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1.
Sensors (Basel) ; 23(24)2023 Dec 07.
Article in English | MEDLINE | ID: mdl-38139530

ABSTRACT

The development of spectral sensors (SSs) capable of retrieving spectral information have opened new opportunities to improve several environmental and agricultural practices, e.g., crop breeding, plant phenotyping, land use monitoring, and crop classification. The SSs are classified as multispectral and hyperspectral (HS) based on the number of the spectral bands resolved and sampled during data acquisition. Large-scale applications of the HS remain limited due to the cost of this type of technology and the technical difficulties in hyperspectral data processing. Low-cost portable hyperspectral cameras (PHCs) have been progressively developed; however, critical aspects associated with data acquisition and processing, such as the presence of spectral discontinuities, signal jumps, and a high level of background noise, were reported. The aim of this work was to analyze and improve the hyperspectral output of a PHC Senop HSC-2 device by developing a general use methodology. Several signal gaps were identified as falls and jumps across the spectral signatures near 513, 650, and 930 nm, while the dark current signal magnitude and variability associated with instrumental noise showed an increasing trend over time. A data correction pipeline was successfully developed and tested, leading to 99% and 74% reductions in radiance signal jumps identified at 650 and 830 nm, respectively, while the impact of noise on the acquired signal was assessed to be in the range of 10% to 15%. The developed methodology can be effectively applied to other low-cost hyperspectral cameras.

2.
Proc Natl Acad Sci U S A ; 116(1): 123-128, 2019 01 02.
Article in English | MEDLINE | ID: mdl-30584094

ABSTRACT

Food security relies on the resilience of staple food crops to climatic variability and extremes, but the climate resilience of European wheat is unknown. A diversity of responses to disturbance is considered a key determinant of resilience. The capacity of a sole crop genotype to perform well under climatic variability is limited; therefore, a set of cultivars with diverse responses to weather conditions critical to crop yield is required. Here, we show a decline in the response diversity of wheat in farmers' fields in most European countries after 2002-2009 based on 101,000 cultivar yield observations. Similar responses to weather were identified in cultivar trials among central European countries and southern European countries. A response diversity hotspot appeared in the trials in Slovakia, while response diversity "deserts" were identified in Czechia and Germany and for durum wheat in southern Europe. Positive responses to abundant precipitation were lacking. This assessment suggests that current breeding programs and cultivar selection practices do not sufficiently prepare for climatic uncertainty and variability. Consequently, the demand for climate resilience of staple food crops such as wheat must be better articulated. Assessments and communication of response diversity enable collective learning across supply chains. Increased awareness could foster governance of resilience through research and breeding programs, incentives, and regulation.


Subject(s)
Climate , Triticum/physiology , Crop Production/statistics & numerical data , Europe , Food Supply , Plant Breeding , Principal Component Analysis , Rain , Temperature , Weather
3.
Sensors (Basel) ; 22(12)2022 Jun 14.
Article in English | MEDLINE | ID: mdl-35746261

ABSTRACT

An innovative low-cost device based on hyperspectral spectroscopy in the near infrared (NIR) spectral region is proposed for the non-invasive detection of moldy core (MC) in apples. The system, based on light collection by an integrating sphere, was tested on 70 apples cultivar (cv) Golden Delicious infected by Alternaria alternata, one of the main pathogens responsible for MC disease. Apples were sampled in vertical and horizontal positions during five measurement rounds in 13 days' time, and 700 spectral signatures were collected. Spectral correlation together with transmittance temporal patterns and ANOVA showed that the spectral region from 863.38 to 877.69 nm was most linked to MC presence. Then, two binary classification models based on Artificial Neural Network Pattern Recognition (ANN-AP) and Bagging Classifier (BC) with decision trees were developed, revealing a better detection capability by ANN-AP, especially in the early stage of infection, where the predictive accuracy was 100% at round 1 and 97.15% at round 2. In subsequent rounds, the classification results were similar in ANN-AP and BC models. The system proposed surpassed previous MC detection methods, needing only one measurement per fruit, while further research is needed to extend it to different cultivars or fruits.


Subject(s)
Malus , Fruit/chemistry , Malus/chemistry , Neural Networks, Computer
4.
Sensors (Basel) ; 20(11)2020 Jun 02.
Article in English | MEDLINE | ID: mdl-32498361

ABSTRACT

This study aims to test the performances of a low-cost and automatic phenotyping platform, consisting of a Red-Green-Blue (RGB) commercial camera scanning objects on rotating plates and the reconstruction of main plant phenotypic traits via the structure for motion approach (SfM). The precision of this platform was tested in relation to three-dimensional (3D) models generated from images of potted maize, tomato and olive tree, acquired at a different frequency (steps of 4°, 8° and 12°) and quality (4.88, 6.52 and 9.77 µm/pixel). Plant and organs heights, angles and areas were extracted from the 3D models generated for each combination of these factors. Coefficient of determination (R2), relative Root Mean Square Error (rRMSE) and Akaike Information Criterion (AIC) were used as goodness-of-fit indexes to compare the simulated to the observed data. The results indicated that while the best performances in reproducing plant traits were obtained using 90 images at 4.88 µm/pixel (R2 = 0.81, rRMSE = 9.49% and AIC = 35.78), this corresponded to an unviable processing time (from 2.46 h to 28.25 h for herbaceous plants and olive trees, respectively). Conversely, 30 images at 4.88 µm/pixel resulted in a good compromise between a reliable reconstruction of considered traits (R2 = 0.72, rRMSE = 11.92% and AIC = 42.59) and processing time (from 0.50 h to 2.05 h for herbaceous plants and olive trees, respectively). In any case, the results pointed out that this input combination may vary based on the trait under analysis, which can be more or less demanding in terms of input images and time according to the complexity of its shape (R2 = 0.83, rRSME = 10.15% and AIC = 38.78). These findings highlight the reliability of the developed low-cost platform for plant phenotyping, further indicating the best combination of factors to speed up the acquisition and elaboration process, at the same time minimizing the bias between observed and simulated data.


Subject(s)
Imaging, Three-Dimensional , Phenotype , Plant Leaves , Solanum lycopersicum , Olea , Reproducibility of Results , Zea mays
5.
Glob Chang Biol ; 25(4): 1428-1444, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30536680

ABSTRACT

Efforts to limit global warming to below 2°C in relation to the pre-industrial level are under way, in accordance with the 2015 Paris Agreement. However, most impact research on agriculture to date has focused on impacts of warming >2°C on mean crop yields, and many previous studies did not focus sufficiently on extreme events and yield interannual variability. Here, with the latest climate scenarios from the Half a degree Additional warming, Prognosis and Projected Impacts (HAPPI) project, we evaluated the impacts of the 2015 Paris Agreement range of global warming (1.5 and 2.0°C warming above the pre-industrial period) on global wheat production and local yield variability. A multi-crop and multi-climate model ensemble over a global network of sites developed by the Agricultural Model Intercomparison and Improvement Project (AgMIP) for Wheat was used to represent major rainfed and irrigated wheat cropping systems. Results show that projected global wheat production will change by -2.3% to 7.0% under the 1.5°C scenario and -2.4% to 10.5% under the 2.0°C scenario, compared to a baseline of 1980-2010, when considering changes in local temperature, rainfall, and global atmospheric CO2 concentration, but no changes in management or wheat cultivars. The projected impact on wheat production varies spatially; a larger increase is projected for temperate high rainfall regions than for moderate hot low rainfall and irrigated regions. Grain yields in warmer regions are more likely to be reduced than in cooler regions. Despite mostly positive impacts on global average grain yields, the frequency of extremely low yields (bottom 5 percentile of baseline distribution) and yield inter-annual variability will increase under both warming scenarios for some of the hot growing locations, including locations from the second largest global wheat producer-India, which supplies more than 14% of global wheat. The projected global impact of warming <2°C on wheat production is therefore not evenly distributed and will affect regional food security across the globe as well as food prices and trade.

6.
Glob Chang Biol ; 25(1): 155-173, 2019 01.
Article in English | MEDLINE | ID: mdl-30549200

ABSTRACT

Wheat grain protein concentration is an important determinant of wheat quality for human nutrition that is often overlooked in efforts to improve crop production. We tested and applied a 32-multi-model ensemble to simulate global wheat yield and quality in a changing climate. Potential benefits of elevated atmospheric CO2 concentration by 2050 on global wheat grain and protein yield are likely to be negated by impacts from rising temperature and changes in rainfall, but with considerable disparities between regions. Grain and protein yields are expected to be lower and more variable in most low-rainfall regions, with nitrogen availability limiting growth stimulus from elevated CO2 . Introducing genotypes adapted to warmer temperatures (and also considering changes in CO2 and rainfall) could boost global wheat yield by 7% and protein yield by 2%, but grain protein concentration would be reduced by -1.1 percentage points, representing a relative change of -8.6%. Climate change adaptations that benefit grain yield are not always positive for grain quality, putting additional pressure on global wheat production.


Subject(s)
Adaptation, Physiological , Climate Change , Grain Proteins/analysis , Triticum/chemistry , Triticum/physiology , Carbon Dioxide/metabolism , Droughts , Food Quality , Models, Theoretical , Nitrogen/metabolism , Temperature
7.
Glob Chang Biol ; 24(3): 1291-1307, 2018 03.
Article in English | MEDLINE | ID: mdl-29245185

ABSTRACT

Climate change impact assessments are plagued with uncertainties from many sources, such as climate projections or the inadequacies in structure and parameters of the impact model. Previous studies tried to account for the uncertainty from one or two of these. Here, we developed a triple-ensemble probabilistic assessment using seven crop models, multiple sets of model parameters and eight contrasting climate projections together to comprehensively account for uncertainties from these three important sources. We demonstrated the approach in assessing climate change impact on barley growth and yield at Jokioinen, Finland in the Boreal climatic zone and Lleida, Spain in the Mediterranean climatic zone, for the 2050s. We further quantified and compared the contribution of crop model structure, crop model parameters and climate projections to the total variance of ensemble output using Analysis of Variance (ANOVA). Based on the triple-ensemble probabilistic assessment, the median of simulated yield change was -4% and +16%, and the probability of decreasing yield was 63% and 31% in the 2050s, at Jokioinen and Lleida, respectively, relative to 1981-2010. The contribution of crop model structure to the total variance of ensemble output was larger than that from downscaled climate projections and model parameters. The relative contribution of crop model parameters and downscaled climate projections to the total variance of ensemble output varied greatly among the seven crop models and between the two sites. The contribution of downscaled climate projections was on average larger than that of crop model parameters. This information on the uncertainty from different sources can be quite useful for model users to decide where to put the most effort when preparing or choosing models or parameters for impact analyses. We concluded that the triple-ensemble probabilistic approach that accounts for the uncertainties from multiple important sources provide more comprehensive information for quantifying uncertainties in climate change impact assessments as compared to the conventional approaches that are deterministic or only account for the uncertainties from one or two of the uncertainty sources.


Subject(s)
Climate Change , Crops, Agricultural/physiology , Models, Biological , Uncertainty , Arctic Regions , Crops, Agricultural/growth & development , Finland , Forecasting , Mediterranean Region , Spain , Time Factors
8.
Glob Chang Biol ; 23(3): 1258-1281, 2017 03.
Article in English | MEDLINE | ID: mdl-27387228

ABSTRACT

A potato crop multimodel assessment was conducted to quantify variation among models and evaluate responses to climate change. Nine modeling groups simulated agronomic and climatic responses at low-input (Chinoli, Bolivia and Gisozi, Burundi)- and high-input (Jyndevad, Denmark and Washington, United States) management sites. Two calibration stages were explored, partial (P1), where experimental dry matter data were not provided, and full (P2). The median model ensemble response outperformed any single model in terms of replicating observed yield across all locations. Uncertainty in simulated yield decreased from 38% to 20% between P1 and P2. Model uncertainty increased with interannual variability, and predictions for all agronomic variables were significantly different from one model to another (P < 0.001). Uncertainty averaged 15% higher for low- vs. high-input sites, with larger differences observed for evapotranspiration (ET), nitrogen uptake, and water use efficiency as compared to dry matter. A minimum of five partial, or three full, calibrated models was required for an ensemble approach to keep variability below that of common field variation. Model variation was not influenced by change in carbon dioxide (C), but increased as much as 41% and 23% for yield and ET, respectively, as temperature (T) or rainfall (W) moved away from historical levels. Increases in T accounted for the highest amount of uncertainty, suggesting that methods and parameters for T sensitivity represent a considerable unknown among models. Using median model ensemble values, yield increased on average 6% per 100-ppm C, declined 4.6% per °C, and declined 2% for every 10% decrease in rainfall (for nonirrigated sites). Differences in predictions due to model representation of light utilization were significant (P < 0.01). These are the first reported results quantifying uncertainty for tuber/root crops and suggest modeling assessments of climate change impact on potato may be improved using an ensemble approach.


Subject(s)
Climate Change , Solanum tuberosum , Biomass , Bolivia , Denmark , Models, Theoretical , Washington
10.
Plants (Basel) ; 12(8)2023 Apr 21.
Article in English | MEDLINE | ID: mdl-37111953

ABSTRACT

Recent developments in low-cost imaging hyperspectral cameras have opened up new possibilities for high-throughput phenotyping (HTP), allowing for high-resolution spectral data to be obtained in the visible and near-infrared spectral range. This study presents, for the first time, the integration of a low-cost hyperspectral camera Senop HSC-2 into an HTP platform to evaluate the drought stress resistance and physiological response of four tomato genotypes (770P, 990P, Red Setter and Torremaggiore) during two cycles of well-watered and deficit irrigation. Over 120 gigabytes of hyperspectral data were collected, and an innovative segmentation method able to reduce the hyperspectral dataset by 85.5% was developed and applied. A hyperspectral index (H-index) based on the red-edge slope was selected, and its ability to discriminate stress conditions was compared with three optical indices (OIs) obtained by the HTP platform. The analysis of variance (ANOVA) applied to the OIs and H-index revealed the better capacity of the H-index to describe the dynamic of drought stress trend compared to OIs, especially in the first stress and recovery phases. Selected OIs were instead capable of describing structural changes during plant growth. Finally, the OIs and H-index results have revealed a higher susceptibility to drought stress in 770P and 990P than Red Setter and Torremaggiore genotypes.

11.
Intensive Care Med Exp ; 9(1): 6, 2021 Feb 09.
Article in English | MEDLINE | ID: mdl-33559781

ABSTRACT

The COVID-19 pandemic has increased the need for a bedside tool for lung mechanics assessment and ventilator-induced lung injury (VILI) monitoring. Mechanical power is a unifying concept including all the components which can possibly cause VILI (volume, pressures, flow, respiratory rate), but the complexity of its mathematical computation makes it not so feasible in routine practice and limits its clinical use. In this letter, we describe the development of a mobile application that allows to simply measure power associated with mechanical ventilation, identifying each component (respiratory rate, resistance, driving pressure, PEEP volume) as well. The major advantage, according to the authors who developed this mathematical description of mechanical power, is that it enables the quantification of the relative contribution of its different components (tidal volume, driving pressure, respiratory rate, resistance). Considering the potential role of medical apps to improve work efficiency, we developed an open source Progressive Web Application (PWA), named "PowerApp" (freely available at https://mechpower.goodbarber.app ), in order to easily obtain a bedside measurement of mechanical power and its components. It also allows to predict how the modification of ventilatory settings or physiological conditions would affect power and each relative component. The "PowerApp" allows to measure mechanical power at a glance during mechanical ventilation, without complex mathematical computation, and making mechanical power equation useful and feasible for everyday clinical practice.

12.
World J Clin Cases ; 8(5): 912-921, 2020 Mar 06.
Article in English | MEDLINE | ID: mdl-32190627

ABSTRACT

BACKGROUND: Allograft artery mycotic aneurysm (MA) represents a rare but life-threatening complication of kidney transplantation. Graftectomy is widely considered the safest option. Due to the rarity of the disease and the substantial risk of fatal consequences, experience with conservative strategies is limited. To date, only a few reports on surgical repair have been published. We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis. CASE SUMMARY: An 18-year-old gentleman, on post-operative day 70 after deceased donor kidney transplantation, presented with malaise, low urinary output, and worsening renal function. Screening organ preservation fluid cultures, collected at the time of surgery, were positive for Candida albicans. Doppler ultrasound and contrast-enhanced computer tomography showed a 4-cm-sized, saccular aneurysm of the iuxta-anastomotic segment of the allograft artery, suspicious for MA. The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch, thus preventing endovascular stenting and embolization. After multidisciplinary discussion, the patient underwent surgical exploration, aneurysm excision, and re-anastomosis between the stump of the allograft artery and the internal iliac artery. The procedure was uneventful. Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection. Three years after the operation, the patient is doing very well with excellent allograft function and no signs of recurrent disease. CONCLUSION: Surgical repair represents a feasible option in carefully selected patients with allograft artery MA. Anti-fungal prophylaxis is advised when preservation fluid cultures are positive.

14.
Front Plant Sci ; 9: 1158, 2018.
Article in English | MEDLINE | ID: mdl-30135696

ABSTRACT

Soil organic carbon (SOC) has a vital role to enhance agricultural productivity and for mitigation of climate change. To quantify SOC effects on productivity, process models serve as a robust tool to keep track of multiple plant and soil factors and their interactions affecting SOC dynamics. We used soil-plant-atmospheric model viz. DAISY, to assess effects of SOC on nitrogen (N) supply and plant available water (PAW) under varying N fertilizer rates in winter wheat (Triticum aestivum) in Denmark. The study objective was assessment of SOC effects on winter wheat grain and aboveground biomass accumulation at three SOC levels (low: 0.7% SOC; reference: 1.3% SOC; and high: 2% SOC) with five nitrogen rates (0-200 kg N ha-1) and PAW at low, reference, and high SOC levels. The three SOC levels had significant effects on grain yields and aboveground biomass accumulation at only 0-100 kg N ha-1 and the SOC effects decreased with increasing N rates until no effects at 150-200 kg N ha-1. PAW had significant positive correlation with SOC content, with high SOC retaining higher PAW compared to low and reference SOC. The mean PAW and SOC correlation was given by PAW% = 1.0073 × SOC% + 15.641. For the 0.7-2% SOC range, the PAW increase was small with no significant effects on grain yields and aboveground biomass accumulation. The higher winter wheat grain and aboveground biomass was attributed to higher N supply in N deficient wheat production system. Our study suggested that building SOC enhances agronomic productivity at only 0-100 kg N ha-1. Maintenance of SOC stock will require regular replenishment of SOC, to compensate for the mineralization process degrading SOC over time. Hence, management can maximize realization of SOC benefits by building up SOC and maintaining N rates in the range 0-100 kg N ha-1, to reduce the off-farm N losses depending on the environmental zones, land use and the production system.

15.
Nat Commun ; 9(1): 4249, 2018 10 12.
Article in English | MEDLINE | ID: mdl-30315168

ABSTRACT

Understanding the drivers of yield levels under climate change is required to support adaptation planning and respond to changing production risks. This study uses an ensemble of crop models applied on a spatial grid to quantify the contributions of various climatic drivers to past yield variability in grain maize and winter wheat of European cropping systems (1984-2009) and drivers of climate change impacts to 2050. Results reveal that for the current genotypes and mix of irrigated and rainfed production, climate change would lead to yield losses for grain maize and gains for winter wheat. Across Europe, on average heat stress does not increase for either crop in rainfed systems, while drought stress intensifies for maize only. In low-yielding years, drought stress persists as the main driver of losses for both crops, with elevated CO2 offering no yield benefit in these years.


Subject(s)
Droughts , Triticum/physiology , Zea mays/physiology , Climate Change , Europe , Hot Temperature , Seasons
16.
Trends Plant Sci ; 22(6): 472-490, 2017 06.
Article in English | MEDLINE | ID: mdl-28389147

ABSTRACT

With world population growing quickly, agriculture needs to produce more with fewer inputs while being environmentally friendly. In a context of changing environments, crop models are useful tools to simulate crop yields. Wheat (Triticum spp.) crop models have been evolving since the 1960s to translate processes related to crop growth and development into mathematical equations. These have been used over decades for agronomic purposes, and have more recently incorporated advances in the modeling of environmental footprints, biotic constraints, trait and gene effects, climate change impact, and the upscaling of global change impacts. This review outlines the potential and limitations of modern wheat crop models in assisting agronomists, breeders, and policymakers to address the current and future challenges facing agriculture.


Subject(s)
Crops, Agricultural/metabolism , Crops, Agricultural/physiology , Triticum/metabolism , Triticum/physiology , Adaptation, Physiological/genetics , Adaptation, Physiological/physiology , Crops, Agricultural/genetics , Models, Theoretical , Triticum/genetics
17.
Sci Total Environ ; 598: 445-470, 2017 Nov 15.
Article in English | MEDLINE | ID: mdl-28454025

ABSTRACT

Biogeochemical simulation models are important tools for describing and quantifying the contribution of agricultural systems to C sequestration and GHG source/sink status. The abundance of simulation tools developed over recent decades, however, creates a difficulty because predictions from different models show large variability. Discrepancies between the conclusions of different modelling studies are often ascribed to differences in the physical and biogeochemical processes incorporated in equations of C and N cycles and their interactions. Here we review the literature to determine the state-of-the-art in modelling agricultural (crop and grassland) systems. In order to carry out this study, we selected the range of biogeochemical models used by the CN-MIP consortium of FACCE-JPI (http://www.faccejpi.com): APSIM, CERES-EGC, DayCent, DNDC, DSSAT, EPIC, PaSim, RothC and STICS. In our analysis, these models were assessed for the quality and comprehensiveness of underlying processes related to pedo-climatic conditions and management practices, but also with respect to time and space of application, and for their accuracy in multiple contexts. Overall, it emerged that there is a possible impact of ill-defined pedo-climatic conditions in the unsatisfactory performance of the models (46.2%), followed by limitations in the algorithms simulating the effects of management practices (33.1%). The multiplicity of scales in both time and space is a fundamental feature, which explains the remaining weaknesses (i.e. 20.7%). Innovative aspects have been identified for future development of C and N models. They include the explicit representation of soil microbial biomass to drive soil organic matter turnover, the effect of N shortage on SOM decomposition, the improvements related to the production and consumption of gases and an adequate simulations of gas transport in soil. On these bases, the assessment of trends and gaps in the modelling approaches currently employed to represent biogeochemical cycles in crop and grassland systems appears an essential step for future research.

18.
Open Med (Wars) ; 11(1): 497-508, 2016.
Article in English | MEDLINE | ID: mdl-28352842

ABSTRACT

Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh.

19.
Open Med (Wars) ; 11(1): 418-425, 2016.
Article in English | MEDLINE | ID: mdl-28352830

ABSTRACT

Aim of the study is to highlight difficulties faced by an inexperienced surgeon in approaching endorectal-ultrasound, trying to define when learning curve can be considered complete. A prospective analysis was conducted on endorectal-ultrasound performed for subperitoneal rectal adenocarcinoma staging in the period from January 2008 to July 2013, reported by a single surgeon of Department of Oncology, Section of General Surgery, "San Luigi Gonzaga" Teaching Hospital, Orbassano (Turin, Italy); the surgeon had no previous experience in endorectal-ultrasound. Fourty-six endorectal-ultrasounds were divided into two groups: early group (composed by 23 endorectal-ultrasounds, made from January 2008 to May 2009) and late group (composed by 23 endorectal-ultrasound, carried out from June 2009 to July 2013). In our experience, the importance of a learning curve is evident for T staging, but no statystical significance is reached for results deal with N stage. We can conclude that ultrasound evaluation of anorectal and perirectal tissues is technically challenging and requires a long learning curve. Our learning curve can not be closed down, at least for N parameter.

20.
Open Med (Wars) ; 11(1): 489-496, 2016.
Article in English | MEDLINE | ID: mdl-28352841

ABSTRACT

A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms "surgeon", "specialized surgeon", and "specialist surgeon"; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee's progress. CONCLUSIONS: The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor's ability, the trainee's own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

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