PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Computer Simulation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources

The effects of nested primer binding sites on the reproducibility of PCR: mathematical modeling and computer simulation studies.

The polymerase chain reaction (PCR) has become an indispensable tool in modern biological research. Although the application of PCR is a standard routine, we widely lack a theoretical understanding of the dynamic processes involved, especially with respect to the amplification of nonreproducible and/or unexpected amplification products. For one potential source of uncertainty, the presence of nested primer binding sites within an amplifyable DNA locus, we consider a simple stochastic model for the dynamics of PCR amplification of competing products. For commonly used thermostable DNA polymerases lacking a 5'-3'-exonuclease activity, we predict the relative amplification frequencies of competing PCR products dependent on the primer binding probability, the number of PCR cycles, and the number of initial DNA template molecules. At low primer binding probabilities and low numbers of initial DNA template molecules and PCR cycles, we expect the amplification of two products. At high primer binding probabilities and/or high copy numbers of initial template molecules only one main amplification product is predicted at increasing cycle numbers. Furthermore, by means of computer simulation studies we quantify the stochastic variation for the amplification frequencies of competing products.

Bacteriophage lambda↗

Computer simulation of a breast cancer metastasis model.

Recent analysis of relapse data from 1173 untreated early stage breast cancer patients with 16-20 year follow-up shows that frequency of relapse has a double peaked distribution. There is a sharp peak at 18 months, a nadir at 50 months and a broad peak at 60 months. Patients with larger tumors more frequently relapse in the first peak while those with smaller tumors relapse equally in both peaks. No existing theory of tumor growth predicts this effect. To help understand this phenomenon, a model of metastatic growth has been proposed consisting of three distinct phases: a single cell, an avascular growth, and a vascularized lesion. Computer simulation of this model shows that the second relapse peak can be explained by a steady stochastic progression from one phase to the next phase. However, to account for the first relapse peak, a sudden perturbation of the development at the time of surgery is necessary. Model simulations predict that patients who relapse in the second peak would have micrometastases in states of relatively low chemosensitivity when adjuvant therapy is normally administered. The simulation predicts that 15% of T1, 39% of T2, and 51% of T3 staged patients benefit from adjuvant chemotherapy, partially offsetting the advantage of early detection. This suggests that early detection and adjuvant chemotherapy may not be symbiotic strategies. New therapies are needed to benefit patients who would relapse in the second peak.

Breast Neoplasms↗

Confocal 3D DNA cytometry: assessment of required coefficient of variation by computer simulation.

BACKGROUND: Confocal Laser Scanning Microscopy (CLSM) provides the opportunity to perform 3D DNA content measurements on intact cells in thick histological sections. So far, sample size has been limited by the time consuming nature of the technology. Since the power of DNA histograms to resolve different stemlines depends on both the sample size and the coefficient of variation (CV) of histogram peaks, interpretation of 3D CLSM DNA histograms might be hampered by both a small sample size and a large CV. The aim of this study was to analyze the required CV for 3D CLSM DNA histograms given a realistic sample size. METHODS: By computer simulation, virtual histograms were composed for sample sizes of 20000, 10000, 5000, 1000, and 273 cells and CVs of 30, 25, 20, 15, 10 and 5%. By visual inspection, the histogram quality with respect to resolution of G0/1 and G2/M peaks of a diploid stemline was assessed. RESULTS: As expected, the interpretability of DNA histograms deteriorated with decreasing sample sizes and higher CVs. For CVs of 15% and lower, a clearly bimodal peak pattern with well distinguishable G0/1 and G2/M peaks were still seen at a sample size of 273 cells, which is our current average sample size with 3D CLSM DNA cytometry. CONCLUSIONS: For unambiguous interpretation of DNA histograms obtained using 3D CLSM, a CV of at most 15% is tolerable at currently achievable sample sizes. To resolve smaller near diploid stemlines, a CV of 10% or better should be aimed at. With currently available 3D imaging technology, this CV is achievable.

Computer Simulation↗

A computer simulation study on the input function sampling schedules in tracer kinetic modeling with positron emission tomography (PET).

Tracer kinetic modeling with positron emission tomography (PET) requires measurements of the time-activity curves in both plasma (PTAC) and tissue (TTAC) to estimate physiological parameters, i.e. to fit the parameters of certain compartmental models using PTAC and TTAC as the model input and output functions, respectively. In this paper, we first explored the optimal blood sampling schedule (OBSS) for the input function, based on the tracer [18F]2-fluoro-2-deoxy-D-glucose (FDG) blood sample experimental data. Then using a 5-parameter FDG model we investigated the effects of the plasma sampling schedule, as well as PTAC measurement noise, on the estimation accuracy and reliability of FDG model macro- and micro-parameters and the physiological parameter local cerebral metabolic rates of glucose (LCMRGlc), using computer simulation. Three different methods were used: (a) estimation of the FDG model parameters ignoring PTAC noise using the traditional PTAC schedule (non-OBSS); (b) estimation of the PTAC model parameters and FDG model parameters simultaneously using both non-OBSS and OBSS; (c) estimation of the PTAC model parameters first, then the FDG model parameters using both non-OBSS and OBSS. The results show that OBSS can provide more reliable estimates and largely simplifies the experiment operations.

Blood Specimen Collection↗

Computer simulation of DNA supercoiling.

Major goals of this research are to comprehend and visualize the detailed three-dimensional arrangements of supercoiled DNA. Attention has been focused in the initial stages on mathematical procedures to generate the spatial coordinates of the B-DNA double helix constrained to specific spatial pathways and on simple energy models of chain conformation. The new treatment of superhelical DNA in terms of parametric curves is an important first step in being able to generate and examine tertiary structure systematically. The location of every residue is implicitly determined by the equation of the closed curve, with the number of computational variables sharply reduced compared to the number required for explicit specification of all chain units. Furthermore, the constraints of ring closure in cyclic chains and/or the end-to-end limitations on constrained open chains are automatically satisfied by the formulations (cubic B-splines and finite Fourier series) chosen in this work. The predicted conformations of elastic DNA do not appear to be tied to either the form of chain representation or the computer simulation method. Significantly, two very different minimization and modeling approaches come to the same structural conclusions. The most stable configurations of the closed circular elastic DNA model are found to be interwound superhelices that are critically dependent on the specified linking number difference. The total elastic energy is proportional to the imposed linking number difference, and beyond the critical linking number difference separating the circular and figure-eight forms, the writhing number of the DNA superhelices is directly proportional to delta Lk. The measured proportionality constant between Wr and delta Lk, however, is somewhat greater than that deduced from experimental observations of plectonemically interwound DNA chains and an assumed structural model. Furthermore, at large delta Lk, the interwound structures appear to curve. The treatment of the DNA double helix as an ideal elastic rod is clearly incorrect. The chain cannot bend with the same ease in all directions. The degree of bending observed in atomic level models is also tied to the angular twist so that the presumed partitioning of bending and twisting components is in error. Furthermore, the local chain bending and twisting are base sequence dependent, with certain residues able to flex more symmetrically than others. The polyelectrolyte character of the DNA is additionally expected to govern the overall folding of the chain and to influence the local secondary structure. The next step in this work is to compare the properties of such "real" DNA with conventional elastic models.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Simulation↗

The computer leucocyte. Analysis of the random movement of leucocytes in a visual field by means of computer simulation.

In vital preparations moving polymorphonuclear leucocytes (PMNs) disappear from the visual field. The present study provides evidence by means of geometrical analysis and computer simulation, that this disappearance is due to a heterogeneous distribution of the PMNs at the beginning of observation. The path of random-moving computer leucocytes is more tortuous than the path of comparable vital PMNs without obvious attractant, i.e. vital PMNs supposed to be random-moving. This finding is in agreement with the Allan-Wilkinson observation of 'persistent random walk' of vital cells.

Cell Movement↗

Solution conformation of the Pseudomonas syringae MSU 16H phytotoxic lipodepsipeptide Pseudomycin A determined by computer simulations using distance geometry and molecular dynamics from NMR data.

Pseudomycin A is a cyclic lipodepsinonapeptide phytotoxin produced by a strain of the plant pathogenic bacterium Pseudomonas syringae. Like other members of this family of bacterial metabolites, it is characterised by a fatty acylated cyclic peptide with mixed chirality and lactonic closure. Several biological activities of Pseudomycin A are lower than those found for some of its congeners, a difference which might depend on the diverse number and distribution of charged residues in the peptide moiety. Hence, it was of interest to investigate its conformation in solution. After the complete interpretation of the two-dimensional NMR spectra, NOE data were obtained and the structure was determined by computer simulations, applying distance geometry and molecular dynamics procedures. The conformation of the large ring of Pseudomycin A in solution includes three rigid structural regions interrupted by three short flexible regions that act as hinges. The overall three-dimensional structure of the cyclic moiety is similar to that of previously studied bioactive lipodepsinonapeptides produced by other pseudomonads.

Computer Simulation↗

Scheduling surgical cases into overflow block time- computer simulation of the effects of scheduling strategies on operating room labor costs.

UNLABELLED: "Overflow" block time is operating room (OR) time for a surgical group's cases that cannot be completed in the regular block time allocated to each surgeon in the surgical group. Having such overflow block time increases OR utilization. The optimal way to schedule patients into a surgical group's overflow block time is unknown. In this study, we developed a scheduling strategy that balances the OR manager's need to reduce staffing costs and the needs of patients and surgeons for flexibility in choosing the dates and times of cases. We used computer simulation to evaluate our scheduling strategy. Surgeons and patients (i) can schedule the case into any overflow block within 2 wk; (ii) can only schedule the case into a "first case of the day" start time more than 2 wk in the future if there is not enough open time for the case within 2 wk; (iii) must schedule the case to be done within 4 wk; and (iv) are encouraged to perform the case on the earliest possible date. Staffing costs were lowest when the OR manager did not incorporate surgeon and patient preferences when scheduling cases into overflow block time. The strategy we developed provides surgeons and patients with some flexibility in scheduling, while only increasing OR staffing costs slightly over the minimum achieved when the OR manager controls scheduling. IMPLICATIONS: The strategy we developed provides surgeons and patients with some flexibility in scheduling, while increasing OR staffing costs only slightly over the minimum achieved when the OR manager controls scheduling. Staffing costs were lowest when the operating room (OR) manager did not incorporate surgeon and patient preferences when scheduling cases into overflow block time.

Appointments and Schedules↗

Computer simulations of NMDA and non-NMDA receptor-mediated synaptic drive: sensory and supraspinal modulation of neurons and small networks.

1. The segmental locomotor network in lamprey can generate the rhythmic burst pattern underlying locomotion when it is driven via synaptic glutamate receptors. Lower rates of activity can be evoked by activation of N-methyl-D-aspartate (NMDA) receptors, whereas a rapid activity can only be induced by non-NMDA receptors [kainate/alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)]. The reticulospinal and sensory inputs are known to act via both NMDA and non-NMDA receptors, but it is unclear how these inputs can provide an appropriate control of the locomotor rate. We have examined the effects of different types of excitatory synaptic input to neurons of the locomotor network with the use of a computer-simulated electrical neuron model, with Na+, K+, Ca(2+)-dependent K+ channels, and with inherent oscillatory properties linked to the NMDA conductance. Synapses were modeled as a modulated ionic conductance in the membrane of the postsynaptic cell comprising a voltage-dependent NMDA component (Na+, K+, Ca2+ conductances) of long duration, and/or a non-NMDA component (Na+, K+ conductance) of short duration. 2. By using two neurons to drive a postsynaptic cell with non-NMDA-type synapses, a continuous range of firing frequencies could be evoked in the postsynaptic cell, by altering the firing rate of the presynaptic cells. If a single presynaptic neuron was used, there was a tendency toward spike synchronization between the pre- and postsynaptic cells. 3. When a postsynaptic neuron was driven via NMDA synapses, an oscillatory burst activity could be evoked. The rate of the oscillations was, however, little affected by the presynaptic firing rate. When a drive neuron with mixed (NMDA and non-NMDA) synapses was used, the rate of the oscillations could be changed within a limited frequency range by altering the presynaptic firing rate. By adding another larger drive neuron, having a larger rheobase current and mixed synapses with smaller relative NMDA components, the frequency range of the postsynaptic oscillations could be markedly increased. The frequency range depended on the parameters selected for each of the two types of mixed synapses. 4. A small rhythm-generating neuronal network, comprising six cells connected as the principal interneurons of the lamprey spinal locomotor network, was used to test the role of a tonic NMDA and non-NMDA receptor activation to drive the network and produce bursting.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Cryptococcus neoformans chemotyping by quantitative analysis of 1H nuclear magnetic resonance spectra of glucuronoxylomannans with a computer-simulated artificial neural network.

The complete assignment of the proton chemical shifts obtained by nuclear magnetic resonance (NMR) spectroscopy of de-O-acetylated glucuronoxylomannans (GXMs) from Cryptococcus neoformans permitted the high-resolution determination of the total structure of any GXM. Six structural motifs based on an alpha-(1-->3)-mannotriose substituted with variable quantities of 2-O-beta- and 4-O-beta-xylopyranosyl and 2-O-beta-glucopyranosyluronic acid were identified. The chemical shifts of only the anomeric protons of the mannosyl residues served as structure reporter groups (SRG) for the identification and quantitation of the six triads present in any GXM. The assigned protons for the mannosyl residues resonated at clearly distinguishable positions in the spectrum and supplied all the information essential for the assignment of the complete GXM structure. This technique for assigning structure is referred to as the SRG concept. The SRG concept was used to analyze the distribution of the six mannosyl triads of GXMs obtained from 106 isolates of C. neoformans. The six mannosyl triads occurred singularly or in combination with one or more of the other triads. The identification and quantitation of the SRG were simplified by using a computer-simulated artificial neural network (ANN) to automatically analyze the SRG region of the one-dimensional proton NMR spectra. The occurrence and relative distribution of the six mannosyl triads were used to chemotype C. neoformans on the basis of subtle variations in GXM structure determined by analysis of the SRG region of the proton NMR spectrum by the ANN. The data for the distribution of the six SRGs from GXMs of 106 isolates of C. neoformans yielded eight chemotypes, Chem1 through Chem8.

Bacterial Typing Techniques↗

How does GAP catalyze the GTPase reaction of Ras? A computer simulation study.

The formation of a complex between p21(ras) and GAP accelerates the GTPase reaction of p21(ras) and terminates the signal for cell proliferation. The understanding of this rate acceleration is important for the elucidation of the role of Ras mutants in tumor formation. In principle there are two main options for the origin of the effect of GAP. One is a direct electrostatic interaction between the residues of GAP and the transition state of the Ras-GAP complex and the other is a GAP-induced shift of the structure of Ras to a configuration that increases the stabilization of the transition state. This work examines the relative importance of these options by computer simulations of the catalytic effect of Ras. The simulations use the empirical valence bond (EVB) method to study the GTPase reaction along the alternative associative and dissociative paths. This approach reproduces the trend in the overall experimentally observed catalytic effect of GAP: the calculated effect is 7 +/- 3 kcal/mol as compared to the observed effect of approximately 6.6 kcal/mol. Furthermore, the calculated effect of mutating Arg789 to a nonpolar residue is 3-4 kcal/mol as compared to the observed effect of 4.5 kcal/mol for the Arg789Ala mutation. It is concluded, in agreement with previous proposals, that the effect of Arg789 is associated with its direct interaction with the transition state charge distribution. However, calculations that use the coordinates of Ras from the Ras-GAP complex (referred to here as Ras') reproduce a significant catalytic effect relative to the Ras coordinates. This indicates that part of the effect of GAP involves a stabilization of a catalytic configuration of Ras. This configuration increases the positive electrostatic potential on the beta-phosphate (relative to the corresponding situation in the free Ras). In other words, GAP stabilizes the GDP bound configuration of Ras relative to that of the GTP-bound conformation. The elusive oncogenic effect of mutating Gln61 is also explored. The calculated effect of such mutations in the Ras-GAP complex are found to be small, while the observed effect is very large (8.7 kcal/mol). Since the Ras is locked in its Ras-GAP configuration in our simulations, we conclude that the oncogenic effect of mutation of Gln61 is indirect and is associated most probably with the structural changes of Ras upon forming the Ras-GAP complex. In view of these and the results for the Ras' we conclude that GAP activates Ras by both direct electrostatic stabilization of the transition state and an indirect allosteric effect that stabilizes the GDP-bound form. The present study also explored the feasibility of the associative and dissociative mechanism in the GTPase reaction of Ras. It is concluded that the reaction is most likely to involve an associative mechanism.

Computer Simulation↗

Babesia bovis: computer simulation of the relationship between the tick vector, parasite, and bovine host.

Components contributing to the survival of Babesia bovis in its tick vector (Boophilus microplus) and bovine host were identified and their relationship simulated with an interactive BASIC computer program. Estimates for major independent variables (host-finding success, feeding success, filial infection rate, recovery rate) were derived from published laboratory and field data. Values for dependent variables (tick burden, inoculation rate, tick and bovine infection rates) were calculated during successive tick generations until equilibrium conditions were reached. The simulation was used to predict the effects of alternate disease control strategies. Babesiosis outbreaks were associated with simulated daily infestations of approximately two to eight engorged ticks. Below this range, B. bovis parasites disappeared, while above it all cattle were infected during the period of calfhood resistance (through 9 months of age). The babesial inoculation rate was most unstable over the above range due to instability in tick populations and tick infection rates. The risk of babesiosis outbreaks among older, less resistant cattle was also greatest over this range. The optimum daily infestation was eight to nine engorged ticks. This level would maintain herd immunity to babesiosis without causing significant physiologic stress to the bovine host. The difficulty in maintaining ecological and immunological stability at low infestation rates discourages "strategic dipping" as a means of maintaining herd immunity to babesiosis. Introduction of tick-resistant cattle provided a more effective means of reducing the risk of babesiosis outbreaks. The economic implications of computer-simulated babesiosis control alternatives should be analyzed. The validity of simulation parameters should be confirmed by field studies on the relationship between tick burdens and the babesial inoculation rate. These studies would be greatly facilitated by development of an assay system for the detection of babesiae in field-collected ticks.

Aging↗

Mathematical description and computer simulation of retinal cometlike afterimages: a modified neural equation with stability analysis.

A mathematical model for the spatiotemporal description of a well-known psychophysical phenomenon, the cometlike afterimage effect (CLAIE), is presented. The CLAIE occurs when a bright circular light spot moves slowly in the peripheral human retina. Under these conditions, the leading edge of the dot looks circular, but the trailing edge becomes elongated like a comet's tail whose length increases with speed and luminance, and the illusion is more prominent for photopic backgrounds. This cometlike motion smear is described on the basis of the temporal responsiveness and adaptation of rods. The model is an extension of an existing neural model of M. N. Oğuztöreli et al., with an additional term that allows prolonged saturation and long decay time following exposure to intense stimuli, and these effects are held responsible for the cometlike smear. The model predicts the response of photoreceptors through a nonlinear ordinary integrodifferential equation, which includes known biophysical terms for response dynamics, adaptation, saturation, and kinetics of intermediate components of the phototransduction process. The introduction of a saturation coefficient into the neural equation makes it possible to distinguish the different saturation thresholds of the rod-and-cone system. Numerical determination of the stationary solutions and complete linear stability analysis of the improved neural equation are given for a neuron of second order, and some computational results are presented for phase flows around different singular points in the phase field. A computer simulation based on the improved neural equation is presented for modeling the development and features of the CLAIE as a function of the speed and luminance of the stimulus and the background intensity. The computational results agree well with the psychophysical findings relating to the CLAIE.

Afterimage↗

Computer-simulation studies on roles of potassium currents in neurotransmission of the auditory nerve.

Our previous work showed that action potentials (APs) fired in spiral ganglion (SG) neurons broaden gradually as a result of cumulative inactivation of the potassium current (I(K)), or with the application of a tinnitus-inducing drug (quinine). These results led us to speculate that AP width could affect neurotransmission of the auditory nerve under both normal and pathological conditions. This study used both experimental and theoretical approaches to test this hypothesis. We first measured the effect of AP broadening on Ca2+ entry into SG neurons. The effect of pre-synaptic AP broadening on post-synaptic responses was then assessed using computer-simulations. Results showed that wider presynaptic APs augmented responses of all types of postsynaptic glutamatergic receptors mainly by amplifying responses of postsynaptic receptors whose locations were not well aligned with the presynaptic release sites. A cumulative inactivation of I(K) in SG neurons significantly enhanced the responses of kainate receptors at all spike rates, while the augmentations for the alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid and N-methyl-D-aspartic acid receptors were most prominent below 100 spikes/s. These modeling results suggest that, in addition to the AP firing rate and timing, the width of APs could affect the neurotransmission of the auditory nerve under both normal and pathological conditions.

Action Potentials↗

Computer simulation of Gumboro disease outbreak. IV. Epizootics obtained by mode G-4 with flock size, age and immunity changed.

For the computer simulation of Gumboro disease outbreak by Model G-4 a program was written in FORTRAN. Of over twenty parameters involved in the model, the following three were used as input variables: (1) age of chickens at housing a1 (= 1 and 21); (2) size of flock at housing, N(a1) (= 100 and 1,000); and (3) geometric mean of the level of parentally conferred immunity at hatching, G(1) (= 0, 2, 8, and 32). The outputs were the graphic images demonstrating the chronological changes in a flock of innate resistance, parentally conferred immunity, and their sum, and the epizootic patterns composed of numbers of chickens at subclinical stage, clinically diseased, recovered, condemned, etc. at each age. As a result, stronger epizootics were produced at a lower level of parentally conferred immunity, and a higher age and a larger size of flocks. It was suggested that the subclinical stage might not be understood as an inapparent infection, and that a further postulate on the infection might be necessary to be introduced into this model to increase the practical utility, as well as the theoretical soundness, of this series of studies.

Age Factors↗

Age-at-interview bias in anticipation studies: computer simulations and an example with panic disorder.

The phenomenon of anticipation has received considerable interest recently, especially among researchers investigating the genetics of psychiatric disorders. Anticipation can involve an earlier age at onset, greater severity, and/or a higher number of affected individuals in successive generations within a family. There is some controversy concerning detection of age-at-onset anticipation, due to problems of sampling bias, which may account for the phenomenon by preferentially sampling either lateronset parents or earlier-onset children. One source of bias that has not been explicitly investigated is differential age at interview between parent and child, such that parents have passed through more of the risk period than their offspring. We conducted a computer simulation study of affected parent-child pairs to determine whether, for realistic age-at-onset and age-at-interview distributions, this source of bias is a serious one. Our results show that the timing of diagnostic assessment can strongly affect the ascertainment of parent-child pairs, to produce a severely biased sample exhibiting apparent anticipation. Under realistic assumptions, an investigator may face a greatly increased risk of false positives (i.e. detecting anticipation when none exists). For example, a nominal 5% significance level may correspond to true p values as high as 50% or even approaching 100%. We conclude with an application to existing data on panic disorder.

Adult↗

BULLET: a computer simulation of shotgun DNA sequencing.

BULLET is a computer program that simulates shotgun sequencing of DNA. The program has been used to simulate the sequencing of DNA fragments from 2 to 30 kb. To obtain 80% single or double-stranded sequence, a doubling of the DNA fragment size necessitates twice the number of sequencing reactions. However, a similar linear relationship does not apply to the determination of 100% single or double-stranded sequence. Data from BULLET were used to derive simple linear formulae that estimate the number of sequencing reactions necessary to partially sequence a fragment of DNA irrespective of size. When 80% of the double-stranded sequence has been determined, approximately 98% of single-stranded sequence will be known. This is a reasonable point to change to a more directed strategy of DNA sequencing.

Algorithms↗

Use of a computer simulation to evaluate a seminar on child abuse.

A computerized patient simulation was used to evaluate the effectiveness of a seminar on child abuse in changing students' behavior in assessing the problem and developing a treatment plan. The CAMPS system (DACIS Software) was selected because it allows students freedom to follow any pathway in selecting over 500 items of history, physical examination, laboratory, and treatments. In interacting with this simulation, students demonstrated how they integrate their knowledge into a clinical setting. The three-hour seminar covered the topics of physical and sexual abuse, patient neglect, and utilization of community resources for treatment. The control (n = 43) and experimental (n = 38) groups, enrolled in an introductory course in pediatrics, were given references to read about child abuse as part of the core curriculum, but they may or may not have had exposure to patients in their clinical work. Only the experimental group attended the seminar. As part of the course evaluation program, both groups interacted with eight computer simulations, two of which involved cases of child abuse. In the classic case of child abuse, the control and experimental groups had similar results. In the more difficult diagnostic problem (shaken baby), the groups differed significantly in total score, cost of the evaluation, and percentage of correct diagnosis.

Child↗