The (Under)Use of Eye-Tracking in Evolutionary Ecology.

To survive and pass on their genes, animals must perform many tasks that affect their fitness, such as mate-choice, foraging, and predator avoidance. The ability to make rapid decisions is dependent on the information that needs to be sampled from the environment and how it is processed. We highlight the need to consider visual attention within sensory ecology and advocate the use of eye-tracking methods to better understand how animals prioritise the sampling of information from their environments prior to making a goal-directed decision. We consider ways in which eye-tracking can be used to determine how animals work within attentional constraints and how environmental pressures may exploit these limitations.

Operating list composition and surgical performance.

BACKGROUND: Recent reviews suggest that the way in which surgeons prepare for a procedure (warm up) can affect performance. Operating lists present a natural experiment to explore this phenomenon. The aim was to use a routinely collected large data set on surgical procedures to understand the relationship between case list order and operative performance. METHOD: Theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the UK over 26 months were examined. A linear mixed-effects model and matched analysis were used to estimate the impact of list order and the cost of switching between procedures on a list while controlling for key prognosticators. The influence of procedure method (open versus minimally invasive) and complexity was also explored. RESULTS: The linear mixed-effects model included 255 757 procedures, and the matched analysis 48 632 pairs of procedures. Repeating the same procedure in a list resulted in an overall time saving of 0·98 per cent for each increase in list position. Switching between procedures increased the duration by an average of 6·48 per cent. The overall reduction in operating time from completing the second procedure straight after the first was 6·18 per cent. This pattern of results was consistent across procedure method and complexity. CONCLUSION: There is a robust relationship between operating list composition and surgical performance (indexed by duration of operation). An evidence-based approach to structuring a theatre list could reduce the total operating time.

A systematic examination of preoperative surgery warm-up routines.

BACKGROUND: Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented? METHODS: In order to address these issues, we adopted a two-pronged approach: (1) we conducted a systematic review of the literature to identify existing studies utilising preoperative simulation techniques; (2) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised cross-over trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation. RESULTS: Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. While the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies. CONCLUSIONS: There is an urgent need for a more rigorous approach to the development of "warm-up" routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance.

A three dimensional view of stereopsis in dentistry.

Stereopsis and its role in dental practice has been a topic of debate in recent editions of this Journal. These discussions are particularly timely as they come at a point when virtual reality simulators are becoming increasingly popular in the education of tomorrow's dentists. The aim of this article is to discuss the lack of robust empirical evidence to ascertain the relationship (if any) between stereopsis and dentistry and to build a case for the need for further research to build a strong evidence base on the topic.

Inconsistent reporting of minimally invasive surgery errors.

INTRODUCTION: Minimally invasive surgery (MIS) is a complex task requiring dexterity and high level cognitive function. Unlike surgical 'never events', potentially important (and frequent) manual or cognitive slips ('technical errors') are underresearched. Little is known about the occurrence of routine errors in MIS, their relationship to patient outcome, and whether they are reported accurately and/or consistently. METHODS: An electronic survey was sent to all members of the Association of Surgeons of Great Britain and Ireland, gathering demographic information, experience and reporting of MIS errors, and a rating of factors affecting error prevalence. RESULTS: Of 249 responses, 203 completed more than 80% of the questions regarding the surgery they had performed in the preceding 12 months. Of these, 47% reported a significant error in their own performance and 75% were aware of a colleague experiencing error. Technical skill, knowledge, situational awareness and decision making were all identified as particularly important for avoiding errors in MIS. Reporting of errors was variable: 15% did not necessarily report an intraoperative error to a patient while 50% did not consistently report at an institutional level. Critically, 12% of surgeons were unaware of the procedure for reporting a technical error and 59% felt guidance is needed. Overall, 40% believed a confidential reporting system would increase their likelihood of reporting an error. CONCLUSION: These data indicate inconsistent reporting of operative errors, and highlight the need to better understand how and why technical errors occur in MIS. A confidential 'no blame' reporting system might help improve patient outcomes and avoid a closed culture that can undermine public confidence.

A new tool for assessing head movements and postural sway in children.

Current methods of measuring gross motor abilities in children involve either high-cost specialist apparatus that is unsuitable for use in schools, or low-cost but nonoptimal observational measures. We describe the development of a low-cost system that is capable of providing high-quality objective data for the measurement of head movements and postural sway. This system is based on off-the-shelf components available for the Nintendo Wii: (1) The infrared cameras in a pair of WiiMotes are used to track head movements by resolving the position of infrared-emitting diodes in three dimensions, and (2) center-of-pressure data are captured using the WiiFit Balance board. This allows the assessment of children in school settings, and thus provides a mechanism for identifying children with neurological problems affecting posture. In order to test the utility of the system, we installed the apparatus in two schools to determine whether we could collect meaningful data on hundreds of children in a short time period. The system was successfully deployed in each school over a week, and data were collected on all of the children within the school buildings at the time of testing (N = 269). The data showed reliable effects of age and viewing condition, as predicted from previous small-scale studies that had used specialist apparatus to measure childhood posture. Thus, our system has the potential to allow screening of children for gross postural deficits in a manner that has never previously been possible. It follows that our system opens up the possibility of conducting large-scale behavioral studies concerning the development of posture.

Involving children in the development of assistive technology devices.

PURPOSE: To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment. METHOD: Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age = 9 years and 8 months, SD = 1.51; 123 males, 134 females) including children with cerebral palsy (N = 11), varying levels of deafness (N = 7), global developmental delay (N = 2) and Down's syndrome (N = 1) participated. Observations were taken whilst the children completed the survey tasks. RESULTS: All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters. CONCLUSIONS: The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed.

Is tracing or copying better when learning to reproduce a pattern?

Learning to write requires the repeated manual production of spatial patterns. It remains unclear whether tracing or copying provides better training: tracing provides accurate and immediate performance feedback, whereas copying may require greater use of memory and recall during training. We asked sixteen adults to copy or trace novel patterns then reproduce these from memory using a stylus and tablet PC. A week later, a retention test was performed. Sophisticated analyses indexed the extent to which participants had learned the dimensions and shape of patterns. We found that participants: (a) showed better shape and dimensional accuracy when tracing; (b) had better shape and dimensional retention immediately after tracing; (c) showed no differences between copying and tracing in their ability to redraw the pattern (shape or dimensions) 1 week later. Our methods provide a useful starting point for examining training and feedback on the generation and recall of spatial patterns.

Using vision to control locomotion: looking where you want to go.

Looking at the inside edge of the road when steering a bend seems to be a well-established strategy linked to using a feature called the tangent point. An alternative proposal suggests that the gaze patterns observed when steering result from looking at the points in the world through which one wishes to pass. In this explanation fixation on or near the tangent point results from trying to take a trajectory that cuts the corner. To test these accounts, we recorded gaze and steering when taking different paths along curved roadways. Participants could gauge and maintain their lateral distance, but crucially, gaze was predominantly directed to the region proximal to the desired path rather than toward the tangent point per se. These results show that successful control of high-speed locomotion requires fixations in the direction you want to steer rather than using a single road feature like the tangent point.

Using self-evaluation to maintain competence.

This limited study examined differences in pharmacists' competencies through self-assessment. By using self-assessment with specified objectives, pharmacists can target areas for CE programs. Pharmacists can then improve and maintain their competencies in these specific areas. A future study could focus on discovering the reasons some pharmacists do not feel comfortable in giving advice/information to other healthcare professionals.