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PubMed1989

Isokinetic dynamometry. Applications and limitations.

Isokinetic contraction is the muscular contraction that accompanies constant velocity limb movements around a joint. The velocity of movement is maintained constant by a special dynamometer. The resistance of the dynamometer is equal to the muscular forces applied throughout the range of movement. This method allows the measurement of the muscular forces in dynamic conditions and provides optimal loading of the muscles. However, during movements in the vertical plane, the torque registered by the dynamometer is the resultant torque produced by the muscular and gravitational forces. The error depends on the angular position and the torque potential of the tested muscle group. Several methods have been developed for the correction of gravitational errors in isokinetic data. The torque output also contains artefacts that are associated with the inertial forces during acceleration and deceleration periods before the development of the constant preset angular velocity. For an accurate assessment of muscle function, only constant velocity data should be analysed. The most frequently used isokinetic parameters are the maximum torque and the angular position where it was recorded, the torque output at different angular velocities of movement, the torque ratio of reciprocal muscle groups and the torque output during repeated contractions. The unique features of isokinetic dynamometry are optimal loading of the muscles in dynamic conditions and constant preselected velocity of movement. These features provide safety in the rehabilitation of patients with muscular and ligamentous injuries. Isokinetic dynamometry has also been used for the training of various muscle groups in order to improve the muscular performance in dynamic conditions. The movement velocity of different activities can be simulated during training in order to improve the training effect. Data acquisition and analysis have been improved by using computer systems interfaced to isokinetic dynamometers. Recently developed computer systems provide correction for gravitational and inertial errors, accurate computation of isokinetic parameters and real-time display of the torque output.

Biomechanical Phenomena↗

PubMed1993

A kinetic model of the circulatory regulation of tissue plasminogen activator during exercise, epinephrine infusion, and endurance training.

A computer simulation of the circulatory system was used to kinetically model secretion, inhibition, and clearance of tissue plasminogen activator (t-PA) during three different processes that increase active t-PA levels: epinephrine infusion, exercise, and endurance training. Infusion of epinephrine stimulated an increase in t-PA secretion that was proportional to the plasma epinephrine concentration. In addition, epinephrine infusion increased hepatic blood flow and t-PA clearance, thus slowing the increase of plasma t-PA levels. During exercise, t-PA levels increased due both to increased t-PA secretion and to decreased clearance secondary to reduced hepatic blood flow. The increase in t-PA secretion during exercise was directly proportional to the epinephrine concentration in blood with the same ratio of t-PA secretion to epinephrine as found during epinephrine infusion, suggesting that increased plasma epinephrine during exercise was the primary stimulus for t-PA secretion. Lastly, the simulation predicted that 6 months of endurance training produced a decrease in resting plasminogen activator inhibitor type 1 (PAI-1) secretion, resulting in less t-PA inhibition and an overall increase in active t-PA after training. Accurate analysis of the regulation of active t-PA levels in blood required simultaneous modeling of t-PA and PAI-1 secretion, hepatic clearance, and inhibition of t-PA by PAI-1.

Computer Simulation↗

PubMed1996

Open thoracotomy procedural competency: validity study of teaching and assessment modalities.

STUDY OBJECTIVES: To determine (1) reliability and validity estimates of three modalities used to assess open thoracotomy procedural competency and (2) the effect of computer practice on procedural performance as measured by the three assessment modalities. METHODS: An experimental, sequential assessment design with volunteer examinees completing all three assessment modalities (paper, computer, pig model) was implemented at the animal support facilities of a university medical school with an affiliated emergency medicine residency program. Level of physician training (student, resident, faculty) and type of computer practice (thoracotomy, cricothyrotomy) were independent variables. Procedural competency scores were determined for each modality; scores were defined in terms of performance time and performance accuracy for three thoracotomy procedures (opening the chest, pericardiotomy, and aortic cross-clamping). RESULTS: Thoracotomy performance on the pig reliably discriminated among examinees known to differ in level of training. However, computer simulation performance did not significantly differ among examinees with different levels of training. Computer simulation practice significantly improved later performance on the computer assessment (P < .05) but not on the pig assessment. The greatest predictor of procedural competency (time and accuracy) on the pig assessment was the ability to sequentially order procedural steps. CONCLUSION: This study establishes the pig model as superior to the paper and computer models as the criterion standard for open thoracotomy assessment. Psychometric properties support the pig model as the most reliable and valid model yet described for assessing thoracotomy procedural competency. Computer simulation practice using visual images (complex anatomy) and the sequential ordering of procedural steps through paper modeling show promise for teaching and assessment of prerequisite skills required to develop psychomotor procedural competency.

Animals↗

PubMed1996

Computer-based cognitive training in Alzheimer's disease patients.

Memory training programs for cognitively impaired patients have often been criticized for their lack of relevance to everyday activities. We therefore report our experience with four patients suffering from probable Alzheimer's disease, who were trained with a new computer-based program recently developed by our research group. An everyday task of personal relevance to the patient is simulated and trained on a PC-touch-screen using personal photographs of the patient's surroundings and biography. According to the degree of cognitive impairment, training has three major aspects 1) social competence in patients with beginning deficiencies, 2) orientation in patients with moderate disease, and 3) emotional aspects in patients with advanced deficiencies. The patient's training performance improved substantially. While psychopathometric tests showed no significant effects with regard to general cognitive performance, levels of motivation were high and there was a positive acceptance of the training and signs of emotional activation.

Aged↗

PubMed1995

[Computer-assisted individualized memory training in Alzheimer patients].

Memory training programs for cognitively impaired patients have often been criticized for their lack of relevance to everyday activities. We therefore report our experience with two patients suffering from probable Alzheimer's disease who were trained with a new computer-based program recently developed by our research group. An everyday task of personal relevance to the patient was simulated and trained on a PC touch screen using personal photographs of the patient's surroundings and biography. The patient's training performance (time, mistakes, number of advices) improved substantially. While psychopathometric tests showed no significant effects with regard to general cognitive performance, levels of motivation were high and there was a positive acceptance of the training, signs of emotional activation and of a transfer of the trained skills into real situations.

Activities of Daily Living↗

PubMed1988

Respiratory and cardiac responses to exercise-simulating peripheral perfusion in endurance trained and untrained rats. II. Temporal relationships between outflow parameters and cardiac and respiratory responses.

In endurance trained (TR) and untrained (UTR) rats heart rate (HR) and respiratory rate (RR) were recorded during perfusion of the circulatorily isolated hind leg of the rat with exercise simulating modified tyrode solutions (TR:n = 10, UTR:n = 10; compare part I). During the 20 min test period and the preceding and succeeding periods of control perfusions with an unmodified tyrode solution, [lactate], pH, [K+], [Na+], PO2 and PCO2 were measured in the outflow of the femoral vein. In 3 experimental series: (1) hypoxic tyrode solution enriched with lactic acid (15 mmol.l-1), (2) normoxic solution with lactic acid, (3) hypoxic solution without lactic acid, were applied. The outflow parameters were cross correlated with both HR and RR. The analysis revealed a significant temporal relationship between [lactate], pH, PO2, PCO2 and [K+] and both HR and RR. In the trained rats no temporal correlation between either of the outflow and reflex parameters could be determined. This result was not due to low [lactate], but was also found during perfusion with lactic acid. In all 3 test conditions [lactate] in untrained individuals was best correlated with both HR and RR. Although the correlation peaks of the respiratory response, but not of the HR response were definitely lower in normoxic lactic and perfusion than in the two other experimental conditions, both inter- and intraindividual correlation analyses revealed a high degree of interdependence between respiratory and cardiac responses.

Animals↗

PubMed1995

A statistically tailored neural network approach to tomographic image reconstruction.

In previous work it has been shown that a standard backpropagation neural network can be trained to reconstruct sections of single photon emission computed tomography (SPECT) images based on the planar image projections as inputs. In this study, it is demonstrated that an artificial neural network (ANN) trained on a series of simulated SPECT images or trained on a set of rudimentary geometric images can learn the planar data-to-tomographic image relationship for 64 x 64 tomograms. As a result, a properly trained ANN can produce accurate, novel image reconstructions but without the high computational cost inherent in some traditional reconstruction techniques. We also present a method of deriving activation functions for a backpropagation ANN that make it readily trainable for cardiac SPECT image reconstruction. The activation functions are derived from the estimated probability density functions (p.d.f.s) of the ANN training set data. The performance of the statistically tailored ANNs are compared with the performance of standard sigmoidal back-propagation ANNs, both in terms of their trainability and generalization ability. The results presented demonstrate that statistically tailored ANNs are significantly better than standard sigmoidal ANNs at reconstructing novel tomographic images based on a simulated SPECT image training set or a rudimentary geometric image training set. Neural network based image reconstruction has two potential advantages over conventional reconstruction methods. The first advantage is that ANNs can rapidly reconstruction tomograms. Secondly, the quality of the reconstructions produced are directly correlated to the quality of the images used to train the ANN.

Heart↗

PubMed2026

Nondominant Hand Training in Laparoscopy for Surgical Interns: Feasibility and Impact.

OBJECTIVE: Laparoscopy requires bimanual proficiency, yet early trainees demonstrate underdeveloped nondominant hand (NDH) performance. Although deliberate practice of NDH skill contributes to overall performance, NDH training is rarely incorporated into residency simulation curricula and has not been formally evaluated in surgical trainees. We assessed feasibility and impact of integrating structured NDH training with established laparoscopic curriculum for surgery interns. DESIGN: Prospective, single-institution randomized pilot study. Interns were assigned the standard 4-week curriculum of laparoscopic dominant hand and bimanual tasks (Control) or completed assigned NDH tasks in addition to the standard curriculum (Intervention). Feasibility was determined by assigned task completion, daily standard and NDH-specific self-reported practice time, and improvement in bimanual task performance. Performance was video recorded weekly and assessed by blinded evaluators using MISTELS and GOALS scoring. Cognitive workload during laparoscopic tasks was measured via NASA-TLX. Exploratory analyses were conducted within a Bayesian framework. SETTING: A single academic institution with a surgical simulation training program. PARTICIPANTS: General surgery interns on their 4-week simulation rotation. RESULTS: Eleven general surgery interns (6 intervention, 5 controls; all right-hand dominant) completed the study with 100% task completion and practice log compliance. Both groups improved in bimanual performance and perceived cognitive load. Reduction in cognitive workload during bimanual task performance was greater in the NDH group. Time spent on NDH practice over 4 weeks was associated with improved bimanual performance, independent of time spent on standard curriculum tasks. CONCLUSIONS: Structured NDH training is feasible to implement within an existing curriculum and reduces perceived cognitive workload during bimanual laparoscopic tasks. NDH practice demonstrates a beneficial dose-response relationship with performance, supporting its integration into early laparoscopic training.

Laparoscopy↗

PubMed1996

A simple spike train decoder inspired by the sampling theorem.

Reconstructing a time-varying stimulus estimate from a spike train (Bialek's "decoding" of a spike train) has become an important way to study neural information processing. In this paper, we describe a simple method for reconstructing a time-varying current injection signal from the simulated spike train it produces. This technique extracts most of the information from the spike train, provided that the input signal is appropriately matched to the spike generator. To conceptualize this matching, we consider spikes as instantaneous "samples" of the somatic current. The Sampling Theorem is then applicable, and it suggests that the bandwidth of the injected signal not exceed half the spike generator's average firing rate. The average firing rate, in turn, depends on the amplitude range and DC bias of the injected signal. We hypothesize that nature faces similar problems and constraints when transmitting a time-varying waveform from the soma of one neuron to the dendrite of the postsynaptic cell.

Action Potentials↗

PubMed1997

A prototype simulator for endovascular repair of abdominal aortic aneurysms.

A prototype simulator for training in endovascular repair of abdominal aortic aneurysms (AAA) has been developed. Employing transparent models of human AAA complete with renal, iliac and femoral arteries, this system allows accurate simulation of aortography, road-mapping, catheter guidewire manipulation and stent-graft deployment while obviating the need for ionising radiation.

Aortic Aneurysm, Abdominal↗

PubMed2026

Effectiveness of artificial intelligence in nursing simulation education: A systematic review, meta-analysis and bibliometric visualization analysis.

OBJECTIVES: To synthesize the roles and core functions of AI in nursing simulation education for nursing students via systematic review, quantitatively evaluate its effects on students' knowledge and skill outcomes through meta-analysis, and map the research landscape and development trends of this field through bibliometric visualization analysis. DESIGN: Systematic review, meta-analysis and bibliometric visualization analysis. DATA SOURCES: Eight electronic databases: PubMed, Web of Science, MEDLINE, ERIC, Academic Search Complete, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science and Technology Journal Database (VIP) were employed to search studies from the time of construction to 16 December 2025. REVIEW METHODS: Studies meeting the inclusion criteria were screened. The revised Cochrane Risk of Bias tool (ROB 2) and Joanna Briggs Institute (JBI) critical appraisal checklists were used for quality assessment. Meta-analysis was performed with Review Manager 5.4, and bibliometric visualization analysis was conducted using VOSviewer 1.6.20 and Bibliometrix (based on R4.4.3). RESULTS: A total of 61 studies were included. AI primarily played two roles in nursing simulation education: peer-type new subject (n = 24) and direct mediator (n = 22). Meta-analysis showed that AI interventions significantly improved nursing students' knowledge (SMD = 1.49, 95% CI [0.55,2.43], p = 0.002) and skills (SMD = 0.66, 95% CI [0.02,1.31], p = 0.04). Bibliometric analysis identified that the United States of America and China were the two main contributing countries in this field, and the key motor themes included generative artificial intelligence, virtual patients, and geriatric care. CONCLUSIONS: AI exerts positive effects on nursing students' knowledge acquisition and skill enhancement in simulation education, with peer-type new subject and direct mediator as the dominant roles. Future research should focus on expanding AI applications in multi-specialty simulation scenarios, activating the data-driven value of machine learning, and strengthening international collaboration and standardization construction, so as to promote the sustainable development of AI-integrated nursing simulation education.

Humans↗

PubMed1982

Training child welfare workers for cultural awareness: the culture simulator technique.

The Mexican-American Culture Simulator introduces a new, cost-effective method of training child welfare workers for cultural awareness. It was published in 1981 by the Worden School as a two-volume module containing 20 vignettes each [7]. The accompanying trainer's manual provides instruction for conducting modular training and a discussion guide that analyzes the values and practice implications in each vignette [8]. The simulator has a number of key advantages over some of the more traditional seminar approaches to this type of training. 1. It is directly related to child welfare practice, providing information in a familiar problem-oriented casework format that facilitates the transfer of knowledge to job-related activities. 2. It enables the trainees to learn at the their own pace, in private, and at a location of their own choice. 3. It exposes the trainees to standardized material that enables them to assess their progress, and controls for variations in the trainer's expertise. 4. It is brief and easily administered, thus allowing for its efficient distribution and use in training large numbers of workers. 5. It provides a baseline level of knowledge that can be supplemented with more extensive and specific training to meet differing staff needs. Its principal disadvantage results from its apparent effectiveness and utility: there is the possibility that it might be used as the sole source of training for child welfare workers about the Mexican-American community whose cultural pattern is too rich, varied, and a complex to be captured by a single instrument that focuses on cognitive awareness of selected traditional values. Within its limitations, however, cultural simulator training introduces an interim method of improving services to the Hispanic community.

Child Welfare↗

PubMed1997

An adaptive training method for optimal interpolative neural nets.

In contrast to conventional multilayered feedforward networks which are typically trained by iterative gradient search methods, an optimal interpolative (OI) net can be trained by a noniterative least squares algorithm called RLS-OI. The basic idea of RLS-OI is to use a subset of the training set, whose inputs are called subprototypes, to constrain the OI net solution. A subset of these subprototypes, called prototypes, is then chosen as the parameter vectors of the activation functions of the OI net to satisfy the subprototype constraints in the least squares (LS) sense. By dynamically increasing the numbers of subprototypes and prototypes, RLS-OI evolves the OI net from scratch to the extent sufficient to solve a given classification problem. To improve the performance of RLS-OI, this paper addresses two important problems in OI net training: the selection of the subprototypes and the selection of the prototypes. By choosing subprototypes from poorly classified regions, this paper proposes a new subprototype selection method which is adaptive to the changing classification performance of the growing OI net. This paper also proposes a new prototype selection criterion to reduce the complexity of the OI net. For the same training accuracy, simulation results demonstrate that the proposed approach produces smaller OI net than the RLS-OI algorithm. Experimental results also show that the proposed approach is less sensitive to the variation of the training set than RLS-OI.

Algorithms↗

PubMed1992

Altitude training and muscular metabolism.

To study the effects of training at moderate altitude on muscle metabolism; we defined the lowest altitude which affected the aerobic capacity in man, and we studied the differences between training at an altitude of 2300 m and at sea level, both at the same relative (to the VO2max) and absolute intensity of work. We confirmed that at 1200 m the VO2max is decreased in sedentary and well-trained persons. Elite athletes already at 900 m decrease their VO2max. We have found an increase in myoglobin, oxidative enzyme activities and endurance capacity and a decrease in some glycolytic enzyme activities associated with simulated altitude training. We conclude that when the amount of training performed at altitude is similar to the amount at sea level, the stimulus of hypoxia associated with the training stimulus induces improvements in the muscle oxidative enzymes and myoglobin.

Adaptation, Physiological↗

PubMed1993

Postural and performance changes following exposures to flight simulators.

Flight simulators are cost-effective, safe, and flexible training tools for aviators. However, their advantages may be offset by the occurrence of motion sickness-like symptoms which have been reported during and following simulator training. Although symptoms have been well documented in simulators, their time course, causes, and implications for training are not yet fully understood. Tests of standing and walking steadiness were administered along with cognitive and motor performance tests to Navy and Marine Corps aviators before and after their regular simulator training, resulting in records of 726 pilot exposure observations. When exposed pilots were compared to a control group who did not fly in a simulator, statistically significant decrements in postural equilibrium test scores were found for all of the moving base simulators, but for only one of the three fixed-base simulators. The size of these losses was approximately 15% of baseline. Cognitive and motor changes, while statistically significant, were complicated by learning effects in all groups for all tests. When compared to the control group, improvement in cognitive scores was always less in the simulator groups, but greater improvement occurred in the simulator groups for motor speed scores, although this latter difference was small (< 1% of baseline). Further study of performance changes is recommended. In those simulators where significant effects occurred, the ataxia and the time-course of the disequilibrium should be followed.

Aerospace Medicine↗

PubMed1991

The design of CAST (Computer-Aided Speechreading Training).

The underlying theoretical assumptions, goals, design, and implementation of a Computer-Aided Speechreading Training system (CAST) are described as a case study in program design. This computerized speechreading assessment and training system simulates face-to-face intervention and is designed to be one component of a comprehensive aural rehabilitation program for preretirement adults with acquired mild-to-moderate hearing loss. The interactive, automated course consists of eight training lessons, each focusing on a particular viseme that is practiced by a modified discourse tracking method using viseme-specific texts. Three basic speechreading skills are emphasized: visual speech perception, use of linguistic redundancy, and use of feedback between message sender and receiver. These skills are evaluated separately by means of CAST tracking rate, receiver strategy, and inferred error type. Four example case assessments are provided to illustrate the potential applications of CAST as a standardizable rehabilitative tool. An independent program evaluation is provided in a companion paper (Gagné, Dinon, & Parsons, 1991). Comparisons between CAST, face-to-face tracking procedures, and natural discourse are presented and discussed with reference to theoretical and clinical issues in speechreading and program evaluation.

Computer-Assisted Instruction↗

PubMed1995

Preventive and promotive medicine in ambulatory clinical practice: a prospective simulated patient study.

OBJECTIVE: This study examines the extent to which preventive and promotive advice is integrated into the clinical practice of doctors. STUDY DESIGN: Using a cross-sectional descriptive survey design, the study compares the performance of doctors in giving healthy lifestyle advice for five clinical conditions, their perceived practice and their rating on the importance of disseminating selected key lifestyle messages. DATA EXTRACTION METHODS: A total of 28 volunteers were trained to simulate the five clinical conditions which required related health advice and to rate the doctors' performance with the use of a prepared checklist. Simulated patient ratings of 343 doctor-patient encounters provided the data on doctors' health promotion efforts for the selected clinical conditions. A post-visit self-administered questionnaire survey of a sub-sample of 100 doctors gave an insight into their opinions and perceived practice. PRINCIPAL FINDINGS: Only in 49% of the instances was a health promotion message given. The doctors' encouraging interest in health education and health promotion and their positive perceptions of their volume of healthy lifestyle counselling were not borne out in actual clinical practice. CONCLUSIONS: The results indicate that the extent of preventive and promotive health education in both the public and private health sectors is unacceptably low. The matter needs to be addressed through training programmes as well as the formulation of clear health promotion priorities and strategies in Malaysia.

Ambulatory Care↗

PubMed1992

An improved graphical method for pattern recognition from spike trains of spontaneously active neurons.

Spontaneous activity and rhythmical oscillations are common features of large neuronal networks in mammals. Detection of repetitive spike patterns or pacemaker activity during electrophysiological recording of spontaneous action potentials from single neurons can be difficult if a "noisy" background is present. This paper describes an improved method for an online spike train analysis based on joint interval histograms (JIH, Rodiek et al. 1962). By means of higher ordered JIH the discrimination of spike patterns with repetitive bursting activity or oscillations is possible even when randomly distributed action potentials appear. Examples of simulated spike trains and those recorded from cultured hippocampal neurons are presented.

Animals↗