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STUDY OBJECTIVE: To develop and validate a procedure-specific scoring algorithm to objectively measure robotic surgical skills during robot-assisted hysterectomy and to facilitate robotic surgery training and education.

DESIGN: (Canadian Task Force classification III).

SETTING: A National Comprehensive Cancer Network-designated comprehensive cancer center.

PATIENTS: Deidentified videos for robot-assisted hysterectomies were evaluated.

INTERVENTIONS: Videos from 26 robotic hysterectomies performed by surgeons with varying degrees of experience using the scoring system were evaluated. In phase I, critical elements of a robotic hysterectomy were deconstructed into 6 key domains to assess technical skills for procedure completion. Anchor descriptions were developed for each domain to match a 5-point Likert scale. Delphi methodology was used for content validation. A panel of 5 expert robotic surgeons refined this scoring system. In phase II, video recordings of procedures performed by surgeons with varying degrees of experience (expert, advanced beginner, and novice) were evaluated by blinded expert reviewers using the scoring system. Descriptive statistics were used to summarize the scores for each domain. Intraclass correlation was used to determine the interrater reliability. A p value <.05 was considered significant.

MEASUREMENTS AND MAIN RESULTS: The average score for the 3 classes of surgeon was 75.6 for expert, 71.3 for advanced beginner, and 69.0 for novice (p = .006). There were significant differences in scores of most individual domains among the various classes of surgeons. Novice surgeons took significantly longer than expert surgeons to complete their half of a hysterectomy (22.2 vs 12.0 minutes; p = .001).

CONCLUSION: This pilot study demonstrates the feasibility of using a standardized rubric for clinical skills assessment in robotic hysterectomy. Blinded expert reviewers were able to differentiate between varying levels of surgical experience using this assessment tool.

STUDY OBJECTIVE: To develop and validate a procedure-specific scoring algorithm to objectively measure robotic surgical skills during robot-assisted hysterectomy and to facilitate robotic surgery training and education.

DESIGN: (Canadian Task Force classification III).

SETTING: A National Comprehensive Cancer Network-designated comprehensive cancer center.

PATIENTS: Deidentified videos for robot-assisted hysterectomies were evaluated.

INTERVENTIONS: Videos from 26 robotic hysterectomies performed by surgeons with varying degrees of experience using the scoring system were evaluated. In phase I, critical elements of a robotic hysterectomy were deconstructed into 6 key domains to assess technical skills for procedure completion. Anchor descriptions were developed for each domain to match a 5-point Likert scale. Delphi methodology was used for content validation. A panel of 5 expert robotic surgeons refined this scoring system. In phase II, video recordings of procedures performed by surgeons with varying degrees of experience (expert, advanced beginner, and novice) were evaluated by blinded expert reviewers using the scoring system. Descriptive statistics were used to summarize the scores for each domain. Intraclass correlation was used to determine the interrater reliability. A p value <.05 was considered significant.

MEASUREMENTS AND MAIN RESULTS: The average score for the 3 classes of surgeon was 75.6 for expert, 71.3 for advanced beginner, and 69.0 for novice (p = .006). There were significant differences in scores of most individual domains among the various classes of surgeons. Novice surgeons took significantly longer than expert surgeons to complete their half of a hysterectomy (22.2 vs 12.0 minutes; p = .001).

CONCLUSION: This pilot study demonstrates the feasibility of using a standardized rubric for clinical skills assessment in robotic hysterectomy. Blinded expert reviewers were able to differentiate between varying levels of surgical experience using this assessment tool.

OBJECTIVES: Many noninvasive methods (using breath, blood, and stool samples) are available to diagnose Helicobacter pylori. However, because the noninvasive tests are proxy measures of the infection, they need validation before use. Factors that may affect test validity include patient age, gender, and geographic location. Because no data were available on the validation of noninvasive tests for the diagnosis of H. pylori among children in the Middle East, this study was performed.

METHODS: Children between 2 and 17 years of age evaluated at the Cairo University School of Medicine pediatric gastroenterology clinic who were already scheduled for upper endoscopy were eligible for enrollment in the study. At the time of endoscopy, 3 biopsies were collected and used for rapid urease, histology, and culture, respectively. All children also donated a sample of stool and blood and had a urea breath test performed. Stool and serum samples were tested for the presence of H. pylori by using commercially available enzyme-linked immunosorbent assay-based technology. The sensitivity, specificity, and positive and negative predictive values were calculated for each noninvasive test used in the study. Receiver operating curves also were charted to determine optimal cut points for the various tests when used in the current study cohort.

RESULTS: One hundred eight children were enrolled in the study, with 52 children being under 6 years of age. The urea breath test and HpStar (DakoCytomation, Norden, Denmark) stool enzyme-linked immunosorbent assay kit had the highest sensitivity and specificity (sensitivity and specificity: 98 and 89 [urea breath test] and 94 and 81 [HpStar], respectively), whereas the serologic kit had an unacceptably low sensitivity (50%). The sensitivity of neither the urea breath test nor the HpStar tests was affected by subject age, but specificity of the HpStar test, although still high, was significantly lower among children under 6 years. Receiver operating curves found optimal cut points of the urea breath test at 6.2 delta over baseline and of the HpStar at 0.25 enzyme-linked immunosorbent assay units.

CONCLUSION: The urea breath test and HpSTAR stool antigen kit are reliable tests for the noninvasive diagnosis of H. pylori among children living in the Middle East.

Cairo Air Pollution and Climate (CAPAC) is dedicated to the understanding of the urban energy balance in Cairo, Egypt, through measurements from space and at ground stations. The in situ measurements will provide a focussed insight into three carefully chosen microclimates (urban, suburban-agriculture, and suburban-desert) and provide at the same time ground-truth data for satellite image analysis, which will expand the acquired knowledge into the spatial domain. In situ measurements were made during a field campaign in Greater Cairo from November 2007 to February 2008. In this study, the dataset of the CAPAC measurement campaign will be presented and analysed in terms of use for a remote sensing study. Measured variables complied with our expectations. The urban area featured a distinct nocturnal heat island. During the day the choice of reference station was responsible for the magnitude of the heat island. The diurnal cycle of radiative temperature at the suburban-desert station clearly exceeded the one at the urban station, thus the urban setting seemed to have a better heat storage than the suburban-desert. The stations also determined the partitioning of the turbulent heat fluxes. While in Cairo and at the suburban-desert station most of the available energy was partitioned into the sensible heat flux, the suburban-agricultural station maintained a high latent heat flux. The radiation and soil heat flux measurements proved to be applicable for comparison with remotely sensed data. However, the analysis of the turbulent heat fluxes showed that several constraints exist: measured fluxes tend to underestimate the actual flux and directional effects complicate the interpretation. An energy balance closure and footprint modelling is necessary to compare measured fluxes with satellite image retrieved products. Finally, turbulent fluxes are time averages, which is contrary to the remote sensing principle. Consequently, a direct use is problematic. Copyright © 2010 Royal Meteorological Society

Cairo Air Pollution and Climate (CAPAC) is dedicated to the understanding of the urban energy balance inCairo, Egypt, through measurements from space and at ground stations. The in situ measurements will provide a focused insight into three carefully chosen microclimates (urban, suburban-agriculture, and suburban-desert) and provide at the sametime ground-truth data for satellite image analysis, which will expand the acquired knowledge into the spatial domain. Insitu measurements were made during a field campaign in Greater Cairo from November 2007 to February 2008. In thisstudy, the dataset of the CAPAC measurement campaign will be presented and analysed in terms of use for a remote sensingstudy. Measured variables complied with our expectations. The urban area featured a distinct nocturnal heat island. Duringthe day the choice of reference station was responsible for the magnitude of the heat island. The diurnal cycle of radiativetemperature at the suburban-desert station clearly exceeded the one at the urban station, thus the urban setting seemed tohave a better heat storage than the suburban-desert. The stations also determined the partitioning of the turbulent heat fluxes.
While in Cairo and at the suburban-desert station most of the available energy was partitioned into the sensible heat flux,the suburban-agricultural station maintained a high latent heat flux. The radiation and soil heat flux measurements provedto be applicable for comparison with remotely sensed data. However, the analysis of the turbulent heat fluxes showedthat several constraints exist: measured fluxes tend to underestimate the actual flux and directional effects complicate theinterpretation. An energy balance closure and footprint modelling is necessary to compare measured fluxes with satelliteimage retrieved products. Finally, turbulent fluxes are time averages, which is contrary to the remote sensing principle. Consequently, a direct use is problematic.

A total of 864 brown-egg laying pullets was used to study the effects of the main cereal of the diet (500 g maize or wheat/kg) and particle size of the cereal (hammer milled to pass through a 6-, 8-, and 10-mm screen) on growth performance and digestive traits from 1 to 120 d of age. Each of the six treatments was replicated six times (24 pullets per replicate). Type of cereal did not affect pullet performance at any age.From1 to 45 d of age, body weight (BW) gain was increased (P<0.001) and feed conversion ratio was improved (P<0.05) as the particle size of the cereal was reduced, but no effects were observed after this age. At 45 d of age, pullets fed maize tended (P<0.10) to have a heavier relative weight (RW, g/kg BW) of the total digestive tract and proventriculi and a higher relative length (RL, cm/kg BW) of the small intestines (SI) than pullets fed wheat. Also at this age, the RW of the digestive tract increased (P<0.05) with increases in the particle size of the cereal. At 120 d of age, dietary treatment did not affect the RW of any of the organs studied or gizzard pH but the RL of the SI was higher (P<0.05) for pullets fed wheat than for pullets fed maize. Also, the RL of the SI was reduced (P<0.05) as the particle size of the cereal increased. We conclude that 500 g wheat/kg can be included in pullet feeds from 1 to 120 d of age, and that particle size of the cereal affects pullet performance during the first 45 d of life but not thereafter. Therefore, it is recommended to grind the cereal used in this period with a screen size of no more than 8mm.