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We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.
Design and setting:
This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.
We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.
This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.
The collaboration principle in multimedia learning, which consists of three related sub-principles, determines when and under what conditions collaboration will positively affect learning in a multimedia environment. Flashmeeting is an example of multimedia collaborative environment that allows for tasks of various complexities to be carried out (Principle 1) and stimulates groups cognitive processes (Principle 2) by providing tools for real-time group work (with synchronous sound, pictures, text, etc.), a repository for sharing documents, and even recording facilities for the meeting, making information available to all participants asynchronously after the meeting has taken place (Principle 3). Collaboration in multimedia learning is effective when the distribution of tasks is such that the cognitive processes involved in carrying out the tasks and the products of those processes are complementary and/or supplementary. The collaborative principles in multimedia learning rest for a large part on hypotheses and assumptions about cognitive load.
The allure of personal epistemology research is the implicit assumption that in some cases students’ poor academic performance may not be due to any deficiency in skill or ability, but rather due to their naïve beliefs about knowledge and knowing (Hofer and Pintrich, 1997). Numerous researchers have asserted that naïve or less sophisticated beliefs about the nature of knowledge and knowing may cause students to memorize facts rather than construct conceptual knowledge, poorly monitor and regulate their learning, exert little effort, and neglect essential thinking skills (Hofer, 2002, 2004a, 2004 b). These students act as mere receivers of information (Belenky et al., 1986) and not active constructors of knowledge who appropriately question authority figures or other sources of knowledge (Baxter Magolda, 2004; King and Kitchener, 1994; Perry, 1970). However, according to personal epistemology researchers, if these students could be shown that knowledge is complex and dynamic, they would see the need for critical thinking skills to evaluate the justifications for knowledge claims and be able to construct complex and coherent knowledge whose warrants could be both appropriately scrutinized when necessary and utilized in a convincing manner on tests, papers, and other academic assignments (Kuhn and Weinstock, 2002). Such sophistication is often described as a prerequisite for success in higher education (Boyer, 1987; Sullivan and Rosin, 2008). Yet, the research on personal epistemology is not clear whether elementary or secondary school students are likely to have or need such sophisticated beliefs regarding the nature of knowledge and knowing.
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