Similarity of individual functional brain connectivity patterns formed by music listening quantified with a data-driven approach.

INTRODUCTION: This study aims to explore the similarities in functional connectivity (FC) patterns in individuals when listening to different music genres and, in comparison, to the spoken word, using a novel data-driven approach. Our model and findings can potentially be utilized for evaluating the neurological effects of therapeutic music interventions. MATERIALS AND METHODS: Twelve healthy volunteers listened to seven different sound tracks while undergoing functional magnetic resonance imaging (fMRI) scans: music of the volunteer's choice with positive emotional attachment, two selections of unfamiliar classical music, one classical piece repeated with visual guidance and three spoken language tracks. FC network graphs were created, and selected graph properties were evaluated toward their commonalities across sound tracks. For comparison, FC patterns represented by the graph adjacency matrices were directly compared for high and low BOLD activation during listening. RESULTS: Graph properties averaged across subjects showed similar values for the same sound track compared to different sound tracks (p < 0.003). For high BOLD activation involving most areas in the auditory cortex, FC patterns for the same sound track correlated highly (0.74 ± 0.11), whereas FC patterns for different sound tracks did not (0.09 ± 0.07; p < 6e-5). For low BOLD activation involving additional brain regions, correlation of FC patterns for the sound tracks was still higher (0.43 ± 0.07) than for different sound tracks (0.09 ± 0.05; p < 8e-6). CONCLUSION: Similar music creates similar functional activation and connectivity patterns in the brain of healthy individuals as does listening to the spoken word. Direct comparison of FC patterns yielded higher correlations than indirect comparisons of graph properties derived from corresponding FC networks.

Simulation Research in Gastrointestinal and Urologic Care-Challenges and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Biomedical Imaging and Bioengineering Workshop.

: A workshop on "Simulation Research in Gastrointestinal and Urologic Care: Challenges and Opportunities" was held at the National Institutes of Health in June 2016. The purpose of the workshop was to examine the extent to which simulation approaches have been used by skilled proceduralists (not trainees) caring for patients with gastrointestinal and urologic diseases. The current status of research findings in the use and effectiveness of simulation applications was reviewed, and numerous knowledge gaps and research needs were identified by the faculty and the attendees. The paradigm of "deliberate practice," rather than mere repetition, and the value of coaching by experts was stressed by those who have adopted simulation in music and sports. Models that are most useful for the adoption of simulation by expert clinicians have yet to be fully validated. Initial studies on the impact of simulation on safety and error reduction have demonstrated its value in the training domain, but the role of simulation as a strategy for increased procedural safety remains uncertain in the world of the expert practitioner. Although the basic requirements for experienced physicians to acquire new skills have been explored, the widespread availability of such resources is an unrealized goal, and there is a need for well-designed outcome studies to establish the role of simulation in improving the quality of health care.

Simulation Research in Gastrointestinal and Urologic Care-Challenges and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Biomedical Imaging and Bioengineering Workshop.

A workshop on ''Simulation Research in Gastrointestinal and Urologic Care: Challenges and Opportunities'' was held at the National Institutes of Health in June 2016. The purpose of the workshop was to examine the extent to which simulation approaches have been used by skilled proceduralists (not trainees) caring for patients with gastrointestinal and urologic diseases. The current status of research findings in the use and effectiveness of simulation applications was reviewed, and numerous knowledge gaps and research needs were identified by the faculty and the attendees. The paradigm of ''deliberate practice,'' rather than mere repetition, and the value of coaching by experts was stressed by those who have adopted simulation in music and sports. Models that are most useful for the adoption of simulation by expert clinicians have yet to be fully validated. Initial studies on the impact of simulation on safety and error reduction have demonstrated its value in the training domain, but the role of simulation as a strategy for increased procedural safety remains uncertain in the world of the expert practitioner. Although the basic requirements for experienced physicians to acquire new skills have been explored, the widespread availability of such resources is an unrealized goal, and there is a need for well-designed outcome studies to establish the role of simulation in improving the quality of health care.

Outcomes of Fundamentals of Laparoscopic Surgery (FLS) mastery training standards applied to an ergonomically different, lower cost platform.

OBJECTIVE: Using previously established mastery learning standards, this study compares outcomes of training on standard FLS (FLS) equipment with training on an ergonomically different (ED-FLS), but more portable, lower cost platform. METHODS: Subjects completed a pre-training FLS skills test on the standard platform and were then randomized to train on the FLS training platform (n = 20) or the ED-FLS platform (n = 19). A post-training FLS skills test was administered to both groups on the standard FLS platform. RESULTS: Group performance on the pretest was similar. Fifty percent of FLS and 32 % of ED-FLS subjects completed the entire curriculum. 100 % of subjects completing the curriculum achieved passing scores on the post-training test. There was no statistically discernible difference in scores on the final FLS exam (FLS 93.4, ED-FLS 93.3, p = 0.98) or training sessions required to complete the curriculum (FLS 7.4, ED-FLS 9.8, p = 0.13). CONCLUSIONS: These results show that when applying mastery learning theory to an ergonomically different platform, skill transfer occurs at a high level and prepares subjects to pass the standard FLS skills test.

Music Listening modulates Functional Connectivity and Information Flow in the Human Brain.

Listening to familiar music has recently been reported to be beneficial during recovery from stroke. A better understanding of changes in functional connectivity and information flow is warranted in order to further optimize and target this approach through music therapy. Twelve healthy volunteers listened to seven different auditory samples during an fMRI scanning session: a musical piece chosen by the volunteer that evokes a strong emotional response (referred to as: "self-selected emotional"), two unfamiliar music pieces (Invention #1 by J. S. Bach* and Gagaku - Japanese classical opera, referred to as "unfamiliar"), the Bach piece repeated with visual guidance (DML: Directed Music Listening) and three spoken language pieces (unfamiliar African click language, an excerpt of emotionally charged language, and an unemotional reading of a news bulletin). Functional connectivity and betweenness (BTW) maps, a measure for information flow, were created with a graph-theoretical approach. Distinct variation in functional connectivity was found for different music pieces consistently for all subjects. Largest brain areas were recruited for processing self-selected music with emotional attachment or culturally unfamiliar music. Maps of information flow correlated significantly with fMRI BOLD activation maps (p<0.05). Observed differences in BOLD activation and functional connectivity may help explain previously observed beneficial effects in stroke recovery, as increased blood flow to damaged brain areas stimulated by active engagement through music listening may have supported a state more conducive to therapy.

Conducting Elite Performance Training.

Training to excellence in the conduct of surgical procedures has many similarities to the acquisition and mastery of technical skills in elite-level music and sports. By using coaching techniques and strategies gleaned from analysis of professional music ensembles and athletic training, surgical educators can set conditions that increase the success rate of training to elite performance. This article describes techniques and strategies used in both music and athletic coaching, and it discusses how they can be applied and integrated into surgical simulation and education.

Virtual operating room for team training in surgery.

BACKGROUND: We proposed to develop a novel virtual reality (VR) team training system. The objective of this study was to determine the feasibility of creating a VR operating room to simulate a surgical crisis scenario and evaluate the simulator for construct and face validity. METHODS: We modified ICE STORM (Integrated Clinical Environment; Systems, Training, Operations, Research, Methods), a VR-based system capable of modeling a variety of health care personnel and environments. ICE STORM was used to simulate a standardized surgical crisis scenario, whereby participants needed to correct 4 elements responsible for loss of laparoscopic visualization. The construct and face validity of the environment were measured. RESULTS: Thirty-three participants completed the VR simulation. Attendings completed the simulation in less time than trainees (271 vs 201 seconds, P = .032). Participants felt the training environment was realistic and had a favorable impression of the simulation. All participants felt the workload of the simulation was low. CONCLUSIONS: Creation of a VR-based operating room for team training in surgery is feasible and can afford a realistic team training environment.

Simulation of Tangential Excision: A Test for Construct Validity.

A foundational skill in burn surgery is tangential excision (TE). The purpose of this study was to develop a simulation model for TE, hypothesizing that simulation could be used in surgical training. TE simulation was created using the TE knife, foam, mineral oil, and base. Subjects, surgeons, or surgeons in training, were given a pre- and post-task questionnaire about experience with TE. Subjects were divided into three TE experience groups: novice--none, intermediate--some, and expert--TE in current or past practice. The task was to excise pre-marked rectangles, generating four excisional products (EPs). Evaluators blindly assessed performance by EP analysis using a novel scoring tool and reviewed videos using a modified objective structured assessment of technical skill (OSATS) rubric. Inter-rater reliabilities and P values were obtained, comparing Novice and Intermediate with Expert scores. Forty subjects completed the study: 16 were identified as TE novices, 17 as intermediates, and seven as experts. All EPs and videos were reviewed blindly by two evaluators using the EP scoring tool and OSATS methodology, respectively. Intraclass correlation coefficients were calculated to measure inter-rater reliabilities, which were acceptable (ICC => 0.42) for OSATS, time, and EP analysis: border and texture. Statistical differences between Novice and Expert scores were found (P < .0100, P < .0200, P < .0025, and P < .0005, respectively). Statistical differences between Intermediate and Expert scores were also found (P < .0100, P < .0200, P < .0100, and P < .0025, respectively). Post-simulation survey results showed experts 86% of the time agreeing or strongly agreeing that the simulation was similar to the clinical skin and 100% felt it would be a useful for training before clinical performance. Simulation for TE was successfully created to blindly discern level of TE experience. Participants agreed that simulation could play an essential role in burn surgical training.

Nonsurgical airway management training for surgeons.

PURPOSE: Airway management occupies a crucial component of surgical education. As such, it can be difficult to provide adequate training within the hospital setting alone. To be facile in all aspects of nonsurgical airway management, the surgical resident must have thorough cognitive understanding of the process as well as technical mastery. The Department of Surgery at the Methodist Hospital in Houston has developed a curriculum for nonsurgical airway management that uses multiple modalities for education, reinforcement, and testing. Didactic lectures based on established national guidelines are provided as a foundation. This method is supplemented by hands-on group scenarios that use inanimate models. Throughout the course, faculty leaders provide guidance and skills assessment. Residents are tested for competency using core value checklists based on knowledge and technical proficiency. During its pilot year, the curriculum has proven its need and success in residency education. Future improvements include development of specific clinical scenarios as well as integration of more advanced educational equipment and models for use in nonsurgical airway management. DEVELOPMENT OF THE ACTIVITY AND MATERIALS: Materials used for this program include an article by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway, the New England Journal of Medicine article entitled "Videos in clinical medicine. Orotracheal intubation" by Kabrhel et al,(2) "Management of the difficult and failed airway" by Hung and Murphy,(3) the American Heart Association Airway Management course 2007,(4) and the Manual of Emergency Airway Management by Walls et al.(5) EVALUATION COMPONENT: Before participating in the module, residents completed a written pretest and performed an initial simulation to establish a baseline. Residents then worked through a series of skills that provided experience in both the cognitive and the procedural aspects of airway management. To complete the module successfully, residents were required to attend three 3-hour sessions. After supervised practice, residents were tested on the procedural techniques via a procedural checklist and cognitive aspects with respect to emergency, crash, difficult, and failed airway algorithms.(1,5) The simulations are based on the 2003 American Society of Anesthesiologists Task Force on Management of the Difficult Airway Algorithms(1) and emergency, crash, difficult, and failed airway algorithms.(2,5) PROPOSED OUTCOME MEASURES: Proposed long-term outcome measures will include evaluations from faculty on a resident's noninvasive airway management skills and the resident's self-evaluation in actual noninvasive airway management situations. Resident performance will be evaluated by faculty using standardized checklists, review of simulation parameters, and review of audio-video recording of the simulation. EXPERIENCE TO DATE: This article describes our first implementation in the evolution of this module. The module was introduced to residents at all postgraduate levels in September 2007. Scores on pretests and performance on initial simulations were similar in all postgraduate years, with minimally superior pretest and initial simulation performance from the senior residents. Correct procedural adoption occurred rapidly after prebriefing and initial hands-on demonstration and supervised practice in simulated patient scenarios on airway mannequins. CONCLUSIONS AND NEXT STEPS: Our preliminary experience with a nonsurgical airway management training module for surgical residents has shown that a need for training exists in this critical area. Correct procedural adoption occurred rapidly after a didactic and procedural hands-on experience. Time intervals needed for review to maintain competence will also be studied. Improvements to the proficiency criteria and simulations are underway.