Low Performers Research Articles

Exploring University Students’ Justifications for Making Metacognitive Judgments of Learning

The accuracy of students’ judgments has important implications for their learning and performance in educational settings. However, little is known about how students make these judgments. This study explored university students’ justifications for making their judgments of learning in a developmental psychology course. Two independent samples were involved, including a total number of 115 senior sport students. Participants responded to a knowledge test and provided their judgments at the local (Sample 1) or at the global level (Sample 2) and then provided their justifications for making these judgments. Students’ justifications for making their judgments were classified in ten categories, including the study of the learning materials, the confidence for answering (or not) correctly, the memory, the general knowledge, the knowledge of the answer and a general reference to common sense, experience, lectures, and judgment. Variations in the frequency of these justifications were found across the local and the global level, low and high accurate students, and low and high performers. These results are discussed regarding their theoretical and practical implications for undergraduate students’ learning.

Pupillary correlates of preparatory control in the Stroop task.

In three experiments, individual differences in preparatory control in the Stroop task were examined. Participants performed variants of the Stroop task while pupillary responses were examined during the preparatory interval. Variation in working memory capacity was also examined. High Stroop performers tended to demonstrate larger preparatory pupillary responses than low Stroop performers. In Experiment 2, when participants were given pre-cues indicating the congruency of the upcoming trial (MATCHING vs. CONFLICTING), high Stroop performers had larger preparatory pupillary responses for incongruent trials compared to congruent trials, whereas low Stroop performers demonstrated similar preparatory pupillary responses on both incongruent and congruent trials. These results suggest that variation in Stroop performance is partially due to individual differences in the ability to ramp up and regulate the intensity of attention allocated to preparatory control processes. Additionally, there was limited evidence that preparatory control processes partially account for the relation between working memory capacity and performance on the Stroop. Overall, these results provide evidence that individual differences in Stroop performance are partialy due to variation in preparatory control.

Differences Between High and Low Performing Police Agencies in Clearing Robberies, Aggravated Assaults, and Burglaries: Findings From an Eight-Agency Case Study

This eight-agency case study analyzes the characteristics of four high-and four low-performing police agencies, as measured by their long-term crime clearance rates. High and low performers were identified through a systematic assessment of 30 years of clearance rates of robberies, aggravated assaults, burglaries, and homicides for the largest 100 police departments in the United States. Researchers then conducted in-depth case studies of eight of these agencies—four of the highest and four of the lowest ranking in terms of their investigative practices. Comparisons of high-and low-performing agencies reveal differences in organizational structure; leadership and resources; selection, training, and performance review for investigators; case assignment and investigative processes; and community interactions. These findings provide direct guidance to agencies seeking to strengthen their investigative organization and practices.

Assessing Tonal Abilities in Elementary School Children: Testing Reliability and Validity of the Implicit Tonal Ability Test Using Rasch Measurement Model

The objective of this study was to develop and validate an instrument measuring the perception and interpretation of several distinct musical features (pitch, tonality, timing, loudness, and timbre). Therefore, we developed the Implicit Tonal Ability Test (ITAT), a listening test containing 49 multiple-choice items. A total of 233 children aged 6 to 12 participated in this study. Rasch model-based analysis of dimensionality and differential item functioning was chosen as the principal analysis strategy. Results revealed that the ITAT discriminated between high and low performers. Responses to distinct musical features behaved as one Rasch dimension in the test and reliability measures were sufficient for persons and items. The ITAT was variable across age and gender, with a positive relation between age and ITAT-score. The ITAT can be reliably used in elementary education to measure children’s musical ability for perception and interpretation of distinct musical features in just one test.

A Novel Team Formation Framework Based on Performance in a Cybersecurity Operations Center

A Cybersecurity Operations Center (CSOC) performs various tasks to protect an organization from cyber threats. Several types of personnel collaborate to function effectively as a team to analyze the threat signals, in the form of alerts, arriving from various sources. Teams are often formed ad hoc, resulting in an imbalance in their performances and thereby increasing the risk associated with the low-performing teams. The current approach taken by behavioral scientists in forming effective teams focuses on first qualitatively assessing individuals such as analysts, who are then grouped into teams based on their credentials and expertise. Our work takes a holistic view of the CSOC by first defining team requirements and then selecting individuals to form several collaborative teams that meet these requirements for every shift of operation. We present a novel team formation framework that integrates optimization, simulation, and scoring methods to form effective teams and introduce a new collaborative score metric that measures their effectiveness. Results from simulated experiments show the formation of effective teams whose collaborative scores are maximized and balanced. Our approach is also able to identify high and low performers within the first few months of implementing the framework.

Relative importance of multimodal risk factors to discriminate memory trajectories: Similarities and differences across ethnoracial groups in cognitively normal older adults

AbstractBackgroundInequalities in dementia incidence and heterogeneities observed on memory decline are present across ethnic/racial groups. Research suggests that inequities in risk/protective factors contribute towards these differences. We examine risk factors across multiple domains to identify those that best discriminate differences in memory trajectories across ethnoracial groups.MethodWe used an ethnoracially diverse longitudinal cohort of cognitively normal older adults (n = 299; mean age = 73.47 (6.90) years; 63.9% female) from the University of California, Davis‐Alzheimer’s Disease Research Center. First, we applied latent class growth analysis to objectively classify memory trajectories into distinct latent groups across a maximum of 10 follow‐ups. Second, we used random forest analyses (RFA) to examine relative importance of 22 risk/protective factors from seven domains (demographic, genetic, brain morphometry, plasma and functional biomarkers, psychological and lifestyle factors) to discriminate low/high memory performers as stratified by three ethnoracial groups (African Americans [AA; n = 111]; Hispanics [n = 108], Whites [n = 66]).ResultFirst, we observed that four latent classes (low, intermediate, high, very high) best represented memory trajectories (Figure 1). Second, for our RFA analyses, we collapsed low and intermediate groups to a low group (n = 136; 40.4% AA, 25.6% Hispanics, 28.8% Whites), and high and very high to a high performing group (n = 148; 34.6% AA, 50% Hispanics, 15.4% Whites). High memory class was predicted (Figure 2) in AA by lower smoking years, lower Functional Assessment Questionnaire (FAQ), younger age, higher education, lower neurofilament light (NfL), Apolipoprotein E non‐carriers, low neuropsychiatric inventory (NPI) severity, men, and higher hippocampal volume (AUC = 0.73); in Hispanics with men, lower FAQ, lower Geriatric Depression Scale (GDS), smaller third ventricle, larger hippocampal volume, lower NPI severity, smaller lateral ventricle, and lower NfL (AUC = 0.86); and in Whites, with lower FAQ, higher education, higher alcohol use frequency, lower NfL, lower GDS, smaller lateral ventricles, and low white matter hyperintensities (AUC = 0.82).ConclusionWe observed similarities and differences in predictors to discriminate low versus high memory performers in three ethnoracial groups. Identifying relative importance of risk factors will promote the integration of multimodal risk factors across ethnoracial groups to develop novel and complex risk profiles leading to early detection and identification of asymptomatic or preclinical older adults.

Needle Angle Matters: An Investigation of the Effect of Needle Angle on Hemodialysis Cannulation Skill.

Cannulation is critical for maintaining a functional vascular access for patients on hemodialysis. However, relatively little is known about the quantitative aspects of needle insertion dynamics required for skilled cannulation. In this paper, we introduce three kinds of metrics that quantify needle insertion angle - recognized as important for safe and effective cannulation - during cannulation on an instrumented simulator for skill assessment. Three questions were examined in this study: (1) Are simulator-based needle angle metrics related to cannulation success? (2) Are needle angle metrics related to simulated blood flashback quality? (3) Can needle angle metrics be used to distinguish between high and low skill levels? Fifty-one cannulators with varying degrees of clinical experience performed cannulation on the instrumented simulator. Each participant cannulated 16 times on different fistulas with varying geometries. During each trial, needle angle along with other sensor data was obtained via a motion sensor placed inside the needle. Data analysis was conducted by relating needle angle over time with our previously validated simulator-based cannulation outcome metrics. Results revealed that all three types of needle angle metrics were useful in predicting the probability of cannulation success. In addition, they were also correlated to flashback quality metrics. Furthermore, these metrics successfully distinguished between high and low performers regardless of whether they were classified using subjective ratings or objective scores. These results indicate that needle insertion angle is an important component of cannulation skill. The simulator-based metrics for needle insertion angle presented in this work measure a key aspect of skilled cannulation. As such, if implemented in a structured way, these metrics could lead to competency-based skill assessment and training for cannulation in the future. Raising the bar of cannulation skill of our clinicians can have a tangible impact on patient outcomes.

Academic Excellence as Yardstick for Employability in Nigeria: A Review of the Experiences of Business Education Graduates in Public Tertiary Institutions in Enugu State

The main purpose of the study was to ascertain if academic excellence is a yardstick for employability in the Nigerian labour market. The study was guided by two research questions and two null hypotheses. The population consisted of 173 Business Education graduates from public tertiary institution offering Business Education programme in Enugu State in the 2019/2020 academic session. No sampling was carried out since the population was manageable. The instrument used for data collection was a 17-itemed questionnaire developed by the researcher. The instrument was validated by three experts and the reliability of the instrument was determined using Crombach Alpha which yielded reliability index of 0.88. The instrument was administered by the researcher. 160 out of 173 copies of the questionnaire were well responded to, returned and therefore, used for data analysis representing 93 percent return rate. Mean and standard deviation were used for data analysis and correlation statistics was used to test the null hypotheses. Findings showed that: High and low achievers get jobs at same rate, Doing well on the job does not depend on grade, High achievers are more creative on jobs, Employers seek skills more than grade, Good grade does not guarantee employability, Job creation is targeted at both high and low achievers are some of the factors to prove that academic excellence is not a yardstick for employability in Nigeria. The null hypotheses showed that no significant relationship exist in the mean responses of high and low achieving Business Education graduates in public tertiary institutions in Enugu State on the itemized variables. Based on the findings, it was recommended among others that Attention should be shifted from academic excellence as yardstick for employability in Nigeria so that students are not pressured into dubious means just to graduate with high grades since findings of the study has shown that the both variables has no direct relationship. Employment opportunities should be massively created for all enough for both high and low academic performers since the findings of the study revealed that those with low academic performance can also have valuable skills capable of keeping them on the job for as long as they intend to.

Over-investment and ESG inequality

PurposeThis study aims to test whether over-investment is associated with environmental, social and governance (ESG) variation (i.e. inequality) across its dimensions, which, if so, would imply the prioritization of the interests of some stakeholders over those of others.Design/methodology/approachDrawing on a global sample of 29,428 observations across nine sectors and 41 countries between 2003 and 2019, the authors executed a country-industry-year fixed-effects regression analysis. In the robustness tests, this study also used the entropy balancing and propensity score matching approaches.FindingsThe authors found that while firm over-investment increases social pillar inequality, it reduces environmental pillar inequality. Further analysis revealed that the over-investment strategy decreases (increases) ESG inequality in low (high) environmental and social performers. This outcome could be of relevance to internal governance mechanisms and policymaking as ESG inequality might raise legitimacy concerns and hamper the long-term sustainability of firms.Practical implicationsThe outcome of the study could be of relevance to internal governance mechanisms as well as policymaking. Considering financial constraints, firms should maintain a balanced strategy between firm investment and addressing stakeholder interests. Otherwise, over-investment might reduce environmental and social engagement in some dimensions, which could prompt criticisms and legitimacy concerns about firms and some stakeholders.Originality/valuePast research has intensively focused on whether ESG – rather than ESG inequality – is associated with investment (in)efficiency. In addition, it has mostly formulated the causality running from ESG to firm investment, and hence, the literature lacks heterogeneity in this respect. Nevertheless, the authors believe that the potential effect of firm investment on ESG is of critical importance and has implications for determining whether over-investment causes variations across ESG engagement. Thus, the authors addressed this gap in the literature by investigating the relationship between over-investment and ESG inequality.

Surveying the Middle Ground: A Thematic Analysis of the Medical School Applications of Standard Performers

As gatekeepers to the medical profession, admissions committees make important decisions through the analysis of quantitative (e.g. test scores and grade point averages) and qualitative (e.g. letters of recommendation and personal statements) data. One area of the application that deserves additional study is the Work and Activities section, where students describe their extracurricular experiences. Previous research has found different themes that sometimes overlap in the applications of exceptional performing and low performing medical students, but it is unclear if these themes are present in the applications of standard performers.An exceptional performing medical student is defined as one who was inducted into both the Alpha Omega Alpha Honor Medical Society and the Gold Humanism Honor Society. A low performing medical student is one who was referred to the Student Promotions Committee (SPC) where an administrative action was made. A standard performing medical student is defined as someone who was neither a member of an honor society nor referred to the SPC during medical school. Using a constant comparative method, the applications of standard performers who graduated from the Uniformed Services University between 2017 and 2019 was assessed using exceptional performer themes (success in a practiced activity, altruism, teamwork, entrepreneurship, wisdom, passion, and perseverance) and low performer themes (witnessing teamwork, embellishment of achievement, and description of a future event). The presence of novel themes was also assessed. The absolute number of themes and the diversity of themes were determined. Demographic data were collected (age, gender, number of Medical School Admissions Test [MCAT] attempts, highest MCAT score, and cumulative undergraduate grade point average), and descriptive statistics was performed.A total of 327 standard performers were identified between 2017 and 2019. No novel themes were found after coding 20 applications. All exceptional performer themes were identified in the population of standard performers. The low performing theme of embellishment of achievement was not found. Standard performers had a lower number of total exceptional performer themes and a lower diversity of exceptional performer themes compared to low and exceptional performers, but standard performers also had a lower number and less diversity of low performing themes compared to low performers.This study suggests that the diversity and frequency of exceptional performing themes in a medical school application may be useful in distinguishing between exceptional performers and other performers, though the small sample size limits quantitative conclusions. Low performing themes may be specific to low performers and thus could be useful to admissions committees. Future studies should include a larger sample size and could assess for predictive validity evidence of these exceptional performing and low performing themes through a blinded protocol.

Exploring the co‐occurrence of students' learning behaviours and reasoning processes in an intelligent tutoring system: An epistemic network analysis

AbstractBackgroundMedical students use a variety of self‐regulated learning (SRL) strategies in different medical reasoning (MR) processes to solve patient cases of varying complexity. However, the interplay between SRL and MR processes is still unclear.ObjectivesThis study investigates how self‐regulated learning (SRL) and medical reasoning (MR) occurred concurrently in medical students while completing a diagnostic task in an intelligent tutoring system. This study aims to provide new insights into performance differences between high‐ and low‐achieving students in tasks of varying complexity.MethodsThirty‐one medical students (67.6% female) from a large North American university were tasked with solving two virtual patient cases in an intelligent tutoring system, BioWorld. BioWorld was designed for medical students to practice clinical reasoning skills deliberately. We collected students' think‐aloud protocols, based on which we coded their use of SRL behaviours and medical reasoning activities. We analysed the co‐occurrences of SRL behaviours and medical reasoning activities using the epistemic network analysis (ENA) method.ResultsThe SRL behaviour self‐reflection and MR activity lines of reasoning co‐occurred more frequently in a difficult task than in an easy task. In both tasks, high performers demonstrated more co‐occurrences of self‐reflection and lines of reasoning than low performers. Moreover, the MR activity conceptual operations co‐occurred more frequently with the SRL activities of monitoring and evaluation among high performers compared to low performers in an easy task.ImplicationsThe co‐occurrences of SRL behaviours and MR processes account for students' performance differences. The design of computer‐based learning environments for clinical reasoning should promote the acquisition of both SRL and medical reasoning abilities. Moreover, medical educators should consider task complexity when scaffolding.

527 Opportunity Amongst the Opportunistic: Improving Administration of Time-Critical Medications within a Burn Center

Abstract Introduction The absence of skin places patients with burns at an increased risk for a compromised immune system, thus susceptible to opportunistic infection. The use of time-critical medications (TCM) is often required for treatment. By definition, untimely administration may result in suboptimal therapy and put the patient at risk for harm. Our institutional goal for administration is 90%. In 2021 we observed a drop in compliance to 86.8% and instituted a multidisciplinary, quality improvement (QI) approach to improve TCM administration. The purpose of this study was to evaluate the efficacy of our interventions and identify trends in medication administration by staff type. Methods QI interventions included a collaboration between Nursing, Pharmacy, and Informatics to overcome barriers to timely administration related to unavailability of medication, education, and options for documentation in the electronic health record (EHR). Medication dispensing systems were floor stocked with eligible TCMs and pharmacists were instructed to refrain from scheduling TCMs within 30 minutes of shift change. Education was disseminated via weekly newsletter, staff huddle, and individual feedback was provided for low performers. TCM metrics were added to the quality board and top performers were acknowledged in a ‘Benchmark Brief.’ Lastly, the EHR was updated to enhance documentation. Medication administration was grouped by year. Staff was identified as burn staff or non-burn staff; comprised of internal resource, contract, and float staff. Results Following initiation of the QI project, timely administration increased by 8.6% to a 95.4% rate of timely administration. Conclusions Despite increases in annual inpatient admissions, our multidisciplinary quality improvement project was successful, increasing administration of TCM by 8.6%. Further, improvement by burn staff exceeded that of non-burn staff in the burn center. This supports a need to enhance quality initiatives for non-burn staff in the center. Applicability of Research to Practice Further research is needed to evaluate efficacy of education, specifically related to temporal dissemination amongst non-burn staff.

Can vibrotactile stimulation and tDCS help inefficient BCI users?

Brain-computer interface (BCI) has helped people by allowing them to control a computer or machine through brain activity without actual body movement. Despite this advantage, BCI cannot be used widely because some people cannot achieve controllable performance. To solve this problem, researchers have proposed stimulation methods to modulate relevant brain activity to improve BCI performance. However, multiple studies have reported mixed results following stimulation, and the comparative study of different stimulation modalities has been overlooked. Accordingly, this study was designed to compare vibrotactile stimulation and transcranial direct current stimulation’s (tDCS) effects on brain activity modulation and motor imagery BCI performance among inefficient BCI users. We recruited 44 subjects and divided them into sham, vibrotactile stimulation, and tDCS groups, and low performers were selected from each stimulation group. We found that the latter’s BCI performance in the vibrotactile stimulation group increased significantly by 9.13% (p < 0.01), and while the tDCS group subjects’ performance increased by 5.13%, it was not significant. In contrast, sham group subjects showed no increased performance. In addition to BCI performance, pre-stimulus alpha band power and the phase locking values (PLVs) averaged over sensory motor areas showed significant increases in low performers following stimulation in the vibrotactile stimulation and tDCS groups, while sham stimulation group subjects and high performers showed no significant stimulation effects across all groups. Our findings suggest that stimulation effects may differ depending upon BCI efficiency, and inefficient BCI users have greater plasticity than efficient BCI users.

Beyond Performance: Does Assessed Potential Matter to Employees’ Voluntary Departure Decisions?

ABSTRACTFirms are increasingly implementing performance–potential assessment systems, whereby supervisors evaluate employees’ current performance and future‐oriented potential (i.e., promotion prospects). Whether retention is greatest for high performance–high potential (HiPo) employees under such a system is an empirical question—while the “promise” of a promotion may aid retention, these employees likely face attractive outside options. Using data from a multinational firm, I find that HiPos generally depart at a lower rate than lower performing non‐HiPos. Among shorter tenured employees, I find the strongest evidence that potential matters to departures, above and beyond performance. In several instances, the rate of departure is lower when assessed potential is higher, holding performance constant. This is the case both among higher performers, where high potential leads to HiPo status, and among lower performers where high potential affords no such status. My findings suggest that HiPo status and potential ratings may help in facilitating employees’ early sorting decisions.

An empirical link between motivation gain and NBA statistics: applying hierarchical linear modelling

BackgroundThis study tested whether the motivation gain in groups is the result of social compensation or the Köhler effect by examining scaled individual salaries of National Basketball Association (NBA) players. Both factors explain the positive effects of a group, unlike social loafing. However, differing causes in motivation gain relate to whether players are low or high performers and the Köhler effect or social compensation.MethodsTo test motivation gain, this study used 11-year NBA statistical data of 3247 players by applying hierarchical linear modelling (HLM) and HLM 7.0 was used for analysis. The players’ individual statistics and annual salaries were collected from the NBA and ESPN websites, respectively. Whereas previous studies have looked at motivation gain through track-and-field and swimming relay records, this study verified motivation gain through salary variations among NBA players and their affiliated teams.ResultsThe high performers, while selecting teams with larger performance gaps among team members, earned a higher salary than while selecting teams with lower performance gaps among team members. This study found that motivation gain existed in high performers, which can be interpreted as support for social compensation rather than the Köhler effect.ConclusionsWe used our result to elucidate the basis for play-by-play decisions made by individuals and team behaviour. Our results are applicable for the enhancement of coaching strategies, ultimately improving team morale and performance. It can be interpreted that the motivation gains of high performers in the NBA are driven by the Cost Component of the Team member Effort Expenditure Model (TEEM), rather than the Expectancy and Value Components.

Heterogeneous Effects of the Deferred Action for Childhood Arrivals (DACA) on Undocumented College Students’ Educational Outcomes

We investigate why prior studies examining the effects of the Deferred Action for Childhood Arrivals (DACA) on undocumented youth's college outcomes in the United States have yielded mixed findings. We draw on unique administrative data from the City University of New York at the time of DACA's implementation and utilize difference-in-difference estimation to examine DACA's effects on undocumented students’ college GPA and interruptions to their college progress. We find that DACA's effects on the educational outcomes of undocumented students enrolled in college were heterogeneous: It had a negative effect on those who, prior to the policy, were academically high performing and taking on a heavy courseload, while it had no significant impact on low academic performers and those maintaining a light courseload. We offer a plausible explanation for this finding: DACA's newfound legal employment opportunities may have incentivized undocumented youth who were previously focused on schooling to seek out employment. In contrast, DACA may have had little impact on low achievers because they were more likely to be already working. While our study is unable to directly identify employment status, our finding that academically achieving students were negatively affected by DACA suggests that the liminal legality experienced by undocumented 1.5-generation youth has a substantive impact on their educational integration and assimilation trajectories. We contend that stopgap programs like DACA that offer contingent rights do not result in unalloyed positive benefits because they do not address undocumented youth's underlying legal precarity.

The Neural Correlates of Exact Calculation in Word and Numerical Formats in Low And High Math Performers: A fNIRS Study

The representation format of math problems can manifest dissimilarly in people with varying levels of math performance. The aim of this study was to investigate the neurocognitive underpinnings of two-digit exact calculation tasks in different formats: numerical and word. Fifty-three students were divided into groups with high and low levels of math performance based on their ability to solve math problems. They were asked to calculate addition problems with two-digit numbers and to read math problems that did not require calculations. Brain activation was recorded using functional near-infrared spectroscopy (fNIRS). General linear model (GLM) analysis revealed that reading math problems without calculation led to increased activation in the inferior temporal and fusiform gyri in a group of high-level performers, while a group of low-level performers demonstrated increased activation in Broca’s area and the inferior frontal gyrus in the same experimental condition, as well as during solving arithmetic problems in a word format of the exact calculation task. Analysis after bootstrapping revealed similar activation patterns in both groups. Both domain-specific and domain-general regions of the frontal and parietal brain areas were involved in the calculations. Right and left hemisphere activation was found both in low and high math performers. Comparing experimental conditions with resting state revealed significant activation in Broca’s area in all conditions in a group of high-level performers and in a word format of arithmetic problems in a group of low-level performers. Thus, the observed brain patterns suggest the involvement of complex sentence comprehension, especially in high-performing students. These results could be used in future to improve educational practice for students with varying levels of math competence.

Do ‘Surgeon Champions’ and High-Volume Surgeons Have Lower Rates of Periprosthetic Femur Fracture? Perspective From a State-Wide Quality Improvement Registry

BackgroundRecently, a state-wide registry identified fracture as a major cause of total hip arthroplasty revision. There were 52.8% of revisions occurring within 6 months (fracture leading cause). Registry sites have a ‘surgeon champion’ who acts as liaison and advocate. This study evaluated the effect of surgeon volume and role of ‘surgeon champion’ on fracture rates. MethodsThere were 95,948 cases from 2012 to 2019 queried with peri-implant femoral fractures identified (within 6 months). Funnel plots were generated to compare individual surgeon-specific fracture rates. Surgeons who had a fracture rate below the confidence interval were labeled ‘green’ (lower than mean), within were ‘yellow’ (no difference), and above were ‘red’ (significantly higher). ResultsFor all surgeons, 19.6% were red, 72.1% yellow, and 8.3% green. There were 17.2% ‘surgeon champions’ and 6.2% ‘nonchampions’ that were green (P = .01), while 20.7 and 19.3% were red (P = .82). There was a significant association between volume and performance (P < .01). No surgeons in the lower two quartiles (<84; 84 to 180 cases), while 4 and 29% of higher-volume surgeons (181 to 404; >404 cases) were green. There was no statistical difference in red status by volume (P = .53). Conclusion‘Surgeon champions’ and high-volume surgeons were more likely to be high performers but not less likely to be low performers. Active involvement in quality improvement and/or high volume was associated with better outcomes but did not impart complication immunity. ‘Green’ surgeons should mentor colleagues to help reduce fractures by re-evaluating modifiable factors. Analyzing outcomes to promote quality and decrease complications is paramount.

MP68-11 THE INFLOW-OPERA STUDY. INVESTIGATIONS IN FLOW STATE MEASUREMENTS WITH EEG DURING SURGICAL PERFORMANCE

You have accessJournal of UrologyCME1 Apr 2023MP68-11 THE INFLOW-OPERA STUDY. INVESTIGATIONS IN FLOW STATE MEASUREMENTS WITH EEG DURING SURGICAL PERFORMANCE Uwe Bieri, Melanie Baumgartner, Cao Tri, Anne-Raphaëlle Richoz, Daniel Eberli, and Cédric Poyet Uwe BieriUwe Bieri More articles by this author , Melanie BaumgartnerMelanie Baumgartner More articles by this author , Cao TriCao Tri More articles by this author , Anne-Raphaëlle RichozAnne-Raphaëlle Richoz More articles by this author , Daniel EberliDaniel Eberli More articles by this author , and Cédric PoyetCédric Poyet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Flow is the optimal mental state where individuals experience the highest focus and are fully absorbed in a task. Furthermore, research has shown that Flow predicts performance outcomes in several disciplines. Brain-Computer interfaces and Heart Rate sensors have shown approaches to distinguish Flow with electroencephalography (EEG) and Heart Rate (HR). Individuals who performed significantly better in specific tasks and were in Flow showed increased theta activity (4-7 HZ) in their EEG spectrum and lower HR. Performance outcome is crucial in surgery, and achieving Flow could enhance physicians' performance significantly. Our study aims to investigate these markers during virtual reality (VR) surgery training to provide objective measurements of peak performance. METHODS: We conducted the study with 20 urologic surgeons. We used a wireless EEG headband to record theta activity. HR was measured with a wireless HR sensor. The VR training was performed on the intuitive DaVinci Skills Simulator for robotic-assisted surgery. After completing the surgical tasks, the Flow Short Scale (FSS) was applied to measure the subjective Flow experience. Two VR tasks were performed on the simulator followed by the FSS. This procedure was repeated three times. Our primary objective was to investigate differences between high and low performers, their EEG output, HR and FSS scores. To test the different models, we conducted Generalized Estimating Equations Models (Wald test). Additionally, Spearman's Rank Correlation was computed to detect associations between the variables. RESULTS: We found that high performers had a significantly higher theta activity than low performers with W(2)=7.29, p=.026. In Addition, we observed a significantly lower HR among high performers than among low performers, with W(1)=9.86, p=.007(MD=10.21, SD=3.33). Furthermore, we detected a positive correlation between VR surgery scores and subjective flow experience within high performers with r(10) = 0.63, p=.048. CONCLUSIONS: Our findings indicate that surgeons who achieved higher performances showed more theta activity in their EEG spectrum and lower HR than surgeons with lower performance during VR surgeries. These findings highlight the importance of the ability to calm one's physiology as a predictor of performance outcomes. These results may lead to specific bio- and neurofeedback training protocols for surgeons to enhance their performance, accelerate the learning curve and reduce their arousal level during challenging intraoperative situations. Source of Funding: UZH Sc. Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e957 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Uwe Bieri More articles by this author Melanie Baumgartner More articles by this author Cao Tri More articles by this author Anne-Raphaëlle Richoz More articles by this author Daniel Eberli More articles by this author Cédric Poyet More articles by this author Expand All Advertisement PDF downloadLoading ...

High and low performers in internal rotation after reverse total shoulder arthroplasty: a biplane fluoroscopic study.

Internal rotation in adduction is often limited after reverse total shoulder arthroplasty (rTSA), but the origins of this functional deficit are unclear. Few studies have directly compared individuals who can and cannot perform internal rotation in adduction. Little data on underlying 3D humerothoracic, scapulothoracic, and glenohumeral joint relationships in these patients are available. Individuals >1-year postoperative to rTSA were imaged with biplane fluoroscopy in resting neutral and internal rotation in adduction poses. Subjects could either perform internal rotation in adduction with their hand at T12 or higher (high, N=7), or below the hip pocket (low, N=8). Demographics, the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and scapular notching grade were recorded. Joint orientation angles were derived from model-based markerless tracking of the scapula and humerus relative to the torso. The 3D implant models were aligned to preoperative computed tomography models to evaluate bone-implant impingement. The Simple Shoulder Test was highest in the high group (11±1 vs. 9±2, P=.019). Two subjects per group had scapular notching (grades 1 and 2), and 3 high group and 4 low group subjects had impingement below the glenoid. In the neutral pose, the scapula had 7° more upward rotation in the high group (P=.100), and the low group demonstrated 9° more posterior tilt (P=.017) and 14° more glenohumeral elevation (P=.047). In the internal rotation pose, axial rotation was >45° higher in the high group (P≤.008) and the low group again had 11° more glenohumeral elevation (P=.058). Large rotational differences within subject groups arose from a combination of differences in the resting neutral and maximum internal rotation in adduction poses, not only the terminal arm position. Individuals who were able to perform high internal rotation in adduction after rTSA demonstrated differences in joint orientation and anatomic biases versus patients with low internal rotation. The high rotation group had 7° more resting scapular upward rotation and used a 15°-30° change in scapular tilt to perform internal rotation in adduction versus patients in the low group. The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. In addition, inter-patient variation in humeral torsion may contribute substantially to postoperative internal rotation differences. These data point toward modifiable implant design and placement factors, as well as foci for physical therapy to strengthen and mobilize the scapula and glenohumeral joint in response to rTSA surgery.