Variation in Competence of Graduating General Surgery Trainees.

OBJECTIVE: To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. DESIGN: Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. SETTING: This study was conducted using data from members of the SIMPL collaborative. PARTICIPANTS: A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. RESULTS: The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. CONCLUSIONS: There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.

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.

Analysis of the most demanding passages of play in elite youth soccer: a comparison between congested and non-congested fixture schedules.

This study aimed to examine the most demanding passages of play in elite youth soccer for congested and non-congested fixture schedules. Seventeen elite youth male soccer players (18.2 ± 1.3 years old) participated in this study across 30 competitive matches. Assessed matches included congested (n = 12, three matches within eight consecutive days or less) and non-congested matches (n = 18, at least 5 days between matches). The players' activity profiles during matches were analysed using global positioning measurement units (GPS). Players activity included: distance covered, distance covered at different velocities, high-intensity accelerations and decelerations, and player load. The most demanding passages (MDP) of match play was calculated using a moving average method within three-time windows (i.e., 1, 5, and 10 min). Data were analysed using a Bayesian ANOVA. During congested fixtures, the players' distance covered and player load declined, with the former decreasing across all the MDP time windows, whereas the latter exclusively into the long-time windows (i.e., 5 and 10 min). Conversely, statistical differences in the remaining variables were anecdotal and in favour of the null hypothesis (i.e., Bayes factor <1), suggesting a non-influence of the competition fixture schedule. These findings provide insight into the MDP of youth soccer, helping practitioners to periodize training and recovery strategies during different competitive fixture schedules.

Resting-State EEG in Alpha Rhythm May Be Indicative of the Performance of Motor Imagery-Based Brain-Computer Interface.

Motor imagery-based brain-computer interfaces (MI-BCIs) have great application prospects in motor enhancement and rehabilitation. However, the capacity to control a MI-BCI varies among persons. Predicting the MI ability of a user remains challenging in BCI studies. We first calculated the relative power level (RPL), power spectral entropy (PSE) and Lempel-Ziv complexity (LZC) of the resting-state open and closed-eye EEG of different frequency bands and investigated their correlations with the upper and lower limbs MI performance (left hand, right hand, both hands and feet MI tasks) on as many as 105 subjects. Then, the most significant related features were used to construct a classifier to separate the high MI performance group from the low MI performance group. The results showed that the features of open-eye resting alpha-band EEG had the strongest significant correlations with MI performance. The PSE performed the best among all features for the screening of the MI performance, with the classification accuracy of 85.24%. These findings demonstrated that the alpha bands might offer information related to the user's MI ability, which could be used to explore more effective and general neural markers to screen subjects and design individual MI training strategies.

Radiologists' Contribution to Variation in Detecting Clinically Significant Prostate Cancer in Men With Prostate MRI.

OBJECTIVE: Assess radiologists' contribution to variation in clinically significant prostate cancer (csPCa) detection in patients with elevated prostate-specific antigen (PSA) and multiparametric MRI (mpMRI). METHODS: This institutional review board-approved, retrospective cohort study was performed at a tertiary, academic, National Cancer Institute-designated Comprehensive Cancer Center with a multidisciplinary prostate cancer program. Men undergoing mpMRI examinations from January 1, 2015, to December 31, 2019, with elevated PSA (≥4 ng/mL) and biopsy within 6 months pre- or post-MRI or prostatectomy within 6 months post-mpMRI were included. Univariate and multivariable hierarchical logistic regression assessed impact of patient, provider, mpMRI examination, mpMRI report, and pathology factors on the diagnosis of Grade Group ≥ 2 csPCa. RESULTS: Study cohort included 960 MRIs in 928 men, mean age 64.0 years (SD ± 7.4), and 59.8% (555 of 928) had csPCa. Interpreting radiologist was not significant individually (P > .999) or combined with mpMRI ordering physician and physician performing biopsy or prostatectomy (P = .41). Prostate Imaging Reporting and Data System (PI-RADS) category 2 (odds ratio [OR] 0.18, P = .04), PI-RADS category 4 (OR 2.52, P < .001), and PI-RADS category 5 (OR 4.99, P < .001) assessment compared with no focal lesion; PSA density of 0.1 to 0.15 ng/mL/cc (OR 2.46, P < .001), 0.15 to 0.2 ng/mL/cc (OR 2.77, P < .001), or ≥0.2 ng/mL/cc (OR 4.52, P < .001); private insurance (reference = Medicare, OR 0.52, P = .001), and unambiguous extraprostatic extension on mpMRI (OR 2.94, P = .01) were independently associated with csPCa. PI-RADS 3 assessment (OR 1.18, P = .56), age (OR 0.99, P = .39), and African American race (OR 0.90, P = .75) were not. DISCUSSION: Although there is known in-practice variation in radiologists' interpretation of mpMRI, in our multidisciplinary prostate cancer program we found no significant radiologist-attributable variation in csPCa detection.

Corrigendum: Relative Power Correlates With the Decoding Performance of Motor Imagery Both Across Time and Subjects.

[This corrects the article DOI: 10.3389/fnhum.2021.701091.].

Corrigendum: Neurofeedback training of alpha relative power improves the performance of motor imagery brain-computer interface.

[This corrects the article DOI: 10.3389/fnhum.2022.831995.].

Neurofeedback Training of Alpha Relative Power Improves the Performance of Motor Imagery Brain-Computer Interface.

Significant variation in performance in motor imagery (MI) tasks impedes their wide adoption for brain-computer interface (BCI) applications. Previous researchers have found that resting-state alpha-band power is positively correlated with MI-BCI performance. In this study, we designed a neurofeedback training (NFT) protocol based on the up-regulation of the alpha band relative power (RP) to investigate its effect on MI-BCI performance. The principal finding of this study is that alpha NFT could successfully help subjects increase alpha-rhythm power and improve their MI-BCI performance. An individual difference was also found in this study in that subjects who increased alpha power more had a better performance improvement. Additionally, the functional connectivity (FC) of the frontal-parietal (FP) network was found to be enhanced after alpha NFT. However, the enhancement failed to reach a significant level after multiple comparisons correction. These findings contribute to a better understanding of the neurophysiological mechanism of cognitive control through alpha regulation.

Relative Power Correlates With the Decoding Performance of Motor Imagery Both Across Time and Subjects.

One of the most significant challenges in the application of brain-computer interfaces (BCI) is the large performance variation, which often occurs over time or across users. Recent evidence suggests that the physiological states may explain this performance variation in BCI, however, the underlying neurophysiological mechanism is unclear. In this study, we conducted a seven-session motor-imagery (MI) experiment on 20 healthy subjects to investigate the neurophysiological mechanism on the performance variation. The classification accuracy was calculated offline by common spatial pattern (CSP) and support vector machine (SVM) algorithms to measure the MI performance of each subject and session. Relative Power (RP) values from different rhythms and task stages were used to reflect the physiological states and their correlation with the BCI performance was investigated. Results showed that the alpha band RP from the supplementary motor area (SMA) within a few seconds before MI was positively correlated with performance. Besides, the changes of RP between task and pre-task stage from theta, alpha, and gamma band were also found to be correlated with performance both across time and subjects. These findings reveal a neurophysiological manifestation of the performance variations, and would further provide a way to improve the BCI performance.

Assessment of Cancer Center Variation in Textbook Oncologic Outcomes Following Colectomy for Adenocarcinoma.

BACKGROUND: Traditional metrics may inadequately represent rates of attaining optimal oncologic care. We evaluated a composite "textbook oncologic outcome" (TOO) to assess the incidence of achieving an "optimal" clinical result after colon adenocarcinoma (CA) resection. METHODS: The National Cancer Database (NCDB) was queried to identify patients undergoing colectomy for non-metastatic CA between 2010 and 2015. TOO was defined as a margin negative resection with an AJCC compliant lymph node evaluation, no prolonged length of stay (LOS) or 30-day readmission/mortality, as well as receipt of stage appropriate adjuvant chemotherapy. RESULTS: Among 170,120 patients who underwent colectomy at 1315 hospitals, 93,204 (54.8%) achieved TOO with large variations observed among facilities. While certain factors were achieved nearly universally (R0 margin, 95.6%; no 30-day mortality, 97.2%), avoidance of prolonged LOS (77.3%) and appropriate adjuvant chemotherapy (83.0%) were achieved less consistently. On multivariable analysis, Black race/ethnicity (OR 0.82, 95% CI 0.80-0.85), Medicaid insurance (OR 0.64, 0.61-0.68), and low-volume facility (< 50/year) (OR 0.83, 0.77-0.89) were associated with decreased likelihood of TOO. Achievement of TOO was associated with improved long-term survival (HR 0.45; 95% CI 0.44-0.46). CONCLUSIONS: Roughly one-half of patients undergoing resection of CA achieved an optimal clinical outcome. TOO may be a more useful quality metric to assess patient-centric composite outcomes following surgical procedures.

Competition-Based Success Factors During the Talent Pathway of Elite Male Swimmers.

Marginal differences in race results between top swimmers have evoked the interest in competition-based success factors of long-term athlete development. To identify novel factors for the multi-dimensional model of talent development, the aim of the study was to investigate annual variation in competition performance (ACV), number of races per year, and age. Therefore, 45,398 race results of all male participants (n = 353) competing in individual events, i.e., butterfly, backstroke, breaststroke, freestyle, and individual medley, at the 2018 European Long-Course Swimming Championships (2018EC) were analyzed retrospectively for all 10 years prior to the championships with Pearson's correlation coefficient and multiple linear regression analysis. Higher ranked swimmers at the 2018EC showed significant medium correlations with a greater number of races per year and small but significant correlations with higher ACV in 10 and nine consecutive years, respectively, prior to the championships. Additionally, better swimmers were older than their lower ranked peers (r = -0.21, p < 0.001). Regression model explained a significant proportion of 2018EC ranking for 50 m (47%), 100 m (45%), 200 m (31%), and 400 m races (29%) but not for 800 and 1,500 m races with number of races having the largest effect followed by age and ACV. In conclusion, higher performance variation with results off the personal best in some races did not impair success at the season's main event and young competitors at international championships may benefit from success chances that increase with age. The higher number of races swum per year throughout the career of higher ranked swimmers may have provided learning opportunities and specific adaptations. Future studies should quantify these success factors in a multi-dimensional talent development model.

Most running demand passages of match play in youth soccer congestion period.

The objective of this study was to determine whether there is a decrease in the physical performance of the players in the most demanding passages (MDP) during periods of competition congestion. The study involved 15 under-19 players, belonging to a club in Spain's first division (age: 18.1 ± 0.8 years, weight: 70.2 ± 4.9 kg and height: 1.78 ± 0.06 m), who were monitored during 23 national and international official matches in the 2018/19 season. The Youth League matches were played between two matches in the national championship in six different weeks. The league matches corresponded to the first 17 matches of the league championship, the period in which the 6 matches in the Youth League were played. The two physical variables analysed were total distance (TD) and distance at > 21 km·h-1 (TD21). Using the rolling average, four time windows were taken (1, 3, 5 and 10 min), and the values were relativized to the minute (m·min-1). The main results were that: there were more MDP in the first halves than in the second halves of all the time windows; 2) the central match in the week (Youth League) was the most demanding one; and 3) the players maintained the TD and TD21 in the MDP in the third match compared to the first. The results of this study could provide trainers with information on the need to design training tasks that simulate the demands of competition in relation to the TD and the TD21 according to different time windows.

[Performance verification of direct chemiluminescence immunoassay to detect the serum 25-hydroxyvitamin D concentration].

OBJECTIVE: To test the performance of direct chemiluminescence immunoassay(CLIA) in the determination of serum 25-hydroxyvitamin D [25(OH)D] concentration. METHODS: The CLIA analyzer of Italy DiaSorin was used to measure the 25(OH)D concentrations in the Standard Reference Material 972 a of National Institute of Standards and Technology, DiaSorin control materials, blind samples of Vitamin D External Quality Assessment Scheme(DEAQS), and outpatient serum samples. The functional sensitivity, precision, accuracy, recovery, and linearity were evaluated, and the samples of mild hemolysis, 5 days' storage at 4 ₿ and >1 year's storage at-80 ₿were tested for 25(OH)D. RESULTS: The functional sensitivity was<4 ng/mL. The coefficient of variations of intra-and inter batch were<8. 1%. The relative deviation was-3. 1%-5. 7%. The recovery rates were 82. 8%-112. 9% and it had good linearity in the range of 7. 6-128. 1 ng/mL. Compared with fresh serum, the serum 25(OH)D concentration was not affected by mild hemolysis or being stored at 4 ₿for 5 days, but averagely decreased at 7. 6% by being stored at-80 ₿for more than 1 year. Compared with others, the deviation was-2. 9%-3. 6%. The differences in precision, accuracy and recovery of this method among the three different hospitals is slightly. CONCLUSION: The performance of direct CLIA for 25(OH)D assay meet the basic technical requirements for laboratory medicine, and is laborsaving and timesaving.

P300 Speller Performance Predictor Based on RSVP Multi-feature.

Brain-computer interface (BCI) systems were developed so that people can control computers or machines through their brain activity without moving their limbs. The P300 speller is one of the BCI applications used most commonly, as is very simple and reliable and can achieve satisfactory performance. However, like other BCIs, the P300 speller still has room for improvements in terms of its practical use, for example, selecting the best compromise between spelling accuracy and information transfer rate (ITR; speed) so that the P300 speller can maintain high accuracy while increasing spelling speed. Therefore, seeking correlates of, and predicting, the P300 speller's performance is necessary to understand and improve the technique. In this work, we investigated the correlations between rapid serial visual presentation (RSVP) task features and the P300 speller's performance. Fifty-five subjects participated in the RSVP and conventional matrix P300 speller tasks and RSVP behavioral and electroencephalography (EEG) features were compared in the P300's speller performance. We found that several of the RSVP's event-related potential (ERP) and behavioral features were correlated with the P300 speller's offline binary classification accuracy. Using these features, we propose a simple multi-feature performance predictor (r = 0.53, p = 0.0001) that outperforms any single feature performance predictor, including that of the conventional RSVP T1% predictor (r = 0.28, p = 0.06). This result demonstrates that selective multi-features can predict BCI performance better than a single feature alone.

Improvements in event-related desynchronization and classification performance of motor imagery using instructive dynamic guidance and complex tasks.

BACKGROUND AND OBJECTIVE: The motor-imagery based brain-computer interface supplies a potential approach for motor-impaired patients, not only to control rehabilitation facilities but also to promote recovery from motor dysfunctions. To improve event-related desynchronization during motor imagery and obtain improved brain-computer interface classification accuracy, we introduce dynamic video guidance and complex motor tasks to the motor imagery paradigm. METHODS: Eleven participants were included in the experiment; 64-channel electroencephalographic data were collected and analyzed during four motor imagery tasks with different guidance. Time-frequency analysis, spectral-time variation analysis, topographical distribution maps, and statistical analysis were utilized to analyze the event-related desynchronization patterns. Common spatial patterns were used to extract spatial pattern features and support vector machines were used to discriminate the offline classification accuracies in three bands (the alpha band, beta band, alpha and beta band) for comparison. RESULTS: The experimental outcomes showed that complex motor imagery tasks coupled with dynamic video guidance induced significantly stronger event-related desynchronization than other paradigms, which use simple motor imagery tasks or static guidance. Similar results were obtained during analysis of the motor imagery brain-computer interface classification performance; namely, the highest average classification accuracy in complex and dynamic guidance was improved by approximately 14%, compared with static guidance. For individually specified paradigms, all participants obtained a classification accuracy that exceeded or was equal to 87.5%. CONCLUSIONS: This study provides an optional route to enhance the event-related desynchronization activities and classification accuracy of a motor imagery brain-computer interface through optimization of motor imagery tasks and instructive guidance.

User's Self-Prediction of Performance in Motor Imagery Brain-Computer Interface.

Performance variation is a critical issue in motor imagery brain-computer interface (MI-BCI), and various neurophysiological, psychological, and anatomical correlates have been reported in the literature. Although the main aim of such studies is to predict MI-BCI performance for the prescreening of poor performers, studies which focus on the user's sense of the motor imagery process and directly estimate MI-BCI performance through the user's self-prediction are lacking. In this study, we first test each user's self-prediction idea regarding motor imagery experimental datasets. Fifty-two subjects participated in a classical, two-class motor imagery experiment and were asked to evaluate their easiness with motor imagery and to predict their own MI-BCI performance. During the motor imagery experiment, an electroencephalogram (EEG) was recorded; however, no feedback on motor imagery was given to subjects. From EEG recordings, the offline classification accuracy was estimated and compared with several questionnaire scores of subjects, as well as with each subject's self-prediction of MI-BCI performance. The subjects' performance predictions during motor imagery task showed a high positive correlation (r = 0.64, p < 0.01). Interestingly, it was observed that the self-prediction became more accurate as the subjects conducted more motor imagery tasks in the Correlation coefficient (pre-task to 2nd run: r = 0.02 to r = 0.54, p < 0.01) and root mean square error (pre-task to 3rd run: 17.7% to 10%, p < 0.01). We demonstrated that subjects may accurately predict their MI-BCI performance even without feedback information. This implies that the human brain is an active learning system and, by self-experiencing the endogenous motor imagery process, it can sense and adopt the quality of the process. Thus, it is believed that users may be able to predict MI-BCI performance and results may contribute to a better understanding of low performance and advancing BCI.

EEG datasets for motor imagery brain-computer interface.

Background: Most investigators of brain-computer interface (BCI) research believe that BCI can be achieved through induced neuronal activity from the cortex, but not by evoked neuronal activity. Motor imagery (MI)-based BCI is one of the standard concepts of BCI, in that the user can generate induced activity by imagining motor movements. However, variations in performance over sessions and subjects are too severe to overcome easily; therefore, a basic understanding and investigation of BCI performance variation is necessary to find critical evidence of performance variation. Here we present not only EEG datasets for MI BCI from 52 subjects, but also the results of a psychological and physiological questionnaire, EMG datasets, the locations of 3D EEG electrodes, and EEGs for non-task-related states. Findings: We validated our EEG datasets by using the percentage of bad trials, event-related desynchronization/synchronization (ERD/ERS) analysis, and classification analysis. After conventional rejection of bad trials, we showed contralateral ERD and ipsilateral ERS in the somatosensory area, which are well-known patterns of MI. Finally, we showed that 73.08% of datasets (38 subjects) included reasonably discriminative information. Conclusions: Our EEG datasets included the information necessary to determine statistical significance; they consisted of well-discriminated datasets (38 subjects) and less-discriminative datasets. These may provide researchers with opportunities to investigate human factors related to MI BCI performance variation, and may also achieve subject-to-subject transfer by using metadata, including a questionnaire, EEG coordinates, and EEGs for non-task-related states.

Performance variation in motor imagery brain-computer interface: a brief review.

Brain-computer interface (BCI) technology has attracted significant attention over recent decades, and has made remarkable progress. However, BCI still faces a critical hurdle, in that performance varies greatly across and even within subjects, an obstacle that degrades the reliability of BCI systems. Understanding the causes of these problems is important if we are to create more stable systems. In this short review, we report the most recent studies and findings on performance variation, especially in motor imagery-based BCI, which has found that low-performance groups have a less-developed brain network that is incapable of motor imagery. Further, psychological and physiological states influence performance variation within subjects. We propose a possible strategic approach to deal with this variation, which may contribute to improving the reliability of BCI. In addition, the limitations of current work and opportunities for future studies are discussed.

Measuring hospital quality using pediatric readmission and revisit rates.

OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals. METHODS: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean. RESULTS: Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%). CONCLUSIONS: We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.

Reviewing the values of a standard operating procedure.

This article addresses the values of a standard operating procedure based on review of articles. It describes the application and importance of a standard operating procedure from different perspectives while emphasizing its critical relevance to medical practice and pharmaceutical service. The review further discusses shortcomings related to nonexistence of standard operating procedure including inconsistent quality of service; performance variation; procedural mix-ups; and misinterpretation or miscommunication of information. In conclusion, standard operating procedure, if realized and materialized as a component of an effective management system, helps cultivate transparent functions; implement error prevention measures and facilitate corrective actions and transfer knowledge and skill.