Nontechnical Skills Assessment in Acute Care Trauma Simulations: A Mixed Methods Approach Using Eye Tracking and Behavioral Marker Systems.

INTRODUCTION: The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current approaches to NTS assessment rely on subjective ratings, which can introduce bias. Accordingly, objective methods of NTS evaluation are needed. Eye-tracking (ET) methods have been applied to studying communication, situation awareness, and leadership in many health care settings, and could be applied to studying physicians' NTS during trauma situations. In this study, we aimed to assess the relationship between trauma team leaders' objective gaze patterns and subjective expert NTS ratings during patient care simulations. MATERIALS AND METHODS: After Institutional Review Board approval, 9 trauma teams from first-year post-graduate general surgery and emergency medicine residents were recruited to participate in 1 of 2 trauma simulations (a difficult airway case and a multi-patient trauma). Each scenario lasted approximately 15 minutes. All team leaders wore a mobile ET system to evaluate gaze metrics-time to first fixation (TTFF), average fixation duration (AFD), and total percentage of the scenario (TPS) focused on Areas of Interest (AOI), which included patient, care team, diagnostic equipment, and patient care equipment. Trained faculty raters completed the Non-Technical Skills for Surgeons (NOTSS) assessment tool and the Trauma Non-Technical Skills (T-NOTECHS) scale. One-way analysis of variance, Kruskal-Wallis, and appropriate post-hoc pairwise comparison tests were run to assess differences between ET metrics across AOI groups. Spearman's Rho tests were used to assess correlations between ET and subjective NTS ratings. RESULTS: Compared to other NTS domains, trauma teams scored relatively poorly on communication across both T-NOTECHS (3.29$ \pm $0.61, maximum = 5) and NOTSS (2.87$ \pm $0.66, maximum = 4). We found significant differences in trauma team leaders' TTFF between teammates and the patient (Team: 1.56 vs Patient: 29.82 seconds, P < .001). TTFF on the diagnostic equipment was negatively correlated (P < .05) to multiple measures of subjective NTS assessments. There were no significant differences in AFD between AOIs, and AFD on teammates was positively correlated (P < .05) to communication and teamwork. There were significant differences in TPS across most AOI pairs (P < .05), and the average TPS fixated was highest on the patient (32%). Finally, there were several significant correlations between additional ET and NTS metrics. CONCLUSIONS: This study utilized a mixed methods approach to assess trauma team leaders' NTS in simulated acute care trauma simulations. Our results provide several objective insights into trauma team leaders' NTS behaviors during patient care simulations. Such objective insights provide a more comprehensive understanding of NTS behaviors and can be leveraged to guide NTS training of trauma physicians in the future. More studies are needed to apply these methods to capture NTS from a larger sample of teams in both simulated and real trauma environments.

Enhancing rheology and reducing lipid digestion of oil-in-water emulsions using controlled aggregation and heteroaggregation of soybean protein isolate-peach gum microspheres.

There is a growing interest in developing highly viscous lipid foods using plant protein and polysaccharide gum-based emulsion technology. However, gaps remain in understanding the rheological, microstructural, and digestive properties of plant proteins like soybean protein isolate (SPI) in combination with various gums. This study investigates how combining SPI and peach gum (PG) affects rheology and lipolysis of oil-in-water (O/W) emulsions containing 20 wt% soybean oil. Emulsions with varying SPI and PG compositions including SPI-PG single and SPI/PG mixed droplet systems were prepared. Heating induced alterations in viscosity (e.g., SPI-PG from 14.88 to 90.27 Pa·s and SPI/PG from 9.66 to 85.32 Pa·s) and microstructure revealing aggregate formation at oil-water interface. The viscosity decreased significantly from the oral to intestinal phase (SPI-PG: 28.10 to 0.19 Pa·s, SPI/PG: 21.27 to 0.10 Pa·s). These changes affected lipid digestion, notably in SPI-PG and SPI/PG emulsions where a compact interface hindered lipolysis during digestion. Interestingly, free fatty acid (FFA) release during small intestinal phase followed a different order: SPI (82.51 %) > SPI-PG (70.77 %) > SPI/PG (63.60 %) > PG (56.09 %). This study provides insights into creating highly viscous O/W spreads with improved rheology, stability, and delayed lipid digestion, offering potential benefits in food product formulation.

Eye tracking and audio sensors to evaluate surgeon's non-technical skills: An empirical study.

Non-Technical Skills (NTS) of medical teams are currently measured using subjective and resource-intensive ratings given by experts. This study explores if objective NTS assessment approaches with eye-tracking and audio sensors can measure teamwork and communication skills in surgery. Eight surgeons participated in a simulated two-phase surgical scenario developed to assess their NTS. Sensor-based audio, eye tracking and video data were collected and analyzed along with rating from the NOTSS scale. Different levels of communication were detected by the sensor data during the two phases of the simulated surgery. Sensor data detected leadership qualities among surgeons based on speech metrics, and eye tracking offered additional evidence about gaze patterns related to NTS. This objective approach to NTS measurement captured differences in communication in greater detail as opposed to a single collective rating obtained using current assessment tools.

Complexity of Documentation Needs for Children With Medical Complexity: Implications for Hospital Providers.

OBJECTIVES: Care coordination is a core component of pediatric complex care programs (CCPs) supporting children with medical complexity (CMC) and their families. In this study, we aim to describe the purpose and characteristics of clinical care notes used within a pediatric CCP. METHODS: We conducted observations of provider-family interactions during CCP clinic visits and 5 focus groups with members of the CCP. Focus groups were recorded and transcribed. Field observation notes and focus group transcripts were subjected to qualitative content analyses. RESULTS: Four major themes help characterize clinical care notes: (1) Diversity of note types and functions: program staff author and use a number of unique note types shared across multiple stakeholders, including clinicians, families, and payers. (2) motivations for care note generation are different and explain how, why, and where they are created. (3) Program staff roles and configuration vary in relation to care note creation and use. (4) Sources of information for creating and updating notes are also diverse. Given the disparate information sources, integrating and maintaining up-to-date information for the child is challenging. To minimize information gaps, program staff devised unique but resource-intensive strategies, such as accompanying families during specialty clinic visits or visiting them inpatient. CONCLUSIONS: CMC have complex documentation needs demonstrated by a variety of professional roles, care settings, and stakeholders involved in the generation and use of notes. Multiple opportunities exist to redesign and streamline the existing notes to support the cognitive work of clinicians providing care for CMC.

Realization of Rapid Large-Size 3D Printing Based on Full-Color Powder-Based 3DP Technique.

The powder-based 3DP (3D printing) technique has developed rapidly in creative and customized industries on account of it's uniqueness, such as low energy consumption, cheap consumables, and non-existent exhaust emissions. Moreover, it could actualize full-color 3D printing. However, the printing time and size are both in need of upgrade using ready printers, especially for large-size 3D printing objects. Given the above issues, the effects of height and monolayer area on printing time were explored and the quantitative relationship was given in this paper conducted on the specimens with a certain gradient. On this basis, an XYX rotation method was proposed to minimize the printing time. The mechanical tests were conducted with three impregnation types as well as seven printing angles and combined with the characterization of surface structure based on the scanning electron microscope (SEM) digital images to explore the optimum parameters of cutting-bonding frame (CBF) applied to powder-based 3D printing. Then, four adhesives were compared in terms of the width of bonded gap and chromatic aberration. The results revealed that ColorBond impregnated specimens showed excellent mechanical properties which reached maximum when printed at 45° to Z axis, and α-cyanoacrylate is the most suitable adhesive to bond full-color powder-based models. Finally, an operation technological process was summarized to realize the rapid manufacturing of large-size full-color 3D printed objects.

Naked-Eye 3D Display Based on Microlens Array Using Combined Micro-Nano Imprint and UV Offset Printing Methods.

An optical film integrating microlens array (MLAs) and 3D micro-graphics is an important way to achieve the naked-eye 3D display effect. The 3D micro-graphics is traditionally generated by the micro-nano imprint technology based on precision engraving mold, which leads to high production cost and low production efficiency, and thus restricts the rapid response to production tasks and large-scale popularization and application. In this study, a process scheme for large-scale printing of 3D micro-graphics using UV offset printing based on presensitized (PS) plate was proposed, matching with the MLAs fabricated by micro-nano imprint process to achieve naked-eye 3D display effect. We used the laser confocal microscope to systematically measure and analyze the geometric and optical performance of the fabricated MLAs in terms of height, curvature radius, center distance, spacing, focal length, and numerical aperture, and evaluated the influence of the publishing resolution of the PS plate on the display effect of 3D micro-graphics. The printing quality and display effect of 3D micro-graphics were further improved by adjusting process parameters such as printing speed and printing pressure. The results of the current study demonstrate that the combined application of micro-nano imprint technology based on precision mold and UV offset printing technology based on PS plate can achieve an excellent naked-eye 3D display effect in 360° all angles, which is efficient, cost-saving, and highly flexible.

Rehabilitation with a combination of scalp acupuncture and exercise therapy in spastic cerebral palsy.

PURPOSE: To use Traditional Chinese Medicine (TCM) and Western approaches to improve gross motor function and activities of daily living (ADL) in children with spastic cerebral palsy. METHODS: Children were randomly divided into a treatment group, which received scalp acupuncture combined with exercise therapy and conventional rehabilitation training, and a control group, which received conventional rehabilitation training alone. Study subjects' gross motor function (gross motor function measure-88 [GMFM-88]) and ADL were evaluated before and after therapy. RESULTS: GMFM-88 and ADL scores were significantly improved in both groups after therapy, but the within group differences in post- and pre-therapy GMFM-88 and ADL scores were significantly higher in the treatment group compared to the control group. CONCLUSION: Scalp acupuncture combined with exercise therapy and conventional rehabilitation training can significantly improve gross motor function and the ability to perform ADLs in children with spastic cerebral palsy compared to conventional rehabilitation training alone.