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Copyright of World Journal of Surgery is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The current fourth industrial revolution is a distinct technological era characterised by the blurring of physics, computing and biology. The driver of change is data, powered by artificial intelligence. The UK National Health Service Topol Report embraced this digital revolution and emphasised the importance of artificial intelligence to the health service. Application of artificial intelligence within regional anaesthesia, however, remains limited. An example of the use of a convoluted neural network applied to visual detection of nerves on ultrasound images is described. New technologies that may impact on regional anaesthesia include robotics and artificial sensing. Robotics in anaesthesia falls into three categories. The first, used commonly, is pharmaceutical, typified by target-controlled anaesthesia using electroencephalography within a feedback loop. Other types include mechanical robots that provide precision and dexterity better than humans, and cognitive robots that act as decision support systems. It is likely that the latter technology will expand considerably over the next decades and provide an autopilot for anaesthesia. Technical robotics will focus on the development of accurate sensors for training that incorporate visual and motion metrics. These will be incorporated into augmented reality and visual reality environments that will provide training at home or the office on life-like simulators. Real-time feedback will be offered that stimulates and rewards performance. In discussing the scope, applications, limitations and barriers to adoption of these technologies, we aimed to stimulate discussion towards a framework for the optimal application of current and emerging technologies in regional anaesthesia. [ABSTRACT FROM AUTHOR]

Summary: Virtual reality is a form of high‐fidelity simulation that may be used to enhance the quality of medical education. We created a bespoke virtual reality trainer software using high resolution motion capture and ultrasound imagery to teach cognitive‐motor needling skills necessary for the performance of ultrasound‐guided regional anaesthesia. The primary objective of this study was to determine the construct validity between novice and experienced regional anaesthetists. Secondary objectives were: to create learning curves for needling performance; compare the virtual environment immersion with other high‐fidelity virtual reality software; and compare cognitive task loads imposed by the virtual trainer compared with real‐life medical procedures. We recruited 21 novice and 15 experienced participants, each of whom performed 40 needling attempts on four different virtual nerve targets. Performance scores for each attempt were calculated based on measured metrics (needle angulation, withdrawals, time taken) and compared between the groups. The degree of virtual reality immersion was measured using the Presence Questionnaire, and cognitive burden was measured using the NASA‐Task Load Index. Scores by experienced participants were significantly higher than novices (p = 0.002) and for each nerve target (84% vs. 77%, p = 0.002; 86% vs. 79%, p = 0.003; 87% vs. 81%, p = 0.002; 87% vs. 80%, p = 0.003). Log–log transformed learning curves demonstrated individual variability in performance over time. The virtual reality trainer was rated as being comparably immersive to other high‐fidelity virtual reality software in the realism, possibility to act and quality of interface subscales (all p > 0.06) but not in the possibility to examine and self‐performance subscales (all p < 0.009). The virtual reality trainer created workloads similar to those reported in real‐life procedural medicine (p = 0.53). This study achieved initial validation of our new virtual reality trainer and allows progression to a planned definitive trial that will compare the effectiveness of virtual reality training on real‐life regional anaesthesia performance. [ABSTRACT FROM AUTHOR]

• Examined links between greenspace and mental health over the lifecourse. • Employed a spatial lifecourse epidemiological framework. • Childhood greenspace was not associated with any adolescent mental health outcomes. • Greenspace showed a protective effect for depressive symptoms across adulthood. • No links were found between greenspace and anxiety or suicidal ideation in adulthood. The beneficial impacts of greenspace availability on mental health are well-documented. However, longitudinal evidence using a spatial lifecourse perspective is rare, leaving the dynamics of how greenspace influences mental health across the lifecourse unclear. This study first uses prospective birth cohort data to examine the associations between greenspace availability in childhood (0–16 years) and mental health in adolescence (16 years) and between greenspace availability and mental health across adulthood (18–40 years). Data were obtained from the Christchurch Health and Development Study, comprised 1,265 cohort members born in Christchurch, New Zealand, in 1977. Mental health outcomes including depressive symptoms, anxiety disorders and suicidal ideation were assessed in adolescence (16 years), and in adulthood (18–40 years). Greenspace availability from birth to age 40 years was measured as the proportion of vegetated areas within circular buffers (radius from 100m to 3000m) around members' geocoded residential addresses using a time-series impervious surfaces data from 1985 to 2015. Bayesian Relevant Lifecourse exposure models examined the associations between childhood greenspace availability and adolescent mental health and tested for critical/sensitive age periods. Generalised Estimating Equation logistic regression models assessed the associations between greenspace availability and mental health across adulthood. These analyses were adjusted for various important individual, family, and area-level covariates. No associations were found between childhood greenspace availability and any adolescent mental health conditions. However, in adulthood, a one standard deviation increase in greenspace availability within 1500m and 2000m buffers was associated with a 12% and 13% reduced risk of depressive symptoms, respectively, after adjusting for various covariates. This study supports the protective effects of greenspace on adult depressive symptoms, highlighting the significance of employing a spatial lifecourse epidemiology framework to examine the long-term effects of environmental factors on health over the lifecourse. [ABSTRACT FROM AUTHOR]