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The aim of this study was to develop machine learning classification models using electroencephalogram (EEG) and eye-gaze features to predict the level of surgical expertise in robot-assisted surgery (RAS). EEG and eye-gaze data were recorded from 11 participants who performed cystectomy, hysterectomy, and nephrectomy using the da Vinci robot. Skill level was evaluated by an expert RAS surgeon using the modified Global Evaluative Assessment of Robotic Skills (GEARS) tool, and data from three subtasks were extracted to classify skill levels using three classification models-multinomial logistic regression (MLR), random forest (RF), and gradient boosting (GB). The GB algorithm was used with a combination of EEG and eye-gaze data to classify skill levels, and differences between the models were tested using two-sample t tests. The GB model using EEG features showed the best performance for blunt dissection (83% accuracy), retraction (85% accuracy), and burn dissection (81% accuracy). The combination of EEG and eye-gaze features using the GB algorithm improved the accuracy of skill level classification to 88% for blunt dissection, 93% for retraction, and 86% for burn dissection. The implementation of objective skill classification models in clinical settings may enhance the RAS surgical training process by providing objective feedback about performance to surgeons and their teachers.

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Objective: Assessment of surgical skills is crucial for improving training standards and ensuring the quality of primary care. This study aimed to develop a gradient boosting classification model (GBM) to classify surgical expertise into inexperienced, competent, and experienced levels in robot-assisted surgery (RAS) using visual metrics. Methods: Eye gaze data were recorded from 11 participants performing four subtasks; blunt dissection, retraction, cold dissection, and hot dissection using live pigs and the da Vinci robot. Eye gaze data were used to extract the visual metrics. One expert RAS surgeon evaluated each participant's performance and expertise level using the modified Global Evaluative Assessment of Robotic Skills (GEARS) assessment tool. The extracted visual metrics were used to classify surgical skill levels and to evaluate individual GEARS metrics. Analysis of Variance (ANOVA) was used to test the differences for each feature across skill levels. Results: Classification accuracies for blunt dissection, retraction, cold dissection, and burn dissection were 95%, 96%, 96%, and 96%, respectively. The time to complete only the retraction was significantly different among the 3 skill levels (p-value = 0.04). Performance was significantly different for 3 categories of surgical skill level for all subtasks (p-values<0.01). The extracted visual metrics were strongly associated with GEARS metrics (R2>0.7 for GEARS metrics evaluation models). Conclusions: Machine learning (ML) algorithms trained by visual metrics of RAS surgeons can classify surgical skill levels and evaluate GEARS measures. The time to complete a surgical subtask may not be considered a stand-alone factor for skill level assessment.

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PURPOSE: To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN: Self-controlled cohort study. PARTICIPANTS: Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS: Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES: Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS: Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS: This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

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OBJECTIVE: There is a growing interest in using pre-heated composites instead of dual-cured cements when luting indirect restorations. This study evaluated the film thickness obtained from two pre-heated composites and two resin cements, by two different operators. The influence of the materials and the level of expertise of the operator were analyzed. MATERIALS AND METHODS: Forty specimens of human dentin and composite discs were prepared and divided into four groups depending on the luting process. Each group was randomly equally divided to be handled by two operators with different levels of experience. Two of the initial four groups were luted using dual-cured cements and the two remaining groups using light-cured pre-heated composites. Specimen discs were cut after luting, and film thickness was measured using a Digital microscope. Data were analyzed using a 2-way ANOVA with the Holm-Sidak pairwise multiple comparison procedure (p < 0.05). RESULTS: Mean film thickness ranged from 156.16 ± 4.7 to 33.82 ± 0.7 µm. Significant differences (p < 0.001) were noticed between expert and novice results with pre-heated composites. CONCLUSION: Within the limits of this study, using pre-heated composites as a luting cement requires a better level of expertise to achieve a clinically acceptable film thickness. CLINICAL SIGNIFICANCE: Using pre-heated composites as luting agent for indirect restorations requires an experimented skill level to achieve a clinically recommended film thickness.

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The purpose of this study was to understand the perceptions of highly skilled and less skilled volleyball players about the influences that parents, coaches, and peers had on their sport development and performance achievement. Highly skilled (n = 30) and less skilled (n = 30) volleyball players participated in semi-structured retrospective interviews to explain how parents, coaches and peers may have influenced their sport participation. Data was analyzed through a process of content analysis. Results indicated that parents, coaches, and peers had an important influence in player's sport development but differing according to players' expertise level. Concerning to parental influences, tangible support during the early years of development was mentioned by all players. However, parents' level of involvement and parenting styles revealed interesting differences between highly skilled and less skilled players. Highly skilled players perceived a moderate parental involvement and an autonomy-supportive parenting style, while less skilled players referred a excessive parental involvement in players' sport participation. Coaches influences showed to have some similarities in the early years with all players mentioning coaches as caring and recognizing their value as an athlete. However, highly skilled players described a different training environment characterized by a demanding coach, individualized instruction, and specific goal setting. Regarding peers' influence, all players recognized that friends were not only one of the main reasons to start playing volleyball, but also an important source of support to remain engaged and staying motivated to do sport. Highly skilled players, however, mentioned the importance of teammates' positive push and critiques during practice for enhancing their motivation, team cohesion and friendship. They also highlighted the importance of friends outside of sport in the later years of their career by acting as an escape from all the pressure that emerged from volleyball training and competition demands. Overall, these findings highlight different social influences according to the players' expertise level suggesting the need to examine more extensively the nature of significant others' support on athlete and talent development.

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BACKGROUND: Despite preventive methods and careful surgical technique, surgical site infection and incisional hernias are of main concern after the closure of surgical incisions and keep haunting abdominal wall wound healing. The aim of this study is to find how surgical expertise level modifies biomechanical properties of sutures commonly used in abdominal wall fascial closure (polypropylene, polyglactin 910, polydioxanone). MATERIALS AND METHODS: Surgery residents with different experience levels performed abdominal wall fascial closure in swine models with the previously mentioned suture materials. A standardized technique was used. Sutures were removed, and a tensile stress test was performed on the removed sutures. A total of 81 abdominal fascial closures were achieved. Time, extension, maximum tensile force (Ftmax), and maximum stress were measured and analyzed. RESULTS: The results of the polydioxanone stress test present a trend in three variables: extension, tensile force, and stress. The trend shows higher medians in the expert group and lower medians in the novice group. While using polypropylene sutures, medians in the expert group are the highest; however, a trend is not observed. Polyglactin 910 sutures have nonspecific behavior among the different experience groups and variables. Polypropylene is the material with the lowest Ftmax tested and fails at 42.64 (IQR 40.98-44.89) N. Regarding the elastic properties of the material, polyglactin demonstrates the least extension of all sutures tested, with a 14 (IQR 13.33-14.83) mm extension. This study demonstrates that polydioxanone has a superior Ftmax compared with polypropylene and has a superior extension at failure properties compared with polyglactin, confirming that polydioxanone could be the suture of choice used for abdominal wall fascial closure. CONCLUSIONS: Study results do not show statistically significant differences regarding the impact of the experience level of different general surgery residents in the biomechanical properties of sutures used in abdominal wall fascial closure.

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The relationship between anthropometric and physical characteristics of female handball players and throwing velocity is considered an important factor in handball performance. The aim of this study was to examine key differences in anthropometric and fitness characteristics between top elite and elite female players competing in the first Spanish handball league. A total of 89 players from the first Spanish handball league were divided into two groups, top elite (38) and elite (51) players, and assessed for anthropometric and fitness characteristics (throwing velocity, vertical jump and hand grip strength). A Student's t-test was used to determine whether a statistically significant difference between the two different levels of play occurred. Significant differences were found in age, body height, body mass, arm span, muscle mass, different girths (tensed and flexed arm, forearm, wrist, ankle), dominant hand width and length, different breadths (biacromial, bitrochanteric, bistyloid breadth and biepicondylar humerus) and fitness characteristics (hand grip strength and throwing velocity for different positions). Top elite players compared to elite players showed differences in anthropometric characteristics which were mainly located in the upper limbs and mostly were nonmodifiable aspects by training. Furthermore, the best players were able to maintain a high throwing velocity in different tactical situations.

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Motor imagery is the mental process of rehearsing or simulating a given action without overt movements. The aim of the present study is to examine plastic changes in relevant brain areas during motor imagery with increasing expertise level. Subjects (novices, intermediate and elite players) performed motor imagery of basketball throws under two experimental conditions (with-ball and without-ball). We found that all basketball players exhibited better temporal congruence (between motor imagery and motor execution) and higher vividness of motor imagery than novices. The vividness of motor imagery was higher for the with-ball than for the without-ball conditions in all three subject groups. The results from functional magnetic resonance imaging (fMRI) showed three different patterns of cortical activation. Activation in the left middle frontal gyrus increased and that in the left supplementary motor area decreased with increasing levels of motor expertise. Importantly, brain activation in the left postcentral gyrus was the highest in the intermediate players compared to both novices and elite players. For the elite group, these three areas showed higher activation in the without-ball condition than the with-ball condition, while the opposite trend was found in intermediate players. Our findings suggest that the level of motor expertise may be related to high-order brain functions that are linked to different activation patterns in different brain areas.

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The fixed duration of a team-handball game and its continuously changing situations incorporate an inherent temporal pressure. Also, the target's position is not foreknown but online determined by the player's interceptive processing of visual information. These ecological limitations do not favour throwing performance, particularly in novice players, and are not reflected in previous experimental settings of self-paced throws with foreknowledge of target position. The study investigated the self-paced and temporally constrained throwing performance without foreknowledge of target position, in team-handball experts and novices in three shot types (Standing Shot, 3Step Shot, Jump Shot). The target position was randomly illuminated on a tabloid surface before (self-paced condition) and after (temporally constrained condition) shot initiation. Response time, throwing velocity and throwing accuracy were measured. A mixed 2 (experience) X 2 (temporal constraint condition) ANOVA was applied. The novices performed with significantly lower throwing velocity and worse throwing accuracy in all shot types (p = 0.000) and, longer response time only in the 3Step Shot (p = 0.013). The temporal constraint (significantly shorter response times in all shot types at p = 0.000) had a shot specific effect with lower throwing velocity only in the 3Step Shot (p = 0.001) and an unexpected greater throwing accuracy only in the Standing Shot (p = 0.002). The significant interaction between experience and temporal constraint condition in throwing accuracy (p = 0.003) revealed a significant temporal constraint effect in the novices (p = 0.002) but not in the experts (p = 0.798). The main findings of the study are the shot specificity of the temporal constraint effect, as well as that, depending on the shot, the novices' throwing accuracy may benefit rather than worsen under temporal pressure. Key pointsThe temporal constraint induced a shot specific significant difference in throwing velocity in both the experts and the novices.The temporal constraint induced a shot specific significant difference in throwing accuracy only in the novices.Depending on the shot demands, the throwing accuracy of the novices may benefit under temporally constrained situations.

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El objetivo de este trabajo es determinar la(s) influencia(s) de los modelos de nivel de pericia y de metacognición, sobre la concepción de aprendizaje en estudiantes universitarios de psicología. Participaron 184 sujetos de ambos sexos, pertenecientes a la ciudad de Arica, Chile. Se utilizó el Inventario de Concepciones de Aprendizaje (Martínez, 2000) y el Cuestionario de Estrategias Metacognitivas (O’Neil y Abedi, 1996). Los resultados apuntan a que el nivel de pericia y las estrategias metacognitivas correlacionan significativamente con la concepción de aprendizaje. Sin embargo, en un análisis detallado para cada tipo de concepción de aprendizaje se encontraron diferencias estadísticas significativas entre ambos modelos explicativos. Estos resultados evidencian que las concepciones interpretativa y constructiva se ven mayormente influenciadas por el uso de estrategias metacognitivas de aprendizaje, en contraposición al tipo directivo, el cual es explicado, en mayor medida, por el nivel de pericia de los estudiantes.

The aim of this work is to determine how expertise level models and metacognition influence on undergraduate psychologist learning conception. 144 male and female participants from the city of Arica in Chile took part in this study. They responded the learning conception inventory (Martínez, 2000) and the metacognitive strategy questionnaire (O’Neil & Abedi, 1996). Results showed that expertise levels and metacognitive strategies significantly correlated with learning conceptions. However, in a detailed analysis design for each type of learning, statistically significant differences were found between the two explanatory models. These results suggest that the constructive and interpretative conceptions are largely influenced by the use of specific metacognitive strategies, in spite of the directive strategy, which is mainly explained by the student´s expertise levels.

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