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Educational Time Out (ETO) incorporates intraoperative goal setting, task delineation, and debriefing. ETO has been previously reported to generate positive learning experiences for residents. This study aimed to study the impact of ETO on surgery residents’ cognitive load. A cross-over study design utilized the ETO arm during the first half of the rotation followed by no ETO for the second half. Surgery residents completed a modified NASA Task Load Index (NASA TLX) questionnaire following each operative case to report their cognitive load. 141 modified NASA TLX questionnaire responses were obtained where ETO occurred in 73 responses and no ETO in 68 responses. Residents reported a higher performance (p = 0.004) and a lower frustration (p = 0.018) component scores when ETO occurred. This study identified improved cognitive load on the modified NASA TLX instrument with higher performance and lower frustration scores associated with trainees who underwent preoperative goal setting with an ETO using the GUTS method. •Cross-over study examining the impact of Educational Time Out (ETO) on cognitive load.•Trainees reported improved cognitive load with ETO as intraoperative teaching method.•ETO using GUTS method was associated with lower resident reported frustration level.

Background While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019–2020 Hong Kong social unrest, this study explored the correlations between trauma victims’ quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms. Methods Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20– to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants’ SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective. Results The study reveals how metaphor usage patterns can reflect the speakers’ differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns. Conclusion This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.

Small primary breast cancers can show surprisingly high potential for metastasis. Clinical decision-making for tumor aggressiveness, including molecular profiling, relies primarily on analysis of the cancer cells. Here we show that this analysis is insufficient — that the stromal microenvironment of the primary tumor plays a key role in tumor cell dissemination and implantation at distant sites. We previously described 2 cancer-associated fibroblasts (CAFs) that either express (CD146 + ) or lack (CD146 – ) CD146 (official symbol MCAM, alias MUC18). We now find that when mixed with human breast cancer cells, each fibroblast subtype determines the fate of cancer cells: CD146 – fibroblasts promoted increased metastasis compared with CD146 + fibroblasts. Potentially novel quantitative and qualitative proteomic analyses showed that CD146 + CAFs produced an environment rich in basement membrane proteins, while CD146 – CAFs exhibited increases in fibronectin 1, lysyl oxidase, and tenascin C, all overexpressed in aggressive disease. We also show clinically that CD146 – CAFs predicted for likelihood of lymph node involvement even in small primary tumors (<5 cm). Clearly small tumors enriched for CD146 – CAFs require aggressive treatments.

The invasion of bladder cancer into the sub-urothelial muscle and vasculature are key determinants leading to lethal metastatic progression. However, the molecular basis is poorly understood, partly because of the lack of uncomplicated and reliable models that recapitulate the biology of locally invasive disease. We developed a surgical grafting technique, characterized by a simple, rapid, reproducible and high-efficiency approach, to recapitulate the pathobiological events of human bladder cancer invasion in mice. This technique consists of a small laparotomy and direct implantation of human cancer cells into the bladder lumen. Unlike other protocols, it does not require debriding of the urothelial lining, injection into the bladder wall, specialized imaging equipment, bladder catheterization or costly surgical equipment. With minimal practice, the procedure can be executed in <10 min. Tumors develop with a high take rate, and most cell lines exhibit local invasion within 4 weeks of implantation. A small laparotomy is carried out, and human cancer cells are implanted into the mouse bladder lumen. This reproduces the pathobiological events of human bladder cancer invasion in mice.

Soft robotic hands can facilitate human–robot interaction by allowing robots to grasp a wide range of objects safely and gently. However, their performance has been hampered by a lack of suitable sensing systems. We present a flexible and stretchable multi-modal sensor network integrated with a soft robotic hand. The design of wired sensors on a flexible metalized film was embodied through a manufacturing approach that uses both UV laser metal ablation and plastic cutting simultaneously to create sensor electrode and stretchable conductive wires in a Kirigami pattern into a single network. We evaluated the interconnects and sensors by measuring an impedance change to each external stimulus and showed that are not substantially affected by stretching the network. With the sensor sheet wrapped around a soft robotic gripper, we demonstrated several interaction scenarios, including a warm burrito for food handling, and a warm baby doll for medical applications.

Abstract Precise calibration of ultrasonic probes is vital for the accuracy of image-guided surgical procedures, where exact positioning of instruments is crucial. Conventional methods depend on phantoms with defined geometries—such as wires, steps, wedges, styluses, or cones—but these approaches are prone to errors due to manufacturing tolerances, insufficient sampling across six degrees of freedom, and time delays between tracking systems and ultrasound image acquisition. Additionally, most current techniques address spatial and temporal calibration separately, which increases complexity and prolongs the process. To address this issue, we propose a robust and rapid calibration technique for ultrasonic probes, utilizing a straightforward phantom that can be easily fabricated in a laboratory environment, alongside a newly developed algorithm. We designed a phantom with randomly placed spherical features of various gelatins. The phantom is computed tomography (CT)-visible so that the phantom features are accurately measured via CT, obviating the need for high-precision phantom fabrication. The ultrasonic probe and phantom were tracked by an optical tracking system to transform the phantom's coordinate system into the probe's coordinate system. Furthermore, an algorithm for synchronization was developed to compensate for the 150 ms delay in the system. We developed an easily-fabricated phantom and conducted a CT scan to accurately capture its geometry for ultrasonic spatial calibration. The projected images of the phantom, captured using an ultrasonic probe, showed ellipses. By measuring the centres, major, and minor axes of these ellipses, we estimated calibration parameters with the newly proposed algorithm that aligns the images with the transformation between the probe and the phantom. We conducted the calibration at three ultrasonic imaging depths: 6, 9, and 12 cm. Three operators continuously swept the probe over the phantom without stopping or controlling speed, achieving an average error of 1.2106 mm. While numerous studies have proposed various methodologies, they face challenges in phantom fabrication, non-universality of the approach, and susceptibility to significant errors when deviating slightly from pre-defined constraints. Our approach, featuring real-time spatial calibration at various depths, consistently achieves precise alignments with minimal errors, proving its potential for widespread applications. Graphical Abstract Graphical Abstract

We evaluated the physiological efficacy and safety of a novel device-based preload reduction strategy that applies external cyclic compression to the superior vena cava (SVC) in a preclinical heart failure model. Heart failure was induced in eleven pigs using ischemia–reperfusion injury, and a 3D-printed SVC compression device was tested under varying compression ratios (70%, 85%, and 100%) and protocols. Hemodynamic responses were monitored using right-heart catheterization and pressure–volume loop analysis. Among the tested conditions, cyclic compression at 85% with 20/5-minute compression–release cycles resulted in marked within-group improvements in key hemodynamic parameters. Cardiac output increased by 27.3% (3.83 to 4.88 L/min, Wilcoxon signed-rank test, p  = 0.125) and stroke volume by 19.5% (38.6 to 46.1 mL, p  = 0.125), while mean arterial and pulmonary pressures remained stable. Systemic vascular resistance decreased by 29.0% (from 1,200 to 852 dyn·s·cm − 5 , p  = 0.125), accompanied by reductions in left ventricular end-diastolic pressure and a trend suggestive of improved contractility. These results demonstrate that externally applied cyclic SVC compression effectively reduces preload and augments cardiac performance without compromising hemodynamic stability. Our study provides a proof-of-concept for the clinical utility of device-driven external cyclic compression of the SVC as an adjunctive therapy for acute decompensated heart failure, especially in perioperative or critical care settings, and supports further development toward an implantable clinical system. These findings are preliminary, based on small subgroup sizes ( n  = 1, n  = 2, n  = 4, and n  = 4), and require confirmation in larger, adequately powered studies. Future development of a fully implantable and autonomous version of the device could enable real-time, closed-loop preload modulation in advanced heart failure care.

This work presents a modular approach to the development of strain sensors for large deformations. The proposed method separates the extension and signal transduction mechanisms using a soft, elastomeric transmission and a high-sensitivity microelectromechanical system (MEMS) transducer. By separating the transmission and transduction, they can be optimized independently for application-specific mechanical and electrical performance. This work investigates the potential of this approach for human health monitoring as an implantable cardiac strain sensor for measuring global longitudinal strain (GLS). The durability of the sensor was evaluated by conducting cyclic loading tests over one million cycles, and the results showed negligible drift. To account for hysteresis and frequency-dependent effects, a lumped-parameter model was developed to represent the viscoelastic behavior of the sensor. Multiple model orders were considered and compared using validation and test data sets that mimic physiologically relevant dynamics. Results support the choice of a second-order model, which reduces error by 73% compared to a linear calibration. In addition, we evaluated the suitability of this sensor for the proposed application by demonstrating its ability to operate on compliant, curved surfaces. The effects of friction and boundary conditions are also empirically assessed and discussed.