High Level Of Experience Research Articles

Objectification of intracochlear electrocochleography using machine learning.

IntroductionElectrocochleography (ECochG) measures inner ear potentials in response to acoustic stimulation. In patients with cochlear implant (CI), the technique is increasingly used to monitor residual inner ear function. So far, when analyzing ECochG potentials, the visual assessment has been the gold standard. However, visual assessment requires a high level of experience to interpret the signals. Furthermore, expert-dependent assessment leads to inconsistency and a lack of reproducibility. The aim of this study was to automate and objectify the analysis of cochlear microphonic (CM) signals in ECochG recordings.MethodsProspective cohort study including 41 implanted ears with residual hearing. We measured ECochG potentials at four different electrodes and only at stable electrode positions (after full insertion or postoperatively). When stimulating acoustically, depending on the individual residual hearing, we used three different intensity levels of pure tones (i.e., supra-, near-, and sub-threshold stimulation; 250–2,000 Hz). Our aim was to obtain ECochG potentials with differing SNRs. To objectify the detection of CM signals, we compared three different methods: correlation analysis, Hotelling's T2 test, and deep learning. We benchmarked these methods against the visual analysis of three ECochG experts.ResultsFor the visual analysis of ECochG recordings, the Fleiss' kappa value demonstrated a substantial to almost perfect agreement among the three examiners. We used the labels as ground truth to train our objectification methods. Thereby, the deep learning algorithm performed best (area under curve = 0.97, accuracy = 0.92), closely followed by Hotelling's T2 test. The correlation method slightly underperformed due to its susceptibility to noise interference.ConclusionsObjectification of ECochG signals is possible with the presented methods. Deep learning and Hotelling's T2 methods achieved excellent discrimination performance. Objective automatic analysis of CM signals enables standardized, fast, accurate, and examiner-independent evaluation of ECochG measurements.

Gender Impact on Entrepreneurial Success: A Meta-Analytical Structural Equations Analysis

Drawing on the social feminism theory and liberal feminism theory, this meta-analysis studied the effects of gender on different performance measures (financial performance, growth, survival, and satisfaction) for new ventures through the mediatory effect of hours worked, human capital levels (education level and experience level), social capital, and debt. The results, based on a meta-analysis of 69 studies with a total sample size of 51,985 new ventures, show that male entrepreneurs invest more hours in their business and have higher level of experience. Moreover, male gender was positively related to financial performance and growth directly and indirectly by influencing hours worked and experience level. Results show that female entrepreneurs are more satisfied with their businesses than male entrepreneurs, and finally our results could not establish an effect for gender on the survival of new ventures.

Global Competence in Canadian Teacher Candidates

The purpose of the study was to determine the global competence of 115 Canadian teacher candidates using a new measurement tool. Non-parametric tests indicated several differences in self-reported global competence within individual indicators across the three areas of Exploring, Engaging, and Acting with global competence. Two indicators showed that male teacher candidates reported higher levels of global competence than did females in the Exploring and Acting areas. Teacher candidates intending to teach in middle and senior high school reported higher levels in one indicator within the Acting area. Moreover, Canadian-born teacher candidates reported higher levels of Engaging and Acting than did non-Canadian-born students across six indicators total. While there were no differences across the three areas by age, results showed that higher levels of experience in their teacher education program were associated with greater global competence across all three areas as indicated by five indicators total, with three at the Acting stage. Implications for teacher education are discussed.

PORTABLE MULTI-CAMERA SYSTEM: FROM FAST TUNNEL MAPPING TO SEMI-AUTOMATIC SPACE DECOMPOSITION AND CROSS-SECTION EXTRACTION

Abstract. The paper outlines the first steps of a research project focused on the digitalization of underground tunnels for the mining industry. The aim is to solve the problem of rapidly, semi-automatically, efficiently, and reliably digitizing complex and meandering tunnels. A handheld multi-camera photogrammetric tool is used for the survey phase, which allows for the rapid acquisition of the image dataset needed to produce the 3D data. Moreover, since often, automatic, and fast acquisitions are not supported by easy-to-use tools to access and use the data at an operational level, a second aim of the research is to define a method able to arrange and organise the gathered data so that it would be easily accessible. The proposed approach is to compute the 3D skeleton of the surveyed environment by employing tools developed for the analysis of vascular networks in medical imagery. From the computed skeletonization of the underground tunnels, a method is proposed to automatically extrapolate valuable information such as cross-sections, decomposed portions of the tunnel, and the referenced images from the photogrammetric survey. The long-term research goal is to create an effective workflow, both at the hardware and software level, that can reduce computation times, process large amounts of data, and reduce dependency on high levels of experience.

Preparedness for practice of newly qualified dental professionals in Australia - educator, employer, and consumer perspectives

BackgroundLimited data regarding the perspectives of other observers (i.e. those who educate, employ or receive care from) of new graduates’ preparedness to practice is available. The present study aimed to explore perceptions of different observers regarding the preparedness to practice and work readiness of newly qualified dental professionals. This broader range of perspectives is crucial to inform the development of educational programs, including continuing professional development, for newly qualified dental professionals, by clarifying the skills, knowledge and behaviours expected by the dental profession and wider public.ResultsNineteen individual qualitative interviews were undertaken. Interview participants included clinical demonstrators (n = 9; 2 Oral Health Therapists; 5 Dentists; and 2 Prosthetists), dental course convenors (n = 4), representatives of large employers (n = 2), and consumers (n = 4). According to this diverse group of respondents, dental students receive adequate theoretical and evidence-based information in their formal learning and teaching activities, which prepares them for practice as dental professionals.There were no specific clinical areas or procedures where preparedness was highlighted as a major concern. Notwithstanding this, specific graduate skills which would benefit from further training and consolidation were identified, including areas where higher levels of experience would be beneficial. Nonetheless, respondents indicated that new graduates were aware of their limitations and had developed self-discipline and ethics that would allow them to identify conditions/situations where they would not have the experience or expertise to provide care safely.ConclusionsFrom an observer perspective, dental students appeared to have gained adequate theoretical and evidence-based information in their formal learning and teaching activities to prepared them to commence practicing safely as dental professionals. Areas were identified in which new graduates were underprepared and when transitional support may be required.

Molecular-genetic approaches to species identif ication of platyhelminthes of the genus Ligophorus (Monogenea) parasitising f lathead mullet.

Mugil cephalus L., 1758 (flathead mullet) is a valuable commercial fish and a promising object of artificial breeding in the Black Sea and the Sea of Azov, and the study of its parasite fauna is important for fishery and mariculture. Monogeneans of the genus Ligophorus are common ectoparasites dwelling on the gills of mullets. Two representatives of this genus parasitise flathead mullet in the Azov-Black Sea region, namely Ligophorus mediterraneus Sarabeev, Balbuena et Euzet, 2005 and Ligophorus cephali Rubtsova, Balbuena, Sarabeev, Blasco- Costa et Euzet, 2006. Morphological identification of these species requires spending much time and a high level of experience in monogenean taxonomy. For quick and correct species identification of these parasites, we have developed a genotyping approach based on the polymerase chain reaction of allele-specific gene sites for various Monogenea species. A fragment of the 28S ribosomal gene, which includes conserved and variable sites, was chosen as a genetic marker. Three approaches were used as follows: amplified fragment length analysis, allelespecific PCR with endpoint detection and allele-specific real-time PCR using SYBR Green intercalating dye. The first approach was by obtaining PCR products of different lengths that were specific either to L. mediterraneus or to L. cephali. This approach was implemented due to the presence of several variable sites located at a distance from each other. The PCR mixture contained three primers: one forward and two reverse. The forward primer was complementary to the conserved site, which did not differ between species. Reverse primers were speciesspecific and, for each species, they were complementary to different DNA regions located 100 bp apart. As a result, L. mediterraneus was characterized by shorter amplicons than L. cephali. For the second and third approaches, a pair of primers was designed according to the following principle: the forward primer was complementary to both species, since it was selected for the conserved gene region. Reverse primers were species-specific and were designed for the 28S variable region. The two parasite species were distinguished by three-point mutations. Thus, one pair of primers was complementary to L. mediterraneus, the other, to L. cephali. The amplified fragment length analysis and the allele-specific real-time PCR demonstrated 100 % coincidence of genotyping results compared with Sanger sequencing. The developed genotyping protocols can be used not only to distinguish two species of Ligophorus from flathead mullet in ecological studies and veterinary practice but also for further development of similar approaches for other monogeneans, among which there are many pathogenic species.

Optimal Synthesis of Loader Drive Mechanisms: A Group Robust Decision-Making Rule Generation Approach

The objective of this paper is to present a novel, hybrid group multi-criteria decision approach that can be used to evaluate alternatives for the optimal synthesis of loader drive mechanisms. In most product design engineering groups, experts have expertise in different areas and robust decision-making is necessary to integrate a number of opposing opinions, attitudes, and solutions. This study presents the application of an integrated approach for decision-making, i.e., the generation of a robust decision-making rule for group decision-making (RDMR-G) by combining different multi-criteria decision-making (MCDM) methods and Taguchi’s robust quality engineering principles. The basic idea behind this article was to create an approach that enables the comprehensive and robust consideration of expert opinions given the existence of numerous objective and subjective methods for determining the criteria weights, which are crucial to the final ranking of alternatives in any decision-making problem. In order to set the optimal configuration of a loader drive mechanism, five experts, all with a high level of experience and knowledge in this field, considered twenty-six different kinematic chain construction solutions, i.e., alternatives, and evaluated them with respect to six criteria. The obtained results and rankings provided by each expert and each criteria weighting method were compared using Kendall’s τb and Spearman’s ρ tests. As an example, this paper demonstrates the practical application of a RDMR-G approach and in doing so contributes to the literature in the fields of product design engineering and decision-making.

Educational technology applied to adult education

Adult learning has been ubiquitous not only in the institutions of higher learning but in the lower learning institutions. As shown by many authors, adult learners often bring with them a high level of experience and higher expectations that positively reflect their performance in their classroom-based activity. This study is done explicitly on educational technology applied in adult learning to enhance the learning activities and increase the level of enrollment in adult learners. Also, the study brings to light how significant technological advancement in education is to adult learners since a higher percentage of students are busy people with different sets of commitments. The study suggests that faculty members' attitudes toward instructional technology, particularly those geared at adults, need to be re-evaluated to serve their students better. Instructors need to think about how technology might affect the development and use of andragogy in the classroom to help adult learners.

Mapping of State Transportation Agencies’ Practices and Perceptions in Project Bundling

State transportation agencies (STAs) have been using the project bundling method primarily on bridge projects. While many studies suggest that bundling bridges can reduce project costs and expedite project delivery, more research is needed to help STAs to achieve advanced use of project bundling by understanding the current state of the practice and perceptions about project bundling among STA representatives. This paper presents the detailed findings of a survey, including the perceived benefits, challenges, and risks involved in the bundling method among STA representatives. The survey found that project bundling helps reduce individual project costs in a bundle as well as agency administrative costs and provides an individual project with the flexibility to schedule around other projects in a bundle. Project bundling was found to have a major impact on the cost and delivery time of the project. The major factors that are considered for bundling effectiveness were found to be work type, project type, and spatial proximity. The major concern that most of the STAs had during bundling was that the bundled projects may eliminate the competition from smaller contractors. However, the concerns over the bundling method were found to be less among agencies with a high-level experience of bundling. The survey also found that the majority of STAs have not quantified the impact of the project bundling yet. The results from this study suggest that further research on bundling mixed-type projects and risks associated with bundled contracts is necessary.

Investigating the role of technostress, cognitive appraisal and coping strategies on students' learning performance in higher education: a multidimensional transactional theory of stress approach

PurposeCOVID-19 has galvanized educational institutions to rapidly adopt technology-enhanced learning (TEL) environment where students are required to use and manage a diverse set of information and communication technologies (ICTs). Using the Transactional Theory of Stress, the authors investigate the impact of a TEL environment on students' stress, cognitive appraisal and coping. The authors also explore how the TEL environment impacts students' learning satisfaction and performance.Design/methodology/approachA survey using Qualtrics was developed to collect the data from 275 undergraduate students. The authors used the Partial Least Squares (PLS) through SmartPLS for instrument validation and testing of the structural model. The reflective-formative model was applied as the measures used to evaluate the first-order constructs are unidimensional, and the second-order construct has a formative measurement.FindingsStudents experienced technology-related stress due to ICT use. The negative appraisal such as harm and threat leads to emotion-focused coping among students, while the constructive appraisal such as positive and challenge leads to problem-focused coping. Emotion-focused coping was found to negatively impact learning satisfaction, while problem-focused coping was found to positively impact satisfaction. The authors also found that students with a higher level of experience with online and hybrid classes, higher confidence in computer usage and lower anxiety are better equipped to deal with technostress.Research limitations/implicationsThis study provides the first comprehensive technostress model in the IS literature that uses formative modeling to explain technostress creators and inhibitors and emotion-focused coping and problem-focused coping, as was intended by the Transactional Theory of Stress. The result allows for rethinking TEL environment by drawing attention to strategies that can reduce technological complexity and uncertainty. For future research, it may be helpful to perform a longitudinal or experimental study to obtain rigorous causal inference. Originality/valueThere is limited research on the impact of technostress in the field of higher education. Also, technostress has been used inconsistently in Information Systems research, with the majority of research focusing on technostress creators and inhibitors only. This research incorporates all the constructs of the original theory adding new knowledge to the IS literature about the nature and causes of stress created by the use of technology.

Understanding shoulder pseudoparalysis. Part II: Treatment

Decision-making for the treatment of pseudoparalytic shoulders is complex and a high level of experience in shoulder surgery and outcome evaluation is required.Management and results depend on clinical findings, tear and tissue quality, patient and surgeon criteria. Clinical findings determine the exact definition and direction of pseudoparesis and pseudoparalysis.Tear pattern and tissue quality determine if the rotator cuff is repairable or irreparable. Age and general health are important patient factors.Non-operative treatment is the first option for patients with a higher risk profile for reconstruction or arthroplasty, but delineation of its value requires better evidence.Tendon transfers are used for irreparable loss of the horizontal force couple balance (rotation). Options include latissimus dorsi, pectoralis minor and major for loss of active internal rotation, and latissimus dorsi ± teres major and lower trapezius for loss of active external rotation (AER).Partial cuff repair with or without superior capsular reconstruction using allograft or biceps tendon is an option for loss of active forward elevation.Treatment for the combined loss of elevation and external rotation patients is still not clear. Options include lateralised reverse shoulder arthroplasty (RSA) alone or combined RSA with a tendon transfer.RSA with loss of AER can be revised by adding a tendon transfer.

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

BackgroundPure laparoscopic donor right hepatectomy (PLDRH) can provide better operative outcomes for the donor than conventional open donor right hepatectomy (CODRH). However, the complexity of the procedure typically makes transplant teams reluctant to perform it, especially in low-volume transplant centers. We compared the outcomes of PLDRH and CODRH to demonstrate the feasibility of PLDRH in a low-volume transplant program.MethodsWe carried out a retrospective study of adult living donor liver transplantation in Chiang Mai University Hospital from January 2015 to March 2021. The patients were divided into a PLDRH group and a CODRH group. Baseline characteristics, operative parameters, and postoperative complications of donors and recipients were compared between the two groups.ResultsThirty patients underwent donor hepatectomy between the dates selected (9 PLDRH patients and 21 CODRH patients). The baseline characteristics of the 2 groups were not significantly different. The median graft volume of the PLDRH group was 693.8 mL, which was not significantly different from that of the CODRH group (726.5 mL) The PLDRH group had a longer operative time than the CODRH group, but the difference was not statistically significant (487.5 min vs 425.0 min, p = 0.197). The overall complication rate was not significantly different between the two groups (33.3% vs 22.2%, p = 0.555). Additionally, for the recipients, the incidence of major complications was not significantly different between the groups (71.3 vs 55.6%, p = 0.792).ConclusionEven in the context of this low-volume transplant program, whose staff have a high level of experience in minimally invasive hepatobiliary surgery, PLDRH showed similar results to CODRH in terms of perioperative outcomes for donors and recipients.

Environmental Enrichment Effects on the Brain-Derived Neurotrophic Factor Expression in Healthy Condition, Alzheimer's Disease, and Other Neurodegenerative Disorders.

Brain-derived neurotrophic factor (BDNF), a protein belonging to the neurotrophin family, is known to be heavily involved in synaptic plasticity processes that support brain development, post-lesion regeneration, and cognitive performances, such as learning and memory. Evidence indicates that BDNF expression can be epigenetically regulated by environmental stimuli and thus can mediate the experience-dependent brain plasticity. Environmental enrichment (EE), an experimental paradigm based on the exposure to complex stimulations, constitutes an efficient means to investigate the effects of high-level experience on behavior, cognitive processes, and neurobiological correlates, as the BDNF expression. In fact, BDNF exerts a key role in mediating and promoting EE-induced plastic changes and functional improvements in healthy and pathological conditions. This review is specifically aimed at providing an updated framework of the available evidence on the EE effects on brain and serum BDNF levels, by taking into account both changes in protein expression and regulation of gene expression. A further purpose of the present review is analyzing the potential of BDNF regulation in coping with neurodegenerative processes characterizing Alzheimer's disease (AD), given BDNF expression alterations are described in AD patients. Moreover, attention is also paid to EE effects on BDNF expression in other neurodegenerative disease. To investigate such a topic, evidence provided by experimental studies is considered. A deeper understanding of environmental ability in modulating BDNF expression in the brain may be fundamental in designing more tuned and effective applications of complex environmental stimulations as managing approaches to AD.

Comparison of safety and usability between peristaltic and pneumatic large-volume intravenous smart pumps during actual clinical use

ObjectiveTo describe and compare safety and usability between a peristaltic large-volume intravenous smart pump (IVSP) and a novel pneumatic large-volume IVSP during clinical use.MethodsA prospective, comparative study was conducted in...

Infant Carrying in the United States: A Survey of Current Practices, Physical and Mental Health Benefits, and Challenges of Babywearing

Background: Parents carry their infants, toddlers, and young children every day. An ergonomic aid to carry (ie, babywearing) has been used for generations by caregivers of young children worldwide. While the benefits of close physical contact for infants are well documented, little is known on how this additional load impacts the health of the caregiver. Objective: An understanding of how babies are carried during their early years, especially how this behavior affects the musculoskeletal and mental health of the caregiver, is the first step to understanding this dynamic and is the objective of this research. Study Design: Cross-sectional observational study. Methods: A survey was designed to provide insight into current practices in the United States and the self-perceived physical and mental health benefits or challenges to babywearing. Results: A total of 3758 babywearing enthusiasts with a high level of experience and frequent babywearing responded. Respondents reported babywearing to allow for multitasking (97%) and for bonding/attachment (87%). Increased babywearing frequency was associated with improvements in fatigue, insomnia, and interest in sex among caregivers. Most respondents had experienced back pain (82%). Urinary incontinence and pelvic organ prolapse appear more prevalent than other research reports, although strong relationships were not found with babywearing. Finally, respondents had mild symptoms of stress, anxiety, and depression. Surprisingly, no relationships were identified between mental health scales and babywearing frequency or experience. Conclusions: Taken together, this data provides a better understanding of physical and mental health of caregivers in the United States, especially as they relate to babywearing. See the Video, Supplemental Digital Content A (available at: https://links.lww.com/JWHPT/A72).

Asociación entre factores intraoperatorios y complicaciones post quirúrgicas en cirugía de terceros molares: Un estudio observacional

Objective: The main objective of this study was to establish the association between risk factors and complications after oral surgery. Material and Methods: A cohort study was developed between April of 2017 and March of 2018 through a register of patients admitted with buccal surgery indication at the San Borja Arriarán hospital, Chile. Results: The incidence of post-surgical complications was 5.8%, with alveolitis being the most frequent. In the bivariate analysis, surgical difficulty was the only intraoperative variable that presented a significant association with the development of post-surgical complications (p<0.05). In the multivariate analysis, no associations were found between intraoperative variables and the development of complications. Conclusion: The concentration of highly complex procedures in professionals with a high level of experience (maxillofacial surgeons) allows low post-surgical complication incidence and prevents intraoperative variables from generating a higher risk of post-surgical complications.

Peter Brown—An appreciation

Peter Brown—An appreciation

Trends in East Asian nurses recognizing ethical behavioral practices.

Nurses are expected to make and implement autonomous decisions to provide patients with excellent quality nursing while practicing complex, high-level care. However, studies have shown that nursing practice based on autonomous decision-making is difficult, and a gap exists between decision-making and implementation. This study aims to clarify trends among nursing professionals who recognize they are practicing ethical behavior in their nursing practice. We surveyed the basic attributes of and used the Ode's Ethical Behavior Scale for Nurses with 3467 nursing professionals working at 34 hospitals in suburban cities of Japan and investigated the relationships among these factors. This study was approved by the appropriate research ethics committee. The Ethical Behavior Scale for Nurses was used with the authors' permission. Significant differences were found in the mean "ethical behavior" scores between nurses and licensed practical nurses and midwives and licensed practical nurses. Mean scores for the "justice" subscale differed significantly between the low experience group and mid-level experience group and between the high experience group and mid-level experience group. Significant differences were also found in the mean scores between those with ethics education experience and those without, those with ethics training experience and those without, and those with ethics conference experience and those without. Midwives and nurses had higher ethical behaviors than licensed practical nurses. Nursing professionals with low and high experience had higher justice scores than those with mid-level experience. Finally, nursing professionals with ethics education, training, or conference experience had higher ethical behavior than those without such experience. Nursing professionals who recognize they are practicing ethical behavior tend to be midwives or nurses with low or high levels of experience who attended ethics education, training, or conferences.

Imaging Based Spleen Volume Assessments in Myelofibrosis Clinical Trials - Do We Need a Double Read Model?

▪Myelofibrosis (MF) is a type of chronic blood cancer characterized by bone marrow fibrosis, extramedullary hematopoiesis and splenomegaly. Approximately 89% of patients present palpable splenomegaly with a compromised quality of life and reduced survival. The International Working Group Myeloproliferative Neoplasm Research and Treatment (IWG-MRT) criteria utilize spleen volume (SV) as part of clinical improvement (CI) response in MF trials. These include evaluation of spleen response as a primary/ secondary endpoint - defined as ≥35% SV reduction from baseline. Progressive disease is defined as ≥25% increase in SV from baseline level. Magnetic resonance imaging (MRI) and Computed tomography (CT) provide a non-invasive way to assess change in spleen size both spatially and temporally in a clinical study. While image acquisition with optimized and harmonized protocols is key, a central independent review of images also plays a critical role in correct patient outcome determination. The aim of this study is to determine if a double read model for central independent review is necessary to maintain a high accuracy of SV estimation. To this effect, alignment among independent readers over review criteria was assessed: inter-reader variability (IRV), in addition to assessment of consistency in review approach: intra-reader variability (ARV).Retrospective analysis was implemented on imaging data across 12 multi-center MF trials-MRI/CT images of two time-points (baseline and 1 follow-up) from 142 trial participants for ARV and 85 trial participants for IRV analysis. All images passed image quality checks and were processed for manual segmentation of the spleen by image analysts, followed by an over-read by trained radiologists. The spleen volume was calculated as the sum of spleen cross-sectional area across all slices multiplied by slice interval. For ARV analysis, the images were presented to the same readers in a blinded fashion at least three weeks after the initial review. For IRV analysis, images read by a primary reader were then presented to the secondary reader. The percent discrepancy for ARV and IRV were calculated as the ratio of difference between primary and secondary spleen volumes, divided by the average of the two.The average ARV discrepancy was 0.37±0.55 % (mean±standard deviation) as shown in Fig 1a. Zero subjects had an ARV discrepancy of more than 5%. As shown in Fig 2a, majority of the cases were under an ARV discrepancy of 1%. These results show excellent consistency in approach of readers over time in comparison to 2.8±3.5% reportedby Harris et al (European Journal of Radiology, 2010). For IRV, the average discrepancy was 0.62±0.85 % as shown in Fig 1b. 1.1% of cases had an IRV discrepancy of more than 5%. As shown in Fig 2b, most of the cases were within an ARV discrepancy of 1%. These results show a high level of alignment between readers in their imaging review approach in comparison to 6.4±9.8% reportedby Harris et al (European Journal of Radiology, 2010).The high level of reliability and repeatability seen across radiological reads suggests that a single read model is sufficient to assess imaging volumetrics-based endpoints. It is important to note that a multi-step approach was used to thoroughly train, test and monitor independent readers throughout the study duration. Readers were chosen based on high level of experience with the indication and analysis application. Reader onboarding involved an accurate overview and clear instruction on the review assessments. Multiple MRI/ CT imaging cases were utilized for reader testing and training. Since image quality can be a significant factor influencing the confidence level of a reader, these cases reflected examples of imaging artifacts expected on such trials, such as motion artifacts, low image resolution, ghosting and low contrast to noise ratio. Routine quality checks and variability assessments were done throughout the trial duration, with prompt corrective action taken to prevent inaccuracy of study results. These actions included issuing training points or re-read of cases that contained established error. Further work is necessary on assessing how variables such as spleen size, imaging artifacts and change in imaging modality affect reader variability. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™.

Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption. New advancements in lasers, specifically the Moses™ pulse-modulation technology, have resulted in improvements in hemostasis and achieving same-day discharges and catheter removals. We aimed to perform a cost-comparison to analyze if Moses-augmented HoLEP (m-HoLEP) resulted in cost-savings. A retrospective review was performed of a single expert surgeon's experience from May 2018 to November 2020, comparing m-HoLEP with HoLEP. Perioperative and postoperative variables were abstracted from the medical record. Univariate and multivariate analyses were performed using SAS® 9.4. Two-sided significance was set at p <0.05. A total of 312 men underwent HoLEP during the study period (192 in m-HoLEP group and 120 in HoLEP group). The m-HoLEP group had more same-day discharges (p <0.001) and emergency department visits (6.3% vs 1.7%, p=0.0071). m-HoLEP resulted in hospital cost savings of $840 for the initial surgical episode (p=0.0297). When factoring in emergency department visits/readmissions, the cost savings decreased to $747 per case (p=0.0574). m-HoLEP was associated with same-day discharge and hospital cost savings of $840 for the initial surgical episode. Further study in other institutions with surgeons of varying experience levels will need to be performed to see if these findings can be replicated.