criteria which involved two phases: an observational study and an analytical evaluation. Three classes of vehicles (automobiles, school buses and tractor semi-trailers) and three ...

Studying Weather and Climate Using Atmospheric Retrospective Analyses

NASA Astrophysics Data System (ADS)

Bosilovich, M. G.

2014-12-01

Over the last 35 years, tremendous amounts of satellite observations of the Earth's atmosphere have been collected along side the much longer and diverse record of in situ measurements. The satellite data records have disparate qualities, structure and uncertainty which make comparing weather from the 80s and 2000s a challenging prospect. Likewise, in-situ data records lack complete coverage of the earth in both space and time. Atmospheric reanalyses use the observations with numerical models and data assimilation to produce continuous and consistent weather data records for periods longer than decades. The result is a simplified data format with a relatively straightforward learning curve that includes many more variables available (through the modeling component of the system), but driven by a full suite of observational data. The simplified data format allows introduction into weather and climate data analysis. Some examples are provided from undergraduate meteorology program internship projects. We will present the students progression through the projects from their initial understanding and competencies to some final results and the skills learned along the way. Reanalyses are a leading research tool in weather and climate, but can also provide an introductory experience as well, allowing students to develop an understanding of the physical system while learning basic programming and analysis skills.

Distant failure prediction for early stage NSCLC by analyzing PET with sparse representation

NASA Astrophysics Data System (ADS)

Hao, Hongxia; Zhou, Zhiguo; Wang, Jing

2017-03-01

Positron emission tomography (PET) imaging has been widely explored for treatment outcome prediction. Radiomicsdriven methods provide a new insight to quantitatively explore underlying information from PET images. However, it is still a challenging problem to automatically extract clinically meaningful features for prognosis. In this work, we develop a PET-guided distant failure predictive model for early stage non-small cell lung cancer (NSCLC) patients after stereotactic ablative radiotherapy (SABR) by using sparse representation. The proposed method does not need precalculated features and can learn intrinsically distinctive features contributing to classification of patients with distant failure. The proposed framework includes two main parts: 1) intra-tumor heterogeneity description; and 2) dictionary pair learning based sparse representation. Tumor heterogeneity is initially captured through anisotropic kernel and represented as a set of concatenated vectors, which forms the sample gallery. Then, given a test tumor image, its identity (i.e., distant failure or not) is classified by applying the dictionary pair learning based sparse representation. We evaluate the proposed approach on 48 NSCLC patients treated by SABR at our institute. Experimental results show that the proposed approach can achieve an area under the characteristic curve (AUC) of 0.70 with a sensitivity of 69.87% and a specificity of 69.51% using a five-fold cross validation.

Agile convolutional neural network for pulmonary nodule classification using CT images.

PubMed

Zhao, Xinzhuo; Liu, Liyao; Qi, Shouliang; Teng, Yueyang; Li, Jianhua; Qian, Wei

2018-04-01

To distinguish benign from malignant pulmonary nodules using CT images is critical for their precise diagnosis and treatment. A new Agile convolutional neural network (CNN) framework is proposed to conquer the challenges of a small-scale medical image database and the small size of the nodules, and it improves the performance of pulmonary nodule classification using CT images. A hybrid CNN of LeNet and AlexNet is constructed through combining the layer settings of LeNet and the parameter settings of AlexNet. A dataset with 743 CT image nodule samples is built up based on the 1018 CT scans of LIDC to train and evaluate the Agile CNN model. Through adjusting the parameters of the kernel size, learning rate, and other factors, the effect of these parameters on the performance of the CNN model is investigated, and an optimized setting of the CNN is obtained finally. After finely optimizing the settings of the CNN, the estimation accuracy and the area under the curve can reach 0.822 and 0.877, respectively. The accuracy of the CNN is significantly dependent on the kernel size, learning rate, training batch size, dropout, and weight initializations. The best performance is achieved when the kernel size is set to [Formula: see text], the learning rate is 0.005, the batch size is 32, and dropout and Gaussian initialization are used. This competitive performance demonstrates that our proposed CNN framework and the optimization strategy of the CNN parameters are suitable for pulmonary nodule classification characterized by small medical datasets and small targets. The classification model might help diagnose and treat pulmonary nodules effectively.

A hybrid feature selection algorithm integrating an extreme learning machine for landslide susceptibility modeling of Mt. Woomyeon, South Korea

NASA Astrophysics Data System (ADS)

Vasu, Nikhil N.; Lee, Seung-Rae

2016-06-01

An ever-increasing trend of extreme rainfall events in South Korea owing to climate change is causing shallow landslides and debris flows in mountains that cover 70% of the total land area of the nation. These catastrophic, gravity-driven processes cost the government several billion KRW (South Korean Won) in losses in addition to fatalities every year. The most common type of landslide observed is the shallow landslide, which occurs at 1-3 m depth, and may mobilize into more catastrophic flow-type landslides. Hence, to predict potential landslide areas, susceptibility maps are developed in a geographical information system (GIS) environment utilizing available morphological, hydrological, geotechnical, and geological data. Landslide susceptibility models were developed using 163 landslide points and an equal number of nonlandslide points in Mt. Woomyeon, Seoul, and 23 landslide conditioning factors. However, because not all of the factors contribute to the determination of the spatial probability for landslide initiation, and a simple filter or wrapper-based approach is not efficient in identifying all of the relevant features, a feedback-loop-based hybrid algorithm was implemented in conjunction with a learning scheme called an extreme learning machine, which is based on a single-layer, feed-forward network. Validation of the constructed susceptibility model was conducted using a testing set of landslide inventory data through a prediction rate curve. The model selected 13 relevant conditioning factors out of the initial 23; and the resulting susceptibility map shows a success rate of 85% and a prediction rate of 89.45%, indicating a good performance, in contrast to the low success and prediction rate of 69.19% and 56.19%, respectively, as obtained using a wrapper technique.

Learning curve analysis of mitral valve repair using telemanipulative technology.

PubMed

Charland, Patrick J; Robbins, Tom; Rodriguez, Evilio; Nifong, Wiley L; Chitwood, Randolph W

2011-08-01

To determine if the time required to perform mitral valve repairs using telemanipulation technology decreases with experience and how that decrease is influenced by patient and procedure variables. A single-center retrospective review was conducted using perioperative and outcomes data collected contemporaneously on 458 mitral valve repair surgeries using telemanipulative technology. A regression model was constructed to assess learning with this technology and predict total robot time using multiple predictive variables. Statistical analysis was used to determine if models were significantly useful, to rule out correlation between predictor variables, and to identify terms that did not contribute to the prediction of total robot time. We found a statistically significant learning curve (P < .01). The institutional learning percentage∗ derived from total robot times† for the first 458 recorded cases of mitral valve repair using telemanipulative technology is 95% (R(2) = .40). More than one third of the variability in total robot time can be explained through our model using the following variables: type of repair (chordal procedures, ablations, and leaflet resections), band size, use of clips alone in band implantation, and the presence of a fellow at bedside (P < .01). Learning in mitral valve repair surgery using telemanipulative technology occurs at the East Carolina Heart Institute according to a logarithmic curve, with a learning percentage of 95%. From our regression output, we can make an approximate prediction of total robot time using an additive model. These metrics can be used by programs for benchmarking to manage the implementation of this new technology, as well as for capacity planning, scheduling, and capital budget analysis. Copyright © 2011 The American Association for Thoracic Surgery. All rights reserved.

Teachers' Personal Learning Networks (PLNs): Exploring the Nature of Self-Initiated Professional Learning Online

ERIC Educational Resources Information Center

Tour, Ekaterina

2017-01-01

In the field of Literacy Studies, online spaces have been recognised as providing many opportunities for spontaneous and self-initiated learning. While some progress has been made in understanding these important learning experiences, little attention has been paid to teachers' self-initiated professional learning. Contributing to the debates…

Using a High-Fidelity Patient Simulator with First-Year Medical Students to Facilitate Learning of Cardiovascular Function Curves

ERIC Educational Resources Information Center

Harris, David M.; Ryan, Kathleen; Rabuck, Cynthia

2012-01-01

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into…

How to Avoid a Learning Curve in Stapedotomy: A Standardized Surgical Technique.

PubMed

Kwok, Pingling; Gleich, Otto; Dalles, Katharina; Mayr, Elisabeth; Jacob, Peter; Strutz, Jürgen

2017-08-01

To evaluate, whether a learning curve for beginners in stapedotomy can be avoided by using a prosthesis with thermal memory-shape attachment in combination with a standardized laser-assisted surgical technique. Retrospective case review. Tertiary referral center. Fifty-eight ears were operated by three experienced surgeons and compared with a group of 12 cases operated by a beginner in stapedotomy. Stapedotomy. Difference of pure-tone audiometry thresholds measured before and after surgery. The average postoperative gain for air conduction in the frequencies below 2 kHz was 20 to 25 dB and decreased for the higher frequencies. Using the Mann-Whitney-U test for comparing mean gain between experienced and inexperienced surgeons showed no significant difference (p = 0.281 at 4 kHz and p > 0.7 for the other frequencies). A Spearman rank correlation of the postoperative gain for air- and bone-conduction thresholds was obtained at each test frequency for the first 12 patients consecutively treated with a thermal memory-shape attachment prosthesis by two experienced and one inexperienced surgeon. This analysis does not support the hypothesis of a "learning effect" that should be associated with an improved outcome for successively treated patients. It is possible to avoid a learning curve in stapes surgery by applying a thermal memory-shape prosthesis in a standardized laser-assisted surgical procedure.

Thermomagnetic analysis of meteorites, 2: C2 chondrites

NASA Technical Reports Server (NTRS)

Watson, D. E.; Larson, E. E.; Herndon, J. M.; Rowe, M. W.

1974-01-01

Samples of all eighteen of the known C2 chondrites were analyzed thermomagnetically. For eleven of these, initial Fe3O4 content is low(generally 1%) and the J sub s-T curves are irreversible. The heating curves show variable and erratic behavior, whereas the cooling curves appear to be that of Fe3O4. The saturation moment after cooling is greater (up to 10 times larger) than it is initially. This behavior is interpreted to be the result of the production of magnetite from a thermally unstable phase--apparently FeS. Four of the remaining 7 C2 chondrites contain Fe3O4 as the only significant magnetic phase: initial magnetite contents range from 4 to 13 percent. The remaining three C2 chondrites contain iron or nickel-iron in addition to Fe3O4. These seven C2 chondrites show little evidence of the breakdown of a thermally unstable phase.

Novel Uses of Video to Accelerate the Surgical Learning Curve.

PubMed

Ibrahim, Andrew M; Varban, Oliver A; Dimick, Justin B

2016-04-01

Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementoring. Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.

Advances in Laparoscopic Colorectal Surgery.

PubMed

Parker, James Michael; Feldmann, Timothy F; Cologne, Kyle G

2017-06-01

Laparoscopic colorectal surgery has now become widely adopted for the treatment of colorectal neoplasia, with steady increases in utilization over the past 15 years. Common minimally invasive techniques include multiport laparoscopy, single-incision laparoscopy, and hand-assisted laparoscopy, with the choice of technique depending on several patient and surgeon factors. Laparoscopic colorectal surgery involves a robust learning curve, and fellowship training often lays the foundation for a high-volume laparoscopic practice. This article provides a summary of the various techniques for laparoscopic colorectal surgery, including operative steps, the approach to difficult patients, and the learning curve for proficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

NASA Astrophysics Data System (ADS)

Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

2016-02-01

Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

Digital mammographic tumor classification using transfer learning from deep convolutional neural networks.

PubMed

Huynh, Benjamin Q; Li, Hui; Giger, Maryellen L

2016-07-01

Convolutional neural networks (CNNs) show potential for computer-aided diagnosis (CADx) by learning features directly from the image data instead of using analytically extracted features. However, CNNs are difficult to train from scratch for medical images due to small sample sizes and variations in tumor presentations. Instead, transfer learning can be used to extract tumor information from medical images via CNNs originally pretrained for nonmedical tasks, alleviating the need for large datasets. Our database includes 219 breast lesions (607 full-field digital mammographic images). We compared support vector machine classifiers based on the CNN-extracted image features and our prior computer-extracted tumor features in the task of distinguishing between benign and malignant breast lesions. Five-fold cross validation (by lesion) was conducted with the area under the receiver operating characteristic (ROC) curve as the performance metric. Results show that classifiers based on CNN-extracted features (with transfer learning) perform comparably to those using analytically extracted features [area under the ROC curve [Formula: see text

What is the learning curve for robotic-assisted pedicle screw placement in spine surgery?

PubMed

Hu, Xiaobang; Lieberman, Isador H

2014-06-01

Some early studies with robotic-assisted pedicle screw implantation have suggested these systems increase accuracy of screw placement. However, the relationship between the success rate of screw placement and the learning curve of this new technique has not been evaluated. We determined whether, as a function of surgeon experience, (1) the success rate of robotic-assisted pedicle screw placement improved, (2) the frequency of conversion from robotic to manual screw placement decreased, and (3) the frequency of malpositioned screws decreased. Between June 2010 and August 2012, the senior surgeon (IHL) performed 174 posterior spinal procedures using pedicle screws, 162 of which were attempted with robotic assistance. The use of the robotic system was aborted in 12 of the 162 procedures due to technical issues (registration failure, software crash, etc). The robotic system was successfully used in the remaining 150 procedures. These were the first procedures performed with the robot by the senior surgeon, and in this study, we divided the early learning curve into five groups: Group 1 (Patients 1-30), Group 2 (Patients 31-60), Group 3 (Patients 61-90), Group 4 (Patients 91-120), and Group 5 (Patients 121-150). One hundred twelve patients (75%) had spinal deformity and 80 patients (53%) had previous spine surgery. The accuracy of screw placement in the groups was assessed based on intraoperative biplanar fluoroscopy and postoperative radiographs. The results from these five groups were compared to determine the effect on the learning curve. The numbers of attempted pedicle screw placements were 359, 312, 349, 359, and 320 in Groups 1 to 5, respectively. The rates of successfully placed screws using robotic guidance were 82%, 93%, 91%, 95%, and 93% in Groups 1 to 5. The rates of screws converted to manual placement were 17%, 7%, 8%, 4%, and 7%. Of the robotically placed screws, the screw malposition rates were 0.8%, 0.3%, 1.4%, 0.8%, and 0%. The rate of successfully placed pedicle screws improved with increasing experience. The rate of the screws that were converted to manual placement decreased with increasing experience. The frequency of screw malposition was similar over the learning curve at 0% to 1.4%. Future studies will need to determine whether this finding is generalizable to others. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Learning a New Selection Rule in Visual and Frontal Cortex.

PubMed

van der Togt, Chris; Stănişor, Liviu; Pooresmaeili, Arezoo; Albantakis, Larissa; Deco, Gustavo; Roelfsema, Pieter R

2016-08-01

How do you make a decision if you do not know the rules of the game? Models of sensory decision-making suggest that choices are slow if evidence is weak, but they may only apply if the subject knows the task rules. Here, we asked how the learning of a new rule influences neuronal activity in the visual (area V1) and frontal cortex (area FEF) of monkeys. We devised a new icon-selection task. On each day, the monkeys saw 2 new icons (small pictures) and learned which one was relevant. We rewarded eye movements to a saccade target connected to the relevant icon with a curve. Neurons in visual and frontal cortex coded the monkey's choice, because the representation of the selected curve was enhanced. Learning delayed the neuronal selection signals and we uncovered the cause of this delay in V1, where learning to select the relevant icon caused an early suppression of surrounding image elements. These results demonstrate that the learning of a new rule causes a transition from fast and random decisions to a more considerate strategy that takes additional time and they reveal the contribution of visual and frontal cortex to the learning process. © The Author 2016. Published by Oxford University Press.

Noninertial Multirelativity

NASA Astrophysics Data System (ADS)

Smarandache, Florentin

2012-10-01

We firstly propose an extension of Einstein's thought experiment with atomic clocks of the Special Theory of Relativity: considering non-constant accelerations and arbitrary 3D-curves for both a particle's speed and trajectory inside the rocket and respectively the rocket's speed and trajectory. And secondly we propose as research multiple reference frames F1, F2, , Fn moving on respectively arbitrary 3D-curves C1, C2, , Cn with respectively arbitrary non-constant accelerations a1, a2, , an and respectively initial velocities v1, v2, , vn. The reference frame Fi is moving with a nonconstant acceleration ai and initial velocity vi on a 3D-curve Ci with respect to another reference frame Fi+1 (where 1 <= i <= n-1).

Effect of Pressure Gradients on the Initiation of PBX-9502 via Irregular (Mach) Reflection of Low Pressure Curved Shock Waves

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hull, Lawrence Mark; Miller, Phillip Isaac; Moro, Erik Allan

In the instance of multiple fragment impact on cased explosive, isolated curved shocks are generated in the explosive. These curved shocks propagate and may interact and form irregular or Mach reflections along the interaction loci, thereby producing a single shock that may be sufficient to initiate PBX-9501. However, the incident shocks are divergent and their intensity generally decreases as they expand, and the regions behind the Mach stem interaction loci are generally unsupported and allow release waves to rapidly affect the flow. The effects of release waves and divergent shocks may be considered theoretically through a “Shock Change Equation”.

Spaghetti Sine Curves: Virtual Environments for Reasoning and Sense Making

ERIC Educational Resources Information Center

Özgün-Koca, S. Asli; Edwards, Michael Todd; Meagher, Michael

2013-01-01

In a recent collaboration with an area high school teacher, the authors were asked to develop an introductory sinusoidal curves lesson for a group of second-year algebra students. Because the topic was abstract and unfamiliar to these tenth graders, they looked for hands-on lessons to support their learning. One lesson that they found, which they…

Developing a Drawing Task to Differentiate Group Average Time Course vs. Dynamics in the Individual

ERIC Educational Resources Information Center

Blech, Christine; Gaschler, Robert

2017-01-01

Teaching and theorizing in psychology has long been torn between targeting general underlying principles by observing dynamics in the individual or focusing on average behavior. As dealing with group averages is common practice in psychology, it is important for students to understand how individual learning curves relate to group average curves.…

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study

PubMed Central

Luglio, Gaetano; De Palma, Giovanni Domenico; Tarquini, Rachele; Giglio, Mariano Cesare; Sollazzo, Viviana; Esposito, Emanuela; Spadarella, Emanuela; Peltrini, Roberto; Liccardo, Filomena; Bucci, Luigi

2015-01-01

Background Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, “learning curve” experience, implementing a well standardized operative technique and recovery protocol. Methods The first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed. Results Type of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo–Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission. Conclusion Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon. PMID:25859386

Understanding the gendered patterns of substance use initiation among adolescents living in rural, central Mexico

PubMed Central

Ayers, Stephanie; Marsiglia, Flavio; Hoffman, Steven; Urbaeva, Zhyldyz

2012-01-01

Background Little is known about the age of initiation and gender differences in substance use among adolescents in rural, central Mexico. Methods The cross-sectional data were collected from students enrolled in the Videobachillerato (VIBA) (video high school) program in Guanajuato, Mexico. Questionnaires asked students about the age at which they had used alcohol, cigarettes, or marijuana for the first time. Kaplan-Meier Survival Functions were used to estimate if males and females were significantly different in their cumulative probabilities of initiating substances over time. Results On average, alcohol is initiated at 14.7 years of age, cigarettes at 15.1 years of age, and marijuana at 16.5 years of age. Over time, males had a significantly higher probability of initiating alcohol (Kaplan-Meier Failure Curve: Χ2=26.35, p<0.001), cigarettes (Kaplan-Meier Failure Curve: Χ2=41.90, p<0.001), and marijuana (Kaplan-Meier Failure Curve: Χ2=38.01, p<0.001) compared to females. Conclusions These results highlight the gendered patterns of substance use initiation among adolescents in rural, central Mexico and underscore the need for gendered substance use prevention interventions with these adolescents. By putting forth efforts to understand substance use initiation patterns of adolescents living in rural, central Mexico, culturally specific and efficacious prevention efforts can be tailor-made to create lasting differences. PMID:22421555

Development and validation of a learning progression for change of seasons, solar and lunar eclipses, and moon phases

NASA Astrophysics Data System (ADS)

Testa, Italo; Galano, Silvia; Leccia, Silvio; Puddu, Emanuella

2015-12-01

In this paper, we report about the development and validation of a learning progression about the Celestial Motion big idea. Existing curricula, research studies on alternative conceptions about these phenomena, and students' answers to an open questionnaire were the starting point to develop initial learning progressions about change of seasons, solar and lunar eclipses, and Moon phases; then, a two-tier multiple choice questionnaire was designed to validate and improve them. The questionnaire was submitted to about 300 secondary students of different school levels (14 to 18 years old). Item response analysis and curve integral method were used to revise the hypothesized learning progressions. Findings support that spatial reasoning is a key cognitive factor for building an explanatory framework for the Celestial Motion big idea, but also suggest that causal reasoning based on physics mechanisms underlying the phenomena, as light flux laws or energy transfers, may significantly impact a students' understanding. As an implication of the study, we propose that the teaching of the three discussed astronomy phenomena should follow a single teaching-learning path along the following sequence: (i) emphasize from the beginning the geometrical aspects of the Sun-Moon-Earth system motion; (ii) clarify consequences of the motion of the Sun-Moon-Earth system, as the changing solar radiation flow on the surface of Earth during the revolution around the Sun; (iii) help students moving between different reference systems (Earth and space observer's perspective) to understand how Earth's rotation and revolution can change the appearance of the Sun and Moon. Instructional and methodological implications are also briefly discussed.

Action video game play facilitates the development of better perceptual templates.

PubMed

Bejjanki, Vikranth R; Zhang, Ruyuan; Li, Renjie; Pouget, Alexandre; Green, C Shawn; Lu, Zhong-Lin; Bavelier, Daphne

2014-11-25

The field of perceptual learning has identified changes in perceptual templates as a powerful mechanism mediating the learning of statistical regularities in our environment. By measuring threshold-vs.-contrast curves using an orientation identification task under varying levels of external noise, the perceptual template model (PTM) allows one to disentangle various sources of signal-to-noise changes that can alter performance. We use the PTM approach to elucidate the mechanism that underlies the wide range of improvements noted after action video game play. We show that action video game players make use of improved perceptual templates compared with nonvideo game players, and we confirm a causal role for action video game play in inducing such improvements through a 50-h training study. Then, by adapting a recent neural model to this task, we demonstrate how such improved perceptual templates can arise from reweighting the connectivity between visual areas. Finally, we establish that action gamers do not enter the perceptual task with improved perceptual templates. Instead, although performance in action gamers is initially indistinguishable from that of nongamers, action gamers more rapidly learn the proper template as they experience the task. Taken together, our results establish for the first time to our knowledge the development of enhanced perceptual templates following action game play. Because such an improvement can facilitate the inference of the proper generative model for the task at hand, unlike perceptual learning that is quite specific, it thus elucidates a general learning mechanism that can account for the various behavioral benefits noted after action game play.

Action video game play facilitates the development of better perceptual templates

PubMed Central

Bejjanki, Vikranth R.; Zhang, Ruyuan; Li, Renjie; Pouget, Alexandre; Green, C. Shawn; Lu, Zhong-Lin; Bavelier, Daphne

2014-01-01

The field of perceptual learning has identified changes in perceptual templates as a powerful mechanism mediating the learning of statistical regularities in our environment. By measuring threshold-vs.-contrast curves using an orientation identification task under varying levels of external noise, the perceptual template model (PTM) allows one to disentangle various sources of signal-to-noise changes that can alter performance. We use the PTM approach to elucidate the mechanism that underlies the wide range of improvements noted after action video game play. We show that action video game players make use of improved perceptual templates compared with nonvideo game players, and we confirm a causal role for action video game play in inducing such improvements through a 50-h training study. Then, by adapting a recent neural model to this task, we demonstrate how such improved perceptual templates can arise from reweighting the connectivity between visual areas. Finally, we establish that action gamers do not enter the perceptual task with improved perceptual templates. Instead, although performance in action gamers is initially indistinguishable from that of nongamers, action gamers more rapidly learn the proper template as they experience the task. Taken together, our results establish for the first time to our knowledge the development of enhanced perceptual templates following action game play. Because such an improvement can facilitate the inference of the proper generative model for the task at hand, unlike perceptual learning that is quite specific, it thus elucidates a general learning mechanism that can account for the various behavioral benefits noted after action game play. PMID:25385590

Applying Active Learning to Assertion Classification of Concepts in Clinical Text

PubMed Central

Chen, Yukun; Mani, Subramani; Xu, Hua

2012-01-01

Supervised machine learning methods for clinical natural language processing (NLP) research require a large number of annotated samples, which are very expensive to build because of the involvement of physicians. Active learning, an approach that actively samples from a large pool, provides an alternative solution. Its major goal in classification is to reduce the annotation effort while maintaining the quality of the predictive model. However, few studies have investigated its uses in clinical NLP. This paper reports an application of active learning to a clinical text classification task: to determine the assertion status of clinical concepts. The annotated corpus for the assertion classification task in the 2010 i2b2/VA Clinical NLP Challenge was used in this study. We implemented several existing and newly developed active learning algorithms and assessed their uses. The outcome is reported in the global ALC score, based on the Area under the average Learning Curve of the AUC (Area Under the Curve) score. Results showed that when the same number of annotated samples was used, active learning strategies could generate better classification models (best ALC – 0.7715) than the passive learning method (random sampling) (ALC – 0.7411). Moreover, to achieve the same classification performance, active learning strategies required fewer samples than the random sampling method. For example, to achieve an AUC of 0.79, the random sampling method used 32 samples, while our best active learning algorithm required only 12 samples, a reduction of 62.5% in manual annotation effort. PMID:22127105

An Ellipse Morphs to a Cosine Graph!

ERIC Educational Resources Information Center

King, L .R.

2013-01-01

We produce a continuum of curves all of the same length, beginning with an ellipse and ending with a cosine graph. The curves in the continuum are made by cutting and unrolling circular cones whose section is the ellipse; the initial cone is degenerate (it is the plane of the ellipse); the final cone is a circular cylinder. The curves of the…

Growth Curve Models for Zero-Inflated Count Data: An Application to Smoking Behavior

ERIC Educational Resources Information Center

Liu, Hui; Powers, Daniel A.

2007-01-01

This article applies growth curve models to longitudinal count data characterized by an excess of zero counts. We discuss a zero-inflated Poisson regression model for longitudinal data in which the impact of covariates on the initial counts and the rate of change in counts over time is the focus of inference. Basic growth curve models using a…

Can machine-learning improve cardiovascular risk prediction using routine clinical data?

PubMed

Weng, Stephen F; Reps, Jenna; Kai, Joe; Garibaldi, Jonathan M; Qureshi, Nadeem

2017-01-01

Current approaches to predict cardiovascular risk fail to identify many people who would benefit from preventive treatment, while others receive unnecessary intervention. Machine-learning offers opportunity to improve accuracy by exploiting complex interactions between risk factors. We assessed whether machine-learning can improve cardiovascular risk prediction. Prospective cohort study using routine clinical data of 378,256 patients from UK family practices, free from cardiovascular disease at outset. Four machine-learning algorithms (random forest, logistic regression, gradient boosting machines, neural networks) were compared to an established algorithm (American College of Cardiology guidelines) to predict first cardiovascular event over 10-years. Predictive accuracy was assessed by area under the 'receiver operating curve' (AUC); and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) to predict 7.5% cardiovascular risk (threshold for initiating statins). 24,970 incident cardiovascular events (6.6%) occurred. Compared to the established risk prediction algorithm (AUC 0.728, 95% CI 0.723-0.735), machine-learning algorithms improved prediction: random forest +1.7% (AUC 0.745, 95% CI 0.739-0.750), logistic regression +3.2% (AUC 0.760, 95% CI 0.755-0.766), gradient boosting +3.3% (AUC 0.761, 95% CI 0.755-0.766), neural networks +3.6% (AUC 0.764, 95% CI 0.759-0.769). The highest achieving (neural networks) algorithm predicted 4,998/7,404 cases (sensitivity 67.5%, PPV 18.4%) and 53,458/75,585 non-cases (specificity 70.7%, NPV 95.7%), correctly predicting 355 (+7.6%) more patients who developed cardiovascular disease compared to the established algorithm. Machine-learning significantly improves accuracy of cardiovascular risk prediction, increasing the number of patients identified who could benefit from preventive treatment, while avoiding unnecessary treatment of others.

A Framework for Mobile Learning for Enhancing Learning in Higher Education

ERIC Educational Resources Information Center

Barreh, Kadar Abdillahi; Abas, Zoraini Wati

2015-01-01

As mobile learning becomes increasingly pervasive, many higher education institutions have initiated a number of mobile learning initiatives to support their traditional learning modes. This study proposes a framework for mobile learning for enhancing learning in higher education. This framework for mobile learning is based on research conducted…

Design and life-cycle considerations for unconventional-reservoir wells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miskimins, J.L.

2009-05-15

This paper provides an overview of design and life-cycle considerations for certain unconventional-reservoir wells. An overview of unconventional-reservoir definitions is provided. Well design and life-cycle considerations are addressed from three aspects: upfront reservoir development, initial well completion, and well-life and long-term considerations. Upfront-reservoir-development issues discussed include well spacing, well orientation, reservoir stress orientations, and tubular metallurgy. Initial-well-completion issues include maximum treatment pressures and rates, treatment diversion, treatment staging, flowback and cleanup, and dewatering needs. Well-life and long-term discussions include liquid loading, corrosion, refracturing and associated fracture reorientation, and the cost of abandonment. These design considerations are evaluated with case studiesmore » for five unconventional-reservoir types: shale gas (Barnett shale), tight gas (Jonah feld), tight oil (Bakken play), coalbed methane (CBM) (San Juan basin), and tight heavy oil (Lost Hills field). In evaluating the life cycle and design of unconventional-reservoir wells, 'one size' does not fit all and valuable knowledge and a shortening of the learning curve can be achieved for new developments by studying similar, more-mature fields.« less

3D Numerical modelling of topography development associated with curved subduction zones

NASA Astrophysics Data System (ADS)

Munch, Jessica; Ueda, Kosuke; Burg, Jean-Pierre; May, Dave; Gerya, Taras

2017-04-01

Curved subduction zones, also called oroclines, are geological features found in various places on Earth. They occur in diverse geodynamic settings: 1) single slab subduction in oceanic domain (e.g. Sandwich trench in the Southern Atlantic); 2) single slab subduction in continental domain, (e.g. Gibraltar-Alboran orocline in the Western Mediterranean) 3); multi-slab subduction (e.g. Caribbean orocline in the South-East of the Gulf of Mexico). These systems present various curvatures, lengths (few hundreds to thousands of km) and ages (less than 35 Ma for Gibraltar Alboran orocline, up to 100 Ma for the Caribbean). Recent studies suggested that the formation of curved subduction systems depends on slab properties (age, length, etc) and may be linked with processes such as retreating subduction and delamination. Plume induced subduction initiation has been proposed for the Caribbean. All of these processes involve deep mechanisms such as mantle and slab dynamics. However, subduction zones always generate topography (trenches, uplifts, etc), which is likely to be influenced by surface processes. Hence, surface processes may also influence the evolution of subduction zones. We focus on different kinds of subduction systems initiated by plume-lithosphere interactions (single slab subduction/multi-slab subduction) and scrutinize their surface expression. We use numerical modeling to examine large-scale subduction initiation and three-dimensional slab retreat. We perform two kinds of simulations: 1) large scale subduction initiation with the 3D-thermomechanical code I3ELVIS (Gerya and Yuen, 2007) in an oceanic domain and 2) large scale subduction initiation in oceanic domain using I3ELVIS coupled with a robust new surface processes model (SPM). One to several retreating slabs form in the absence of surface processes, when the conditions for subduction initiation are reached (c.f. Gerya et al., 2015), and ridges occur in the middle of the extensional domain opened by slab retreat. Topography associated with slab retreat is curved. Coupling I3ELVIS with SPM yields more accurate topography of the curved subduction zone. This allows balancing the relative importance of surface and deep processes in the evolution of curved subduction zones and the development of their related topography. References: Gerya, T. V., & Yuen, D. A. (2007). Robust characteristics method for modelling multiphase visco-elasto-plastic thermo-mechanical problems. Physics of the Earth and Planetary Interiors, 163(1), 83-105. Gerya, T. V., Stern, R. J., Baes, M., Sobolev, S. V., & Whattam, S. A. (2015). Plate tectonics on the Earth triggered by plume-induced subduction initiation. Nature, 527(7577), 221-225.

5 Myths about Classroom Technology: How Do We Integrate Digital Tools to Truly Enhance Learning?

ERIC Educational Resources Information Center

Renwick, Matt

2015-01-01

What's keeping your school behind the technology curve? Is it a fear of the unfamiliar? Expenses? Or some other myth? Have you considered how students with special needs or students learning a second language may benefit from using digital tools? If you've fallen for the perception that technology is too expensive, unnecessary for real learning,…

Implementing Machine Learning in the PCWG Tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clifton, Andrew; Ding, Yu; Stuart, Peter

The Power Curve Working Group (www.pcwg.org) is an ad-hoc industry-led group to investigate the performance of wind turbines in real-world conditions. As part of ongoing experience-sharing exercises, machine learning has been proposed as a possible way to predict turbine performance. This presentation provides some background information about machine learning and how it might be implemented in the PCWG exercises.

Experimental data filtration algorithm

NASA Astrophysics Data System (ADS)

Oanta, E.; Tamas, R.; Danisor, A.

2017-08-01

Experimental data reduction is an important topic because the resulting information is used to calibrate the theoretical models and to verify the accuracy of their results. The paper presents some ideas used to extract a subset of points from the initial set of points which defines an experimentally acquired curve. The objective is to get a subset with significantly fewer points as the initial data set and which accurately defines a smooth curve that preserves the shape of the initial curve. Being a general study we used only data filtering criteria based geometric features that at a later stage may be related to upper level conditions specific to the phenomenon under investigation. Five algorithms were conceived and implemented in an original software consisting of more than 1800 computer code lines which has a flexible structure that allows us to easily update it using new algorithms. The software instrument was used to process the data of several case studies. Conclusions are drawn regarding the values of the parameters used in the algorithms to decide if a series of points may be considered either noise, or a relevant part of the curve. Being a general analysis, the result is a computer based trial-and-error method that efficiently solves this kind of problems.

Controlling Chaos Via Knowledge of Initial Condition for a Curved Structure

NASA Technical Reports Server (NTRS)

Maestrello, L.

2000-01-01

Nonlinear response of a flexible curved panel exhibiting bifurcation to fully developed chaos is demonstrated along with the sensitivity to small perturbation from the initial conditions. The response is determined from the measured time series at two fixed points. The panel is forced by an external nonharmonic multifrequency and monofrequency sound field. Using a low power time-continuous feedback control, carefully tuned at each initial condition, produces large long-term effects on the dynamics toward taming chaos. Without the knowledge of the initial conditions, control may be achieved by destructive interference. In this case, the control power is proportional to the loading power. Calculation of the correlation dimension and the estimation of positive Lyapunov exponents, in practice, are the proof of chaotic response.

Learning Under Stress: The Inverted-U-Shape Function Revisited

ERIC Educational Resources Information Center

Salehi, Basira; Cordero, M. Isabel; Sandi, Carmen

2010-01-01

Although the relationship between stress intensity and memory function is generally believed to follow an inverted-U-shaped curve, strikingly this phenomenon has not been demonstrated under the same experimental conditions. We investigated this phenomenon for rats' performance in a hippocampus-dependent learning task, the radial arm water maze…

Tale of the Tape: International Teaching Assistant Noticing during Videotaped Classroom Observations

ERIC Educational Resources Information Center

Williams, Gwendolyn M.; Case, Rod E.

2015-01-01

International teaching assistants face challenges in learning the norms for teaching in American universities. In order to address this learning curve this article describes a qualitative study of twenty international teaching assistants that examined how these participants viewed observations as part of their professional development. The study…

Assessment of Postflight Locomotor Performance Utilizing a Test of Functional Mobility: Strategic and Adaptive Responses

NASA Technical Reports Server (NTRS)

Warren, L. E.; Mulavara, A. P.; Peters, B. T.; Cohen, H. S.; Richards, J. T.; Miller, C. A.; Brady, R.; Ruttley, T. M.; Bloomberg, J. J.

2006-01-01

Space flight induces adaptive modification in sensorimotor function, allowing crewmembers to operate in the unique microgravity environment. This adaptive state, however, is inappropriate for a terrestrial environment. During a re-adaptation period upon their return to Earth, crewmembers experience alterations in sensorimotor function, causing various disturbances in perception, spatial orientation, posture, gait, and eye-head coordination. Following long duration space flight, sensorimotor dysfunction would prevent or extend the time required to make an emergency egress from the vehicle; compromising crew safety and mission objectives. We are investigating two types of motor learning that may interact with each other and influence a crewmember's ability to re-adapt to Earth's gravity environment. In strategic learning, crewmembers make rapid modifications in their motor control strategy emphasizing error reduction. This type of learning may be critical during the first minutes and hours after landing. In adaptive learning, long-term plastic transformations occur, involving morphological changes and synaptic modification. In recent literature these two behavioral components have been associated with separate brain structures that control the execution of motor strategies: the strategic component was linked to the posterior parietal cortex and the adaptive component was linked to the cerebellum (Pisella, et al. 2004). The goal of this paper was to demonstrate the relative contributions of the strategic and adaptive components to the re-adaptation process in locomotor control after long duration space flight missions on the International Space Station (ISS). The Functional Mobility Test (FMT) was developed to assess crewmember s ability to ambulate postflight from an operational and functional perspective. Sixteen crewmembers were tested preflight (3 sessions) and postflight (days 1, 2, 4, 7, 25) following a long duration space flight (approx 6 months) on the ISS. We have further analyzed the FMT data to characterize strategic and adaptive components during the postflight readaptation period. Crewmembers walked at a preferred pace through an obstacle course set up on a base of 10 cm thick medium density foam (Sunmate Foam, Dynamic Systems, Inc., Leicester, NC). The 6.0m X 4.0m course consisted of several pylons made of foam; a Styrofoam barrier 46.0cm high that crewmembers stepped over; and a portal constructed of two Styrofoam blocks, each 31cm high, with a horizontal bar covered by foam and suspended from the ceiling which was adjusted to the height of the crewmember s shoulder. The portal required crewmembers to bend at the waist and step over a barrier simultaneously. All obstacles were lightweight, soft and easily knocked over. Crewmembers were instructed to walk through the course as quickly and as safely as possible without touching any of the objects on the course. This task was performed three times in the clockwise direction and three times in the counterclockwise direction that was randomly chosen. The dependent measures for each trial were: time to complete the course (seconds) and the number of obstacles touched or knocked down. For each crewmember, the time to complete each FMT trial from postflight days 1, 2, 4, 7 and 25 were further analyzed. A single logarithmic curve using a least squares calculation was fit through these data to produce a single comprehensive curve (macro). This macro curve composed of data spanning 25 days, illustrates the re-adaptive learning function over the longer time scale term. Additionally, logarithmic curves were fit to the 6 data trials within each individual post flight test day to produce 5 separate daily curves. These micro curves, produced from data obtained over the course of minutes, illustrates the strategic learning function exhibited over a relative shorter time scale. The macro curve for all subjects exhibited adaptive motor learning patterns over the 25 day period. Howev, 9/16 crewmembers exhibited significant strategic motor learning patterns in their micro curves, as defined by m > 1 in the equation of the line y=m*LN(x) +b. These data indicate that postflight recovery in locomotor function involves both strategic and adaptive mechanisms. Future countermeasures will be designed to enhance both recovery processes.

Hydrologic Impacts of Oak Harvesting and Evaluation of the Modified Universal Soil Loss Equation

Treesearch

Charlette R. Epifanio; Michael J. Singer; Xiaohong Huang

1991-01-01

Two Sierra foothill watersheds were monitored to learn what effects selective oak removal would have on watershed hydrology and water quality. We also used the data to generate sediment rating curves and evaluate the modified universal soil loss equation (MUSLE). Annual sediment rating curves better accounted for the variability in precipitation events from year to...

What Does a Graphical Representation Mean for Students at the Beginning of Function Teaching?

ERIC Educational Resources Information Center

Yavuz, Ilyas

2010-01-01

This study examines how students in the early stages of learning about the concept of functions, describe a curve and, in particular, evaluate the appropriateness of their argument about the representation of a function. Students are offered a message game which is related to a curve drawn on a coordinate system, representing an "imaginary…

Longitudinal Examination of Procrastination and Anxiety, and Their Relation to Self-Efficacy for Self- Regulated Learning: Latent Growth Curve Modeling

ERIC Educational Resources Information Center

Yerdelen, Sündüs; McCaffrey, Adam; Klassen, Robert M.

2016-01-01

This study investigated the longitudinal association between students' anxiety and procrastination and the relation of self-efficacy for self-regulation to these constructs. Latent Growth Curve Modeling was used to analyze data gathered from 182 undergraduate students (134 female, 48 male) at 4 times during a semester. Our results showed that…

The "U" Curve Hypothesis: A Framework for Making Sense of Learning to Teach in Diverse Settings

ERIC Educational Resources Information Center

Birrell, James R.; Tinney, Mari Vawn

2008-01-01

Experiences in this research study started in 1991 before many teacher educators were aware of the "?U"? curve hypothesis or predictable stages of culture shock and the recognizable stages used on the path to gaining intercultural competence. This study of student teachers is used here as an illustration of what happens when teachers are…

The Sociocultural Adjustment Trajectory of International University Students and the Role of University Structures: A Qualitative Investigation

ERIC Educational Resources Information Center

Coles, Rebecca; Swami, Viren

2012-01-01

The present research explores the sociocultural adjustment of international students and the role played by university structures in the process. The adjustment process of international students has been modelled in psychological literature as a U-curve, a learning curve and most recently as a long, uneven and unending process of change. Yet,…

Applying active learning to supervised word sense disambiguation in MEDLINE.

PubMed

Chen, Yukun; Cao, Hongxin; Mei, Qiaozhu; Zheng, Kai; Xu, Hua

2013-01-01

This study was to assess whether active learning strategies can be integrated with supervised word sense disambiguation (WSD) methods, thus reducing the number of annotated samples, while keeping or improving the quality of disambiguation models. We developed support vector machine (SVM) classifiers to disambiguate 197 ambiguous terms and abbreviations in the MSH WSD collection. Three different uncertainty sampling-based active learning algorithms were implemented with the SVM classifiers and were compared with a passive learner (PL) based on random sampling. For each ambiguous term and each learning algorithm, a learning curve that plots the accuracy computed from the test set as a function of the number of annotated samples used in the model was generated. The area under the learning curve (ALC) was used as the primary metric for evaluation. Our experiments demonstrated that active learners (ALs) significantly outperformed the PL, showing better performance for 177 out of 197 (89.8%) WSD tasks. Further analysis showed that to achieve an average accuracy of 90%, the PL needed 38 annotated samples, while the ALs needed only 24, a 37% reduction in annotation effort. Moreover, we analyzed cases where active learning algorithms did not achieve superior performance and identified three causes: (1) poor models in the early learning stage; (2) easy WSD cases; and (3) difficult WSD cases, which provide useful insight for future improvements. This study demonstrated that integrating active learning strategies with supervised WSD methods could effectively reduce annotation cost and improve the disambiguation models.

Applying active learning to supervised word sense disambiguation in MEDLINE

PubMed Central

Chen, Yukun; Cao, Hongxin; Mei, Qiaozhu; Zheng, Kai; Xu, Hua

2013-01-01

Objectives This study was to assess whether active learning strategies can be integrated with supervised word sense disambiguation (WSD) methods, thus reducing the number of annotated samples, while keeping or improving the quality of disambiguation models. Methods We developed support vector machine (SVM) classifiers to disambiguate 197 ambiguous terms and abbreviations in the MSH WSD collection. Three different uncertainty sampling-based active learning algorithms were implemented with the SVM classifiers and were compared with a passive learner (PL) based on random sampling. For each ambiguous term and each learning algorithm, a learning curve that plots the accuracy computed from the test set as a function of the number of annotated samples used in the model was generated. The area under the learning curve (ALC) was used as the primary metric for evaluation. Results Our experiments demonstrated that active learners (ALs) significantly outperformed the PL, showing better performance for 177 out of 197 (89.8%) WSD tasks. Further analysis showed that to achieve an average accuracy of 90%, the PL needed 38 annotated samples, while the ALs needed only 24, a 37% reduction in annotation effort. Moreover, we analyzed cases where active learning algorithms did not achieve superior performance and identified three causes: (1) poor models in the early learning stage; (2) easy WSD cases; and (3) difficult WSD cases, which provide useful insight for future improvements. Conclusions This study demonstrated that integrating active learning strategies with supervised WSD methods could effectively reduce annotation cost and improve the disambiguation models. PMID:23364851

Medical learning curves and the Kantian ideal.

PubMed

Le Morvan, P; Stock, B

2005-09-01

A hitherto unexamined problem for the "Kantian ideal" that one should always treat patients as ends in themselves, and never only as a means to other ends, is explored in this paper. The problem consists of a prima facie conflict between this Kantian ideal and the reality of medical practice. This conflict arises because, at least presently, medical practitioners can only acquire certain skills and abilities by practising on live, human patients, and given the inevitability and ubiquity of learning curves, this learning requires some patients to be treated only as a means to this end. A number of ways of attempting to establish the compatibility of the Kantian Ideal with the reality of medical practice are considered. Each attempt is found to be unsuccessful. Accordingly, until a way is found to reconcile them, we conclude that the Kantian ideal is inconsistent with the reality of medical practice.

Medical learning curves and the Kantian ideal

PubMed Central

Le Morvan, P; Stock, B

2005-01-01

A hitherto unexamined problem for the "Kantian ideal" that one should always treat patients as ends in themselves, and never only as a means to other ends, is explored in this paper. The problem consists of a prima facie conflict between this Kantian ideal and the reality of medical practice. This conflict arises because, at least presently, medical practitioners can only acquire certain skills and abilities by practising on live, human patients, and given the inevitability and ubiquity of learning curves, this learning requires some patients to be treated only as a means to this end. A number of ways of attempting to establish the compatibility of the Kantian Ideal with the reality of medical practice are considered. Each attempt is found to be unsuccessful. Accordingly, until a way is found to reconcile them, we conclude that the Kantian ideal is inconsistent with the reality of medical practice. PMID:16131552

Barriers to Change: Findings from Three Literacy Professional Learning Initiatives

ERIC Educational Resources Information Center

Parsons, Allison Ward; Parsons, Seth A.; Morewood, Aimee; Ankrum, Julie W.

2016-01-01

In this article, we describe lessons learned from three separate literacy professional learning initiatives that took place in elementary schools in three different locations: high-poverty urban, medium-poverty rural, and low-poverty suburban. The professional learning initiatives were also diverse in scope: one was a three-year, school-wide…

Programmable logic devices

NASA Astrophysics Data System (ADS)

Jacobs, J. L.

1993-04-01

Erasable programmable logic devices (EPLD's) were investigated to determine their advantages and/or disadvantages in Test Equipment Engineering applications. It was found that EPLD's performed as well as or better than identical circuits using standard transistor transistor logic (TTL). The chip count in these circuits was reduced, saving printed circuit board space and shortening fabrication and prove-in time. Troubleshooting circuits of EPLD's was also easier with 10 to 100 times fewer wires needed. The reduced number of integrated circuits (IC's) contributed to faster system speeds and an overall lower power consumption. In some cases changes to the circuit became software changes using EPLD's instead of hardware changes for standard logic. Using EPLD's was fairly easy; however, as with any new technology, a learning curve must be overcome before EPLD's can be used efficiently. The many benefits of EPLD's outweighed this initial inconvenience.

Fluctuations in Student Understanding of Newton's 3rd Law

NASA Astrophysics Data System (ADS)

Clark, Jessica W.; Sayre, Eleanor C.; Franklin, Scott V.

2010-10-01

We present data from a between-student study on student response to questions on Newton's Third Law given throughout the academic year. The study, conducted at Rochester Institute of Technology, involved students from the first and third of a three-quarter sequence. Construction of a response curve reveals subtle dynamics in student learning not captured by simple pre/post testing. We find a a significant positive effect from direct instruction, peaking at the end of instruction on forces, that diminishes by the end of the quarter. Two quarters later, in physics III, a significant dip in correct response occurs when instruction changes from the vector quantities of electric forces and fields to the scalar quantity of electric potential. Student response rebounds to its initial values, however, once instruction returns to the vector-based topics involving magnetic fields.

Isolated Capsulorhexis Flap Technique in Femtosecond Laser-Assisted Cataract Surgery to Protect the Corneal Endothelial Cells.

PubMed

Li, Shaowei; Chen, Xu; Zhao, Jun; Xu, Man; Yu, Zhouxing

2017-12-18

To present a novel technique that using capsulorhexis flap to protect corneal endothelial cells during femtosecond laser-assisted cataract surgery. During the procedure, an isolated capsulorhexis flap was used to lift it up carefully by using OVD until the flap attached to the corneal inner layer. It kept steady during the phaco phase, and been removed by I/A tip after intraocular lens implantation. In our pilot study, the damage to the corneal endothelial cells from the phacoemulsification procedure were no more than the traditional phaco procedure, even femtosecond laser assisted cataract surgery. Isolated capsulorhexis flap technique initiate a new approach to protect the endothelial cell. It is a simple technique with a short learning curve, but still need a further investigation to prove the protection of corneal endothelial cells.

Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes.

PubMed

Wiltz, Aimee L; Shikanov, Sergey; Eggener, Scott E; Katz, Mark H; Thong, Alan E; Steinberg, Gary D; Shalhav, Arieh L; Zagaja, Gregory P; Zorn, Kevin C

2009-02-01

To determine the impact of body mass index (BMI) on perioperative functional and oncological outcomes in patients undergoing robotic laparoscopic radical prostatectomy (RLRP) when stratified by BMI. Data were collected prospectively for 945 consecutive patients undergoing RLRP. Patients were evaluated with the UCLA-PCI-SF36v2 validated-quality-of-life questionnaire preoperatively and postoperatively to 24 months. Patients were stratified by BMI as normal weight (BMI < 25 kg/m(2)), overweight (BMI = 25 to < 30 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) for outcomes analysis. Preoperatively, obese men had a significantly greater percentage of medical comorbidities (P < .01) as well as a baseline erectile dysfunction (lower mean baseline Sexual Health Inventory for Men score [P = .01] and UCLA-PCI-SF36v2 sexual function domain scores [P = .01]). Mean operative time was significantly longer in obese patients when compared with normal and overweight men (234 minutes vs 217 minutes vs 214 minutes; P = .0003). Although overall complication rates were comparable between groups, a greater incidence of case abortion caused by pneumoperitoneal pressure with excessive airway pressures was noted in obese men. Urinary continence and potency outcomes were significantly lower for obese men at both 12 and 24 months (all P < .05). In this series, obese men experienced a longer operative time, particularly during the initial robotic experience. As such, surgeons early in their RLRP learning curve should proceed cautiously with surgery in these technically more difficult patients or reserve such cases until the learning curve has been surmounted. These details, including inferior urinary and sexual outcomes, should be discussed with obese patients during preoperative counseling.

The Opponent Channel Population Code of Sound Location Is an Efficient Representation of Natural Binaural Sounds

PubMed Central

Młynarski, Wiktor

2015-01-01

In mammalian auditory cortex, sound source position is represented by a population of broadly tuned neurons whose firing is modulated by sounds located at all positions surrounding the animal. Peaks of their tuning curves are concentrated at lateral position, while their slopes are steepest at the interaural midline, allowing for the maximum localization accuracy in that area. These experimental observations contradict initial assumptions that the auditory space is represented as a topographic cortical map. It has been suggested that a “panoramic” code has evolved to match specific demands of the sound localization task. This work provides evidence suggesting that properties of spatial auditory neurons identified experimentally follow from a general design principle- learning a sparse, efficient representation of natural stimuli. Natural binaural sounds were recorded and served as input to a hierarchical sparse-coding model. In the first layer, left and right ear sounds were separately encoded by a population of complex-valued basis functions which separated phase and amplitude. Both parameters are known to carry information relevant for spatial hearing. Monaural input converged in the second layer, which learned a joint representation of amplitude and interaural phase difference. Spatial selectivity of each second-layer unit was measured by exposing the model to natural sound sources recorded at different positions. Obtained tuning curves match well tuning characteristics of neurons in the mammalian auditory cortex. This study connects neuronal coding of the auditory space with natural stimulus statistics and generates new experimental predictions. Moreover, results presented here suggest that cortical regions with seemingly different functions may implement the same computational strategy-efficient coding. PMID:25996373

Early Detection of Ureteropelvic Junction Obstruction Using Signal Analysis and Machine Learning: A Dynamic Solution to a Dynamic Problem.

PubMed

Blum, Emily S; Porras, Antonio R; Biggs, Elijah; Tabrizi, Pooneh R; Sussman, Rachael D; Sprague, Bruce M; Shalaby-Rana, Eglal; Majd, Massoud; Pohl, Hans G; Linguraru, Marius George

2017-10-21

We sought to define features that describe the dynamic information in diuresis renograms for the early detection of clinically significant hydronephrosis caused by ureteropelvic junction obstruction. We studied the diuresis renogram of 55 patients with a mean ± SD age of 75 ± 66 days who had congenital hydronephrosis at initial presentation. Five patients had bilaterally affected kidneys for a total of 60 diuresis renograms. Surgery was performed on 35 kidneys. We extracted 45 features based on curve shape and wavelet analysis from the drainage curves recorded after furosemide administration. The optimal features were selected as the combination that maximized the ROC AUC obtained from a linear support vector machine classifier trained to classify patients as with or without obstruction. Using these optimal features we performed leave 1 out cross validation to estimate the accuracy, sensitivity and specificity of our framework. Results were compared to those obtained using post-diuresis drainage half-time and the percent of clearance after 30 minutes. Our framework had 93% accuracy, including 91% sensitivity and 96% specificity, to predict surgical cases. This was a significant improvement over the same accuracy of 82%, including 71% sensitivity and 96% specificity obtained from half-time and 30-minute clearance using the optimal thresholds of 24.57 minutes and 55.77%, respectively. Our machine learning framework significantly improved the diagnostic accuracy of clinically significant hydronephrosis compared to half-time and 30-minute clearance. This aids in the clinical decision making process by offering a tool for earlier detection of severe cases and it has the potential to reduce the number of diuresis renograms required for diagnosis. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Numerical Simulation of Particle Motion in a Curved Channel

NASA Astrophysics Data System (ADS)

Liu, Yi; Nie, Deming

2018-01-01

In this work the lattice Boltzmann method (LBM) is used to numerically study the motion of a circular particle in a curved channel at intermediate Reynolds numbers (Re). The effects of the Reynolds number and the initial particle position are taken into account. Numerical results include the streamlines, particle trajectories and final equilibrium positions. It has been found that the particle is likely to migrate to a similar equilibrium position irrespective of its initial position when Re is large.

Marine Structural Steel Toughness Data Bank. Volume 3

DTIC Science & Technology

1991-08-28

Headings: Break? Did specimen fracture completely? CODIc Critical COD CODi Initial COD CVN Energy Charpy V Energy Crack lgth Crack Length Curve Curve...BS5762 -Standard Year Test Temp CODIc degC mm -30 0.57 -30 0.68 -30 . 1.26 not rporw(continued) Main Stutua To n ssDta:an Material BS4360 Gr50D Page...Initial JI. . . .. ._I. . . Maximum 1, ]max * Tearing Modulus ......... Standard Method ~P S5762 -Standard Year_______________ Test Tcmp CODIc degC mm

A Study of Learning in the Operations of a Viscous Damped Traversing Unit.

DTIC Science & Technology

1978-06-01

Finally I would like to express special appreciation to my wife, Donna Pardue Robinson, and my children, Kristin, Keith and Stephanie for their...indication of learning. Bahrick, Fitts and Briggs dealt with learning curves in a 1957 article which supported their earlier work. They used the same data...Olof and Kaare Rodahl, Textbook of Work Physiology, New York: McGraw-Hill Book Compnay, 1970. 2. Bahrick, H. P., F. M. Fitts and G. E. Briggs , "Learning

Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy.

PubMed

Jirapinyo, Pichamol; Abidi, Wasif M; Aihara, Hiroyuki; Zaki, Theodore; Tsay, Cynthia; Imaeda, Avlin B; Thompson, Christopher C

2017-10-01

Preclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases. Twenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand. Twenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #] -0.615 ; r 2  = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training. Preclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training sessions and obtain a simulator score of at least 265 to be best prepared for clinical endoscopy.

Pressure effects on the relaxation of an excited nitromethane molecule in an argon bath

NASA Astrophysics Data System (ADS)

Rivera-Rivera, Luis A.; Wagner, Albert F.; Sewell, Thomas D.; Thompson, Donald L.

2015-01-01

Classical molecular dynamics simulations were performed to study the relaxation of nitromethane in an Ar bath (of 1000 atoms) at 300 K and pressures 10, 50, 75, 100, 125, 150, 300, and 400 atm. The molecule was instantaneously excited by statistically distributing 50 kcal/mol among the internal degrees of freedom. At each pressure, 1000 trajectories were integrated for 1000 ps, except for 10 atm, for which the integration time was 5000 ps. The computed ensemble-averaged rotational energy decay is ˜100 times faster than the vibrational energy decay. Both rotational and vibrational decay curves can be satisfactorily fit with the Lendvay-Schatz function, which involves two parameters: one for the initial rate and one for the curvature of the decay curve. The decay curves for all pressures exhibit positive curvature implying the rate slows as the molecule loses energy. The initial rotational relaxation rate is directly proportional to density over the interval of simulated densities, but the initial vibrational relaxation rate decreases with increasing density relative to the extrapolation of the limiting low-pressure proportionality to density. The initial vibrational relaxation rate and curvature are fit as functions of density. For the initial vibrational relaxation rate, the functional form of the fit arises from a combinatorial model for the frequency of nitromethane "simultaneously" colliding with multiple Ar atoms. Roll-off of the initial rate from its low-density extrapolation occurs because the cross section for collision events with L Ar atoms increases with L more slowly than L times the cross section for collision events with one Ar atom. The resulting density-dependent functions of the initial rate and curvature represent, reasonably well, all the vibrational decay curves except at the lowest density for which the functions overestimate the rate of decay. The decay over all gas phase densities is predicted by extrapolating the fits to condensed-phase densities.

Pressure effects on the relaxation of an excited nitromethane molecule in an argon bath

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rivera-Rivera, Luis A.; Wagner, Albert F.; Sewell, Thomas D.

2015-01-07

Classical molecular dynamics simulations were performed to study the relaxation of nitromethane in an Ar bath (of 1000 atoms) at 300 K and pressures 10, 50, 75, 100, 125, 150, 300, and 400 atm. The molecule was instantaneously excited by statistically distributing 50 kcal/mol among the internal degrees of freedom. At each pressure, 1000 trajectories were integrated for 1000 ps, except for 10 atm, for which the integration time was 5000 ps. The computed ensemble-averaged rotational energy decay is similar to 100 times faster than the vibrational energy decay. Both rotational and vibrational decay curves can be satisfactorily fit withmore » the Lendvay-Schatz function, which involves two parameters: one for the initial rate and one for the curvature of the decay curve. The decay curves for all pressures exhibit positive curvature implying the rate slows as the molecule loses energy. The initial rotational relaxation rate is directly proportional to density over the interval of simulated densities, but the initial vibrational relaxation rate decreases with increasing density relative to the extrapolation of the limiting low-pressure proportionality to density. The initial vibrational relaxation rate and curvature are fit as functions of density. For the initial vibrational relaxation rate, the functional form of the fit arises from a combinatorial model for the frequency of nitromethane "simultaneously" colliding with multiple Ar atoms. Roll-off of the initial rate from its low-density extrapolation occurs because the cross section for collision events with L Ar atoms increases with L more slowly than L times the cross section for collision events with one Ar atom. The resulting density-dependent functions of the initial rate and curvature represent, reasonably well, all the vibrational decay curves except at the lowest density for which the functions overestimate the rate of decay. The decay over all gas phase densities is predicted by extrapolating the fits to condensed-phase densities. (C) 2015 AIP Publishing LLC.« less

Pressure effects on the relaxation of an excited nitromethane molecule in an argon bath.

PubMed

Rivera-Rivera, Luis A; Wagner, Albert F; Sewell, Thomas D; Thompson, Donald L

2015-01-07

Classical molecular dynamics simulations were performed to study the relaxation of nitromethane in an Ar bath (of 1000 atoms) at 300 K and pressures 10, 50, 75, 100, 125, 150, 300, and 400 atm. The molecule was instantaneously excited by statistically distributing 50 kcal/mol among the internal degrees of freedom. At each pressure, 1000 trajectories were integrated for 1000 ps, except for 10 atm, for which the integration time was 5000 ps. The computed ensemble-averaged rotational energy decay is ∼100 times faster than the vibrational energy decay. Both rotational and vibrational decay curves can be satisfactorily fit with the Lendvay-Schatz function, which involves two parameters: one for the initial rate and one for the curvature of the decay curve. The decay curves for all pressures exhibit positive curvature implying the rate slows as the molecule loses energy. The initial rotational relaxation rate is directly proportional to density over the interval of simulated densities, but the initial vibrational relaxation rate decreases with increasing density relative to the extrapolation of the limiting low-pressure proportionality to density. The initial vibrational relaxation rate and curvature are fit as functions of density. For the initial vibrational relaxation rate, the functional form of the fit arises from a combinatorial model for the frequency of nitromethane "simultaneously" colliding with multiple Ar atoms. Roll-off of the initial rate from its low-density extrapolation occurs because the cross section for collision events with L Ar atoms increases with L more slowly than L times the cross section for collision events with one Ar atom. The resulting density-dependent functions of the initial rate and curvature represent, reasonably well, all the vibrational decay curves except at the lowest density for which the functions overestimate the rate of decay. The decay over all gas phase densities is predicted by extrapolating the fits to condensed-phase densities.

Pressure effects on the relaxation of an excited nitromethane molecule in an argon bath

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rivera-Rivera, Luis A.; Sewell, Thomas D.; Thompson, Donald L.

2015-01-07

Classical molecular dynamics simulations were performed to study the relaxation of nitromethane in an Ar bath (of 1000 atoms) at 300 K and pressures 10, 50, 75, 100, 125, 150, 300, and 400 atm. The molecule was instantaneously excited by statistically distributing 50 kcal/mol among the internal degrees of freedom. At each pressure, 1000 trajectories were integrated for 1000 ps, except for 10 atm, for which the integration time was 5000 ps. The computed ensemble-averaged rotational energy decay is ∼100 times faster than the vibrational energy decay. Both rotational and vibrational decay curves can be satisfactorily fit with the Lendvay-Schatzmore » function, which involves two parameters: one for the initial rate and one for the curvature of the decay curve. The decay curves for all pressures exhibit positive curvature implying the rate slows as the molecule loses energy. The initial rotational relaxation rate is directly proportional to density over the interval of simulated densities, but the initial vibrational relaxation rate decreases with increasing density relative to the extrapolation of the limiting low-pressure proportionality to density. The initial vibrational relaxation rate and curvature are fit as functions of density. For the initial vibrational relaxation rate, the functional form of the fit arises from a combinatorial model for the frequency of nitromethane “simultaneously” colliding with multiple Ar atoms. Roll-off of the initial rate from its low-density extrapolation occurs because the cross section for collision events with L Ar atoms increases with L more slowly than L times the cross section for collision events with one Ar atom. The resulting density-dependent functions of the initial rate and curvature represent, reasonably well, all the vibrational decay curves except at the lowest density for which the functions overestimate the rate of decay. The decay over all gas phase densities is predicted by extrapolating the fits to condensed-phase densities.« less

An evidence-based virtual reality training program for novice laparoscopic surgeons.

PubMed

Aggarwal, Rajesh; Grantcharov, Teodor P; Eriksen, Jens R; Blirup, Dorthe; Kristiansen, Viggo B; Funch-Jensen, Peter; Darzi, Ara

2006-08-01

To develop an evidence-based virtual reality laparoscopic training curriculum for novice laparoscopic surgeons to achieve a proficient level of skill prior to participating in live cases. Technical skills for laparoscopic surgery must be acquired within a competency-based curriculum that begins in the surgical skills laboratory. Implementation of this program necessitates the definition of the validity, learning curves and proficiency criteria on the training tool. The study recruited 40 surgeons, classified into experienced (performed >100 laparoscopic cholecystectomies) or novice groups (<10 laparoscopic cholecystectomies). Ten novices and 10 experienced surgeons were tested on basic tasks, and 11 novices and 9 experienced surgeons on a procedural module for dissection of Calot triangle. Performance of the 2 groups was assessed using time, error, and economy of movement parameters. All basic tasks demonstrated construct validity (Mann-Whitney U test, P < 0.05), and learning curves for novices plateaued at a median of 7 repetitions (Friedman's test, P < 0.05). Expert surgeons demonstrated a learning rate at a median of 2 repetitions (P < 0.05). Performance on the dissection module demonstrated significant differences between experts and novices (P < 0.002); learning curves for novice subjects plateaued at the fourth repetition (P < 0.05). Expert benchmark criteria were defined for validated parameters on each task. A competency-based training curriculum for novice laparoscopic surgeons has been defined. This can serve to ensure that junior trainees have acquired prerequisite levels of skill prior to entering the operating room, and put them directly into practice.

Da Vinci© Skills Simulator™: is an early selection of talented console surgeons possible?

PubMed

Meier, Mark; Horton, Kevin; John, Hubert

2016-12-01

To investigate whether the learning curve of robotic surgery simulator training depends on the probands' characteristics, such as age and prior experience, we conducted a study of six distinct proband groups, using the da Vinci Skills Simulator: experienced urological robotic surgeons, surgeons with experience as da Vinci tableside assistants, urological surgeons with laparoscopic experience, urological surgeons without laparoscopic experience, and complete novices aged 25 and younger and 40 and older. The results showed that all experienced robotic surgeons reached expert level (>90 %, as defined previously in the literature) within the first three repetitions and remained on a high level of performance. All other groups performed worse. Tableside assistants, laparoscopically experienced surgeons, and younger novices showed a better performance in all exercises than surgeons without laparoscopic experience and older novices. A linear mixed-effects model analysis demonstrated no significant difference in learning curves between proband groups in all exercises except the RW1 exercise for the younger proband group. In summary, we found that performance in robotic surgery, measured by performance scores in three virtual simulator modules using the EndoWrist techniques, was dependent on age and prior experience with robotic and laparoscopic surgery. However, and most importantly, the learning curve was not significantly affected by these factors. This suggests that the da Vinci Skills Simulator™ is a useful practice tool for everyone learning or performing robotic surgery, and that early selection of talented surgeons is neither possible nor necessary.

Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke.

PubMed

Goodman, Ronald N; Rietschel, Jeremy C; Roy, Anindo; Jung, Brian C; Diaz, Jason; Macko, Richard F; Forrester, Larry W

2014-01-01

Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot) under either high reward (HR) or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG) coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05), smoother movements (p

Equation of state of fluid helium at high temperatures and densities

NASA Astrophysics Data System (ADS)

Cai, Lingcang; Chen, Qifeng; Gu, Yunjun; Zhang, Ying; Zhou, Xianming; Jing, Fuqian

2005-03-01

Hugoniot curves and shock temperatures of gas helium with initial temperature 293 K and three initial pressures 0.6, 1.2, and 5.0 MPa were measured up to 15000 K using a two-stage light-gas gun and transient radiation pyrometer. It was found that the calculated Hugoniot EOS of gas helium at the same initial pressure using Saha equation with Debye-Hückel correction was in good agreement with the experimental data. The curve of the calculated shock wave velocity with the particle velocity of gas helium which is shocked from the initial pressure 5 MPa and temperature 293 K, i.e., the D ≈ u relation, D= C 0+λ u ( u<10 km/s, λ=1.32) in a low pressure region, is approximately parallel with the fitted D ≈ u (λ=1.36) of liquid helium from the experimental data of Nellis et al. Our calculations show that the Hugoniot parameter λ is independent of the initial density p{in0}. The D≈ u curves of gas helium will transfer to another one and approach a limiting value of compression when their temperature elevates to about 18000 K and the ionization degree of the shocked gas helium reaches 10-3.

Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve.

PubMed

Rotzinger, Roman; Gebauer, Bernhard; Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Grieser, Christian; Freyhardt, Patrick; Hamm, Bernd; Maurer, Martin H

2017-12-01

Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.

Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience.

PubMed

Saredi, Giovanni; Pirola, Giacomo Maria; Pacchetti, Andrea; Lovisolo, Jon Alexander; Borroni, Giacomo; Sembenini, Federico; Marconi, Alberto Mario

2015-06-09

The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.

Microinvasive Glaucoma Stent (MIGS) Surgery With Concomitant Phakoemulsification Cataract Extraction: Outcomes and the Learning Curve.

PubMed

Al-Mugheiry, Toby S; Cate, Heidi; Clark, Allan; Broadway, David C

2017-07-01

To evaluate learning effects with respect to outcomes of a microinvasive glaucoma stent (MIGS) inserted during cataract surgery in glaucoma patients. Single surgeon, observational cohort study of 25 consecutive Ivantis Hydrus microstent insertions, with a minimum follow-up of 12 months. A learning curve analysis was performed by assessing hypotensive effect, adverse effects, and surgical procedure duration, with respect to consecutive case number. Success was defined with respect to various intraocular pressure (IOP) targets (21, 18, 15 mm Hg) and reduction in required antiglaucoma medications. Complete success was defined as achieving target IOP without antiglaucoma therapy. No clinically significant adverse events or learning effects were identified, although surgical time reduced with consecutive case number. Mean follow-up was 16.8 months. At final follow-up the mean IOP for all eyes was reduced from 18.1 (±3.6) mm Hg [and a simulated untreated value of 25.9 (±5.2) mm Hg] to 15.3 (±2.2) mm Hg (P=0.007; <0.0001) and the mean number of topical antiglaucoma medications was reduced from 1.96 (±0.96) to 0.04 (±0.20) (P<0.0001). Complete success (IOP<21 mm Hg, no medications) was 96% at final follow-up. Complete success (IOP<18 mm Hg, no medications) was 80% at final follow-up, but only 32% with a target IOP of <15 mm Hg (no medications). No significant learning curve effects were observed for a trained surgeon with respect to MIGS microstent insertion performed at the time of cataract surgery. Adjunctive MIGS surgery was successful in lowering IOP to <18 mm Hg and reducing/abolishing the requirement for antiglaucoma medication in eyes with open-angle glaucoma, but less successful at achieving low IOP levels (<15 mm Hg).

Spatial and reversal learning in the Morris water maze are largely resistant to six hours of REM sleep deprivation following training

PubMed Central

Walsh, Christine M.; Booth, Victoria; Poe, Gina R.

2011-01-01

This first test of the role of REM (rapid eye movement) sleep in reversal spatial learning is also the first attempt to replicate a much cited pair of papers reporting that REM sleep deprivation impairs the consolidation of initial spatial learning in the Morris water maze. We hypothesized that REM sleep deprivation following training would impair both hippocampus-dependent spatial learning and learning a new target location within a familiar environment: reversal learning. A 6-d protocol was divided into the initial spatial learning phase (3.5 d) immediately followed by the reversal phase (2.5 d). During the 6 h following four or 12 training trials/day of initial or reversal learning phases, REM sleep was eliminated and non-REM sleep left intact using the multiple inverted flowerpot method. Contrary to our hypotheses, REM sleep deprivation during four or 12 trials/day of initial spatial or reversal learning did not affect training performance. However, some probe trial measures indicated REM sleep-deprivation–associated impairment in initial spatial learning with four trials/day and enhancement of subsequent reversal learning. In naive animals, REM sleep deprivation during normal initial spatial learning was followed by a lack of preference for the subsequent reversal platform location during the probe. Our findings contradict reports that REM sleep is essential for spatial learning in the Morris water maze and newly reveal that short periods of REM sleep deprivation do not impair concurrent reversal learning. Effects on subsequent reversal learning are consistent with the idea that REM sleep serves the consolidation of incompletely learned items. PMID:21677190

Learning, Labour and Union Learning Representatives: Promoting Workplace Learning

ERIC Educational Resources Information Center

Ball, Malcolm

2011-01-01

The initiative by the Trades Union Congress (TUC) and affiliated trade unions in the UK to appoint trade union learning representatives (ULRs), to promote learning among their members, is a significant development in adult learning. Understandably, the initiative has attracted the attention of academic researchers, but primarily from the…

MULTIVARIATE CURVE RESOLUTION OF NMR SPECTROSCOPY METABONOMIC DATA

EPA Science Inventory

Sandia National Laboratories is working with the EPA to evaluate and develop mathematical tools for analysis of the collected NMR spectroscopy data. Initially, we have focused on the use of Multivariate Curve Resolution (MCR) also known as molecular factor analysis (MFA), a tech...

Experience in the management of ECMO therapy as a mortality risk factor.

PubMed

Guilló Moreno, V; Gutiérrez Martínez, A; Romero Berrocal, A; Sánchez Castilla, M; García-Fernández, J

2018-02-01

The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. Our purpose is to evaluate and analyse the effect of the learning curve on mortality. Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Learning curve of thyroid fine-needle aspiration biopsy.

PubMed

Penín, Manuel; Martín, M Ángeles; San Millán, Beatriz; García, Juana

2017-12-01

Fine-needle aspiration biopsy (FNAB) is the reference procedure for thyroid nodule evaluation. Its main limitation are inadequate samples, which should be less than 20%. To analyze the learning curve of the procedure by comparing the results of a non-experienced endocrinologist (endocrinologist 2) to those of an experienced one (endocrinologist 1). Sixty FNABs were analyzed from February to June 2016. Each endocrinologist made 2punctures of every nodule in a random order. This order and the professional making every puncture were unknown to the pathologist who examined the samples. Endocrinologist 1 had a higher percentage of diagnoses than endocrinologist 2 (82% vs. 72%, P=.015). In the first 20 FNABs, the difference between both physicians was remarkable and statistically significant (80% vs. 50%, P=.047). In the following 20 FNABs, the difference narrowed and was not statistically significant (90% vs. 65%, P=.058). In the final 20 FNABs, the difference was minimal and not statistically significant (75% vs. 70%, P=.723). The learning curve of ultrasound-guided FNAB may be completed in a suitable environment by performing it at least 60 times. Although the guidelines recommend at least 3punctures per nodule, 2are enough to achieve an accurate percentage of diagnoses. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Developmental Changes in Cross-Situational Word Learning: The Inverse Effect of Initial Accuracy

ERIC Educational Resources Information Center

Fitneva, Stanka A.; Christiansen, Morten H.

2017-01-01

Intuitively, the accuracy of initial word-referent mappings should be positively correlated with the outcome of learning. Yet recent evidence suggests an inverse effect of initial accuracy in adults, whereby greater accuracy of initial mappings is associated with poorer outcomes in a cross-situational learning task. Here, we examine the impact of…

Robot-Assisted Mckeown Esophagectomy is Feasible After Neoadjuvant Chemoradiation. Our Initial Experience.

PubMed

Goel, Ashish; Shah, Swati H; Selvakumar, Veda Padma Priya; Garg, Shubha; Kumar, Kapil

2018-02-01

Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical oncologists have now shifted to video-assisted and robot-assisted thoracoscopic esophagectomy; there is still limited experience for the use of minimal-assisted approaches in patients undergoing surgery after neoadjuvant chemoradiation. Most surgeons have concerns of feasibility, safety, and oncological outcomes as well as issues related to difficult learning curve in adopting robotic esophagectomy in patients after chemoradiation. We present our initial experience of Robot-Assisted Mckeown Esophagectomy in 27 patients after neoadjuvant chemoradiation, from May 2013 to October 2014. All patients underwent neoadjuvant chemoradiation to a dose of 50.4 Gy/25Fr with concurrent weekly cisplatin, followed by reassessment with clinical examination and repeat FDG PET/CT 6 weeks after completion of chemoradiation. Patients with progressive disease underwent palliative chemotherapy while patients with either partial or significant response to chemoradiation underwent Robot-Assisted Mckeown Esophagectomy with esophageal replacement by gastric conduit and esophagogastric anastomosis in the left neck. Out of 27 patients, 92.5 % patients had stage cT3/T4 tumours and node-positive disease in 48.1 % on imaging. Most patients were middle thoracic esophageal cancers (23/27), with squamous histology in all except for one. All patients received neoadjuvant chemoradiation and subsequently underwent Robot Assisted Mckeown Esophagectomy. The average time for robot docking, thoracic mobilization and total surgical procedure was 13.2, 108.4 and 342.7 min, respectively. The procedure was well tolerated by all patients with only one case of peri-operative mortality. Average ICU stay was 6.35 days (range 3-9 days). R0 resection rate of 96.3 % and average lymph node yield of 18 could be achieved. Pathological node negativity rate (pN0) and complete response (pCR) were 66.6 and 44.4 %, respectively. In the initial cases, four patients had to be converted to open due technical reasons or intraoperative complications. The present study, with shorter operative times, similar ICU stay, overall low morbidity, and mortality and optimal oncological outcomes suggest that robot-assisted thoracic mobilization of esophagus in patients with prior chemoradiation is feasible and safe with acceptable oncological outcomes. It has a shorter learning curve and hence allows for a transthoracic minimally invasive transthoracic esophagectomy to more and more patients, otherwise unfit for conventional approach.

Task-based image quality assessment in radiation therapy: initial characterization and demonstration with CT simulation images

NASA Astrophysics Data System (ADS)

Dolly, Steven R.; Anastasio, Mark A.; Yu, Lifeng; Li, Hua

2017-03-01

In current radiation therapy practice, image quality is still assessed subjectively or by utilizing physically-based metrics. Recently, a methodology for objective task-based image quality (IQ) assessment in radiation therapy was proposed by Barrett et al.1 In this work, we present a comprehensive implementation and evaluation of this new IQ assessment methodology. A modular simulation framework was designed to perform an automated, computer-simulated end-to-end radiation therapy treatment. A fully simulated framework was created that utilizes new learning-based stochastic object models (SOM) to obtain known organ boundaries, generates a set of images directly from the numerical phantoms created with the SOM, and automates the image segmentation and treatment planning steps of a radiation therapy work ow. By use of this computational framework, therapeutic operating characteristic (TOC) curves can be computed and the area under the TOC curve (AUTOC) can be employed as a figure-of-merit to guide optimization of different components of the treatment planning process. The developed computational framework is employed to optimize X-ray CT pre-treatment imaging. We demonstrate that use of the radiation therapy-based-based IQ measures lead to different imaging parameters than obtained by use of physical-based measures.

The effects of initial participation motivations on learning engagement in transition training for future general practitioners in rural China: perceived deterrents as mediator

PubMed Central

Cui, Guan-yu; Yao, Mei-lin; Zhang, Xia; Guo, Yan-kui; Li, Hui-min; Yao, Xiu-ping

2016-01-01

Background For the shortage of high-quality general practitioners (GPs) in China's rural areas, Chinese government has taken steps to encourage rural specialists to participate in transition training for future GPs. Specialists’ initial participation motivations and their perceived deterrents during training may play important roles for their learning engagement in the transition training. This study aimed at revealing the relationships among the variables of initial participation motivations, perceived deterrents in training, and learning engagement. Methods A questionnaire survey was used in this study. A total of 156 rural specialists who participated in transition training for future GPs filled out the questionnaire, which consisted of the measurements of initial participation motivations, perceived deterrents, and learning engagement in training. The data about specialists’ demographic variables were collected at the same time. Results The variance of initial escape/stimulations motivation significantly predicted the variance of learning engagement through the full mediating role of perceived deterrents in training. In addition, initial educational preparation motivations predicted the variance of learning engagement directly. Conclusions Specialists’ initial participation motivations and perceived deterrents in training played important roles for learning engagement in the transition training. PMID:27340086

Millennials Invading: Building Training for Today's Admissions Counselors

ERIC Educational Resources Information Center

Barnds, W. Kent

2009-01-01

As chief admissions officer at two small colleges, the author has been responsible, in part, for ensuring that entry-level admissions counselors are trained properly. He learned through trial and error, and has adapted his methods to be increasingly sensitive to the learning curve of new employees. His thoughts about training new admissions…

Learning, Retention, and Forgetting of Newton's Third Law throughout University Physics

ERIC Educational Resources Information Center

Sayre, Eleanor C.; Franklin, Scott V.; Dymek, Stephanie; Clark, Jessica; Sun, Yifei

2012-01-01

We present data from a between-student study on student response to questions on Newton's third law given in two introductory calculus-based physics classes (Mechanics and Electromagnetism) at a large northeastern university. Construction of a response curve reveals subtle dynamics in student learning not capturable by pretesting and post-testing.…

Home Literacy Environment and Head Start Children's Language Development: The Role of Approaches to Learning

ERIC Educational Resources Information Center

Meng, Christine

2015-01-01

Research Findings: This study examined whether approaches to learning moderate the association between home literacy environment and English receptive vocabulary development. The Head Start Family and Child Experiences Survey (2003 cohort) was used for analysis. Latent growth curve modeling was utilized to test a quadratic model of English…

Relevance Vector Machine and Support Vector Machine Classifier Analysis of Scanning Laser Polarimetry Retinal Nerve Fiber Layer Measurements

PubMed Central

Bowd, Christopher; Medeiros, Felipe A.; Zhang, Zuohua; Zangwill, Linda M.; Hao, Jiucang; Lee, Te-Won; Sejnowski, Terrence J.; Weinreb, Robert N.; Goldbaum, Michael H.

2010-01-01

Purpose To classify healthy and glaucomatous eyes using relevance vector machine (RVM) and support vector machine (SVM) learning classifiers trained on retinal nerve fiber layer (RNFL) thickness measurements obtained by scanning laser polarimetry (SLP). Methods Seventy-two eyes of 72 healthy control subjects (average age = 64.3 ± 8.8 years, visual field mean deviation =−0.71 ± 1.2 dB) and 92 eyes of 92 patients with glaucoma (average age = 66.9 ± 8.9 years, visual field mean deviation =−5.32 ± 4.0 dB) were imaged with SLP with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, San Diego, CA). RVM and SVM learning classifiers were trained and tested on SLP-determined RNFL thickness measurements from 14 standard parameters and 64 sectors (approximately 5.6° each) obtained in the circumpapillary area under the instrument-defined measurement ellipse (total 78 parameters). Tenfold cross-validation was used to train and test RVM and SVM classifiers on unique subsets of the full 164-eye data set and areas under the receiver operating characteristic (AUROC) curve for the classification of eyes in the test set were generated. AUROC curve results from RVM and SVM were compared to those for 14 SLP software-generated global and regional RNFL thickness parameters. Also reported was the AUROC curve for the GDx VCC software-generated nerve fiber indicator (NFI). Results The AUROC curves for RVM and SVM were 0.90 and 0.91, respectively, and increased to 0.93 and 0.94 when the training sets were optimized with sequential forward and backward selection (resulting in reduced dimensional data sets). AUROC curves for optimized RVM and SVM were significantly larger than those for all individual SLP parameters. The AUROC curve for the NFI was 0.87. Conclusions Results from RVM and SVM trained on SLP RNFL thickness measurements are similar and provide accurate classification of glaucomatous and healthy eyes. RVM may be preferable to SVM, because it provides a Bayesian-derived probability of glaucoma as an output. These results suggest that these machine learning classifiers show good potential for glaucoma diagnosis. PMID:15790898

Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

PubMed

Jowett, Charlie R J; Bedi, Harvinder S

Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p < .001). The mean hallux valgus and intermetatarsal angles preoperatively were 29.7° (range 12° to 46°) and 14.0° (range 8° to 20°). The corresponding postoperative angles were 10.3° (range 0° to 25°) and 7.6° (range 3° to 15°; p < .001). The patients were satisfied with the results of surgery in 87% of cases (92 of 106). The incidence of reoperation was 14% (15 of 106). These are the only reported results for this technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers.

PubMed

Peyronnet, Benoit; Robert, Grégoire; Comat, Vincent; Rouprêt, Morgan; Gomez-Sancha, Fernando; Cornu, Jean-Nicolas; Misrai, Vincent

2017-06-01

To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP. Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients' characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups. Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Q max at 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP. Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.

Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve.

PubMed

Boone, Brian A; Zenati, Mazen; Hogg, Melissa E; Steve, Jennifer; Moser, Arthur James; Bartlett, David L; Zeh, Herbert J; Zureikat, Amer H

2015-05-01

Quality assessment is an important instrument to ensure optimal surgical outcomes, particularly during the adoption of new surgical technology. The use of the robotic platform for complex pancreatic resections, such as the pancreaticoduodenectomy, requires close monitoring of outcomes during its implementation phase to ensure patient safety is maintained and the learning curve identified. To report the results of a quality analysis and learning curve during the implementation of robotic pancreaticoduodenectomy (RPD). A retrospective review of a prospectively maintained database of 200 consecutive patients who underwent RPD in a large academic center from October 3, 2008, through March 1, 2014, was evaluated for important metrics of quality. Patients were analyzed in groups of 20 to minimize demographic differences and optimize the ability to detect statistically meaningful changes in performance. Robotic pancreaticoduodenectomy. Optimization of perioperative outcome parameters. No statistical differences in mortality rates or major morbidity were noted during the study. Statistical improvements in estimated blood loss and conversions to open surgery occurred after 20 cases (600 mL vs 250 mL [P = .002] and 35.0% vs 3.3% [P < .001], respectively), incidence of pancreatic fistula after 40 cases (27.5% vs 14.4%; P = .04), and operative time after 80 cases (581 minutes vs 417 minutes [P < .001]). Complication rates, lengths of stay, and readmission rates showed continuous improvement that did not reach statistical significance. Outcomes for the last 120 cases (representing optimized metrics beyond the learning curve) included a mean operative time of 417 minutes, median estimated blood loss of 250 mL, a conversion rate of 3.3%, 90-day mortality of 3.3%, a clinically significant (grade B/C) pancreatic fistula rate of 6.9%, and a median length of stay of 9 days. Continuous assessment of quality metrics allows for safe implementation of RPD. We identified several inflexion points corresponding to optimization of performance metrics for RPD that can be used as benchmarks for surgeons who are adopting this technology.

Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video).

PubMed

Mathus-Vliegen, Elisabeth M H; Duflou, Ann; Spanier, Marcel B W; Fockens, Paul

2010-04-01

The early institution of feeding in patients who need postpyloric feeding tubes is often hampered by a limited availability of endoscopists experienced in safe tube positioning. To test the feasibility of having nurses place postpyloric feeding tubes by using a universal path finding system device. Prospective study. Academic hospital. The success rate and learning curve of a senior nurse placing postpyloric feeding tubes in 50 patients was studied, followed by a study in 160 patients on the success rates and learning curves of 4 inexperienced nurses instructed by the senior nurse. Finally, the success rate of postpyloric feeding tube placement by the senior nurse in 50 critically ill patients was investigated. Postpyloric feeding tube positioning by nurses using an electromagnetic universal path-finding system device enabling them to follow the path of the tip of the feeding tube on a monitor screen. Success was defined by postpyloric positioning of the feeding tube. The ultimate aim was to reach at least the duodenojejunal flexure. In the first part, the senior nurse was successful in 72% of cases. There was a clear learning curve. In the second part, the 4 newly instructed nurses had a success rate of 89.4% without an evident learning curve. In the third part, successful feeding tube positioning was achieved in 78% of critically ill patients. Of the 217 successfully positioned tubes, 74% reached at least the duodenojejunal flexure. In half of the unsuccessful cases, an explanation for the failure was found at endoscopy. No complications were seen. The generalization to less-specialized hospitals should be investigated. Postpyloric positioning of feeding tubes by nurses at the bedside without endoscopy is feasible and safe. Nurses may take over some of the tasks of doctors in a time of high endoscopic needs. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.

PubMed

Pampalona, Jennifer Rovira; Bastos, Maria Degollada; Moreno, Gemma Mancebo; Pust, Andrea Buron; Montesdeoca, Gemma Escribano; Guerra Garcia, Angel; Pruñonosa, Juan Carles Mateu; Collado, Ramon Carreras; Torras, Pere Bresco

2015-01-01

To assess and compare efficacy, pain, and the learning curve associated with diagnostic therapeutic hysteroscopy using mechanical tissue removal versus bipolar electrical resection in the management of endometrial polyps in an ambulatory care setting. A randomized controlled clinical trial (Canadian Task Force classification I). Hospital de Igulada, Barcelona, Spain. A total of 133 patients diagnosed with endometrial polyp(s) were included and randomly assigned to 1 of the 2 hysteroscopic methods. Criteria assessed were total hysteroscopy time, full polypectomy procedure time, pain experienced by patients, and learning curve of staff in training. The average time to perform total hysteroscopy using the mechanical tissue removal system (TRUCLEAR 5.0 System; Smith & Nephew Inc., Andover, MD) was 6 minutes 49 seconds versus 11 minutes 37 seconds required for the bipolar electrosurgery system (GYNECARE VERSAPOINT; Ethicon Inc, Somerville, NJ) (p < .01). Results for complete polypectomy time favored the TRUCLEAR System at 3 minutes 7 seconds over the VERSAPOINT System at 8 minutes 25 seconds (p < .01). If a successful procedure is predicated on access to cavity, visualization, and complete resection and excision of endometrial polyp, the mechanical TRUCLEAR Tissue Removal System shows a higher success rate than the VERSAPOINT Bipolar Electrosurgery System at 92% and 77%, respectively. Analysis of pain using the visual analog scale revealed no significant differences between the 2 techniques (p > .05). A study of the residents' learning curve showed a higher level of autonomy with hysteroscopy using the TRUCLEAR Tissue Removal System with which residents showed a higher level of confidence compared with hysteroscopy with the VERSAPOINT Bipolar Electrosurgery System. In hysteroscopic polypectomy, the mechanical tissue removal system was significantly faster, achieved a greater success rate for complete polypectomy, and required a shorter learning curve from staff being trained in the management of endometrial polyps when compared with bipolar electrical resection. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Ensemble based adaptive over-sampling method for imbalanced data learning in computer aided detection of microaneurysm.

PubMed

Ren, Fulong; Cao, Peng; Li, Wei; Zhao, Dazhe; Zaiane, Osmar

2017-01-01

Diabetic retinopathy (DR) is a progressive disease, and its detection at an early stage is crucial for saving a patient's vision. An automated screening system for DR can help in reduce the chances of complete blindness due to DR along with lowering the work load on ophthalmologists. Among the earliest signs of DR are microaneurysms (MAs). However, current schemes for MA detection appear to report many false positives because detection algorithms have high sensitivity. Inevitably some non-MAs structures are labeled as MAs in the initial MAs identification step. This is a typical "class imbalance problem". Class imbalanced data has detrimental effects on the performance of conventional classifiers. In this work, we propose an ensemble based adaptive over-sampling algorithm for overcoming the class imbalance problem in the false positive reduction, and we use Boosting, Bagging, Random subspace as the ensemble framework to improve microaneurysm detection. The ensemble based over-sampling methods we proposed combine the strength of adaptive over-sampling and ensemble. The objective of the amalgamation of ensemble and adaptive over-sampling is to reduce the induction biases introduced from imbalanced data and to enhance the generalization classification performance of extreme learning machines (ELM). Experimental results show that our ASOBoost method has higher area under the ROC curve (AUC) and G-mean values than many existing class imbalance learning methods. Copyright © 2016 Elsevier Ltd. All rights reserved.

Landslide susceptibility modeling applying machine learning methods: A case study from Longju in the Three Gorges Reservoir area, China

NASA Astrophysics Data System (ADS)

Zhou, Chao; Yin, Kunlong; Cao, Ying; Ahmed, Bayes; Li, Yuanyao; Catani, Filippo; Pourghasemi, Hamid Reza

2018-03-01

Landslide is a common natural hazard and responsible for extensive damage and losses in mountainous areas. In this study, Longju in the Three Gorges Reservoir area in China was taken as a case study for landslide susceptibility assessment in order to develop effective risk prevention and mitigation strategies. To begin, 202 landslides were identified, including 95 colluvial landslides and 107 rockfalls. Twelve landslide causal factor maps were prepared initially, and the relationship between these factors and each landslide type was analyzed using the information value model. Later, the unimportant factors were selected and eliminated using the information gain ratio technique. The landslide locations were randomly divided into two groups: 70% for training and 30% for verifying. Two machine learning models: the support vector machine (SVM) and artificial neural network (ANN), and a multivariate statistical model: the logistic regression (LR), were applied for landslide susceptibility modeling (LSM) for each type. The LSM index maps, obtained from combining the assessment results of the two landslide types, were classified into five levels. The performance of the LSMs was evaluated using the receiver operating characteristics curve and Friedman test. Results show that the elimination of noise-generating factors and the separated modeling of each landslide type have significantly increased the prediction accuracy. The machine learning models outperformed the multivariate statistical model and SVM model was found ideal for the case study area.

Assessment of an introductory cervicocerebral catheter angiography learning program: a pilot study.

PubMed

Lui, Y W; Farinhas, J M; Basalely, A M; Hsu, K A; Freeman, K; Bello, J A

2012-06-01

There is no standardized curriculum currently available at most institutions for establishing procedural competency in trainees performing cervicocerebral angiography. The purpose of this study was to evaluate a simple learning program to supplement the teaching of basic cervicocerebral angiography. An 11-session interactive curriculum was implemented covering anatomic, clinical, and radiographic topics for the novice cervicocerebral angiographer. The target learner was the neuroradiology fellow. Data were gathered regarding fellow comfort level on topics relating to cervicocerebral angiography by using a 5-point Likert scale. Improvement in scores on knowledge-based questions after completion of the curriculum was calculated (McNemar test). Trainee-perceived utility of the program was also recorded by using a 5-point Likert scale. Focus sessions were held at the completion of the curriculum to gather feedback regarding the strengths and weaknesses of the program from participants. Ten subjects were enrolled in this pilot study for 3 years. Topics where participants reported a poor initial comfort level (4 or higher) included selection of injection rates and volumes and reformation of reverse-curve catheters. Trainees demonstrated a statistically significant change in the distribution of scores of 29.3% (49.4%-78.7% correct response rate, P < .0001). The average perceived utility was 1.5 (1 = most useful, 5 = least useful). This simple learning program was a useful adjunct to the training of fellows in diagnostic cervicocerebral angiography, resulting in quantitative improvements in knowledge.

Initial Abstraction and Curve Numbers in a Semiarid Watershed in Southeastern Arizona

EPA Science Inventory

The Soil Conservation Service curve number estimates of direct runoff from rainfall for semiarid catchments can be inaccurate. Investigation of the Walnut Gulch Experimental Watershed (Southeastern Arizona) and its 10 nested catchments determined that the inaccuracy is due to an ...

An Efficacious Measurement of Learning Initiatives: E-Learning Systems, Learning-Organization Culture, Knowledge Creation, and Innovativeness

ERIC Educational Resources Information Center

Grundhoefer, Raymie

2013-01-01

The purpose of this research is twofold: (a) develop a validated measure for learning initiatives based on knowledge-creation theory and (b) conduct a quantitative study to investigate the relationships between electronic learning systems, learning-organization culture, efficacious knowledge creation (EKC), and innovativeness. Although Cheng-Chang…

DES14X3taz: A TYPE I SUPERLUMINOUS SUPERNOVA SHOWING A LUMINOUS, RAPIDLY COOLING INITIAL PRE-PEAK BUMP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, M.; Sullivan, M.; D’Andrea, C. B.

2016-02-03

We present DES14X3taz, a new hydrogen-poor superluminous supernova (SLSN-I) discovered by the Dark Energy Survey (DES) supernova program, with additional photometric data provided by the Survey Using DECam for Superluminous Supernovae. Spectra obtained using Optical System for Imaging and low-Intermediate-Resolution Integrated Spectroscopy on the Gran Telescopio CANARIAS show DES14X3taz is an SLSN-I at z = 0.608. Multi-color photometry reveals a double-peaked light curve: a blue and relatively bright initial peak that fades rapidly prior to the slower rise of the main light curve. Our multi-color photometry allows us, for the first time, to show that the initial peak cools frommore » 22,000 to 8000 K over 15 rest-frame days, and is faster and brighter than any published core-collapse supernova, reaching 30% of the bolometric luminosity of the main peak. No physical Ni-56-powered model can fit this initial peak. We show that a shock-cooling model followed by a magnetar driving the second phase of the light curve can adequately explain the entire light curve of DES14X3taz. Models involving the shock-cooling of extended circumstellar material at a distance of similar or equal to 400 R-circle dot are preferred over the cooling of shock-heated surface layers of a stellar envelope. We compare DES14X3taz to the few double-peaked SLSN-I events in the literature. Although the rise. times and characteristics of these initial peaks differ, there exists the tantalizing possibility that they can be explained by one physical interpretation« less

DES14X3taz: A type I superluminous supernova showing a luminous, rapidly cooling initial pre-peak bump

DOE PAGES

Smith, M.

2016-02-03

Here, we present DES14X3taz, a new hydrogen-poor superluminous supernova (SLSN-I) discovered by the Dark Energy Survey (DES) supernova program, with additional photometric data provided by the Survey Using DECam for Superluminous Supernovae. Spectra obtained using Optical System for Imaging and low-Intermediate-Resolution Integrated Spectroscopy on the Gran Telescopio CANARIAS show DES14X3taz is an SLSN-I at z = 0.608. Multi-color photometry reveals a double-peaked light curve: a blue and relatively bright initial peak that fades rapidly prior to the slower rise of the main light curve. Our multi-color photometry allows us, for the first time, to show that the initial peak cools from 22,000more » to 8000 K over 15 rest-frame days, and is faster and brighter than any published core-collapse supernova, reaching 30% of the bolometric luminosity of the main peak. No physical (56)Ni-powered model can fit this initial peak. We show that a shock-cooling model followed by a magnetar driving the second phase of the light curve can adequately explain the entire light curve of DES14X3taz. Models involving the shock-cooling of extended circumstellar material at a distance of ≃400 R ⊙ are preferred over the cooling of shock-heated surface layers of a stellar envelope. We compare DES14X3taz to the few double-peaked SLSN-I events in the literature. Although the rise times and characteristics of these initial peaks differ, there exists the tantalizing possibility that they can be explained by one physical interpretation.« less

Search strategy selection in the Morris water maze indicates allocentric map formation during learning that underpins spatial memory formation.

PubMed

Rogers, Jake; Churilov, Leonid; Hannan, Anthony J; Renoir, Thibault

2017-03-01

Using a Matlab classification algorithm, we demonstrate that a highly salient distal cue array is required for significantly increased likelihoods of spatial search strategy selection during Morris water maze spatial learning. We hypothesized that increased spatial search strategy selection during spatial learning would be the key measure demonstrating the formation of an allocentric map to the escape location. Spatial memory, as indicated by quadrant preference for the area of the pool formally containing the hidden platform, was assessed as the main measure that this allocentric map had formed during spatial learning. Our C57BL/6J wild-type (WT) mice exhibit quadrant preference in the highly salient cue paradigm but not the low, corresponding with a 120% increase in the odds of a spatial search strategy selection during learning. In contrast, quadrant preference remains absent in serotonin 1A receptor (5-HT 1A R) knockout (KO) mice, who exhibit impaired search strategy selection during spatial learning. Additionally, we also aimed to assess the impact of the quality of the distal cue array on the spatial learning curves of both latency to platform and path length using mixed-effect regression models and found no significant associations or interactions. In contrast, we demonstrated that the spatial learning curve for search strategy selection was absent during training in the low saliency paradigm. Therefore, we propose that allocentric search strategy selection during spatial learning is the learning parameter in mice that robustly indicates the formation of a cognitive map for the escape goal location. These results also suggest that both latency to platform and path length spatial learning curves do not discriminate between allocentric and egocentric spatial learning and do not reliably predict spatial memory formation. We also show that spatial memory, as indicated by the absolute time in the quadrant formerly containing the hidden platform alone (without reference to the other areas of the pool), was not sensitive to cue saliency or impaired in 5-HT 1A R KO mice. Importantly, in the absence of a search strategy analysis, this suggests that to establish that the Morris water maze has worked (i.e. control mice have formed an allocentric map to the escape goal location), a measure of quadrant preference needs to be reported to establish spatial memory formation. This has implications for studies that claim hippocampal functioning is impaired using latency to platform or path length differences within the existing Morris water maze literature. Copyright © 2016 Elsevier Inc. All rights reserved.

ENKI - A tool for analysing the learning efficiency

NASA Astrophysics Data System (ADS)

Simona, Dudáková; Boris, Lacsný; Aba, Teleki

2017-01-01

Long-term memory plays a crucial role in learning mechanisms. We start to build up a probability model of learning (ENKI) ten years ago based on findings of micro genetics published in [1]. We accomplished a number of experiments in our department to testify the validity of the model with success. We described ENKI in detail here, giving the general mathematical formula of the learning curve. This paper pointed out that the model ENKI can detect its own strategy of learning in the brain as well as the simulation of the process of learning that will lead to the development of this method using its own strategy.

Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning.

PubMed

Alcaide-Leon, P; Dufort, P; Geraldo, A F; Alshafai, L; Maralani, P J; Spears, J; Bharatha, A

2017-06-01

Accurate preoperative differentiation of primary central nervous system lymphoma and enhancing glioma is essential to avoid unnecessary neurosurgical resection in patients with primary central nervous system lymphoma. The purpose of the study was to evaluate the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma and enhancing glioma. Seventy-one adult patients with enhancing gliomas and 35 adult patients with primary central nervous system lymphomas were included. The tumors were manually contoured on contrast-enhanced T1WI, and the resulting volumes of interest were mined for textural features and subjected to a support vector machine-based machine-learning protocol. Three readers classified the tumors independently on contrast-enhanced T1WI. Areas under the receiver operating characteristic curves were estimated for each reader and for the support vector machine classifier. A noninferiority test for diagnostic accuracy based on paired areas under the receiver operating characteristic curve was performed with a noninferiority margin of 0.15. The mean areas under the receiver operating characteristic curve were 0.877 (95% CI, 0.798-0.955) for the support vector machine classifier; 0.878 (95% CI, 0.807-0.949) for reader 1; 0.899 (95% CI, 0.833-0.966) for reader 2; and 0.845 (95% CI, 0.757-0.933) for reader 3. The mean area under the receiver operating characteristic curve of the support vector machine classifier was significantly noninferior to the mean area under the curve of reader 1 ( P = .021), reader 2 ( P = .035), and reader 3 ( P = .007). Support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma. © 2017 by American Journal of Neuroradiology.

Thermomagnetic analysis of meterorites. 4: Ureilites

NASA Technical Reports Server (NTRS)

Rowe, M. W.; Herndon, J. M.; Larson, E. E.; Watson, D. E.

1974-01-01

Samples of all available ureilites have been analyzed thermomagnetically. For three of the six (Dyalpur, Goalpara and Havero) evidence was found for only low-nickel metallic-iron as the magnetic component and the (saturation magnetization vs, temperature) curves were reversible. In the Novo Urei ureilite, magnetite in addition to low-nickel metallic-iron was indicated and again the Js-T curve was reversible. For the two badly weathered ureilites, Dingo Pup Donga and North Haig, indication was also found that both initial magnetite and low-nickel metallic-iron were present. However, the Js-T curves were somewhat irreversible and the final saturation magnetization was 20% and 50% greater than initially for North Haig and Dingo Pup Donga, respectively. This behavior is interpreted to be the result of magnetite production from a secondary iron oxide during the experiment.

Coseismic temporal changes of slip direction: the effect of absolute stress on dynamic rupture

USGS Publications Warehouse

Guatteri, Mariagiovanna; Spudich, P.

1998-01-01

We investigate the dynamics of rupture at low-stress level. We show that one main difference between the dynamics of high- and low-stress events is the amount of coseismic temporal rake rotation occurring at given points on the fault. Curved striations on exposed fault surfaces and earthquake dislocation models derived from ground-motion inversion indicate that the slip direction may change with time at a point on the fault during dynamic rupture. We use a 3D boundary integral method to model temporal rake variations during dynamic rupture propagation assuming a slip-weakening friction law and isotropic friction. The points at which the slip rotates most are characterized by an initial shear stress direction substantially different from the average stress direction over the fault plane. We show that for a given value of stress drop, the level of initial shear stress (i.e., the fractional stress drop) determines the amount of rotation in slip direction. We infer that seismic events that show evidence of temporal rake rotations are characterized by a low initial shear-stress level with spatially variable direction on the fault (possibly due to changes in fault surface geometry) and an almost complete stress drop.Our models motivate a new interpretation of curved and cross-cutting striations and put new constraints on their analysis. The initial rake is in general collinear with the initial stress at the hypocentral zone, supporting the assumptions made in stress-tensor inversion from first-motion analysis. At other points on the fault, especially away from the hypocenter, the initial slip rake may not be collinear with the initial shear stress, contradicting a common assumption of structural geology. On the other hand, the later part of slip in our models is systematically more aligned with the average stress direction than the early slip. Our modeling suggests that the length of the straight part of curved striations is usually an upper bound of the slip-weakening distance if this parameter is uniform over the fault plane, and the direction of the late part of slip of curved striations should have more weight in the estimate of initial stress direction.

Applying a machine learning model using a locally preserving projection based feature regeneration algorithm to predict breast cancer risk

NASA Astrophysics Data System (ADS)

Heidari, Morteza; Zargari Khuzani, Abolfazl; Danala, Gopichandh; Mirniaharikandehei, Seyedehnafiseh; Qian, Wei; Zheng, Bin

2018-03-01

Both conventional and deep machine learning has been used to develop decision-support tools applied in medical imaging informatics. In order to take advantages of both conventional and deep learning approach, this study aims to investigate feasibility of applying a locally preserving projection (LPP) based feature regeneration algorithm to build a new machine learning classifier model to predict short-term breast cancer risk. First, a computer-aided image processing scheme was used to segment and quantify breast fibro-glandular tissue volume. Next, initially computed 44 image features related to the bilateral mammographic tissue density asymmetry were extracted. Then, an LLP-based feature combination method was applied to regenerate a new operational feature vector using a maximal variance approach. Last, a k-nearest neighborhood (KNN) algorithm based machine learning classifier using the LPP-generated new feature vectors was developed to predict breast cancer risk. A testing dataset involving negative mammograms acquired from 500 women was used. Among them, 250 were positive and 250 remained negative in the next subsequent mammography screening. Applying to this dataset, LLP-generated feature vector reduced the number of features from 44 to 4. Using a leave-onecase-out validation method, area under ROC curve produced by the KNN classifier significantly increased from 0.62 to 0.68 (p < 0.05) and odds ratio was 4.60 with a 95% confidence interval of [3.16, 6.70]. Study demonstrated that this new LPP-based feature regeneration approach enabled to produce an optimal feature vector and yield improved performance in assisting to predict risk of women having breast cancer detected in the next subsequent mammography screening.

Proceedings of the Defense Acquisition Reform: Challenge to Government, Industry, and Academia, Held at Washington, DC on 26 April 1994.

DTIC Science & Technology

1994-04-26

Obviously what we want to do is come down to ber of problems we have had on these contracts, and it the bottom of the cost curve . Many years ago, 50 years...many of our systems the military and answer your first one. To be realistic, there is not primes have had many years of learning curve , not only much...risk levels. In this section I offer some assertions to add more precision to the shape of the boundary curves . D-4 * Assertion 1: Probability is the

Evaluation of multi-level social learning for sustainable landscapes: perspective of a development initiative in Bergslagen, Sweden.

PubMed

Axelsson, Robert; Angelstam, Per; Myhrman, Lennart; Sädbom, Stefan; Ivarsson, Milis; Elbakidze, Marine; Andersson, Kenneth; Cupa, Petr; Diry, Christian; Doyon, Frederic; Drotz, Marcus K; Hjorth, Arne; Hermansson, Jan Olof; Kullberg, Thomas; Lickers, F Henry; McTaggart, Johanna; Olsson, Anders; Pautov, Yurij; Svensson, Lennart; Törnblom, Johan

2013-03-01

To implement policies about sustainable landscapes and rural development necessitates social learning about states and trends of sustainability indicators, norms that define sustainability, and adaptive multi-level governance. We evaluate the extent to which social learning at multiple governance levels for sustainable landscapes occur in 18 local development initiatives in the network of Sustainable Bergslagen in Sweden. We mapped activities over time, and interviewed key actors in the network about social learning. While activities resulted in exchange of experiences and some local solutions, a major challenge was to secure systematic social learning and make new knowledge explicit at multiple levels. None of the development initiatives used a systematic approach to secure social learning, and sustainability assessments were not made systematically. We discuss how social learning can be improved, and how a learning network of development initiatives could be realized.

Habitat suitability index curves for paddlefish, developed by the delphi technique

USGS Publications Warehouse

Crance, John H.

1987-01-01

A Delphi exercise conducted with a panel of 11 experts on paddlefish (Polyodon spathula) and an evaluator resulted in 14 riverine habitat suitability index curves associating various life stages or activities of paddlefish with four variables: velocity, depth, substrate type, and temperature. The panel reached a consensus on six of the curves and eight to 10 panelists agreed on the others. Several panelists reported that they found the Delphi exercise to be a good learning experience, and they believed the technique is an appropriate interim method for developing suitability index curves when available data are inadequate for more conventional statistical analyses. Documentation of good paddlefish spawning habitat was the data need most commonly identified by the panelists.

Free vibration of rectangular plates with a small initial curvature

NASA Technical Reports Server (NTRS)

Adeniji-Fashola, A. A.; Oyediran, A. A.

1988-01-01

The method of matched asymptotic expansions is used to solve the transverse free vibration of a slightly curved, thin rectangular plate. Analytical results for natural frequencies and mode shapes are presented in the limit when the dimensionless bending rigidity, epsilon, is small compared with in-plane forces. Results for different boundary conditions are obtained when the initial deflection is: (1) a polynomial in both directions, and (2) the product of a polynomial and a trigonometric function, and arbitrary. For the arbitrary initial deflection case, the Fourier series technique is used to define the initial deflection. The results obtained show that the natural frequencies of vibration of slightly curved plates are coincident with those of perfectly flat, prestressed rectangular plates. However, the eigenmodes are very different from those of initially flat prestressed rectangular plates. The total deflection is found to be the sum of the initial deflection, the deflection resulting from the solution of the flat plate problem, and the deflection resulting from the static problem.

A study of space shuttle structural integrity test and assessment. Part 1

NASA Technical Reports Server (NTRS)

Anderson, R. E.; Poe, R. G.

1972-01-01

The ultrasonics technique for assessing the structural integrity of the primary surface of the space shuttle vehicles is discussed and evaluated. Analysis was made of transducers, transducer coupling test structure fabrication, flaws, and ultrasonic testing. Graphs of microphone response curves from the initial noise tests, accelerometer response curves from the final noise tests, and microphone curves from the final noise tests are included along with a glossary, bibliography, and results.

Sustainability Factors for E-Learning Initiatives

ERIC Educational Resources Information Center

Gunn, Cathy

2010-01-01

This paper examines the challenges that "grass roots" e-learning initiatives face in trying to become sustainable. A cross-institutional study focused on local, rather than centrally driven, initiatives. A number of successful e-learning innovations were identified that had been driven by capable teachers seeking solutions to real…

Documentation of the Tonge-Ramesh Material Model for Release 2015-06-05-152756

DTIC Science & Technology

2015-10-01

crush curves showing pressure required to initiate pore collapse for pure hydrostatic loading as a function of distension for the 2 different granular...Illustration of the crush curves showing pressure required to initiate pore collapse for pure hydrostatic loading as a function of distension for the 2...is an additional yield surface that depends on only the hydrostatic pressure (p = −1/3tr(σ)). 13 It is defined by fφ(P, J GP , J) =  P Pc−P0

Nonlinear Growth Curves in Developmental Research

ERIC Educational Resources Information Center

Grimm, Kevin J.; Ram, Nilam; Hamagami, Fumiaki

2011-01-01

Developmentalists are often interested in understanding change processes, and growth models are the most common analytic tool for examining such processes. Nonlinear growth curves are especially valuable to developmentalists because the defining characteristics of the growth process such as initial levels, rates of change during growth spurts, and…

Assessing Students' Development in Learning Approaches According to Initial Learning Profiles: A Person-Oriented Perspective

ERIC Educational Resources Information Center

Vanthournout, Gert; Coertjens, Liesje; Gijbels, David; Donche, Vincent; Van Petegem, Peter

2013-01-01

Research regarding the development of students' learning approaches have at times reported unexpected or lack of expected changes. The current study explores the idea of differential developments in learning approaches according to students' initial learning profiles as a possible explanation for these outcomes. A learning profile is conceived as…

Teachers' Self-Initiated Professional Learning through Personal Learning Networks

ERIC Educational Resources Information Center

Tour, Ekaterina

2017-01-01

It is widely acknowledged that to be able to teach language and literacy with digital technologies, teachers need to engage in relevant professional learning. Existing formal models of professional learning are often criticised for being ineffective. In contrast, informal and self-initiated forms of learning have been recently recognised as…

Analysis of Learning Curve Fitting Techniques.

DTIC Science & Technology

1987-09-01

1986. 15. Neter, John and others. Applied Linear Regression Models. Homewood IL: Irwin, 19-33. 16. SAS User’s Guide: Basics, Version 5 Edition. SAS... Linear Regression Techniques (15:23-52). Random errors are assumed to be normally distributed when using -# ordinary least-squares, according to Johnston...lot estimated by the improvement curve formula. For a more detailed explanation of the ordinary least-squares technique, see Neter, et. al., Applied

Astroinformatics in the Age of LSST: Analyzing the Summer 2012 Data Release

NASA Astrophysics Data System (ADS)

Borne, Kirk D.; De Lee, N. M.; Stassun, K.; Paegert, M.; Cargile, P.; Burger, D.; Bloom, J. S.; Richards, J.

2013-01-01

The Large Synoptic Survey Telescope (LSST) will image the visible southern sky every three nights. This multi-band, multi-epoch survey will produce a torrent of data, which traditional methods of object-by-object data analysis will not be able to accommodate. Thus the need for new astroinformatics tools to visualize, simulate, mine, and analyze this quantity of data. The Berkeley Center for Time-Domain Informatics (CTDI) is building the informatics infrastructure for generic light curve classification, including the innovation of new algorithms for feature generation and machine learning. The CTDI portal (http://dotastro.org) contains one of the largest collections of public light curves, with visualization and exploration tools. The group has also published the first calibrated probabilistic classification catalog of 50k variable stars along with a data exploration portal called http://bigmacc.info. Twice a year, the LSST collaboration releases simulated LSST data, in order to aid software development. This poster also showcases a suite of new tools from the Vanderbilt Initiative in Data-instensive Astrophysics (VIDA), designed to take advantage of these large data sets. VIDA's Filtergraph interactive web tool allows one to instantly create an interactive data portal for fast, real-time visualization of large data sets. Filtergraph enables quick selection of interesting objects by easily filtering on many different columns, 2-D and 3-D representations, and on-the-fly arithmetic calculations on the data. It also makes sharing the data and the tool with collaborators very easy. The EB/RRL Factory is a neural-network based variable star classifier, which is designed to quickly identify variable stars in a variety of classes from LSST light curve data (currently tuned to Eclipsing Binaries and RR Lyrae stars), and to provide likelihood-based orbital elements or stellar parameters as appropriate. Finally the LCsimulator software allows one to create simulated light curves of multiple types of variable stars based on an LSST cadence.

Are minimally invasive procedures harder to acquire than conventional surgical procedures?

PubMed

Hiemstra, Ellen; Kolkman, Wendela; le Cessie, Saskia; Jansen, Frank Willem

2011-01-01

It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents' learning curves of both surgical skills are compared. Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery. Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19-2.35 vs. 0.15-1.35, p < 0.01). Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures. Copyright © 2010 S. Karger AG, Basel.

Deep Processing Strategies and Critical Thinking: Developmental Trajectories Using Latent Growth Analyses

ERIC Educational Resources Information Center

Phan, Huy P.

2011-01-01

The author explored the developmental courses of deep learning approach and critical thinking over a 2-year period. Latent growth curve modeling (LGM) procedures were used to test and trace the trajectories of both theoretical frameworks over time. Participants were 264 (119 women, 145 men) university undergraduates. The Deep Learning subscale of…

A Study of Research and Development Contract Requirements and Their Growth.

DTIC Science & Technology

1979-05-01

Bruner , Jerome S.; Jacqueline J. Goodnow; and George A. Austin. A Study of Thinking. New York, N.Y.: John Wiley and Sons, Inc., 1956. 5. Busek...Interest Continued ... 34 A Learning Analogy ............................ 42 CHAPTER THREE - THE CONCEPTUAL MODEL .............. 49 System...Definitions in One Project ......... ............. Table Eight - Requirement Counting Learning Curve Results ....................... 100 Table Nine - Selected

Patterns and Effectiveness of Mobile Device Usage by Japanese Undergraduates for L2 Acquisition Purposes

ERIC Educational Resources Information Center

Pagel, James W.; Lambacher, Stephen G.

2014-01-01

Mobile technologies, such as smartphones and tablets, are rapidly gaining popularity as an effective means to enhance foreign language learning. However, does the incorporation of these mobile devices really benefit the learner or simply satisfy the instructor's need to be innovative and ahead of the learning curve? The present study seeks to…

Learning Alternatives and Strategies for Students Who Are Struggling

ERIC Educational Resources Information Center

Johnston, Don C.

2008-01-01

Much of what happens in the learning process focuses on teaching to the average student, but the bell curve has deflated with fewer students in the middle, making the educational dilemma more about "how to connect" with students regardless of diverse abilities and various backgrounds. According to the "Twenty-Fourth Annual Report to Congress" by…

Improving Critical Thinking Skills Using Learning Model Logan Avenue Problem Solving (LAPS)-Heuristic

ERIC Educational Resources Information Center

Anggrianto, Desi; Churiyah, Madziatul; Arief, Mohammad

2016-01-01

This research was conducted in order to know the effect of Logan Avenue Problem Solving (LAPS)-Heuristic learning model towards critical thinking skills of students of class X Office Administration (APK) in SMK Negeri 1 Ngawi, East Java, Indonesia on material curve and equilibrium of demand and supply, subject Introduction to Economics and…

Locus of Control Orientations in Students with Intellectual Disability, Learning Disabilities, and No Disabilities: A Latent Growth Curve Analysis

ERIC Educational Resources Information Center

Shogren, Karrie A.; Bovaird, James A.; Palmer, Susan B.; Wehmeyer, Michael L.

2010-01-01

Previous research has suggested differences in the locus of control (LOC) orientations of students with intellectual disability, learning disabilities, and no disabilities, although this research has been characterized by methodological limitations. The purpose of this study was to examine the development of LOC orientations in students with…

Space Human Factors: Research to Application

NASA Technical Reports Server (NTRS)

Woolford, Barbara

2008-01-01

Human Factors has been instrumental in preventing potential on-orbit hazards and increasing overall crew safety. Poor performance & operational learning curves on-orbit are mitigated. Human-centered design is applied to optimize design and minimize potentially hazardous conditions, especially with larger crew sizes and habitat constraints. Lunar and Mars requirements and design developments are enhanced, based on ISS Lessons Learned.

Development Process and Technical Aspects of Laparoscopic Hepatectomy: Learning Curve Based on 15 Years of Experience.

PubMed

Komatsu, Shohei; Scatton, Olivier; Goumard, Claire; Sepulveda, Ailton; Brustia, Raffaele; Perdigao, Fabiano; Soubrane, Olivier

2017-05-01

Laparoscopic hepatectomy continues to be a challenging operation associated with a steep learning curve. This study aimed to evaluate the learning process during 15 years of experience with laparoscopic hepatectomy and to identify approaches to standardization of this procedure. Prospectively collected data of 317 consecutive laparoscopic hepatectomies performed from January 2000 to December 2014 were reviewed retrospectively. The operative procedures were classified into 4 categories (minor hepatectomy, left lateral sectionectomy [LLS], left hepatectomy, and right hepatectomy), and indications were classified into 5 categories (benign-borderline tumor, living donor, metastatic liver tumor, biliary malignancy, and hepatocellular carcinoma). During the first 10 years, the procedures were limited mainly to minor hepatectomy and LLS, and the indications were limited to benign-borderline tumor and living donor. Implementation of major hepatectomy rapidly increased the proportion of malignant tumors, especially hepatocellular carcinoma, starting from 2011. Conversion rates decreased with experience for LLS (13.3% vs 3.4%; p = 0.054) and left hepatectomy (50.0% vs 15.0%; p = 0.012), but not for right hepatectomy (41.4% vs 35.7%; p = 0.661). Our 15-year experience clearly demonstrates the stepwise procedural evolution from LLS through left hepatectomy to right hepatectomy, as well as the trend in indications from benign-borderline tumor/living donor to malignant tumors. In contrast to LLS and left hepatectomy, a learning curve was not observed for right hepatectomy. The ongoing development process can contribute to faster standardization necessary for future advances in laparoscopic hepatectomy. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Can Statistical Machine Learning Algorithms Help for Classification of Obstructive Sleep Apnea Severity to Optimal Utilization of Polysomnography Resources?

PubMed

Bozkurt, Selen; Bostanci, Asli; Turhan, Murat

2017-08-11

The goal of this study is to evaluate the results of machine learning methods for the classification of OSA severity of patients with suspected sleep disorder breathing as normal, mild, moderate and severe based on non-polysomnographic variables: 1) clinical data, 2) symptoms and 3) physical examination. In order to produce classification models for OSA severity, five different machine learning methods (Bayesian network, Decision Tree, Random Forest, Neural Networks and Logistic Regression) were trained while relevant variables and their relationships were derived empirically from observed data. Each model was trained and evaluated using 10-fold cross-validation and to evaluate classification performances of all methods, true positive rate (TPR), false positive rate (FPR), Positive Predictive Value (PPV), F measure and Area Under Receiver Operating Characteristics curve (ROC-AUC) were used. Results of 10-fold cross validated tests with different variable settings promisingly indicated that the OSA severity of suspected OSA patients can be classified, using non-polysomnographic features, with 0.71 true positive rate as the highest and, 0.15 false positive rate as the lowest, respectively. Moreover, the test results of different variables settings revealed that the accuracy of the classification models was significantly improved when physical examination variables were added to the model. Study results showed that machine learning methods can be used to estimate the probabilities of no, mild, moderate, and severe obstructive sleep apnea and such approaches may improve accurate initial OSA screening and help referring only the suspected moderate or severe OSA patients to sleep laboratories for the expensive tests.

SkyDOT: a publicly accessible variability database, containing multiple sky surveys and real-time data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Starr, D. L.; Wozniak, P. R.; Vestrand, W. T.

2002-01-01

SkyDOT (Sky Database for Objects in Time-Domain) is a Virtual Observatory currently comprised of data from the RAPTOR, ROTSE I, and OGLE I1 survey projects. This makes it a very large time domain database. In addition, the RAPTOR project provides SkyDOT with real-time variability data as well as stereoscopic information. With its web interface, we believe SkyDOT will be a very useful tool for both astronomers, and the public. Our main task has been to construct an efficient relational database containing all existing data, while handling a real-time inflow of data. We also provide a useful web interface allowing easymore » access to both astronomers and the public. Initially, this server will allow common searches, specific queries, and access to light curves. In the future we will include machine learning classification tools and access to spectral information.« less

Training in urological robotic surgery. Future perspectives.

PubMed

El Sherbiny, Ahmed; Eissa, Ahmed; Ghaith, Ahmed; Morini, Elena; Marzotta, Lucilla; Sighinolfi, Maria Chiara; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo

2018-01-01

As robotics are becoming more integrated into the medical field, robotic training is becoming more crucial in order to overcome the lack of experienced robotic surgeons. However, there are several obstacles facing the development of robotic training programs like the high cost of training and the increased operative time during the initial period of the learning curve, which, in turn increase the operative cost. Robotic-assisted laparoscopic prostatectomy is the most commonly performed robotic surgery. Moreover, robotic surgery is becoming more popular among urologic oncologists and pediatric urologists. The need for a standardized and validated robotic training curriculum was growing along with the increased number of urologic centers and institutes adopting the robotic technology. Robotic training includes proctorship, mentorship or fellowship, telementoring, simulators and video training. In this chapter, we are going to discuss the different training methods, how to evaluate robotic skills, the available robotic training curriculum, and the future perspectives.

It Pays to Go Off-Track: Practicing with Error-Augmenting Haptic Feedback Facilitates Learning of a Curve-Tracing Task

PubMed Central

Williams, Camille K.; Tremblay, Luc; Carnahan, Heather

2016-01-01

Researchers in the domain of haptic training are now entering the long-standing debate regarding whether or not it is best to learn a skill by experiencing errors. Haptic training paradigms provide fertile ground for exploring how various theories about feedback, errors and physical guidance intersect during motor learning. Our objective was to determine how error minimizing, error augmenting and no haptic feedback while learning a self-paced curve-tracing task impact performance on delayed (1 day) retention and transfer tests, which indicate learning. We assessed performance using movement time and tracing error to calculate a measure of overall performance – the speed accuracy cost function. Our results showed that despite exhibiting the worst performance during skill acquisition, the error augmentation group had significantly better accuracy (but not overall performance) than the error minimization group on delayed retention and transfer tests. The control group’s performance fell between that of the two experimental groups but was not significantly different from either on the delayed retention test. We propose that the nature of the task (requiring online feedback to guide performance) coupled with the error augmentation group’s frequent off-target experience and rich experience of error-correction promoted information processing related to error-detection and error-correction that are essential for motor learning. PMID:28082937

Machine learning models in breast cancer survival prediction.

PubMed

Montazeri, Mitra; Montazeri, Mohadeseh; Montazeri, Mahdieh; Beigzadeh, Amin

2016-01-01

Breast cancer is one of the most common cancers with a high mortality rate among women. With the early diagnosis of breast cancer survival will increase from 56% to more than 86%. Therefore, an accurate and reliable system is necessary for the early diagnosis of this cancer. The proposed model is the combination of rules and different machine learning techniques. Machine learning models can help physicians to reduce the number of false decisions. They try to exploit patterns and relationships among a large number of cases and predict the outcome of a disease using historical cases stored in datasets. The objective of this study is to propose a rule-based classification method with machine learning techniques for the prediction of different types of Breast cancer survival. We use a dataset with eight attributes that include the records of 900 patients in which 876 patients (97.3%) and 24 (2.7%) patients were females and males respectively. Naive Bayes (NB), Trees Random Forest (TRF), 1-Nearest Neighbor (1NN), AdaBoost (AD), Support Vector Machine (SVM), RBF Network (RBFN), and Multilayer Perceptron (MLP) machine learning techniques with 10-cross fold technique were used with the proposed model for the prediction of breast cancer survival. The performance of machine learning techniques were evaluated with accuracy, precision, sensitivity, specificity, and area under ROC curve. Out of 900 patients, 803 patients and 97 patients were alive and dead, respectively. In this study, Trees Random Forest (TRF) technique showed better results in comparison to other techniques (NB, 1NN, AD, SVM and RBFN, MLP). The accuracy, sensitivity and the area under ROC curve of TRF are 96%, 96%, 93%, respectively. However, 1NN machine learning technique provided poor performance (accuracy 91%, sensitivity 91% and area under ROC curve 78%). This study demonstrates that Trees Random Forest model (TRF) which is a rule-based classification model was the best model with the highest level of accuracy. Therefore, this model is recommended as a useful tool for breast cancer survival prediction as well as medical decision making.

Learning Initiatives in the Residential Setting. The First-Year Experience Monograph Series No. 48

ERIC Educational Resources Information Center

Luna, Gene, Ed.; Gahagan, Jimmie, Ed.

2008-01-01

In 2004, "Learning Reconsidered" urged educators to think more holistically about student learning and development. "Learning Initiatives in the Residential Setting" provides a framework for putting this call into action at large universities and small colleges alike. Chapters trace the history of learning in residence halls, discuss academic and…

X-Rays from the Explosion Site: Fifteen Years of Light Curves of SN 1993J

NASA Technical Reports Server (NTRS)

Chandra, Poonam; Dwarkadas, Vikram V.; Ray, Alak; Immler, Stefan; Pooley, David

2009-01-01

We present a comprehensive analysis of the X-ray light curves of SN 1993J in a nearby galaxy M81. This is the only supernova other than SN 1987A, which is so extensively followed in the X-ray bands. Here we report on SN 1993J observations with the Chandra in the year 2005 and 2008, and Swift observations in 2005, 2006 and 2008. We combined these observations with all available archival data of SN 1993J, which includes ROSAT, ASCA, Chandra, and XMM-Newton, observations from 1993 April to 2006 August. In this paper we report the X-ray light curves of SN 1993J, extending up to fifteen years, in the soft (0.3-2.4 keV), hard (2-8 keV) and combined (0.3-8 keV) bands. The hard and soft-band fluxes decline at different rates initially, but after about 5 years they both undergo a t(sup -1) decline. The soft X-rays, which are initially low, start dominating after a few hundred days. We interpret that most of the emission below 8 keV is coming from the reverse shock which is radiative initially for around first 1000-2000 days and then turn into adiabatic shock. Our hydrodynamic simulation also confirms the reverse shock origin of the observed light curves. We also compare the Ha line luminosity of SN 1993J with its X-ray light curve and note that the Ha line luminosity has a fairly high fraction of the X-ray emission, indicating presence of clumps in the emitting plasma.

Is there a learning curve for the TVT-O procedure? A prospective single-surgeon study of 372 consecutive cases.

PubMed

Serati, Maurizio; Bogani, Giorgio; Braga, Andrea; Sorice, Paola; Salvatore, Stefano; Uccella, Stefano; Ghezzi, Fabio

2015-03-01

To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™). A prospective observational study was conducted in a tertiary reference center. Consecutive women treated by TVT-O™ performed by one surgeon were included. Data regarding subjective, objective cure rates, and adverse events were collected. Trends, over the number of procedures, were estimated using assay analyses. Number of procedures and variables were interpolating in standard curves using linear lines. Three hundred and seventy two procedures were included. Postoperative pain levels decreased with the increase in the level of expertise (pain levels: 1-day: from 6.6 (±3.3) to 4.3 (±3.1); 95%CI: -0.01603 to 0.001235, p=0.04; 2-day: from 5.6 (±4.1) to 3.6 (±3.7); 95%CI: -0.02092 to -0.002497, p=0.01; 12-month: from 0.1 (±0.7) to 0 (±0); 95%CI: -0.001814 to 0.05019, p=0.07). Overall, objective cure rate was achieved in 93.5% of patients. Additionally, 88.2% and 88.7% patients reported "much better" feeling at PGI-I scale and 80% reduction in UDI score, respectively. We observed, that delta ICIQ-sf (from 12 (±8.7) to 14 (±6.0); p=0.04) and delta-UDI (from 91% to 97%; p=0.04) improved over the time. TVT-O procedure offers excellent outcomes with high objective and subjective cure rates and low complications rate, even at the beginning of the surgeon's learning curve. However, a high experience of the surgeon could significantly improve the subjective cure rate and could reduce postoperative the groin pain. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Isentropic fluid dynamics in a curved pipe

NASA Astrophysics Data System (ADS)

Colombo, Rinaldo M.; Holden, Helge

2016-10-01

In this paper we study isentropic flow in a curved pipe. We focus on the consequences of the geometry of the pipe on the dynamics of the flow. More precisely, we present the solution of the general Cauchy problem for isentropic fluid flow in an arbitrarily curved, piecewise smooth pipe. We consider initial data in the subsonic regime, with small total variation about a stationary solution. The proof relies on the front-tracking method and is based on [1].

A learning curve-based method to implement multifunctional work teams in the Brazilian footwear sector.

PubMed

Guimarães, L B de M; Anzanello, M J; Renner, J S

2012-05-01

This paper presents a method for implementing multifunctional work teams in a footwear company that followed the Taylor/Ford system for decades. The suggested framework first applies a Learning Curve (LC) modeling to assess whether rotation between tasks of different complexities affects workers' learning rate and performance. Next, the Macroergonomic Work Analysis (MA) method (Guimarães, 1999, 2009) introduces multifunctional principles in work teams towards workers' training and resources improvement. When applied to a pilot line consisting of 100 workers, the intervention-reduced work related accidents in 80%, absenteeism in 45.65%, and eliminated work related musculoskeletal disorders (WMSD), medical consultations, and turnover. Further, the output rate of the multifunctional team increased average 3% compared to the production rate of the regular lines following the Taylor/Ford system (with the same shoe model being manufactured), while the rework and spoilage rates were reduced 85% and 69%, respectively. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Learning the ideal observer for SKE detection tasks by use of convolutional neural networks (Cum Laude Poster Award)

NASA Astrophysics Data System (ADS)

Zhou, Weimin; Anastasio, Mark A.

2018-03-01

It has been advocated that task-based measures of image quality (IQ) should be employed to evaluate and optimize imaging systems. Task-based measures of IQ quantify the performance of an observer on a medically relevant task. The Bayesian Ideal Observer (IO), which employs complete statistical information of the object and noise, achieves the upper limit of the performance for a binary signal classification task. However, computing the IO performance is generally analytically intractable and can be computationally burdensome when Markov-chain Monte Carlo (MCMC) techniques are employed. In this paper, supervised learning with convolutional neural networks (CNNs) is employed to approximate the IO test statistics for a signal-known-exactly and background-known-exactly (SKE/BKE) binary detection task. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) are compared to those produced by the analytically computed IO. The advantages of the proposed supervised learning approach for approximating the IO are demonstrated.

Three Years of the New Mexico Laptop Learning Initiative (NMLLI): Stumbling toward Innovation

ERIC Educational Resources Information Center

Rutledge, David; Duran, James; Carroll-Miranda, Joseph

2007-01-01

This article presents qualitative results of the first three years of the New Mexico Laptop Learning Initiative (NMLLI). Results suggest that teachers, students, and their communities support this initiative to improve student learning. Descriptive statistics were used during year two to further understand how the laptops were being used by…

Propagation of waves from an arbitrary shaped surface-A generalization of the Fresnel diffraction integral

NASA Astrophysics Data System (ADS)

Feshchenko, R. M.; Vinogradov, A. V.; Artyukov, I. A.

2018-04-01

Using the method of Laplace transform the field amplitude in the paraxial approximation is found in the two-dimensional free space using initial values of the amplitude specified on an arbitrary shaped monotonic curve. The obtained amplitude depends on one a priori unknown function, which can be found from a Volterra first kind integral equation. In a special case of field amplitude specified on a concave parabolic curve the exact solution is derived. Both solutions can be used to study the light propagation from arbitrary surfaces including grazing incidence X-ray mirrors. They can find applications in the analysis of coherent imaging problems of X-ray optics, in phase retrieval algorithms as well as in inverse problems in the cases when the initial field amplitude is sought on a curved surface.

An Image Encryption Algorithm Utilizing Julia Sets and Hilbert Curves

PubMed Central

Sun, Yuanyuan; Chen, Lina; Xu, Rudan; Kong, Ruiqing

2014-01-01

Image encryption is an important and effective technique to protect image security. In this paper, a novel image encryption algorithm combining Julia sets and Hilbert curves is proposed. The algorithm utilizes Julia sets’ parameters to generate a random sequence as the initial keys and gets the final encryption keys by scrambling the initial keys through the Hilbert curve. The final cipher image is obtained by modulo arithmetic and diffuse operation. In this method, it needs only a few parameters for the key generation, which greatly reduces the storage space. Moreover, because of the Julia sets’ properties, such as infiniteness and chaotic characteristics, the keys have high sensitivity even to a tiny perturbation. The experimental results indicate that the algorithm has large key space, good statistical property, high sensitivity for the keys, and effective resistance to the chosen-plaintext attack. PMID:24404181

A Cognitive Machine Learning Algorithm for Cardiac Imaging: A Pilot Study for Differentiating Constrictive Pericarditis from Restrictive Cardiomyopathy

PubMed Central

Sengupta, Partho P.; Huang, Yen-Min; Bansal, Manish; Ashrafi, Ali; Fisher, Matt; Shameer, Khader; Gall, Walt; Dudley, Joel T

2016-01-01

Background Associating a patient’s profile with the memories of prototypical patients built through previous repeat clinical experience is a key process in clinical judgment. We hypothesized that a similar process using a cognitive computing tool would be well suited for learning and recalling multidimensional attributes of speckle tracking echocardiography (STE) data sets derived from patients with known constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). Methods and Results Clinical and echocardiographic data of 50 patients with CP and 44 with RCM were used for developing an associative memory classifier (AMC) based machine learning algorithm. The STE data was normalized in reference to 47 controls with no structural heart disease, and the diagnostic area under the receiver operating characteristic curve (AUC) of the AMC was evaluated for differentiating CP from RCM. Using only STE variables, AMC achieved a diagnostic AUC of 89·2%, which improved to 96·2% with addition of 4 echocardiographic variables. In comparison, the AUC of early diastolic mitral annular velocity and left ventricular longitudinal strain were 82.1% and 63·7%, respectively. Furthermore, AMC demonstrated greater accuracy and shorter learning curves than other machine learning approaches with accuracy asymptotically approaching 90% after a training fraction of 0·3 and remaining flat at higher training fractions. Conclusions This study demonstrates feasibility of a cognitive machine learning approach for learning and recalling patterns observed during echocardiographic evaluations. Incorporation of machine learning algorithms in cardiac imaging may aid standardized assessments and support the quality of interpretations, particularly for novice readers with limited experience. PMID:27266599

Computer-based learning of spelling skills in children with and without dyslexia.

PubMed

Kast, Monika; Baschera, Gian-Marco; Gross, Markus; Jäncke, Lutz; Meyer, Martin

2011-12-01

Our spelling training software recodes words into multisensory representations comprising visual and auditory codes. These codes represent information about letters and syllables of a word. An enhanced version, developed for this study, contains an additional phonological code and an improved word selection controller relying on a phoneme-based student model. We investigated the spelling behavior of children by means of learning curves based on log-file data of the previous and the enhanced software version. First, we compared the learning progress of children with dyslexia working either with the previous software (n = 28) or the adapted version (n = 37). Second, we investigated the spelling behavior of children with dyslexia (n = 37) and matched children without dyslexia (n = 25). To gain deeper insight into which factors are relevant for acquiring spelling skills, we analyzed the influence of cognitive abilities, such as attention functions and verbal memory skills, on the learning behavior. All investigations of the learning process are based on learning curve analyses of the collected log-file data. The results evidenced that those children with dyslexia benefit significantly from the additional phonological cue and the corresponding phoneme-based student model. Actually, children with dyslexia improve their spelling skills to the same extent as children without dyslexia and were able to memorize phoneme to grapheme correspondence when given the correct support and adequate training. In addition, children with low attention functions benefit from the structured learning environment. Generally, our data showed that memory sources are supportive cognitive functions for acquiring spelling skills and for using the information cues of a multi-modal learning environment.

Development of cubic Bezier curve and curve-plane intersection method for parametric submarine hull form design to optimize hull resistance using CFD

NASA Astrophysics Data System (ADS)

Chrismianto, Deddy; Zakki, Ahmad Fauzan; Arswendo, Berlian; Kim, Dong Joon

2015-12-01

Optimization analysis and computational fluid dynamics (CFDs) have been applied simultaneously, in which a parametric model plays an important role in finding the optimal solution. However, it is difficult to create a parametric model for a complex shape with irregular curves, such as a submarine hull form. In this study, the cubic Bezier curve and curve-plane intersection method are used to generate a solid model of a parametric submarine hull form taking three input parameters into account: nose radius, tail radius, and length-height hull ratio ( L/ H). Application program interface (API) scripting is also used to write code in the ANSYS design modeler. The results show that the submarine shape can be generated with some variation of the input parameters. An example is given that shows how the proposed method can be applied successfully to a hull resistance optimization case. The parametric design of the middle submarine type was chosen to be modified. First, the original submarine model was analyzed, in advance, using CFD. Then, using the response surface graph, some candidate optimal designs with a minimum hull resistance coefficient were obtained. Further, the optimization method in goal-driven optimization (GDO) was implemented to find the submarine hull form with the minimum hull resistance coefficient ( C t ). The minimum C t was obtained. The calculated difference in C t values between the initial submarine and the optimum submarine is around 0.26%, with the C t of the initial submarine and the optimum submarine being 0.001 508 26 and 0.001 504 29, respectively. The results show that the optimum submarine hull form shows a higher nose radius ( r n ) and higher L/ H than those of the initial submarine shape, while the radius of the tail ( r t ) is smaller than that of the initial shape.

Pulmonary Function in Middle-Aged Patients With Idiopathic Scoliosis With Onset Before the Age of 10 Years.

PubMed

Danielsson, Aina J; Ekerljung, Linda; Hallerman, Kerstin Lofdahl

2015-09-01

Consecutive patients with idiopathic scoliosis diagnosed before age 10 attended a clinical follow-up at least 10 years after treatment. To evaluate the pulmonary function in adulthood after treatment with brace or surgery before maturity. Long-term studies of these patients have not been published. One hundred twenty-four patients (69% of the original group) underwent radiography, spirometry, and answered symptom questionnaires. A total of 73 patients had spirometries before treatment enabling longitudinal evaluation. Overall, 68 braced only (BT) and 56 surgically treated (ST) were analyzed in detail. A population-based control group was used. At follow-up, the mean age was 41.5 years and the mean curve size 36 degrees (26% of the curves >45 degrees). The full patient group had a significantly reduced pulmonary function (as measured by the forced vital capacity [FVC], percentage of predicted) compared with the control group, mean 85% versus 102% (p < .0001). Both subgroups of BT and ST patients showed a significant reduction, more in the ST than the BT group (means 79% and 90%, respectively, p = .0003). The most important risk factor for a low lung function at follow-up was a low initial FVC value. Initial curve size correlated with pulmonary function both before treatment and at follow-up. Most surgically treated patients, who had larger curves before treatment, did not improve their pulmonary function after surgery. Both braced and surgically treated patients had reduced pulmonary function at the age of around 40 years. The pulmonary function did not worsen over time in most patients. There was no difference in terms of symptoms between patient groups and controls. Initial curve size was found to be of great importance for pulmonary function. Initial spirometry and follow-up in selected patients is important. III. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Cumulative sum analysis score and phacoemulsification competency learning curve.

PubMed

Vedana, Gustavo; Cardoso, Filipe G; Marcon, Alexandre S; Araújo, Licio E K; Zanon, Matheus; Birriel, Daniella C; Watte, Guilherme; Jun, Albert S

2017-01-01

To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency. Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval. There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39 th case. He could reach best-corrected visual acuity CUSUM competency at his 22 nd case. The third trainee achieved PCR CUSUM competency at his 41 st case. He reached best-corrected visual acuity CUSUM competency at his 14 th case. The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.

How to start a minimal access mitral valve program.

PubMed

Hunter, Steven

2013-11-01

The seven pillars of governance established by the National Health Service in the United Kingdom provide a useful framework for the process of introducing new procedures to a hospital. Drawing from local experience, the author present guidance for institutions considering establishing a minimal access mitral valve program. The seven pillars of governance apply to the practice of minimally invasive mitral valve surgery, based on the principle of patient-centred practice. The author delineate the benefits of minimally invasive mitral valve surgery in terms of: "clinical effectiveness", including reduced length of hospital stay, "risk management effectiveness", including conversion to sternotomy and aortic dissection, "patient experience" including improved cosmesis and quicker recovery, and the effectiveness of communication, resources and strategies in the implementation of minimally invasive mitral valve surgery. Finally, the author have identified seven learning curves experienced by surgeons involved in introducing a minimal access mitral valve program. The learning curves are defined as: techniques of mitral valve repair, Transoesophageal Echocardiography-guided cannulation, incisions, instruments, visualization, aortic occlusion and cardiopulmonary bypass strategies. From local experience, the author provide advice on how to reduce the learning curves, such as practising with the specialised instruments and visualization techniques during sternotomy cases. Underpinning the NHS pillars are the principles of systems awareness, teamwork, communication, ownership and leadership, all of which are paramount to performing any surgery but more so with minimal access surgery, as will be highlighted throughout this paper.

Anesthesiologists' learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study.

PubMed

Arzola, Cristian; Carvalho, Jose C A; Cubillos, Javier; Ye, Xiang Y; Perlas, Anahi

2013-08-01

Focused assessment of the gastric antrum by ultrasound is a feasible tool to evaluate the quality of the stomach content. We aimed to determine the amount of training an anesthesiologist would need to achieve competence in the bedside ultrasound technique for qualitative assessment of gastric content. Six anesthesiologists underwent a teaching intervention followed by a formative assessment; then learning curves were constructed. Participants received didactic teaching (reading material, picture library, and lecture) and an interactive hands-on workshop on live models directed by an expert sonographer. The participants were instructed on how to perform a systematic qualitative assessment to diagnose one of three distinct categories of gastric content (empty, clear fluid, solid) in healthy volunteers. Individual learning curves were constructed using the cumulative sum method, and competence was defined as a 90% success rate in a series of ultrasound examinations. A predictive model was further developed based on the entire cohort performance to determine the number of cases required to achieve a 95% success rate. Each anesthesiologist performed 30 ultrasound examinations (a total of 180 assessments), and three of the six participants achieved competence. The average number of cases required to achieve 90% and 95% success rates was estimated to be 24 and 33, respectively. With appropriate training and supervision, it is estimated that anesthesiologists will achieve a 95% success rate in bedside qualitative ultrasound assessment after performing approximately 33 examinations.

Novel word acquisition in aphasia: Facing the word-referent ambiguity of natural language learning contexts.

PubMed

Peñaloza, Claudia; Mirman, Daniel; Tuomiranta, Leena; Benetello, Annalisa; Heikius, Ida-Maria; Järvinen, Sonja; Majos, Maria C; Cardona, Pedro; Juncadella, Montserrat; Laine, Matti; Martin, Nadine; Rodríguez-Fornells, Antoni

2016-06-01

Recent research suggests that some people with aphasia preserve some ability to learn novel words and to retain them in the long-term. However, this novel word learning ability has been studied only in the context of single word-picture pairings. We examined the ability of people with chronic aphasia to learn novel words using a paradigm that presents new word forms together with a limited set of different possible visual referents and requires the identification of the correct word-object associations on the basis of online feedback. We also studied the relationship between word learning ability and aphasia severity, word processing abilities, and verbal short-term memory (STM). We further examined the influence of gross lesion location on new word learning. The word learning task was first validated with a group of forty-five young adults. Fourteen participants with chronic aphasia were administered the task and underwent tests of immediate and long-term recognition memory at 1 week. Their performance was compared to that of a group of fourteen matched controls using growth curve analysis. The learning curve and recognition performance of the aphasia group was significantly below the matched control group, although above-chance recognition performance and case-by-case analyses indicated that some participants with aphasia had learned the correct word-referent mappings. Verbal STM but not word processing abilities predicted word learning ability after controlling for aphasia severity. Importantly, participants with lesions in the left frontal cortex performed significantly worse than participants with lesions that spared the left frontal region both during word learning and on the recognition tests. Our findings indicate that some people with aphasia can preserve the ability to learn a small novel lexicon in an ambiguous word-referent context. This learning and recognition memory ability was associated with verbal STM capacity, aphasia severity and the integrity of the left inferior frontal region. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel word acquisition in aphasia: Facing the word-referent ambiguity of natural language learning contexts

PubMed Central

Peñaloza, Claudia; Mirman, Daniel; Tuomiranta, Leena; Benetello, Annalisa; Heikius, Ida-Maria; Järvinen, Sonja; Majos, Maria C.; Cardona, Pedro; Juncadella, Montserrat; Laine, Matti; Martin, Nadine; Rodríguez-Fornells, Antoni

2017-01-01

Recent research suggests that some people with aphasia preserve some ability to learn novel words and to retain them in the long-term. However, this novel word learning ability has been studied only in the context of single word-picture pairings. We examined the ability of people with chronic aphasia to learn novel words using a paradigm that presents new word forms together with a limited set of different possible visual referents and requires the identification of the correct word-object associations on the basis of online feedback. We also studied the relationship between word learning ability and aphasia severity, word processing abilities, and verbal short-term memory (STM). We further examined the influence of gross lesion location on new word learning. The word learning task was first validated with a group of forty-five young adults. Fourteen participants with chronic aphasia were administered the task and underwent tests of immediate and long-term recognition memory at 1 week. Their performance was compared to that of a group of fourteen matched controls using growth curve analysis. The learning curve and recognition performance of the aphasia group was significantly below the matched control group, although above-chance recognition performance and case-by-case analyses indicated that some participants with aphasia had learned the correct word-referent mappings. Verbal STM but not word processing abilities predicted word learning ability after controlling for aphasia severity. Importantly, participants with lesions in the left frontal cortex performed significantly worse than participants with lesions that spared the left frontal region both during word learning and on the recognition tests. Our findings indicate that some people with aphasia can preserve the ability to learn a small novel lexicon in an ambiguous word-referent context. This learning and recognition memory ability was associated with verbal STM capacity, aphasia severity and the integrity of the left inferior frontal region. PMID:27085892

Learning Curves: Making Quality Online Health Information Available at a Fitness Center.

PubMed

Dobbins, Montie T; Tarver, Talicia; Adams, Mararia; Jones, Dixie A

2012-01-01

Meeting consumer health information needs can be a challenge. Research suggests that women seek health information from a variety of resources, including the Internet. In an effort to make women aware of reliable health information sources, the Louisiana State University Health Sciences Center - Shreveport Medical Library engaged in a partnership with a franchise location of Curves International, Inc. This article will discuss the project, its goals and its challenges.

In Vitro Evaluation of Evacuated Blood Collection Tubes as a Closed-Suction Surgical Drain Reservoir.

PubMed

Heiser, Brian; Okrasinski, E B; Murray, Rebecca; McCord, Kelly

The initial negative pressures of evacuated blood collection tubes (EBCT) and their in vitro performance as a rigid closed-suction surgical drain (CSSD) reservoir has not been evaluated in the scientific literature despite being described in both human and veterinary texts and journals. The initial negative pressures of EBCT sized 3, 6, 10, and 15 mL were measured and the stability of the system monitored. The pressure-to-volume curve as either air or water was added and maximal filling volumes were measured. Evacuated blood collection tubes beyond the manufacture's expiration date were evaluated for initial negative pressures and maximal filling volumes. Initial negative pressure ranged from -214 mm Hg to -528 mm Hg for EBCT within the manufacturer's expiration date. Different pressure-to-volume curves were found for air versus water. Optimal negative pressures of CSSD are debated in the literature. Drain purpose and type of exudates are factors that should be considered when deciding which EBCT size to implement. Evacuated blood collection tubes have a range of negative pressures and pressure-to-volume curves similar to previously evaluated CSSD rigid reservoirs. Proper drain management and using EBCT within labeled expiration date are important to ensure that expected negative pressures are generated.

Physiological Sensing Now Open to the World: New Resources Are Allowing Us to Learn, Experiment, and Create Imaginative Solutions for Biomedical Applications.

PubMed

da Silva, Hugo Placido

2018-01-01

With the advent of low-cost computing platforms, such as Arduino (http://www.arduino.cc) and Raspberry Pi (http://www.raspberrypi.org), it has become clear that lowering the cost barrier and shortening the learning curve, with the backing of a motivated community, would play a transformational role in the way people learn, experiment, and create imaginative solutions to outstanding problems that can benefit from embedded systems.

Analyzing Student Learning Outcomes: Usefulness of Logistic and Cox Regression Models. IR Applications, Volume 5

ERIC Educational Resources Information Center

Chen, Chau-Kuang

2005-01-01

Logistic and Cox regression methods are practical tools used to model the relationships between certain student learning outcomes and their relevant explanatory variables. The logistic regression model fits an S-shaped curve into a binary outcome with data points of zero and one. The Cox regression model allows investigators to study the duration…

Subjective Estimates of Job Performance after Job Preview: Determinants of Anticipated Learning Curves

ERIC Educational Resources Information Center

Ackerman, Phillip L.; Shapiro, Stacey; Beier, Margaret E.

2011-01-01

When people choose a particular occupation, they presumably make an implicit judgment that they will perform well on a job at some point in the future, typically after extensive education and/or on-the-job experience. Research on learning and skill acquisition has pointed to a power law of practice, where large gains in performance come early in…

Institutionalizing Blended Learning into Joint Training: A Case Study and Ten Recommendations

DTIC Science & Technology

2014-12-01

mail.mil pbockelman@mesh.dsci.com ABSTRACT In 2011, the Joint Staff J7 (Joint Training) directorate initiated the Continuum of eLearning project in...Orlando, FL. 14. ABSTRACT In 2011, the Joint Staff J7 (Joint Training) directorate initiated the Continuum of eLearning project in order to integrate...dispersed organizations still poses significant challenges. The Joint Staff J7, Deputy Director for Joint Training initiated the Continuum of eLearning

Luck and Learning: Feedback Contingencies and Initial Success in Verbal Discrimination Learning.

ERIC Educational Resources Information Center

Schneider, H. G.; Ferrante, A. P.

1983-01-01

A total of 90 undergraduate volunteers learned a 12-pair, low-frequency verbal discrimination list. Independent variables were feedback (positive only, negative only, or both) and initial success (17, 50, or 83 percent correct on the first trial). While the main effect of feedback was not significant, that of initial success was. (Author/RH)

A service-based BLAST command tool supported by cloud infrastructures.

PubMed

Carrión, Abel; Blanquer, Ignacio; Hernández, Vicente

2012-01-01

Notwithstanding the benefits of distributed-computing infrastructures for empowering bioinformatics analysis tools with the needed computing and storage capability, the actual use of these infrastructures is still low. Learning curves and deployment difficulties have reduced the impact on the wide research community. This article presents a porting strategy of BLAST based on a multiplatform client and a service that provides the same interface as sequential BLAST, thus reducing learning curve and with minimal impact on their integration on existing workflows. The porting has been done using the execution and data access components from the EC project Venus-C and the Windows Azure infrastructure provided in this project. The results obtained demonstrate a low overhead on the global execution framework and reasonable speed-up and cost-efficiency with respect to a sequential version.

Soil Conservation Service Curve Number method: How to mend a wrong soil moisture accounting procedure?

NASA Astrophysics Data System (ADS)

Michel, Claude; Andréassian, Vazken; Perrin, Charles

2005-02-01

This paper unveils major inconsistencies in the age-old and yet efficient Soil Conservation Service Curve Number (SCS-CN) procedure. Our findings are based on an analysis of the continuous soil moisture accounting procedure implied by the SCS-CN equation. It is shown that several flaws plague the original SCS-CN procedure, the most important one being a confusion between intrinsic parameter and initial condition. A change of parameterization and a more complete assessment of the initial condition lead to a renewed SCS-CN procedure, while keeping the acknowledged efficiency of the original method.

Multi-probe-based resonance-frequency electrical impedance spectroscopy for detection of suspicious breast lesions: improving performance using partial ROC optimization

NASA Astrophysics Data System (ADS)

Lederman, Dror; Zheng, Bin; Wang, Xingwei; Wang, Xiao Hui; Gur, David

2011-03-01

We have developed a multi-probe resonance-frequency electrical impedance spectroscope (REIS) system to detect breast abnormalities. Based on assessing asymmetry in REIS signals acquired between left and right breasts, we developed several machine learning classifiers to classify younger women (i.e., under 50YO) into two groups of having high and low risk for developing breast cancer. In this study, we investigated a new method to optimize performance based on the area under a selected partial receiver operating characteristic (ROC) curve when optimizing an artificial neural network (ANN), and tested whether it could improve classification performance. From an ongoing prospective study, we selected a dataset of 174 cases for whom we have both REIS signals and diagnostic status verification. The dataset includes 66 "positive" cases recommended for biopsy due to detection of highly suspicious breast lesions and 108 "negative" cases determined by imaging based examinations. A set of REIS-based feature differences, extracted from the two breasts using a mirror-matched approach, was computed and constituted an initial feature pool. Using a leave-one-case-out cross-validation method, we applied a genetic algorithm (GA) to train the ANN with an optimal subset of features. Two optimization criteria were separately used in GA optimization, namely the area under the entire ROC curve (AUC) and the partial area under the ROC curve, up to a predetermined threshold (i.e., 90% specificity). The results showed that although the ANN optimized using the entire AUC yielded higher overall performance (AUC = 0.83 versus 0.76), the ANN optimized using the partial ROC area criterion achieved substantially higher operational performance (i.e., increasing sensitivity level from 28% to 48% at 95% specificity and/ or from 48% to 58% at 90% specificity).

Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter.

PubMed

Arya, Arash; Kottkamp, Hans; Piorkowski, Christopher; Bollmann, Andreas; Gerdes-Li, Jin-Hong; Riahi, Sam; Esato, Masahiro; Hindricks, Gerhard

2008-05-01

A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus-dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8-mm-tip magnetic catheter to perform RF ablation in patients with AFL. Twenty-six consecutive patients (23 men, mean age 64.6 +/- 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8-mm-tip magnetic catheter (70 degrees C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients. The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and sinus rhythm in six patients. Due to technical issues, the ablation in the 18th patient could not be done with the MNS, and so we switched to conventional ablation. The remote magnetic navigation and ablation procedure was successful in 24 of the 25 (96%) remaining patients with AFL. In one patient (patient 2), conventional catheter was used to complete the isthmus block after termination of AFL. The procedure, preparation, ablation, and fluoroscopy times (median [range]) were 53 (30-130) minutes, 28 (10-65) minutes, 25 (12-78) minutes, and 7.5 (3.2-20.8) minutes, respectively. Patients in group 2 had shorter procedure (45 [30-70] min vs 80 [57-130] min, P = 0.0001), preparation (25 [10-30] min vs 42 [30-65] min, P = 0.0001), ablation (20 [12-40] min vs 31 [20-78] min, P = 0.002), and fluoroscopy (7.2 [3.2-12.2] min vs 11.0 [5.4-20.8] min, P = 0.014) times. No complication occurred during the procedure. Using a remote MNS and an 8-mm-tip magnetic catheter, ablation of AFL is feasible, safe, and effective. Our data suggest that there is a short learning curve for this procedure.

Superposition of Cohesive Elements to Account for R-Curve Toughening in the Fracture of Composites

NASA Technical Reports Server (NTRS)

Davila, Carlos G.; Rose, Cheryl A.; Song, Kyongchan

2008-01-01

The relationships between a resistance curve (R-curve), the corresponding fracture process zone length, the shape of the traction/displacement softening law, and the propagation of fracture are examined in the context of the through-the-thickness fracture of composite laminates. A procedure that accounts for R-curve toughening mechanisms by superposing bilinear cohesive elements is proposed. Simple equations are developed for determining the separation of the critical energy release rates and the strengths that define the independent contributions of each bilinear softening law in the superposition. It is shown that the R-curve measured with a Compact Tension specimen test can be reproduced by superposing two bilinear softening laws. It is also shown that an accurate representation of the R-curve is essential for predicting the initiation and propagation of fracture in composite laminates.

Mediation Analysis in a Latent Growth Curve Modeling Framework

ERIC Educational Resources Information Center

von Soest, Tilmann; Hagtvet, Knut A.

2011-01-01

This article presents several longitudinal mediation models in the framework of latent growth curve modeling and provides a detailed account of how such models can be constructed. Logical and statistical challenges that might arise when such analyses are conducted are also discussed. Specifically, we discuss how the initial status (intercept) and…

Study of the magnetic interaction in nanocrystalline Pr-Fe-Co-Nb-B permanent magnets

NASA Astrophysics Data System (ADS)

Dospial, M.; Plusa, D.; Ślusarek, B.

2012-03-01

The magnetic properties of an isotropic, epoxy resin bonded magnets made from Pr-Fe-Co-Nb-B powder were investigated. The magnetization reversal process and magnetic parameters were examined by measurements of the initial magnetization curve, major and minor hysteresis loops and sets of recoil curves. From the initial magnetization curve and the field dependencies of the reversible and irreversible magnetization components derived from the recoil loops it was found that the magnetization reversal process is the combination of the nucleation of reversed domains and pinning of domain walls at the grain boundaries and the reversible rotation of magnetization vector in single domain grains. The interactions between grains were studied by means of δM plots. The nonlinear behavior of δM curve approve that the short range intergrain exchange coupling interactions are dominant in a field up to the sample coercivity. The interaction domains and fine magnetic structure were revealed as the evidence of exchange coupling between soft α-Fe and hard magnetic Nd2Fe14B grains.

Learning from Simulation Design to Develop Better Experiential Learning Initiatives: An Integrative Approach

ERIC Educational Resources Information Center

Canhoto, Ana Isabel; Murphy, Jamie

2016-01-01

Simulations offer engaging learning experiences, via the provision of feedback or the opportunities for experimentation. However, they lack important attributes valued by marketing educators and employers. This article proposes a "back to basics" look at what constitutes an effective experiential learning initiative. Drawing on the…

CSCL in Teacher Training: What Learning Tasks Lead to Collaboration?

ERIC Educational Resources Information Center

Lockhorst, Ditte; Admiraal, Wilfried; Pilot, Albert

2010-01-01

Professional teacher communities appear to be positively related to student learning, teacher learning, teacher practice and school culture. Teacher collaboration is a significant element of these communities. In initial teacher training as well as in-service training and other initiatives for teacher learning, collaborative skills should be…

Learning curves in abdominal wall reconstruction with components separation: one step closer toward improving outcomes and reducing complications.

PubMed

Hultman, Charles Scott; Clayton, John L; Kittinger, Benjamin J; Tong, Winnie M

2014-01-01

Learning curves are characterized by incremental improvement of a process, through repetition and reduction in variability, but can be disrupted with the emergence of new techniques and technologies. Abdominal wall reconstruction continues to evolve, with the introduction of components separation in the 1990s and biologic mesh in the 2000s. As such, attempts at innovation may impact the success of reconstructive outcomes and yield a changing set of complications. The purpose of this project was to describe the paradigm shift that has occurred in abdominal wall reconstruction during the past 10 years, focusing on the incorporation of new materials and methods. We reviewed 150 consecutive patients who underwent abdominal wall reconstruction of midline defects with components separation, from 2000 to 2010. Both univariate and multivariate logistic regression analyses were performed to identify risk factors for complications. Patients were stratified into the following periods: early (2000-2003), middle (2004-2006), and late (2007-2010). From 2000 to 2010, we performed 150 abdominal wall reconstructions with components separation [mean age, 50.2 years; body mass index (BMI), 30.4; size of defect, 357 cm; length of stay, 9.6 days; follow-up, 4.4 years]. Primary fascial closure was performed in 120 patients. Mesh was used in 114 patients in the following locations: overlay (n = 28), inlay (n = 30), underlay (n = 54), and unknown (n = 2). Complications occurred in a bimodal distribution, highest in 2001 (introduction of biologic mesh) and 2008 (conversion from underlay to overlay location). Age, sex, history of smoking, defect size, and length of stay were not associated with incidence of complications. Unadjusted risk factors for seroma (16.8%) were elevated BMI, of previous hernia repairs, use of overlay mesh, and late portion of the learning curve, with logistic regression supporting only late portion of the learning curve [odds ratio (OR), 4.3; 95% confidence interval (CI), 1.0-18.6] and BMI (OR, 1.17; 95% CI, 1.06-1.29). The only unadjusted risk factor for recurrence was location of mesh. Logistic regression, comparing underlay, inlay, and overlay mesh to no mesh, revealed that the use of underlay mesh predicted recurrence (OR, 3.0; 95% CI, 1.04-8.64). All P values were less than 0.05. The overall learning curve for a specific procedure, such as abdominal wall reconstruction, can be quite volatile, especially as innovative techniques and new technologies are introduced and incorporated into the surgeon's practice. Our current practice includes primary repair myofascial flap of the components separation and the use of biologic mesh as an overlay graft, anchored to the external oblique. This process of outcome improvement is not gradual but is often punctuated by periods of failure and redemption.

"More Confident Going into College": Lessons Learned from Multiple Stakeholders in a New Blended Learning Initiative

ERIC Educational Resources Information Center

Whiteside, Aimee L.; Garrett Dikkers, Amy; Lewis, Somer

2016-01-01

This article examined a blended learning initiative in a large suburban high school in the Midwestern region of the United States. It employed a single-case exploratory design approach to learn about the experience of administrators, teachers, students, and parents. Using Zimmerman's Self-Regulated Learning (SRL) Theory as a guiding framework,…

Hoarding behaviors in children with learning disabilities.

PubMed

Testa, Renée; Pantelis, Christos; Fontenelle, Leonardo F

2011-05-01

Our objective was to describe the prevalence, comorbidity, and neuropsychological profiles of children with hoarding and learning disabilities. From 61 children with learning disabilities, 16.4% exhibited hoarding as a major clinical issue. Although children with learning disabilities and hoarding displayed greater rates of obsessive-compulsive disorder (30%) as compared to those with learning disabilities without hoarding (5.9%), the majority of patients belonging to the former group did not display obsessive-compulsive disorder diagnosis. When learning disability patients with hoarding were compared to age-, sex-, and IQ-matched learning disability subjects without hoarding, hoarders exhibited a slower learning curve on word list-learning task. In conclusion, salient hoarding behaviors were found to be relatively common in a sample of children with learning disabilities and not necessarily associated with obsessive-compulsive disorder, supporting its nosological independence. It is unclear whether underlying cognitive features may play a major role in the development of hoarding behaviors in children with learning disabilities.

Mild angle early onset idiopathic scoliosis children avoid progression under FITS method (Functional Individual Therapy of Scoliosis).

PubMed

Białek, Marianna

2015-05-01

Physiotherapy for stabilization of idiopathic scoliosis angle in growing children remains controversial. Notably, little data on effectiveness of physiotherapy in children with Early Onset Idiopathic Scoliosis (EOIS) has been published.The aim of this study was to check results of FITS physiotherapy in a group of children with EOIS.The charts of the patients archived in a prospectively collected database were retrospectively reviewed. The inclusion criteria were:diagnosis of EOIS based on spine radiography, age below 10 years, both girls and boys, Cobb angle between 118 and 308, Risser zero, FITS therapy, no other treatment (bracing), and a follow-up at least 2 years from the initiation of the treatment. The criterion for curve progression were as follows: the Cobb angle increase of 68 or more, for curve stabilization; the Cobb angle was 58 comparing to the initial radiograph,for curve correction; and the Cobb angle decrease of 68 or more at the final follow-up radiograph.There were 41 children with EOIS, 36 girls and 5 boys, mean age 7.71.3 years (range 4 to 9 years) who started FITS therapy. The curve pattern was single thoracic (5 children), single thoracolumbar (22 children) or double thoracic/thoracolumbar (14 children), totally 55 structural curvatures. The minimum follow-up was 2 years after initiation of the FITS treatment, maximum was 16 years, mean 4.8 years). At follow-up the mean age was 12.53.4 years. Out of 41 children, 10 passed pubertal growth spurt at the final follow-up and 31 were still immature and continued FITS therapy. Out of 41 children, 27 improved, 13 were stable, and one progressed. Out of 55 structural curves, 32 improved, 22 were stable and one progressed. For the 55 structural curves, the Cobb angle significantly decreased from 18.085.48 at first assessment to 12.586.38 at last evaluation,p<0.0001, paired t-test. The angle of trunk rotation decreased significantly from 4.782.98 to 3.282.58 at last evaluation, p<0.0001,paired t-test.FITS physiotherapy was effective in preventing curve progression in children with EOIS. Final postpubertal follow-up data is needed.

Preparing Children To Read and Learn: An Education Initiative of Laura Bush.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

Noting that teaching reading is one of the Bush Administration's top domestic priorities, this pamphlet introduces the Ready to Read, Ready to Learn education initiative of First Lady Laura Bush. The goals of the initiative are to ensure that all young children are ready to read and learn when they enter their first classroom, and to ensure that…

Impact of a learning curve on the survivorship of 4802 cementless total hip arthroplasties.

PubMed

Magill, P; Blaney, J; Hill, J C; Bonnin, M P; Beverland, D E

2016-12-01

Our aim was to report survivorship data and lessons learned with the Corail/Pinnacle cementless total hip arthroplasty (THA) system. Between August 2005 and March 2015, a total of 4802 primary cementless Corail/Pinnacle THAs were performed in 4309 patients. In March 2016, we reviewed these hips from a prospectively maintained database. A total of 80 hips (1.67%) have been revised which is equivalent to a cumulative risk of revision of 2.5% at ten years. The rate of revision was not significantly higher in patients aged ≥ 70 years (p = 0.93). The leading indications for revision were instability (n = 22, 0.46%), infection (n = 20, 0.42%), aseptic femoral loosening (n = 15, 0.31%) and femoral fracture (n = 6, 0.12%). There were changes in the surgical technique with respect to the Corail femoral component during the ten-year period involving a change to collared components and a trend towards larger size. These resulted in a decrease in the rate of iatrogenic femoral fracture and a decrease in the rate of aseptic loosening. The rate of revision in this series is comparable with the best performing THAs in registry data. Most revisions were not directly related to the implants. Despite extensive previous experience with cemented femoral components, the senior author noted a learning curve requiring increased focus on primary stability. The number of revisions related to the femoral component is reducing. Any new technology has a learning curve that may be independent of surgical experience. Cite this article: Bone Joint J 2016;98-B:1589-96. ©2016 The British Editorial Society of Bone & Joint Surgery.

Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves.

PubMed

Broekema, Theo H; Talsma, Aaldert K; Wevers, Kevin P; Pierie, Jean-Pierre E N

Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups. Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands. Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course. In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group. No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The learning curve associated with the introduction of the subcutaneous implantable defibrillator.

PubMed

Knops, Reinoud E; Brouwer, Tom F; Barr, Craig S; Theuns, Dominic A; Boersma, Lucas; Weiss, Raul; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D; Leon, Angel R; Hood, Margaret; Jones, Paul W; Wold, Nicholas; Grace, Andrew A; Olde Nordkamp, Louise R A; Burke, Martin C

2016-07-01

The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters with respect to implant-related complications, procedure time, and inappropriate shocks (IASs). In a pooled cohort from two clinical S-ICD databases, the IDE Trial and the EFFORTLESS Registry, complications, IASs at 180 days follow-up and implant procedure duration were assessed. Patients were grouped in quartiles based on experience of the implanter and Kaplan-Meier estimates of complication and IAS rates were calculated. A total of 882 patients implanted in 61 centres by 107 implanters with a median of 4 implants (IQR 1,8) were analysed. There were a total of 59 patients with complications and 48 patients with IAS. The complication rate decreased significantly from 9.8% in Quartile 1 (least experience) to 5.4% in Quartile 4 (most experience) (P = 0.02) and non-significantly for IAS from 7.9 to 4.8% (P = 0.10). Multivariable analysis demonstrated a hazard ratio of 0.78 (P = 0.045) for complications and 1.01 (P = 0.958) for IAS. Dual-zone programming increased with experience of the individual implanter (P < 0.001), which reduced IAS significantly in the multivariable model (HR 0.44, P = 0.01). Procedure time decreased from 75 to 65 min (P < 0.001). The complication rate and procedure time stabilized after Quartile 2 (>13 implants). There is a short and significant learning curve associated with physicians adopting the S-ICD. Performance stabilizes after 13 implants. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Photometric classification of type Ia supernovae in the SuperNova Legacy Survey with supervised learning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Möller, A.; Ruhlmann-Kleider, V.; Leloup, C.

In the era of large astronomical surveys, photometric classification of supernovae (SNe) has become an important research field due to limited spectroscopic resources for candidate follow-up and classification. In this work, we present a method to photometrically classify type Ia supernovae based on machine learning with redshifts that are derived from the SN light-curves. This method is implemented on real data from the SNLS deferred pipeline, a purely photometric pipeline that identifies SNe Ia at high-redshifts (0.2 < z < 1.1). Our method consists of two stages: feature extraction (obtaining the SN redshift from photometry and estimating light-curve shape parameters)more » and machine learning classification. We study the performance of different algorithms such as Random Forest and Boosted Decision Trees. We evaluate the performance using SN simulations and real data from the first 3 years of the Supernova Legacy Survey (SNLS), which contains large spectroscopically and photometrically classified type Ia samples. Using the Area Under the Curve (AUC) metric, where perfect classification is given by 1, we find that our best-performing classifier (Extreme Gradient Boosting Decision Tree) has an AUC of 0.98.We show that it is possible to obtain a large photometrically selected type Ia SN sample with an estimated contamination of less than 5%. When applied to data from the first three years of SNLS, we obtain 529 events. We investigate the differences between classifying simulated SNe, and real SN survey data. In particular, we find that applying a thorough set of selection cuts to the SN sample is essential for good classification. This work demonstrates for the first time the feasibility of machine learning classification in a high- z SN survey with application to real SN data.« less

Variation of safety indices during in the learning curve for color Doppler assessment of the fetal heart at 11+0 to 13+6 weeks' gestation.

PubMed

Nemescu, Dragos; Berescu, Anca; Rotariu, Cristian

2015-12-01

The aim of our study was to analyze the variation of acoustic output, as expressed by the thermal (TI) and mechanical index (MI), during the learning curve for a fetal heart scan at 11-13 gestational weeks, with the introduction of a new ultrasound system. This was a prospective, observational study on 303 normal fetuses. The fetal heart was examined transabdominally using B-Mode and high definition (HD) color Doppler to obtain standard parameters: four-chamber, outflow tracts and three-vessel-trachea views. Data were analyzed in groups of 20 consecutive examinations and the percentage of successful examinations was calculated. TI and MI were retrieved from HD color Doppler examinations of the fetal heart and from pulsed-wave Doppler assessment of the tricuspid flow and ductus venosus. MI values from the color Doppler examination of the fetal heart showed a continuous decrease (0.81 to 0.75, p<0.001), along the learning phase. TI and MI indices from pulsed-wave Doppler evaluation of the tricuspid flow increased at the beginning of the learning phase and stabilized afterwards (0.34 to 0.36, p<0.05 and 0.37 to 0.4, p<0.001, respectively). TI from color Doppler exam of the heart and indices from ductus venosus assessment were very constant and did not change along the studied periods. The length of Doppler examination of the heart increased after about 80 cases by 25%, to a mean of 4 minutes (p<0.05). Safety indices from Doppler evaluation of the fetal heart and tricuspid flow vary during the learning curve for fetal heart assessment. Also, the occurrence of constant values suggests the potential for their supplementary active reduction. For a better adaptation to a new ultrasound technology, the sonographer should scan the fetal heart longer in the first trimester and follow displayed safety indices along the first 80 cases.

Ion guiding in macro-size insulating capillaries: straight, tapered, and curved shapes

NASA Astrophysics Data System (ADS)

Kojima, Takao M.

2018-02-01

When keV energy ions are injected into a tilted insulating capillary, a certain fraction of the injected ions are transported through the tilt angle of the capillary. This ion guiding phenomenon is considered to be caused by a self-organizing charge distribution, where the inner wall of the capillary becomes charged by initial incoming ions. The charge distribution, which is formed, can guide following ions toward the exit of the capillary. Since the initial discovery of this effect, studies of ion guiding by insulating capillaries have been extended to various materials, and different sizes and shapes of capillaries. In recent years, some investigations of the guiding effect of macro-size curved capillaries have also been reported. In this review, relevant studies in a history of ion guiding in curved capillaries are discussed and future directions in this field are considered.

A methodology for studying tectonic subsidence variations: insights from the Fernie Formation of west-central Alberta

NASA Astrophysics Data System (ADS)

McCartney, Tannis Maureen

Tectonic subsidence curves for over 300 subsurface wells in west-central Alberta indicate that the Western Canada Foreland Basin was initiated at the same time the lower units of the Fernie Formation were being deposited. This evidence is further supported by sedimentological data and fits with the timing of the onset of deformation in the Cordillera and the initiation of the foreland basin in Montana. The volume of subsidence curves in this study required an innovative methodology. Subsidence calculations were performed using customized macros in a spreadsheet. The tectonic subsidence variations were displayed in a tectonic subsidence envelope, which showed the total variation in the subsidence curves, and three suites of maps: tectonic subsidence, tectonic subsidence residuals, and tectonic subsidence ratios. Collectively, the maps of the tectonic subsidence in the Fernie Formation show that there was a western influence on subsidence during deposition of the oldest members of the Fernie Formation.

Artificial intelligence in fracture detection: transfer learning from deep convolutional neural networks.

PubMed

Kim, D H; MacKinnon, T

2018-05-01

To identify the extent to which transfer learning from deep convolutional neural networks (CNNs), pre-trained on non-medical images, can be used for automated fracture detection on plain radiographs. The top layer of the Inception v3 network was re-trained using lateral wrist radiographs to produce a model for the classification of new studies as either "fracture" or "no fracture". The model was trained on a total of 11,112 images, after an eightfold data augmentation technique, from an initial set of 1,389 radiographs (695 "fracture" and 694 "no fracture"). The training data set was split 80:10:10 into training, validation, and test groups, respectively. An additional 100 wrist radiographs, comprising 50 "fracture" and 50 "no fracture" images, were used for final testing and statistical analysis. The area under the receiver operator characteristic curve (AUC) for this test was 0.954. Setting the diagnostic cut-off at a threshold designed to maximise both sensitivity and specificity resulted in values of 0.9 and 0.88, respectively. The AUC scores for this test were comparable to state-of-the-art providing proof of concept for transfer learning from CNNs in fracture detection on plain radiographs. This was achieved using only a moderate sample size. This technique is largely transferable, and therefore, has many potential applications in medical imaging, which may lead to significant improvements in workflow productivity and in clinical risk reduction. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Knowledge retention after an online tutorial: a randomized educational experiment among resident physicians.

PubMed

Bell, Douglas S; Harless, Charles E; Higa, Jerilyn K; Bjork, Elizabeth L; Bjork, Robert A; Bazargan, Mohsen; Mangione, Carol M

2008-08-01

The time course of physicians' knowledge retention after learning activities has not been well characterized. Understanding the time course of retention is critical to optimizing the reinforcement of knowledge. Educational follow-up experiment with knowledge retention measured at 1 of 6 randomly assigned time intervals (0-55 days) after an online tutorial covering 2 American Diabetes Association guidelines. Internal and family medicine residents. Multiple-choice knowledge tests, subject characteristics including critical appraisal skills, and learner satisfaction. Of 197 residents invited, 91 (46%) completed the tutorial and were randomized; of these, 87 (96%) provided complete follow-up data. Ninety-two percent of the subjects rated the tutorial as "very good" or "excellent." Mean knowledge scores increased from 50% before the tutorial to 76% among those tested immediately afterward. Score gains were only half as great at 3-8 days and no significant retention was measurable at 55 days. The shape of the retention curve corresponded with a 1/4-power transformation of the delay interval. In multivariate analyses, critical appraisal skills and participant age were associated with greater initial learning, but no participant characteristic significantly modified the rate of decline in retention. Education that appears successful from immediate posttests and learner evaluations can result in knowledge that is mostly lost to recall over the ensuing days and weeks. To achieve longer-term retention, physicians should review or otherwise reinforce new learning after as little as 1 week.

Applying deep learning technology to automatically identify metaphase chromosomes using scanning microscopic images: an initial investigation

NASA Astrophysics Data System (ADS)

Qiu, Yuchen; Lu, Xianglan; Yan, Shiju; Tan, Maxine; Cheng, Samuel; Li, Shibo; Liu, Hong; Zheng, Bin

2016-03-01

Automated high throughput scanning microscopy is a fast developing screening technology used in cytogenetic laboratories for the diagnosis of leukemia or other genetic diseases. However, one of the major challenges of using this new technology is how to efficiently detect the analyzable metaphase chromosomes during the scanning process. The purpose of this investigation is to develop a computer aided detection (CAD) scheme based on deep learning technology, which can identify the metaphase chromosomes with high accuracy. The CAD scheme includes an eight layer neural network. The first six layers compose of an automatic feature extraction module, which has an architecture of three convolution-max-pooling layer pairs. The 1st, 2nd and 3rd pair contains 30, 20, 20 feature maps, respectively. The seventh and eighth layers compose of a multiple layer perception (MLP) based classifier, which is used to identify the analyzable metaphase chromosomes. The performance of new CAD scheme was assessed by receiver operation characteristic (ROC) method. A number of 150 regions of interest (ROIs) were selected to test the performance of our new CAD scheme. Each ROI contains either interphase cell or metaphase chromosomes. The results indicate that new scheme is able to achieve an area under the ROC curve (AUC) of 0.886+/-0.043. This investigation demonstrates that applying a deep learning technique may enable to significantly improve the accuracy of the metaphase chromosome detection using a scanning microscopic imaging technology in the future.

A New Method to Compare Statistical Tree Growth Curves: The PL-GMANOVA Model and Its Application with Dendrochronological Data

PubMed Central

Ricker, Martin; Peña Ramírez, Víctor M.; von Rosen, Dietrich

2014-01-01

Growth curves are monotonically increasing functions that measure repeatedly the same subjects over time. The classical growth curve model in the statistical literature is the Generalized Multivariate Analysis of Variance (GMANOVA) model. In order to model the tree trunk radius (r) over time (t) of trees on different sites, GMANOVA is combined here with the adapted PL regression model Q = A·T+E, where for and for , A =  initial relative growth to be estimated, , and E is an error term for each tree and time point. Furthermore, Ei[–b·r]  = , , with TPR being the turning point radius in a sigmoid curve, and at is an estimated calibrating time-radius point. Advantages of the approach are that growth rates can be compared among growth curves with different turning point radiuses and different starting points, hidden outliers are easily detectable, the method is statistically robust, and heteroscedasticity of the residuals among time points is allowed. The model was implemented with dendrochronological data of 235 Pinus montezumae trees on ten Mexican volcano sites to calculate comparison intervals for the estimated initial relative growth . One site (at the Popocatépetl volcano) stood out, with being 3.9 times the value of the site with the slowest-growing trees. Calculating variance components for the initial relative growth, 34% of the growth variation was found among sites, 31% among trees, and 35% over time. Without the Popocatépetl site, the numbers changed to 7%, 42%, and 51%. Further explanation of differences in growth would need to focus on factors that vary within sites and over time. PMID:25402427

Learning Curves: Making Quality Online Health Information Available at a Fitness Center

PubMed Central

Dobbins, Montie T.; Tarver, Talicia; Adams, Mararia; Jones, Dixie A.

2012-01-01

Meeting consumer health information needs can be a challenge. Research suggests that women seek health information from a variety of resources, including the Internet. In an effort to make women aware of reliable health information sources, the Louisiana State University Health Sciences Center – Shreveport Medical Library engaged in a partnership with a franchise location of Curves International, Inc. This article will discuss the project, its goals and its challenges. PMID:22545020

Monograph on propagation of sound waves in curved ducts

NASA Technical Reports Server (NTRS)

Rostafinski, Wojciech

1991-01-01

After reviewing and evaluating the existing material on sound propagation in curved ducts without flow, it seems strange that, except for Lord Rayleigh in 1878, no book on acoustics has treated the case of wave motion in bends. This monograph reviews the available analytical and experimental material, nearly 30 papers published on this subject so far, and concisely summarizes what has been learned about the motion of sound in hard-wall and acoustically lined cylindrical bends.

Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial.

PubMed

Tang, Zhouwen; Zhang, Daniel S; Thrift, Aaron P; Patel, Kalpesh K

2018-03-01

Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial. All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age <18 or >90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves. A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P = .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P =.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P = .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups. CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy trainees without prior colonoscopy experience. (Clinical trial registration number: NCT02472730.). Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool.

PubMed

Gaziev, Gabriele; Wadhwa, Karan; Barrett, Tristan; Koo, Brendan C; Gallagher, Ferdia A; Serrao, Eva; Frey, Julia; Seidenader, Jonas; Carmona, Lina; Warren, Anne; Gnanapragasam, Vincent; Doble, Andrew; Kastner, Christof

2016-01-01

To determine the accuracy of multiparametric magnetic resonance imaging (mpMRI) during the learning curve of radiologists using MRI targeted, transrectal ultrasonography (TRUS) guided transperineal fusion biopsy (MTTP) for validation. Prospective data on 340 men who underwent mpMRI (T2-weighted and diffusion-weighted MRI) followed by MTTP prostate biopsy, was collected according to Ginsburg Study Group and Standards for Reporting of Diagnostic Accuracy standards. MRI data were reported by two experienced radiologists and scored on a Likert scale. Biopsies were performed by consultant urologists not 'blinded' to the MRI result and men had both targeted and systematic sector biopsies, which were reviewed by a dedicated uropathologist. The cohorts were divided into groups representing five consecutive time intervals in the study. Sensitivity and specificity of positive MRI reports, prostate cancer detection by positive MRI, distribution of significant Gleason score and negative MRI with false negative for prostate cancer were calculated. Data were sequentially analysed and the learning curve was determined by comparing the first and last group. We detected a positive mpMRI in 64 patients from Group A (91%) and 52 patients from Group E (74%). The prostate cancer detection rate on mpMRI increased from 42% (27/64) in Group A to 81% (42/52) in Group E (P < 0.001). The prostate cancer detection rate by targeted biopsy increased from 27% (17/64) in Group A to 63% (33/52) in Group E (P < 0.001). The negative predictive value of MRI for significant cancer (>Gleason 3+3) was 88.9% in Group E compared with 66.6% in Group A. We demonstrate an improvement in detection of prostate cancer for MRI reporting over time, suggesting a learning curve for the technique. With an improved negative predictive value for significant cancer, decision for biopsy should be based on patient/surgeon factors and risk attributes alongside the MRI findings. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.

Preparing for Operational Use of High Priority Products from the Joint Polar Satellite System (JPSS) in Numerical Weather Prediction

NASA Astrophysics Data System (ADS)

Nandi, S.; Layns, A. L.; Goldberg, M.; Gambacorta, A.; Ling, Y.; Collard, A.; Grumbine, R. W.; Sapper, J.; Ignatov, A.; Yoe, J. G.

2017-12-01

This work describes end to end operational implementation of high priority products from National Oceanic and Atmospheric Administration's (NOAA) operational polar-orbiting satellite constellation, to include Suomi National Polar-orbiting Partnership (S-NPP) and the Joint Polar Satellite System series initial satellite (JPSS-1), into numerical weather prediction and earth systems models. Development and evaluation needed for the initial implementations of VIIRS Environmental Data Records (EDR) for Sea Surface Temperature ingestion in the Real-Time Global Sea Surface Temperature Analysis (RTG) and Polar Winds assimilated in the National Weather Service (NWS) Global Forecast System (GFS) is presented. These implementations ensure continuity of data in these models in the event of loss of legacy sensor data. Also discussed is accelerated operational implementation of Advanced Technology Microwave Sounder (ATMS) Temperature Data Records (TDR) and Cross-track Infrared Sounder (CrIS) Sensor Data Records, identified as Key Performance Parameters by the National Weather Service. Operational use of SNPP after 28 October, 2011 launch took more than one year due to the learning curve and development needed for full exploitation of new remote sensing capabilities. Today, ATMS and CrIS data positively impact weather forecast accuracy. For NOAA's JPSS initial satellite (JPSS-1), scheduled for launch in late 2017, we identify scope and timelines for pre-launch and post-launch activities needed to efficiently transition these capabilities into operations. As part of these alignment efforts, operational readiness for KPPs will be possible as soon as 90 days after launch. The schedule acceleration is possible because of the experience with S-NPP. NOAA operational polar-orbiting satellite constellation provides continuity and enhancement of earth systems observations out to 2036. Program best practices and lessons learned will inform future implementation for follow-on JPSS-3 and -4 missions ensuring benefits and enhancements during the system's design life.

Discovery of 36 eclipsing EL CVn binaries found by the Palomar Transient Factory

NASA Astrophysics Data System (ADS)

van Roestel, J.; Kupfer, T.; Ruiz-Carmona, R.; Groot, P. J.; Prince, T. A.; Burdge, K.; Laher, R.; Shupe, D. L.; Bellm, E.

2018-04-01

We report on the discovery and analysis of 36 new eclipsing EL CVn-type binaries, consisting of a core helium-composition pre-white dwarf (pre-He-WD) and an early-type main-sequence companion. This more than doubles the known population of these systems. We have used supervised machine learning methods to search 0.8 million light curves from the Palomar Transient Factory (PTF), combined with Sloan Digital Sky Survey (SDSS), Panoramic Survey Telescope and Rapid Response System (Pan-STARRS) and Two-Micron All-Sky Survey (2MASS) colours. The new systems range in orbital periods from 0.46 to 3.8 d and in apparent brightness from ˜14 to 16 mag in the PTF R or g΄ filters. For 12 of the systems, we obtained radial velocity curves with the Intermediate Dispersion Spectrograph at the Isaac Newton Telescope. We modelled the light curves, radial velocity curves and spectral energy distributions to determine the system parameters. The radii (0.3-0.7 R⊙) and effective temperatures (8000-17 000 K) of the pre-He-WDs are consistent with stellar evolution models, but the masses (0.12-0.28 M⊙) show more variance than models have predicted. This study shows that using machine learning techniques on large synoptic survey data is a powerful way to discover substantial samples of binary systems in short-lived evolutionary stages.

Unsupervised classification of variable stars

NASA Astrophysics Data System (ADS)

Valenzuela, Lucas; Pichara, Karim

2018-03-01

During the past 10 years, a considerable amount of effort has been made to develop algorithms for automatic classification of variable stars. That has been primarily achieved by applying machine learning methods to photometric data sets where objects are represented as light curves. Classifiers require training sets to learn the underlying patterns that allow the separation among classes. Unfortunately, building training sets is an expensive process that demands a lot of human efforts. Every time data come from new surveys; the only available training instances are the ones that have a cross-match with previously labelled objects, consequently generating insufficient training sets compared with the large amounts of unlabelled sources. In this work, we present an algorithm that performs unsupervised classification of variable stars, relying only on the similarity among light curves. We tackle the unsupervised classification problem by proposing an untraditional approach. Instead of trying to match classes of stars with clusters found by a clustering algorithm, we propose a query-based method where astronomers can find groups of variable stars ranked by similarity. We also develop a fast similarity function specific for light curves, based on a novel data structure that allows scaling the search over the entire data set of unlabelled objects. Experiments show that our unsupervised model achieves high accuracy in the classification of different types of variable stars and that the proposed algorithm scales up to massive amounts of light curves.

da Vinci skills simulator for assessing learning curve and criterion-based training of robotic basic skills.

PubMed

Brinkman, Willem M; Luursema, Jan-Maarten; Kengen, Bas; Schout, Barbara M A; Witjes, J Alfred; Bekkers, Ruud L

2013-03-01

To answer 2 research questions: what are the learning curve patterns of novices on the da Vinci skills simulator parameters and what parameters are appropriate for criterion-based robotic training. A total of 17 novices completed 2 simulator sessions within 3 days. Each training session consisted of a warming-up exercise, followed by 5 repetitions of the "ring and rail II" task. Expert participants (n = 3) performed a warming-up exercise and 3 repetitions of the "ring and rail II" task on 1 day. We analyzed all 9 parameters of the simulator. Significant learning occurred on 5 parameters: overall score, time to complete, instrument collision, instruments out of view, and critical errors within 1-10 repetitions (P <.05). Economy of motion and excessive instrument force only showed improvement within the first 5 repetitions. No significant learning on the parameter drops and master workspace range was found. Using the expert overall performance score (n = 3) as a criterion (overall score 90%), 9 of 17 novice participants met the criterion within 10 repetitions. Most parameters showed that basic robotic skills are learned relatively quickly using the da Vinci skills simulator, but that 10 repetitions were not sufficient for most novices to reach an expert level. Some parameters seemed inappropriate for expert-based criterion training because either no learning occurred or the novice performance was equal to expert performance. Copyright © 2013 Elsevier Inc. All rights reserved.