Initial Learning Period Research Articles

A chronometric relationship between circuits underlying learning and error monitoring in the basal ganglia and salience network

Abstract Healthy individuals readily adjust their behaviour in response to errors using learning mechanisms. This raises the question of how error-related neural mechanisms underlie the learning process and its progress. In this study, 21 healthy participants performed a challenging functional magnetic resonance imaging (fMRI) task to answer this question. We assessed the evolution of error-related neural response as a function of learning progress. We tested the hypothesis that the dorsal anterior cingulate cortex (dACC) and anterior insula, key regions of the error monitoring neural circuitry, reflect both the performance of an action and its improvement. Given the nature of trial-and-error learning, we also expected an involvement of the striatum, particularly the putamen. We found that error-related neural activity (in the dACC and anterior insula) was similar following correct responses and errors in an initial learning period. However, as learning progressed, the activity continuously decreased in response to correct events and increased after errors. In opposition, during the initial learning phase, the putamen activity was modulated by errors, but, as it progressed, this region became unaffected by response outcomes. In sum, our study provides neural evidence for an interaction between the mechanisms underlying error monitoring and learning, contributing to clarifying how error-related neural responses evolve with learning.

The Effect of Age of First Exposure on Vocabulary, Mean Length of Utterance, Morphosyntactic Accuracy, and Semantic and Sentence-Level Patterns in the First 2 Years of French Second-Language Learning by Preschool- to Adolescent-Age Mandarin Speakers.

Bilingual assessment is particularly difficult in the very first period of children's second language (L2) exposure. This exploratory, longitudinal study examined L2 learning after 1 and 2 years of L2 exposure by young immigrants and how it is affected by their age at first exposure to the L2 (AoE). Participants were 18 immigrants ranging in age from 2;11 to 14;2 (years;months), all within their first year in Montreal at Time 1, enrolled in a French school or day care, and from a Mandarin first language background. Participants were tested again a year later. Measures included receptive and expressive French vocabulary tests and conversational language samples analyzed using traditional measures of mean length of utterance (MLU) and morphological accuracy as well as novel measures of semantic and sentence-level patterns. Performance was relatively high already at Time 1 and increased significantly at Time 2 in both vocabulary and MLU. At Time 2, vocabulary scores were below normative values, whereas MLU was within expected values relative to monolingual and simultaneous bilinguals for the majority of the participants. However, higher MLUs were accompanied by more instances of both semantic errors and creative semantic strategies. French performance was strongly related to AoE; with amount of exposure equivalent, older participants outperformed the younger ones on MLU and vocabulary. Semantic errors and creative uses were strongly predicted by AoE; however, morphological accuracy and number of agrammatical utterances were not. This initial period of French learning involved a rapid growth spurt for most of the participants. We argue that the pattern observed, particularly among the older children, constitutes an early stage of L2 learning characterized by long utterances that are also frequently hard to understand as speakers encounter challenges and use creative strategies in their attempt to convey meaning. Comparison with normative reference bases for monolinguals and bilinguals with greater cumulative L2 exposure who have similar MLUs should be done with much caution during this early period.

Symposium 5: Design for networked learning: A case study in health science

Higher education (HE) institutions have been transforming dramatically since the pandemic started late 2019 and early 2020. After an initial period of emergency online teaching and learning, HE educators have focused our energy on supporting students' learning in a complex dynamic learning environment, where digital/online - material/physical - social elements are interwoven and interrelated. Networked learning can be a useful medium for us in this complex context. This paper explores a case study of design for networked learning in a health science postgraduate course. The course was designed in the context of a New Zealand university. The paper will examine how the course design reflects the eight principles of design for networked learning, and proposes some recommendations on design for networked learning at a course level. It links practice and theories, and illustrates how networked learning is unpacked in the context of the course design. While the current paper focuses on the design of the course, it is suggested that future research should conduct an evaluation of the design and develop empirical studies on students' and teacher's experience.

Learning Curve for No-Touch Vein Harvesting Technique in Off-Pump Coronary Artery Bypass Grafting

Introduction: The present study sought to analyze the learning curve of no-touch vein harvesting technique in off-pump coronary artery bypass grafting (CABG). Methods: Logarithmic curve fitting was used to analyze learning curves based on operative time for 160 patients that underwent no-touch CABG. The clinical data of 89 of these patients whose number of grafts was 3 were further retrospectively analyzed based on Cumulative Sum (CUSUM) analysis. Patients were divided into two groups, referring to the surgeon’s learning period and maturation period in chronological order. Perioperative outcomes were compared between two groups. Results: In this study, the learning curve for no-touch vein harvesting technique in off-pump CABG was quantitatively assessed in 51 cases through CUSUM analysis, and the results from logarithmic curve fitting corroborated these findings, indicating a significant milestone in proficiency gain for practitioners. Compared with patients in surgeon’s learning period, the median of the operative, Aorta-saphenous vein graft (SVG) anastomosis, and SVG checking time in the maturation period was significantly shorter (230 min vs. 250 min, p = 0.002; 11.5 min vs. 13.0 min, p = 0.025; 9.0 min vs. 11.0 min, p = 0.002). There was less first 48-h chest tube drainage, shorter postoperative hospital stay and rarer delayed incision healing in the leg in the late period compared with that in the early period (312.6 ± 140.7 mL vs. 401.0 ± 233.5 mL, p = 0.029; 11.0 d vs. 12.0 d, p = 0.026; 15.7% vs. 2.6%, p = 0.043). Conclusion: A cardiac surgeon mastered in CABG using the full-incision SVG harvesting method experienced a learning curve to gain early proficiency in no-touch CABG. In the initial learning period, Aorta-SVG anastomosis, bleeding check of SVG, and wound complications need to be paid more attention.

Переход от букв к слову: к проблеме осмысленности начального чтения дошкольников и первоклассников

Background. Problems of finding meaning of what is being read can accompany students’ already formed skills of fluent reading, reducing their academic success. The issues of reader's literacy are in the focus of modern psychological and pedagogical research, and the consideration of the mechanisms of its formation at the initial stages of learning to read is therefore relevant. Objectives. The study performs the analysis of the quality of children’s orientation in the initial period of learning to read and of the conditions for its actualization. Study Participants. 26 subjects (6–7 years old) took part in the diagnostic examination, including 10 first-graders and 16 senior preschoolers who studied reading in the kindergarten preparatory group or as a part of preschool training. Experimental teaching for children aged 6–7 years was conducted in two preschool groups of 4 people and in one group of 6 first-graders. Methods. The assessment of children’s capability to read meaningfully (the first part of the study) was carried out individually according to the modified technique of D.B. Elkonin “fusion of words” (Elkonin, 1998). To test and refine the designed training materials (the second part of the study), 30 half-hour classes were conducted within experimental teaching in each group. Results. A qualitative analysis of the filled in diagnostic forms and videotaped children's actions and reasoning allowed us to identify and describe reading strategies demonstrated by children, which we defined as formal (found in 73 % of the subjects) and meaningful (27 %) — in accordance with the nature of attempts to comprehend what they read, which participants resorted to in the process of deciphering the “fusion of words”. The results of our experimental teaching showed the effectiveness of the approach we developed to create some conditions for meaningful mediation of initial reading. Conclusions. One of the important conditions for the formation of the meaningfulness in reading during the transition “from letters to words” is to provide the orientative function of referring to reality, standing both for the word itself and for the sentence in which it should be read correctly. The method of “end-forward” reading of deformed words and simplest texts, which we developed, can be considered as a resource for improving the literacy in initial reading.

Using Software to Implant Orthopaedic Hardware: Surgeon Intraoperative Confidence Increased with Latest Technological Updates.

Robotic-assisted total knee arthroplasty (TKA) has been associated with improved accuracy and precision of implant placement, protection of soft tissue, and improved patient-reported postoperative outcomes when compared to manual TKA techniques. Previous studies have highlighted the importance of surgical confidence throughout the learning curve when adopting robotic-assisted platforms. The purpose of this study was to evaluate the confidence and efficiencies of surgeons when utilizing computed tomography (CT)-based robotic TKA technology. A cross-sectional, questionnaire-based study was conducted with 20 arthroplasty-trained surgeons with prior experience in both manual TKA and robotic-assisted TKA techniques. The surgeons completed an initial learning period, with new software, during various stages of their experience. The new TKA software upgrade builds on the prior software version with new features. A Net Promoter Score (NPS), the measurement of a respondent's likelihood to recommend a product or service to others, was used during the analysis of survey questions. A NPS over 50 indicates a positive score. When compared to manual TKA techniques, 95% of surgeons reported that their overall intraoperative confidence increased with the new software upgrade for CT-based robotic technology and had an average rating of 8.9 out of 10 for their intraoperative confidence with the new software upgrade. Additionally, 100% of surgeons reported that they were more confident when performing intraoperative implant adjustments with the new software upgrade when compared to manual TKA. Surgeons determined that the overall use of the new software upgrade was intuitive (8.4 of 10 average rating) and were satisfied with the overall use of the new software upgrade (9 of 10 average rating). Also, surgeons reported that they would recommend the new software upgrade for CT-based robotic technology to colleagues (NPS of 85), as well as being used as a research tool (NPS of 85) or for a training and education tool in a fellowship program (NPS of 90). As new technology continues to enter the field of orthopedics, it is important to ensure upgrades and advancements continue to serve surgeons and provide efficiencies in the operating room. For established robotic surgeons, the new robotic technology assessed in this study provided increased confidence when compared to manual TKA. Based on these results, the new software upgrade demonstrated value during various stages of a TKA procedure and is highly recommended for use by others in the field of orthopedics.

Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon’s learning curve experience

ObjectivesTo evaluate the safety and efficacy of the port access approach for left atrial (LA) myxoma resection and to analyze the learning curve for this procedure. MethodsThirty-six consecutive patients with LA myxoma who underwent port access surgery between April 2018 and March 2023 were enrolled in this retrospective study. The procedure included (1) unilateral or bilateral femoral artery cannulation; (2) the use of three 5-mm trocars and a 20- to 30-mm port; (3) a transseptal, biatrial, or LA approach depending on the location of the tumor base; and (4) complete or subendocardial tumor resection. CUSUM analysis was used to evaluate the aortic cross-clamp (ACC) time and cardiopulmonary bypass (CPB) time learning curves. Variables among the learning curve phases were compared. ResultsThe average ACC and CPB times were 49 (range, 45-79) minutes and 127 (range, 120-164) minutes, respectively. There was 1 case of conversion to sternotomy due to aortic root bleeding and 1 case of unilateral pulmonary edema. CUSUMACCtime analysis included 3 phases: phase I, the initial learning period (cases 1-11); phase II, the technical competence period (cases 12-23); and phase III, the challenging period (cases 24-36). ConclusionsThe port access approach is safe and feasible for LA myxoma resection. According to the learning curve analysis, 11 cases are required to achieve technical competence, and 23 cases are required to address highly challenging cases.

Transfer learning for occupancy-based HVAC control: A data-driven approach using unsupervised learning of occupancy profiles and deep reinforcement learning

Model-free heating, ventilation, and air conditioning (HVAC) control systems have demonstrated promising potential for adjusting indoor setpoint temperature based on dynamic occupancy patterns in smart buildings. Although these control systems offer the advantage of not needing building or occupancy models, the involved trial-and-error learning process can cause considerable thermal discomfort for occupants, particularly during the initial learning period. Given the critical importance of thermal comfort, this limitation is a major barrier to the practical implementation of such systems. To address this challenge, the present study proposes a framework to enhance the learning process of the model-free HVAC controllers. Specifically, a transfer learning (TL) technique is adopted based on a similarity analysis of occupancy patterns using an unsupervised learning of occupancy profiles. This control framework leverages a k-means clustering algorithm with dynamic time warping to match the most similar households in terms of occupancy patterns within 26 residential units. The results demonstrate that the proposed method significantly improves the performance of the HVAC control system. It enhances the jumpstart performance and total rewards by nearly 25% and 5%, respectively, compared to a conventional model-free controller. Furthermore, it reduces the deviation period and mean temperature deviation by approximately 4% and 68%, respectively. Overall, this framework presents a promising approach to enhancing the performance and practicality of model-free HVAC control systems by reducing the thermal discomfort during the learning process.

Adaptation of first-year students to the conditions of the educational environment by means of physical culture and sports

The process of adapting students to the learning and educational environment of a higher education institution is an area of extremely close attention, as it is viewed from the perspective of student health promotion. Physical education and sport occupy an important place in the paradigm of health-preserving function. Given the socially conditioned orientation of the physical education and sport continuum, part of its tasks contribute to solving the issues of adaptation of the student population. The subject orientation of physical education and sport considers the mental processes and the physical state of the attending students’ organisms in the format of the adaptation capabilities of the said people. Due to the peculiarities of the adaptation process, what remains an important condition is the initial period of learning, which has a significant impact on the process of self-determination of students in the learning community. A special role is assigned to the process of physical upbringing with enhanced opportunities for specific communication in learning and sportsmanship in this context. The personal factors that stimulate the adaptability of the trainees – the presence or absence of sports experience, the level of physical fitness – are tested in the course of the study. A comparative analysis of the performance of the attestation requirements in the subject "Physical Education & Sport" in the 1st semester of 3 categories of students – with high, medium & low levels of physical fitness – is conducted. The lack of goal-oriented practice in the use of physical education and sport for the above-mentioned purpose is revealed in the study of 1st year students' adaptation to the conditions of the educational environment. This is the proposed in this study to consider the problematic of 1st-year students' adaptation through the analysis of the interacting components of the above-mentioned activity – motor training, motivational aspects, mental reactions. What served as evaluation tools in the process of extracurricular activities, included the motivational side of the conducted experiment, including personal sports achievements.

Initial Experiences of Left Bundle Branch Area Pacing in Daegu, South Korea – New Procedure with Familiar Tools

Implantation of a permanent pacemaker is a safe and effective treatment for symptomatic bradycardia. Conventionally, ventricular lead is placed at the right ventricular (RV) muscles. Therefore, this causes interventricular dyssynchrony, and long-term high RV pacing (RVP) burden is associated with an increased risk of heart failure and atrial fibrillation. Hence, attempts to directly pace the cardiac conduction system have been made, and finally, a technique called left bundle branch area pacing (LBBAP) has emerged. In our country, the clinical experience of LBBAP is in the early stages. Especially, LBBAP using standard stylet-driven leads (SDL), a major procedural method performed in our country, is also in the early stages, and there are only a few reports about this method worldwide. Herein, we are reporting our initial experiences of LBBAP with SDL. Compared to conventional RVP performed during the same period, LBBAP required an initial learning period a more extended procedure, and fluoroscopy time. However, the paced QRS duration was significantly shorter in the LBBAP group (LBBAP group 120.6 ± 13.0 msec, RVP group 165.2 ± 16.0 msec, <i>p</i> < 0.001). It is fascinating that simply adding a ventricular lead delivery sheath can create a whole new outcome, even at centers that are only familiar with the standard tools. Our experience will be helpful in arrhythmia centers that aim to start LBBAP for the first time.

Junior High School Students’ Perception of Using Mobile Application to Learn English Pronunciation

Technology into their teaching as well as how to assist students in making use of resources such as media and the internet to improve their learning of all four skills, particularly teaching and learning English pronunciation. Students are gradually motivated by their personal learning needs, including those that arise from greater mobility and traveling activities, during the initial period of mobile learning. Mobile learning, particularly Mobile Assisted Language Learning (MALL), has become essential tools in the teaching and learning process as a result of this process. The purpose of this research is to look into junior high school students' perceptions of using a mobile app to learn English pronunciation. This study is an action research project that was carried out in one of Indonesia's Islamic Junior High Schools with first-grade students as participants (a total of 65 students). Data were collected through questionnaires and interviews. The results revealed that students perceived the use of mobile application in learning pronunciation positive and it can enhanceding the participants’ English pronunciation skills. The data analysis is shown by their positive feedbacks during the action implementation. The findings of this study suggest that various teaching media and tools be used to improve the English language skills of Junior High School students in the future. In this era, teachers are required to understand how to incorporate.

Rethinking statistical learning as a continuous dynamic stochastic process, from the motor systems perspective.

The brain integrates streams of sensory input and builds accurate predictions, while arriving at stable percepts under disparate time scales. This stochastic process bears different unfolding dynamics for different people, yet statistical learning (SL) currently averages out, as noise, individual fluctuations in data streams registered from the brain as the person learns. We here adopt a new analytical approach that instead of averaging out fluctuations in continuous electroencephalographic (EEG)-based data streams, takes these gross data as the important signals. Our new approach reassesses how individuals dynamically learn predictive information in stable and unstable environments. We find neural correlates for two types of learners in a visuomotor task: narrow-variance learners, who retain explicit knowledge of the regularity embedded in the stimuli. They seem to use an error-correction strategy steadily present in both stable and unstable environments. This strategy can be captured by current optimization-based computational frameworks. In contrast, broad-variance learners emerge only in the unstable environment. Local analyses of the moment-by-moment fluctuations, naïve to the overall outcome, reveal an initial period of memoryless learning, well characterized by a continuous gamma process starting out exponentially distributed whereby all future events are equally probable, with high signal (mean) to noise (variance) ratio. The empirically derived continuous Gamma process smoothly converges to predictive Gaussian signatures comparable to those observed for the error-corrective mode that is captured by current optimization-driven computational models. We coin this initially seemingly purposeless stage exploratory. Globally, we examine a posteriori the fluctuations in distributions' shapes over the empirically estimated stochastic signatures. We then confirm that the exploratory mode of those learners, free of expectation, random and memoryless, but with high signal, precedes the acquisition of the error-correction mode boasting smooth transition from exponential to symmetric distributions' shapes. This early naïve phase of the learning process has been overlooked by current models driven by expected, predictive information and error-based learning. Our work demonstrates that (statistical) learning is a highly dynamic and stochastic process, unfolding at different time scales, and evolving distinct learning strategies on demand.

Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis.

Simple SummaryRectal cancer surgery remains a challenge and information about the learning curve in adopting new techniques is lacking. This paper analyzes our experience in taTME (since 2015) and robotic surgery (since 2018) at a fully accredited referral center for the treatment of rectal cancer in Spain. In this retrospective study, we aim to analyze the learning curves for taTME and robot-assisted rectal procedures in the incorporation of these platforms into our practice. We sought to describe our team’s experience in incorporating these techniques and to analyze the difficulties that we have had. Hoping that sharing our experience can help other groups improve their results during the difficult initial phase of incorporating new techniques.New techniques are being developed to improve the results of laparoscopic surgery for rectal cancer. This paper analyzes the learning curves for transanal total mesorectal excision (taTME) and robot-assisted surgery in our colorectal surgery department. We analyzed retrospectively data from patients undergoing curative and elective surgery for rectal cancer ≤12 cm from the anal verge. We excluded extended surgeries. We used cumulative sum (CUSUM) curve analysis to identify inflection points. Between 2015 and 2021, 588 patients underwent surgery for rectal cancer at our center: 67 taTME and 79 robot-assisted surgeries. To overcome the operative time learning curve, 14 cases were needed for taTME and 53 for robot-assisted surgery. The morbidity rate started to decrease after the 17th case in taTME and after the 49th case in robot-assisted surgery, but it is much less abrupt in robot-assisted group. During the initial learning phase, the rate of anastomotic leakage was higher in taTME (35.7% vs. 5.7%). Two Urological lesions occurred in taTME but not in robot-assisted surgery. The conversion rate was higher in robot-assisted surgery (1.5% vs. 10.1%). Incorporating new techniques is complex and entails a transition period. In our experience, taTME involved a higher rate of serious complications than robot-assisted surgery during initial learning period but required a shorter learning curve.

Learning Curve of Laparoscopic Surgery for Colorectal Cancer at a New Regional State Hospital: A Single-Surgeon Experience Of 106 Consecutive Cases Without Supervision.

Laparoscopic surgery for colorectal cancer is mostly performed in university hospitals or experienced centers. This study aimed at determining the learning curve of laparoscopic surgery for colorectal cancer at a new regional state hospital. Clinico-pathological data of 106 consecutive patients who underwent laparoscopic surgery for colorectal cancer at a new regional state hospital between August 2018 and September 2021 were prospectively recorded and analyzed. All surgeries were performed by a single inexperienced surgeon without supervision. The primary outcome of the study was the operative time, which was used for a Cumulative Sum (CUSUM) analysis of the learning curve. The secondary outcomes included a comparison of preoperative, intraoperative, and postoperative outcomes during the learning curve period. According to the CUSUM analysis, the learning curve consisted of three unique phases: phase 1 [the initial learning period (cases 1-53)], phase 2 [the consolidation period (cases 54-68)], and phase 3 [the experienced period (cases 69-106)]. Of the intraoperative outcomes, operative time and estimated blood loss were significantly reduced from phase 1 to phase 3 (p<0.001). Of the postoperative outcomes, time to pass stool (p<0.05), time to oral feeding (p=0.001), drain removal time (p<0.001), and length of hospital stay (p=0.042) were shorter in phase 3 compared to phases 1 and 2. Of the histopathological results, the specimen length and the number of harvested lymph nodes increased with experience (p=0.001). The present results suggest that a surgeon at a new regional state hospital must experience 53-68 cases to achieve competence in laparoscopic colorectal cancer surgery.

Learning curve in performing palatoplasty

Objectives: The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas and breakdowns following palatoplasty. Materials and Methods: A retrospective review on the outcomes of palatoplasty done by a young surgeon in his initial 3 years of operating cleft palate was done. Cleft palate repair was performed using the Pinto's modification of Wardill–Kilner palatoplasty, Veau-Wardill-Kilner V-Y Pushback in both the techniques radical levator muscle dissection was carried out. Data were collected for age, sex, date of birth, syndrome, cleft palate type, type of repair, cleft width, length of soft palate, quality and quantity of muscle, fistula occurrence, and location of fistula. Results: Retrospective analysis was done on the outcomes of palatoplasty performed by a young surgeon in his initial 3 years at Charles pinto center for cleft lip palate and craniofacial on 220 cleft palate children which included all variants and dimensions of cleft palates. Postoperatively, the incidence of palatal fistulas occurred in 12 patients, three patients had bifid uvula, however, out of 12 patients who had fistulas only four needed fistula closure and one required a uvula re-repair; the rest healed well. Conclusion: We believe there is a learning curve in performing cleft palate repair. Our technique and principles followed in palatoplasty appear to have a low or zero fistula rate even in the initial period of learning. Furthermore, effective mentorship and guidance help in reducing errors and providing a better outcome.

Learning curve analysis using the cumulative summation method for totally extraperitoneal repair of the inguinal hernia.

The totally extraperitoneal repair (TEP) technique has been widely performed, and compared with open surgery, TEP results in less postoperative pain and similar surgical outcomes in the treatment of inguinal hernias. However, TEP has a longer learning curve than does conventional surgery. The data for patients who underwent TEP for inguinal hernias by a single surgeon between April 2017 and July 2019 were analyzed retrospectively. The cumulative summation (CUSUM) method and the following two variables were used to analyze the learning curve: (1) the operation event (OE), including intraoperative complications and conversion to open surgery; and (2) the operation score (OS), as calculated by the operation time, patient body mass index, and disease characteristics. The CUSUM chart showed three phases for both the OE and OS. The former reached a first inflection point after the 85th case and decreased after the 200th case, and the latter reached a plateau after the 101st case and decreased after the 203rd case. The operation time was longer in phases 1 and 2 than in phase 3 (64.2min versus 47.9min versus 31.1min; p < 0.001), and the OS was lower in phase 3 than in the other phases (71.9 points versus 106.4 points versus 142.7 points; p < 0.001). Ten cases of intraoperative complications were observed, all in the first and second phases (p = 0.011). At least approximately 100 cases are required for the initial learning period, and an additional 103 cases are required for the accumulation of additional experience. Surgical competency can be gained after 203 TEPs are performed.

Learning Curve of Laparoscopic Kasai Portoenterostomy in a Tertiary Hospital with Low Caseload of Biliary Atresia.

Background: Laparoscopic Kasai portoenterostomy (KPE) is generally considered to be technically challenging. A scarcity of studies has particularly focused on the learning curve (LC) of this technique. The present study was aimed to objectively evaluate the LC of laparoscopic KPE in a medical center with relatively low caseload of biliary atresia (BA). Materials and Methods: Thirty-five consecutive pediatric patients treated with laparoscopic KPE for BA by the same surgeon team between 2012 and 2018 were retrospectively enrolled in the present study. Operative time (OT) was selected as the surrogate marker. Cumulative sum (CUSUM) analysis was applied to describe the LC of laparoscopic KPE. Results: The turning point of the CUSUM curve occurred at the 21st case, which divided the curve into two distinct phases, phase 1 (the initial 21 cases) and phase 2 (the remaining 14 cases). The curve was best modeled as a second-order polynomial with equation CUSUM in minutes equal to -0.9161 × case number2 + 32.097 × case number + 7.8217 (R2 = 0.981). Age at surgery, sex, weight, and preoperative liver function were well balanced between the two phases (each P > .05). The OT was significantly decreased in phase 2 compared with phase 1 (P < .0001). Furthermore, the rates of early jaundice clearance and 2-year native liver survival were higher in phase 2. The rate of postoperative cholangitis was comparable between the two phases. Conclusions: Two characteristic phases of the LC for laparoscopic KPE were identified using CUSUM analysis and represented the initial learning period and the subsequent period of technical mastery, respectively. Surgeons are possible to acquire competency of laparoscopic KPE in relatively low-case centers.

Аналіз та оцінка викладачами досвіду дистанційного навчання при вивченні графічних дисциплін

The article presents the results of a study that was conducted to analyze and evaluate the new pedagogical experience of teachers obtained in distance learning in the context of a global pandemic. According to the results of the survey, most teachers assess this period as more difficult than the period of traditional education, but they consider the experience gained as positive and useful for the future. The teachers noted the need to master modern digital tools suitable for distance learning (video conferencing and communication services, recording audio and video lectures, etc.), design and transform their lecture courses, methodological materials and all auxiliary materials for successful online learning. Teaching graphic disciplines, as well as a new look at the possibilities of social networks, instant messengers and the e-learning system of the Odessa State Academy of Civil Engineering and Architecture. At present, an urgent task is to comprehend this experience in order to understand its essence, identify positive and negative factors, determine the most effective technologies in terms of teaching disciplines by teachers and assimilation of material by students, predicting possible options for the development of the education system within the framework of not anti-pandemic measures, but during hostilities and after the introduction of martial law in Ukraine. This experience was very useful for the teachers of our country, because, despite today’s conditions, the educational cycle continues in some regions of the country. Teachers were asked questions about their psychological state in the initial period of online learning, when they had not yet gained some experience in this area, and questions about the experience, quality and achievements of the students and teachers themselves during distance learning. The opinions of teachers differed in assessing the degree of assimilation of educational material by students in the context of online learning. Most teachers believe that students have mastered the material at the same level as in full-time study, or even better; some teachers noted a decrease in this level. The need to ensure the appropriate quality of education requires finding ways to solve problems that arise in the process of distance learning in modern military and post-war conditions in Ukraine.

Implementing the da Vinci SP Without Increasing Positive Surgical Margins: Experience and Pathologic Outcomes of a Prostate Cancer Referral Center.

Background: Different consoles have been described for the da Vinci single-port (SP) surgery since it was cleared by the FDA in November 2018. However, the literature still lacks studies identifying factors related to the SP learning curve and how to overcome the technological limitations, especially in terms of maintaining acceptable positive surgical margins (PSMs). This study describes our perioperative experience implementing a safe SP approach to radical prostatectomy (RP) while minimizing PSM, especially during the initial learning period. Materials and Methods: We performed a retrospective analysis of 100 consecutive patients with prostate cancer who underwent RP with the SP robot from June 2019 to December 2020 (IRB 237998). We accessed the perioperative data, pathology report, and short-term oncologic outcomes. We also represented our PSM trends in 100 consecutive cases, discussing potential factors for minimizing the learning curve impact on positive margins and outcomes. Medians and interquartile ranges, as well as frequencies and proportions, were reported for continuous and categorical variables, respectively. Results and Limitations: The median follow-up is 14 months (8-17). The cohort has a median age of 62 years (56-68), median prostate-specific antigen of 5.5 (4.3-7.7), median preoperative Sexual Health Inventory for Men (SHIM) of 20, median American Urological Association (AUA) of 7 (3-11), and median body mass index of 25.4 (23.4-27.4). The median total operative time was 114 minutes (104-124), the median console time was 80 minutes (75-90). No intraoperative complications were reported. The overall rate of PSMs was 15% (5% were pT2 and 10% were pT3). Conclusions: The SP approach to RP is feasible, safe, and with acceptable intraoperative performance. In this study, we have described crucial factors for considering selection criteria in candidates for SP-robot-assisted RP. We believe that with an appropriate patient selection, this robot can be safely implemented without increasing positive margins and compromising the outcomes, especially during the learning curve period.

Sociality, resilience and agency: how did young Australians experience online learning during Covid-19?

In 2020 when schooling was abruptly reconfigured by the pandemic, young people were required to demonstrate new capabilities to manage their learning and their wellbeing. This paper reports on the feelings, thoughts and experiences of eight Year 9 and 10 students in NSW and Victoria about the initial period of online learning in Australian schools that resulted from the Covid-19 pandemic. Beyond dominant narratives of vulnerability and losses in learning, our participants offered counternarratives that stressed their capacities to rise and meet the times. We trace three central themes on how they: found moments of agency that increased their confidence, reconfigured resilience as a socially responsible set of practices, deployed sociality as a resource for the benefit of themselves and others. The pandemic opened up conversations with young people about where and how learning takes place and how schools might adapt and respond to young people’s growing sense of urgency about the future of schooling.