† Visual attention, as an underlying process of situational awareness (SA), was studied in anaesthetists attending simulated critical incidents. † 20% of the attention was directed to patient monitor; this increased to 30% during critical incidents. † Manual tasks increased from 21% to 25% in experienced anaesthetists and decreased from 20% to 14% in inexperienced anaesthetists. † This small sample study provides important evidence of how experience changes SA of anaesthetists during simulated critical incidents.Background. Situation awareness (SA) is considered to be an important non-technical skill for delivering safe anaesthesia. The spatial distribution of visual attention (VA) is an underlying process for attaining adequate SA. In the present study, a novel technology was used to assess the distribution of VA in anaesthetists delivering anaesthesia. The impact of a critical incident on VA in relation to individual experience is analysed in a descriptive and exploratory manner.Methods. Fifteen anaesthetists induced general anaesthesia in a full-scale simulator while wearing a head-mounted eye-tracking camera system. After an uneventful session, workload was increased in a randomized order by simulation of a critical incident in the second or third session. Eye tracking was used for the assessment of individual's distribution of VA to monitors, patient, and environment. A post hoc video analysis revealed information about the spatial distribution of VA. Descriptive statistics and exploratory analysis were used.Results. Twenty per cent of VA was directed to the patient monitor (30% during critical incident scenarios, P¼0.003). The more experienced anaesthetists (more than 2 yr of work experience) increased the amount of time dedicated to manual tasks from 21% to 25% during critical incidents, whereas the less experienced decreased from 20% to 14% (P¼0.061).Conclusions. Distribution of attention is different during anaesthesia induction with critical incidents compared with uneventful anaesthesia induction. Less experienced anaesthesia providers spend more time on monitoring tasks. Further investigation in confirmatory designs is needed.
Pupil size and heart rate reflect workload increase within simulator sessions, but they do not permit overall workload comparisons between individuals or sessions. Contrary to our assumption, the duration of fixation decreased with increased workload. Saccade amplitude did not reflect workload fluctuations.
A convergent strategy was developed for the synthesis of the C12-C40 segment of (-)-pulvomycin. Key step was a diastereoselective aldol reaction between a chiral ethyl ketone representing the C24-C40 fragment and a chiral aldehyde representing the C12-C23 fragment. Both compounds were prepared from enantiomerically pure building blocks in a convergent fashion. The longest linear sequence commenced with a known D-fucose-derived glycosyl donor and entailed a total number of 16 steps. The desired anti-aldol product was obtained in a total yield of 5% over these steps and contains 12 out of 13 stereogenic centers present in the natural product.
In Scheme3 of this Research Article,t he triethylsilyl groups in structures 14, 16, 18 and 19 were incorrectly labelleda s" SET" rather than "TES". The corrected Scheme 3 is given below.Scheme3.Synthesis of the C1-C7 fragment 20 of pulvomycin Df rom iodide 14 and Weinreba mide 15.Conditionsfor the Pinnick-Lindgren oxidation: [26] NaOCl,N aH 2 PO 4 ,2 -methyl-2-butene, r.t. (tert-butanol/H 2 O = 1/1)
A synthetic route to the pulvomycin class of natural products is presented, which culminated in the first synthesis of a pulvomycin, pulvomycin D. Key elements of the strategy include a pivotal aldol reaction which led to bond formation between the C24‐C40 and the C8‐C23 fragment. The remaining C1‐C7 fragment was attached by a Yamaguchi esterification completing the assembly of the 40 carbon atoms within the main skeleton. Ring closure to the 22‐membered lactone ring was achieved in the final stages of the synthesis by a Heck reaction. The completion of the synthesis required the removal of six silyl protecting groups in combination with olefin formation at C26‐C27 by a Peterson elimination.
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