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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↗

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↗

Cognitive avionics and watching spaceflight crews think: generation-after-next research tools in functional neuroimaging.

Confinement and isolation have always confounded the extraordinary endeavor of human spaceflight. Psychosocial health is at the forefront in considering risk factors that imperil missions of 1- to 2-yr duration. Current crewmember selection metrics restricted to behavioral observation by definition observe rather than prevent performance degradation and are thus inadequate when preflight training cannot simulate an entire journey. Nascent techniques to monitor functional and task-related cortical neural activity show promise and can be extended to include whole-brain monitoring. Watching spaceflight crews think can reveal the efficiency of training procedures. Moreover, observing subcortical emotion centers may provide early detection of developing neuropsychiatric disorders. The non-invasive functional neuroimaging modalities electroencephalography (EEG), magnetoencephalography (MEG), magnetic resonance imaging (MRI), and near-infrared spectroscopy (NIRS), and highlights of how they may be engineered for spacecraft are detailed. Preflight and in-flight applications to crewmember behavioral health from current generation, next generation, and generation-after-next neuroscience research studies are also described. The emphasis is on preventing the onset of neuropsychiatric dysfunctions, thus reducing the risk of mission failure due to human error.

Aerospace Medicine↗

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↗

Heterogeneous displays for surgery and surgical simulation.

Instruments and procedures continue to become more complex and challenging, but the display environments to which these technologies are connected have not kept pace. Display real-estate (the size and resolution of the display), the configurability of the display, and the ability for display systems to incorporate, fuse and present diverse informational sources are limiting factors. The capabilities of display technologies are far exceeded by the procedures and instruments that rely on them. In this paper we show how to break free from display constraints by moving forward with a hybrid, heterogeneous display framework that preserves key characteristics of current systems (low latency, specialized devices). We have engineered a hybrid display and are currently using it to build a surgical simulation and training environment within which we can evaluate both the technology and the performance of subjects using the technology.

Computer Simulation↗

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↗

Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory.

Injuries related to the events of September 11, 2001, and continuing military actions associated with Operation Enduring Freedom underscore the accurate focus of the Joint Trauma Training Center and the Warskills Simulation Laboratory. These two programs ensure that nurses are prepared to respond to diverse medical situations worldwide. Outcome measures from both initiatives attest to the effectiveness of an integrated program that facilitates critical thinking skills and clinical judgment to increase the nurses' ability to provide trauma care to severely injured military personnel.

Clinical Competence↗

Use of a motion sickness history questionnaire for prediction of simulator sickness.

This research assessed the usefulness of the Motion History Questionnaire (MHQ) for the prediction of simulator sickness, a form of motion sickness experienced by pilots training in ground-based flight simulators. Four MHQ scoring keys were compared: (1) the original MHQ key which had been validated on a sample of U.S. Navy student pilots exposed to Coriolis forces, (2 and 3) two keys which had been validated on a sample of civilian college students exposed to simulated ship motions, and (4) a simulator sickness key empirically derived in the present research and cross-validated. Navy and Marine Corps aviators (N = 456) filled out the MHQ prior to their regularly scheduled flight simulator training and were divided into validation and cross-validation samples. All scoring keys were predictive of reported symptoms of sickness, but highest correlations were obtained with the empirically-derived simulator sickness (SS) key. It is suggested that the SS key be used for self-testing so that pilots may be made aware of their risk for developing simulator sickness.

Aerospace Medicine↗

Laparoscopic skills are improved with LapMentor training: results of a randomized, double-blinded study.

OBJECTIVE: To determine if prior training on the LapMentor laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment. SUMMARY BACKGROUND DATA: Numerous influences have led to the development of computer-aided laparoscopic simulators: a need for greater efficiency in training, the unique and complex nature of laparoscopic surgery, and the increasing demand that surgeons demonstrate competence before proceeding to the operating room. The LapMentor simulator is expensive, however, and its use must be validated and justified prior to implementation into surgical training programs. METHODS: Nineteen surgical interns were randomized to training on the LapMentor laparoscopic simulator (n = 10) or to a control group (no simulator training, n = 9). Subjects randomized to the LapMentor trained to expert criterion levels 2 consecutive times on 6 designated basic skills modules. All subjects then completed a series of laparoscopic exercises in a live porcine model, and performance was assessed independently by 2 blinded reviewers. Time, accuracy rates, and global assessments of performance were recorded with an interrater reliability between reviewers of 0.99. RESULTS: LapMentor trained interns completed the 30 degrees camera navigation exercise in significantly less time than control interns (166 +/- 52 vs. 220 +/- 39 seconds, P < 0.05); they also achieved higher accuracy rates in identifying the required objects with the laparoscope (96% +/- 8% vs. 82% +/- 15%, P < 0.05). Similarly, on the two-handed object transfer exercise, task completion time for LapMentor trained versus control interns was 130 +/- 23 versus 184 +/- 43 seconds (P < 0.01) with an accuracy rate of 98% +/- 5% versus 80% +/- 13% (P < 0.001). Additionally, LapMentor trained interns outperformed control subjects with regard to camera navigation skills, efficiency of motion, optimal instrument handling, perceptual ability, and performance of safe electrocautery. CONCLUSIONS: This study demonstrates that prior training on the LapMentor laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment. This work marks the first prospective, randomized evaluation of the LapMentor simulator, and provides evidence that LapMentor training may lead to improved operating room performance.

Clinical Competence↗

The use of a neural network system in the identification of motor unit characteristics from surface detected action potentials: a simulation study.

The surface detected motor unit action potential (MUAP) morphology depends on many physiological and anatomical characteristics of the contracting muscle that are not directly accessible to measurement. In this paper, a neural network based approach is proposed to estimate the motor unit (MU) parameters from a simulated single surface MUAP. We have developed an estimation system that is composed of the following stages: conduction velocity estimation, signal dimension reduction, MU parameters estimation, and number of MU fibres estimation. The parameter estimation stage employs four multilayer neural networks trained on simulated MUAPs corresponding to various ranges of MU parameters. In the estimation mode, this module produces four MU parameters sets. The selected set of the five muscle characteristics is that which minimises an error criterion on a signal reconstructed from the estimated parameters. The proposed system is tested with several simulated MUAPs signals with additive white noise in order to evaluate its performance. It is shown that the technique performs well when the signal to noise ratio is greater than 20 dB.

Action Potentials↗

Radiology education: a glimpse into the future.

The digital revolution in radiology continues to advance rapidly. There are a number of interesting developments within radiology informatics which may have a significant impact on education and training of radiologists in the near future. These include extended functionality of handheld computers, web-based skill and knowledge assessment, standardization of radiological procedural training using simulated or virtual patients, worldwide videoconferencing via high-quality health networks such as Internet2 and global collaboration of radiological educational resources via comprehensive, multi-national databases such as the medical imaging resource centre initiative of the Radiological Society of North America. This article will explore the role of e-learning in radiology, highlight a number of useful web-based applications in this area, and explain how the current and future technological advances might best be incorporated into radiological training.

Clinical Competence↗

Determining the efficacy of an immersive trainer for arthroscopy skills.

The present study examined the effectiveness of an immersive arthroscopic simulator for training naive participants to identify major anatomical structures and manipulate the arthroscope and probe. Ten psychology graduate students engaged in five consecutive days of practice sessions with the arthroscopic trainer. Following each session, participants were tested to see how quickly and accurately they could identify 10 anatomical landmarks and manipulate the arthroscope and probe. The results demonstrated steady learning on both tasks. For the anatomy task, participants correctly identified an average of 7.7 out of 10 structures correctly in the first session and 9.5 in the last. During the manipulation task, participants collided 53.5 times with simulated tissues in the first session and 13.2 times during the final session. Participants (n=9) also demonstrated minimal performance degradation when tested 4 weeks later. These data suggest that the immersive arthroscopic trainer might be useful as an initial screening or training tool for beginning medical students.

Adult↗

Measurement of time-dependent changes in the irregularity of neural spiking.

Irregularity of firing in spike trains has been associated with coding processes and information transfer or alternatively treated as noise. Previous studies of irregularity have mainly used the coefficient of variation (CV) of the interspike interval distribution. Proper estimation of CV requires a constant underlying firing rate, a condition that most experimental situations do not fulfill either within or across trials. Here we introduce a novel irregularity metric based on the ratio of adjacent intervals in the spike train. The new metric is not affected by firing rate and is very localized in time so that it can be used to examine the time course of irregularity relative to an alignment marker. We characterized properties of the new metric with simulated spike trains of known characteristics and then applied it to data recorded from 108 single neurons in the motor cortex of two monkeys during performance of a precision grip task. Fifty-six cells were antidromically identified as pyramidal tract neurons (PTNs). Sixty-one cells (30 PTNs) exhibited significant temporal modulation of their irregularity during task performance with the contralateral hand. The irregularity modulations generally differed in sign and latency from the modulations of firing rate. High irregularity tended to occur during the task phases requiring the most detailed control of movement, whereas neural firing became more regular during the steady hold phase. Such irregularity modulation could have important consequences for the response of downstream neurons and may provide insight into the nature of the cortical code.

Algorithms↗

Development, implementation and outcomes of a training program for responders to acts of terrorism.

INTRODUCTION: Responding to acts of terrorism requires the effective use of public-safety and medical-response resources. The knowledge, skills and attitudes necessary to respond to future threats is unfamiliar to most emergency responders. OBJECTIVES: The purpose of this report to describe the development, implementation and evaluation of a multidisciplinary, interactive and simulation-enhanced course to prepare responders to acts of terrorism. METHODS: We used a 5-step systematic process to develop a blended-learning, simulation-enhanced training program. Learners completed a self-confidence questionnaire and written examination prior to the course and a self-confidence questionnaire, written examination and course evaluation when they finished the course. RESULTS: From July 7, 2003 to March 8, 2005, 497 consenting learners completed the course. After course completion, learners demonstrated significant increases in their knowledge of terrorism response (t = -64.3, df = 496, p < 0.05) and their confidence in responding to terrorist events (t = -45.5, df = 496, p < 0.05). Learner feedback about the course was highly positive. CONCLUSIONS: We successfully implemented a two-day course for professionals likely to respond to terrorist acts that included scenario-based performance training and assessment. Course participants increased their knowledge and were more confident in their ability to respond to acts of terrorism after participating in this course.

Adult↗

The effects of adult guidance and peer discussion on the development of children's representations: evidence from the training of pedestrian skills.

It was hypothesized that practical training is effective in improving children's pedestrian skills because adult scaffolding and peer discussion during training specifically promote E3 level representation (linguistically-encoded, experientially-grounded, generalizable knowledge), as defined by Karmiloff-Smith's (1992) representational redescription (RR) model. Two studies were conducted to examine in detail the impact of this social input in the context of simulation-based training in roadside search skills. A group of 5-8-year-olds were pre-tested on ability to detect relevant road-crossing features. They then participated in four training sessions designed to promote attunement to these, under peer discussion versus adult guidance conditions (Study 1), and adult-child versus adult-group conditions (Study 2). Performance at post-test was compared with that of controls who underwent no training. Study 1 found that children in the adult guidance condition improved significantly more than those in the peer discussion or control conditions, and this improvement was directly attributable to appropriation of E3 level representations from adult dialogue. Study 2 found that progress was greater still when adult scaffolding was supplemented by peer discussion, with E3 level representation attributable to the children's exploration of conflicting ideas. The implications of these findings for the RR model and for practical road safety education are discussed.

Accident Prevention↗

Effect of blood flow, tumour and cold stress in a female breast: a novel time-accurate computer simulation.

Breast cancer is a dreadful disease among women and early detection helps in achieving a cure. The mammogram is presently the standard tool for detecting breast abnormality, but its sensitivity is lower for women with dense breasts. It has been found that women with an abnormal thermogram are at a higher risk and have a poorer prognosis. However, performing and interpreting thermograms requires meticulous training. Computer simulations can be an additional tool to help the clinician in the interpretation. In this paper, a novel and flexible finite element model of a female breast is developed. Both steady state and time-dependent solutions are obtained. Steady state solutions globally match experimental thermographic results with the proper choice of blood perfusion source terms, tissue thickness and geometric scaling factor. Although the simulations may not be useful in providing a unique solution (i.e. exact size and location of the tumour owing to the complex physiological relationship between the tumour and the breast surface temperature), it would nevertheless help in the 'analysis by elimination'. An example of this type of analysis is also presented.

Body Temperature↗

[Formation of a unified system of mental regulation of activities and functional state of the flyer during effects of piloting strain].

The article describes the method of improving professional dependability of pilot impacted by aerobat g-loads through formation of a unified system for psychic regulation of his activity and status of the psychological function in the process of training on flight simulator. To this end, the simulator was retrofitted with an adaptive training circuit to establish functional and correction feedback by changing the intensity of display brightness proportionally to the degree of "g-load" and effectiveness of countermeasures applied to simulate visual disorders due to hypergravity. Data from real flights with high aerobat g-loads proved effectiveness of the proposed training scenarios as judged by increased probability of administration of breathing (0.9 vs. 0.4) and muscular (1.0 vs. 0.8) countermeasures by members of the experimental group against their controls. Besides, the trained pilots had no visual disorders, whereas this was the case in 28% of their controls. Possible mechanisms of how to form a unified system for psychic regulation in which implementation of a task is kept under permanent conscious control and self-control of the psychological function is essentially accomplished on the level of automated habits are the subject of the authors' discussion.

Aerospace Medicine↗

Limitations of postural equilibrium tests for examining simulator sickness.

The psychometric properties of four ataxia tests and their sensitivities to disorientation were examined to assess their potential for measuring balance disturbances frequently reported with simulator sickness. The study was conducted in two parts. In the first, subjects practiced for 10 sessions to examine learning effects and to stabilize performance. In the second, the sensitivities of the four tests were examined by comparing performance before and after exposure to sensory conflict produced using a disorientation training flight simulator. Subjective measures of disorientation, including reports of postural disequilibrium, were also collected. The results indicated initial learning on all four ataxia measures. Two of the tests, the Stand on One Leg Eyes Closed and the Sharpened Romberg, exhibited acceptable levels of reliability. However, only the latter showed sufficient sensitivity to corroborate subjective reports of postural disequilibrium.

Adult↗