Level Of Experience Research Articles

Understanding the factors that influence CT utilization for mild traumatic brain injury in a low resource setting - a qualitative study using the Theoretical Domains Framework

IntroductionIn low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs). ObjectivesThe primary objective was to explore IRs’ beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored. Materials and MethodsIn-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF. ResultsEleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.Identified factors within skills domain involved IRs’ clinical assessment and decision-making abilities, while beliefs about capabilities and consequences encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The environmental context and resources domain addressed the availability of CT scanners and financial constraints. The knowledge domain elicited IRs’ understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For memory, attention & decision processes domain, IRs adherence to guidelines and intentions to order CT scans were cited. ConclusionUsing TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others.

Undergraduates’ experience and satisfaction of massive open online course in Malaysia

<span lang="EN-US">While massive open online course (MOOC) is gaining popularity, studies have shown how negative user experience of the learning platform can lead to issues related to poor learning performance. OpenLearning, as the official national coordinated MOOCs program for higher education institutions in Malaysia, is still considerably gaining momentum in this country, thus much can still be observed in the usability aspect of this platform from the student’s perspective. This study aimed to evaluate the aspects of user experience and learning satisfaction of MOOC OpenLearning involving undergraduate students in a public university in Malaysia. Data were gathered through the online survey method which adapted questions from the user experience questionnaire (UEQ) and the usefulness, satisfaction, and ease of use (USE) questionnaire. Descriptive analyses revealed moderate positive levels of user experience and learning satisfaction towards MOOC OpenLearning among the respondents. Furthermore, there was a significant positive correlation between both factors, suggesting the importance of considering user experience as the key factor in enhancing students’ satisfaction with MOOC. Recommendations arising from the students’ perceptions and concerns on the usability aspect contribute towards developing strategic guidelines for enhancing students’ learning experiences, especially during circumstances that necessitate effective online learning strategies.</span>

Development of Android App on Scheduling Payments and Financial Management of Workers in Construction Industry

Abstract: A innovation centralized platform designed specifically for labour payment to efficiently manage project management, labour payments and generate detailed financial reports. Mobile computing offers helps to construction workers improve efficiency and minimize the paper works. However, the uptake of the technology is quite low in the industry, with little research on key constraint factors and the priority needs of the construction workforce. In recent year mobile applications have become increasingly popular years and is expected to continue like that as all the tech is moving towards mobile. However, unfortunately, in the face of accelerating user demand, businesses are not validating that their apps are safe, secure and they are more dragged by the speed-to-market pressure as well as the need to maintain a high level of user experience. As the application contains all the payment information tedious writing work can be avoided on site. Just set the payment in the application and are free to go. Extensive time and effort are spent on inspecting and documenting of payments. Managing large number of projects with various subcontractors will be difficult. If the hard copy is lost, entire data set cannot be taken back. In financial updates client also face same problem, to get clients according to their requirements. To bridge this gap and to develop better connection between client, engineers and subcontractors, we need a platform. Project cost based on labour payments and payments pending can be accessed easily. Maintain a history of project payments, weekly payments balance payments tracker

한국 청소년의 문화·예술경험과 정의적 성취

Objectives This study aims to examine the disparities in cultural and artistic experiences among adolescents ac-cording to gender and family background. It seeks to clarify the longitudinal relationship between cultural and ar-tistic experiences and affective achievements, shedding light on the growing issue of educational inequality in Korean society. Methods Using the Korean Children and Youth Panel Survey 2018 Middle School Panel, structural equation models with fixed effects were applied to examine the longitudinal relationship between adolescent cultural and artistic experiences and affective aspects such as happiness, self-esteem, and life satisfaction. Results Descriptive statistical analysis showed that female students and those with parents of higher educational and income levels had significantly higher levels of cultural and artistic experiences. Meanwhile, the positive rela-tionship between cultural and artistic experiences and affective achievements was more pronounced among male students. Specifically, for male students, the relationships between cultural and artistic experiences during the past year and current life satisfaction, happiness, and self-esteem were statistically significant, and the creativity was positively significant for both male and female students. Conclusions The research findings demonstrate the gap in cultural and artistic experiences among adolescents across social classes, and the longitudinal relationship between the experiences and adolescents' affective development. It supports the need for enhanced accessibility to cultural and art education through public educa-tion systems.

A COMPREHENSIVE ANALYSIS OF COMPETENCY AND TRAINING PERSPECTIVES AMONG AIR TRAFFIC CONTROLLERS

The aim of the study was to examine air traffic controllers’ perspectives on competency, performance, and training. Analysing data from 182 participants, the results revealed a strong focus on competency with the controllers actively evaluating their skills. Notably, the experienced controllers (19+ years) displayed a heightened commitment to continuous learning, reflected in their higher participation in individual training and perception of its value for their career goals and adaptation to the evolving aviation industry. Competency-based training programs also received positive feedback across experience levels, highlighting their potential effectiveness. Moreover, training was universally perceived as key to performance throughout careers. These results highlighted the importance of fostering a culture of continuous learning within air traffic control (ATC) communities. Aviation authorities can support this by providing diverse training opportunities, including individual and competency-based programs. Future research should continue investigating the impact of technological advancements and AI/machine learning on ATC competencies, the effectiveness of competency-based training programs, and the role of individual training in competency development, ultimately ensuring the vital role of air traffic controllers in aviation safety.

Enhancing Accuracy in Breast Density Assessment Using Deep Learning: A Multicentric, Multi-Reader Study

The evaluation of mammographic breast density, a critical indicator of breast cancer risk, is traditionally performed by radiologists via visual inspection of mammography images, utilizing the Breast Imaging-Reporting and Data System (BI-RADS) breast density categories. However, this method is subject to substantial interobserver variability, leading to inconsistencies and potential inaccuracies in density assessment and subsequent risk estimations. To address this, we present a deep learning-based automatic detection algorithm (DLAD) designed for the automated evaluation of breast density. Our multicentric, multi-reader study leverages a diverse dataset of 122 full-field digital mammography studies (488 images in CC and MLO projections) sourced from three institutions. We invited two experienced radiologists to conduct a retrospective analysis, establishing a ground truth for 72 mammography studies (BI-RADS class A: 18, BI-RADS class B: 43, BI-RADS class C: 7, BI-RADS class D: 4). The efficacy of the DLAD was then compared to the performance of five independent radiologists with varying levels of experience. The DLAD showed robust performance, achieving an accuracy of 0.819 (95% CI: 0.736–0.903), along with an F1 score of 0.798 (0.594–0.905), precision of 0.806 (0.596–0.896), recall of 0.830 (0.650–0.946), and a Cohen’s Kappa (κ) of 0.708 (0.562–0.841). The algorithm achieved robust performance that matches and in four cases exceeds that of individual radiologists. The statistical analysis did not reveal a significant difference in accuracy between DLAD and the radiologists, underscoring the model’s competitive diagnostic alignment with professional radiologist assessments. These results demonstrate that the deep learning-based automatic detection algorithm can enhance the accuracy and consistency of breast density assessments, offering a reliable tool for improving breast cancer screening outcomes.

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

Assessing the Teaching Strategies and Techniques Used by TVL Teachers: Basis for Pedagogical Training Design

This research study aimed to evaluate the teaching strategies and techniques employed by Technical-Vocational-Livelihood (TVL) teachers, with a focus on informing the design of pedagogical training programs. Employing a qualitative approach through thematic analysis, the study engaged ten TVL Senior High School teachers from five schools in Lanao del Sur. Utilizing semi-structured questionnaires and individual interviews, the research delved into the diverse array of teaching methodologies utilized by TVL educators. The findings elucidate the pivotal role of these teachers in employing various pedagogical approaches such as lectures, demonstrations, oral questioning, and discussions to foster effective student learning. Despite the prevalence of conventional teaching methods, the adaptability of TVL instructors was evident as they tailored their strategies to accommodate factors like resource availability, experience levels, and financial constraints, ensuring sustained student engagement and learning effectiveness. However, the study uncovered significant challenges stemming from resource constraints, particularly in practical skill development. The scarcity of materials, facilities, laboratories, and adequately trained personnel hinders the attainment of desired learning outcomes and poses obstacles in aligning with the TVL curriculum. Notwithstanding these impediments, TVL teachers showcased a steadfast commitment to student-centered learning principles and technological integration. Leveraging advancements in technology, they seek to enrich teaching practices and augment the overall learning experience. Nevertheless, inequities in access to training opportunities emerged as a barrier to professional development, impeding the full exploitation of digital tools' potential. In conclusion, this thematic analysis offers valuable insights into the nuanced landscape of TVL education, highlighting the indispensable role of teachers in navigating challenges and maximizing opportunities for student learning and skill development. The findings underscore the imperative for targeted pedagogical training interventions to address existing gaps and empower TVL educators to deliver high-quality education effectively.

Enhancing music rhythmic perception and performance with a VR game

This study analyzes the effect of using a virtual reality (VR) game as a complementary tool to improve users’ rhythmic performance and perception in a remote and self-learning environment. In recent years, remote learning has gained importance due to various everyday situations; however, the effects of using VR in such situations for individual and self-learning have yet to be evaluated. In music education, learning processes are usually heavily dependent on face-to-face communication with a teacher and are based on a formal or informal curriculum. The aim of this study is to investigate the potential of gamified VR learning and its influence on users’ rhythmic sensory and perceptual abilities. We developed a drum-playing game based on a tower defense scenario designed to improve four aspects of rhythmic perceptual skills in elementary school children with various levels of music learning experience. In this study, 14 elementary school children received Meta Quest 2 headsets for individual use in a 14-day individual training session. The results showed a significant increase in their rhythmical skills through an analysis of their rhythmic performance before and after the training sessions. In addition, the experience of playing the VR game and using the HMD setup was also assessed, highlighting some of the challenges of currently available affordable headsets for gamified learning scenarios.

Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey.

Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs.A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.

Deep learning driven diagnosis of malignant soft tissue tumors based on dual-modal ultrasound images and clinical indexes

BackgroundSoft tissue tumors (STTs) are benign or malignant superficial neoplasms arising from soft tissues throughout the body with versatile pathological types. Although Ultrasonography (US) is one of the most common imaging tools to diagnose malignant STTs, it still has several drawbacks in STT diagnosis that need improving.ObjectivesThe study aims to establish this deep learning (DL) driven Artificial intelligence (AI) system for predicting malignant STTs based on US images and clinical indexes of the patients.MethodsWe retrospectively enrolled 271 malignant and 462 benign masses to build the AI system using 5-fold validation. A prospective dataset of 44 malignant masses and 101 benign masses was used to validate the accuracy of system. A multi-data fusion convolutional neural network, named ultrasound clinical soft tissue tumor net (UC-STTNet), was developed to combine gray scale and color Doppler US images and clinic features for malignant STTs diagnosis. Six radiologists (R1-R6) with three experience levels were invited for reader study.ResultsThe AI system achieved an area under receiver operating curve (AUC) value of 0.89 in the retrospective dataset. The diagnostic performance of the AI system was higher than that of one of the senior radiologists (AUC of AI vs R2: 0.89 vs. 0.84, p=0.022) and all of the intermediate and junior radiologists (AUC of AI vs R3, R4, R5, R6: 0.89 vs 0.75, 0.81, 0.80, 0.63; p <0.01). The AI system also achieved an AUC of 0.85 in the prospective dataset. With the assistance of the system, the diagnostic performances and inter-observer agreement of the radiologists was improved (AUC of R3, R5, R6: 0.75 to 0.83, 0.80 to 0.85, 0.63 to 0.69; p<0.01).ConclusionThe AI system could be a useful tool in diagnosing malignant STTs, and could also help radiologists improve diagnostic performance.

Assessing the Effects of Various Gaming Platforms on Players’ Affective States and Workloads through Electroencephalogram

Game platforms have different impacts on player experience in terms of affective states and workloads. By studying these impacts, we can uncover detailed aspects of the gaming experience. Traditionally, understanding player experience has relied on subjective methods, such as self-reported surveys, where players reflect on their experience and effort levels. However, complementing these subjective measures with electroencephalogram (EEG) analysis introduces an objective approach to assessing player experience. In this study, we examined player experiences across PlayStation 5, Nintendo Switch, and Meta Quest 2. Using a mixed-methods approach, we merged subjective user assessments with EEG data to investigate brain activity, affective states, and workload during low- and high-stimulation games. We recruited 30 participants to play two games across three platforms. Our findings reveal that there is a statistically significant difference between these three platforms for seven out of nine experience factors. Also, three platforms have different impacts on play experience and brain activity. Additionally, we utilized a linear model to associate player experience aspects such arousal, frustration, and mental workload with different brain regions using EEG data.

Effectiveness of The Education Level, Understanding of Accounting and Work Experience on the Quality of Financial Statements in The MSMEs Indonesian Local Government

Micro, Small and Medium Enterprises (MSMEs) face several obstacles so that in their business it is difficult to develop, one of which lies in financial management in their business activities so that the presentation of financial statements poses its own problems for MSMEs. The purpose of this study is to determine the influence of education level, accounting understanding and work experience on the quality of financial statements produced by MSMEs in MaLang City. This research approach uses quantitative techniques and measures the results using the Likert scale sourced from questionnaire data. Using agency theory and stewardship theory. The sampling technique uses a purposive sampling method with predetermined criteria. The population of this study is MSMEs in Malang City, the number of respondents who filled out questionnaires that have been distributed through whatsapp grub assisted by the MSME cooperative office in Malang City 45 respondents but who met the criteria of 38 respondents. Using analysis techniques which include validity, reliability and hypothetical tests used are R tests and T tests with the help of SPSS 25 software. The results showed that 53.4% of the influence of the quality of MSME financial statements was influenced by the variables studied. Understanding accounting has a significant positive effect on the quality of financial statements, the level of education and work experience does not affect the quality of financial statements.

The interplay between teachers’ trust in artificial intelligence and digital competence

AbstractThis study examines the relation between K-12 teachers’ trust in artificial intelligence (TAI), their knowledge of AI (KAI), and their digital competence (DC). It further examines the relation between TAI and age, sex, teaching experience and International Standard Classification of Education (ISCED) levels. The study employed a comprehensive and validated instrument and used a sample of 211 primary and secondary school teachers. The results show that there is a significant positive relation between all three variables and that KAI is a robust and substantial predictor of TAI. In the absence of KAI, the significant relation between DC and TAI ceases to exist. In addition, teachers with different levels of DC do not show significant differences in their attitudes towards AI. Results further show that TAI is independent of age, sex, teaching experience and ISCED level in this sample of teachers. The study contributes valuable insights into the complex interplay between teachers’ TAI, their KAI, and their DC, providing practical implications for policy, teacher preparation and professional development in the rapidly evolving landscape of AI integration in education.

The Impact of Service Recovery Actions and Perceived Justice on Customer Satisfaction: Insights from Thailand's Private Hospitals

The research explores service recovery strategies' impact on customer satisfaction, word-of-mouth (WOM), and revisit intention in private hospitals in Thailand, drawing upon the expectation confirmation theory and social exchange theory. Using a quantitative approach, data was collected via an online questionnaire from service users of private hospitals in Thailand, with 600 usable responses analyzed using Structural Equation Modeling (SEM) and multi-group analysis with SEM. The findings reveal that service recovery actions (SRA) and perceived justice (PJ) significantly influence customer satisfaction with service recovery, WOM, and revisit intentions. Focusing on tangible actions and perceived justice can enhance customer retention in private hospitals. Private hospitals should emphasize tangible actions and perceived justice to enhance customer satisfaction and retention. Additionally, tailoring service recovery efforts based on customers' varying experience levels within the healthcare sector is crucial. The research contributes valuable insights to the healthcare industry's understanding of service recovery strategies, offering guidance for marketing strategy planning and enhancing customer satisfaction and retention in private hospitals in Thailand.

Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis

BACKGROUND Primary thumb carpometacarpal (CMC) osteoarthritis is one of the most common conditions encountered by hand surgeons. Of the vast number of operations that have been proposed, none have demonstrated results significantly superior to trapeziectomy alone. AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis. METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis. Surgeons were contacted by e-mail once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions. RESULTS Of 950 responses were received. 40.5% of surgeons preferred trapeziectomy + ligament reconstruction tendon interposition (LRTI), followed by trapeziectomy + suspensionplasty (28.2%), suture button suspension (5.9 %), trapeziectomy alone (4.6%), prosthetic arthroplasty (3.2%), arthrodesis (1.1%), and other (6.6%). Proponents of trapeziectomy + LRTI cited familiarity (73.2%), exposure during fellowship (48.8%) and less proximal migration (60%) to be the main reasons affecting their decision. Surgeons who preferred trapeziectomy + suspensionplasty most reported simplicity (74.9%), fewer complications (45.3%), less proximal migration (43.8%), and avoidance of autogenous tissue harvest (42.7%). Advocates of suture button suspension cited avoidance of autogenous tissue harvest (80.4%), shorter immobilization (76.8%), and quicker recovery (73.2%) with their technique. Advocates of trapeziectomy alone cited simplicity (97.7%), fewer complications (86.4%), and avoidance of autogenous tissue harvest (59.1%). In their comments, 45% of surgeons choosing trapeziectomy alone cited evidence as an additional rationale. Advocates of prosthetic arthroplasty cited improved pinch strength (83.3%) and improved range of motion (63.3%), while those preferring arthrodesis cited better pinch strength (90%) and frequently in their comments, durability. Of the surgeons who preferred a technique other than LRTI, 41.8% reported they had tried LRTI in the past, citing complexity of the procedure, flexor carpi radialis harvest, and longer operative time as reasons for moving on. CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons' decision making in the management of thumb carpometacarpal osteoarthritis. Despite strong Level 1 evidence supporting the use of trapeziectomy alone, our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty. Several factors including familiarity, personal experience (Level 4 evidence), and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium. Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’ choice.

Building Bridges: Understanding the Interplay between Generation X, Generation Y, and Generation Baby Boomers – Characteristics, Organisational Culture, and Organisational Identification in Modern Cities

Over the years, the profile of a modern city dweller has been evolving and diversifying due to the emergence of various generations. Different generations are characterised by distinct expectations and perspectives towards life. Therefore, in today’s highly dynamic environment, city authorities must deeply understand their city dwellers to build an influential organisational culture which will lead them to have city friendly citizens in order to create resilient, sustainable, and inclusive cities. This study aims to define the impact of Generation X, Generation Y, and Generation Baby Boomers employees’ characteristics on organisational culture and organisational identification relationships in terms of professional and urban life. From this perspective, a study was carried out on 460 white-collar employees who are city dwellers working stationary in the private sector in Istanbul. The data were obtained in the course of a quantitative study carried out through an interview questionnaire using the CAPI (Computer Assisted Personal Interview) technique. The primary conclusions are that there is a statistically significant and positive relationship between clan (β = 0.360, p < 0.01) as well as market (β = 0.147, p < 0.05) culture and organisational identification. In addition, there is a statistically significant relationship between employees’ experience levels and their perceptions of adhocracy culture (F = 3.19, p < 0.05), and there is no statistically significant difference between the perceptions of Generation X, Y, and Baby Boomers employees about organisational culture and organisational identification levels.

Robotic-Assisted Inguinal Hernia Repair with The Dexter System™: A Prospective Multicentre Clinical Investigation

Abstract Background Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) is established as safe and feasible with various robotic platforms. The Dexter robotic system is an open platform with a sterile surgeon’s console, two robotic instrument arms, and one robotic endoscope arm. Aims We conducted a prospective multicentre study (ClinicalTrials.gov NCT05873582) to assess the safety and performance of this new robotic platform. Methods Three centres in France, Germany, and Switzerland participated. The primary objectives of the study were to document the successful completion of the rTAPP procedures and to collect data on the occurrence of adverse events and device-related events perioperatively and up to 30 days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems, including novice, intermediate and expert. Results Fifty patients were operated for inguinal hernia repair (33 unilateral, 17 bilateral). The mean age and BMI of the patients were 60 years (±15) and 25.7 kg/cm2 (±3.3), respectively. All surgeries were successfully completed as planned using three standard laparoscopy trocars sized 10/12mm. Each procedure was performed with robotic assistance, and there were no conversions to open surgery. No intra-operative complications, device deficiency, or adverse events of Clavien-Dindo Grade III to V occurred. The mean skin-to-skin operative time was 55 min (±14) for unilateral hernia repair and 95 min (±22) for bilateral hernia repair. The mean robotic console time was 34 min (±12) for unilateral hernia and 68 min (±21) for bilateral hernia repairs. The patients were discharged within 1day (± 1 day) after surgery. Conclusion Our rTAPP experience with the Dexter system confirms feasibility, safety, and comparable operative times to other robotic platforms. This study demonstrates the practicality and safety of the robotic techniques, positioning the Dexter system as a valuable tool in hernia repair.

The impact of transformational leadership on classroom interaction in UAE secondary schools

AbstractDepartment heads play a critical role in executing school plans, particularly in adopting contemporary instructional methods, integrating technology, assessing student progress, and maintaining high standards of classroom interactions. They facilitate essential interactions within the classroom, spanning teacher-student, student–student, and student-content interactions, aligning with transformational leadership practices. This study explores the influence of department heads' transformational leadership on classroom interaction, mediating teachers' teaching experience in enhancing leadership capacity. Using a straightforward random sampling procedure, 374 teachers from 226 privately owned secondary schools were selected. Descriptive statistics were employed to represent the extent of department heads' engagement in transformational leadership practices. Findings indicate that teachers' role in clarifying activities and assignments to encourage classroom involvement received the highest average rating, emphasizing the importance of diverse instructional approaches. The study reveals a significant, positive influence of teachers' years of experience as a moderating factor in the relationship between department heads' transformational leadership and classroom interaction. A positive correlation was observed between student–teacher interactions and department heads' use of transformational leadership practices, with teachers' experience levels shaping these relationships. Notably, the study suggests that teachers' experience partially affects this phenomenon. The research concludes with recommendations for policymakers and educators to leverage their pedagogical expertise in fortifying the impact of school leadership on heightened student participation within the classroom.

Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial

Introduction: Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. Methods: Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. Results: A total of 559 procedures were analyzed. The success rate at resident’s first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists’ overall success rate and time to successful cannulation did not differ significantly in both weight strata. Conclusion: Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.