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Background A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery. Methods A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress. Results Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress. Conclusion Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty. [ABSTRACT FROM AUTHOR]

Byline: Saket. Kumar, Nishant. Kurian, Rakesh. Singh, Venkat. Chidipotu, Sanjay. Kumar, Amarjit. Raj, Manish. Mandal Aim: Remnant cystic duct stump calculi are an uncommon but important cause of 'post-cholecystectomy syndrome'. [...]

Soil–alkali-interaction results in unexpected heaving and other negative effects of soil properties, which can lead to complete failure of structures. An investigation was carried out on the impact of highly concentrated sodium hydroxide alkali on the heaving behaviour of low-plasticity clay. The effect of ground-granulated blast-furnace slag as a stabiliser for alkali-interacted soil was also investigated. The interaction of alkali with the soil showed heaving up to 5.25% after 30 days, while a slag content of 20% showed maximum suppression of heave. The alkali-interacted soil stabilised with slag was also compared with un-interacted soil mixed with slag. There was a marginal increase in friction angle with an increase in curing period, and a significant increase in cohesion for both. A substantial improvement in unconfined compressive strength was also evident with increased slag content and curing period. The results were supported by microstructural examinations. The application of slag as a liquid-based stabiliser for alkali-interacted soil was also conducted using electrokinetics. Statistical analysis indicated that the curing period was a dominant parameter in affecting the compressive strength of un-interacted soil while, for alkali-interacted soil, slag content was more dominant. [ABSTRACT FROM AUTHOR]

Background: A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery., Methods: A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress., Results: Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress., Conclusion: Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)