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Dynamic neural network models of the premotoneuronal circuitry controlling wrist movements in primates.

Dynamic recurrent neural networks were derived to simulate neuronal populations generating bidirectional wrist movements in the monkey. The models incorporate anatomical connections of cortical and rubral neurons, muscle afferents, segmental interneurons and motoneurons; they also incorporate the response profiles of four populations of neurons observed in behaving monkeys. The networks were derived by gradient descent algorithms to generate the eight characteristic patterns of motor unit activations observed during alternating flexion-extension wrist movements. The resulting model generated the appropriate input-output transforms and developed connection strengths resembling those in physiological pathways. We found that this network could be further trained to simulate additional tasks, such as experimentally observed reflex responses to limb perturbations that stretched or shortened the active muscles, and scaling of response amplitudes in proportion to inputs. In the final comprehensive network, motor units are driven by the combined activity of cortical, rubral, spinal and afferent units during step tracking and perturbations. The model displayed many emergent properties corresponding to physiological characteristics. The resulting neural network provides a working model of premotoneuronal circuitry and elucidates the neural mechanisms controlling motoneuron activity. It also predicts several features to be experimentally tested, for example the consequences of eliminating inhibitory connections in cortex and red nucleus. It also reveals that co-contraction can be achieved by simultaneous activation of the flexor and extensor circuits without invoking features specific to co-contraction.

Animals↗

Forecasting model for the incidence of hepatitis A based on artificial neural network.

AIM: To study the application of artificial neural network (ANN) in forecasting the incidence of hepatitis A, which had an autoregression phenomenon. METHODS: The data of the incidence of hepatitis A in Liaoning Province from 1981 to 2001 were obtained from Liaoning Disease Control and Prevention Center. We used the autoregressive integrated moving average (ARIMA) model of time series analysis to determine whether there was any autoregression phenomenon in the data. Then the data of the incidence were switched into [0,1] intervals as the network theoretical output. The data from 1981 to 1997 were used as the training and verifying sets and the data from 1998 to 2001 were made up into the test set. STATISTICA neural network (ST NN) was used to construct, train and simulate the artificial neural network. RESULTS: Twenty-four networks were tested and seven were retained. The best network we found had excellent performance, its regression ratio was 0.73, and its correlation was 0.69. There were 2 input variables in the network, one was AR(1), and the other was time. The number of units in hidden layer was 3. In ARIMA time series analysis results, the best model was first order autoregression without difference and smoothness. The total sum square error of the ANN model was 9 090.21, the sum square error of the training set and testing set was 8 377.52 and 712.69, respectively, they were all less than that of ARIMA model. The corresponding value of ARIMA was 12 291.79, 8 944.95 and 3 346.84, respectively. The correlation coefficient of nonlinear regression (R(NL)) of ANN was 0.71, while the R(NL) of ARIMA linear autoregression model was 0.66. CONCLUSION: ANN is superior to conventional methods in forecasting the incidence of hepatitis A which has an autoregression phenomenon.

China↗

A web-based repository of surgical simulator projects.

The use of computer-based surgical simulators for training of prospective surgeons has been a topic of research for more than a decade. As a result, a large number of academic projects have been carried out, and a growing number of commercial products are available on the market. Keeping track of all these endeavors for established groups as well as for newly started projects can be quite arduous. Gathering information on existing methods, already traveled research paths, and problems encountered is a time consuming task. To alleviate this situation, we have established a modifiable online repository of existing projects. It contains detailed information about a large number of simulator projects gathered from web pages, papers and personal communication. The database is modifiable (with password protected sections) and also allows for a simple statistical analysis of the collected data. For further information, the surgical repository web page can be found at www.virtualsurgery.vision.ee.ethz.ch.

Computer Simulation↗

Chemical warfare: disaster preparation in an Israeli hospital.

The situation in the Middle East makes it imperative that Israeli hospitals be prepared for disaster, particularly that associated with chemical warfare. To prepare for the impact of chemical warfare, Israeli hospitals have designed mass trauma programs, which include staff training and simulated disaster drill exercises. These have been incorporated in the conventional disaster program since 1989. This article provides a brief overview of the trauma program at Beilinson Medical Center in Petach Tikva, Israel, including definition of four stages of injury, guidelines for intervention, and a discussion of the role of the social worker in the disaster plan.

Adult↗

Favored patterns in spike trains. I. Detection.

Traditional spike-train analysis methods cannot identify patterns of firing that occur frequently but at arbitrary times. It is appropriate to search for recurring patterns because such patterns could be used for information transfer. In this paper, we present two methods for identifying "favored patterns" --patterns that occur more often than is reasonably expected at random. The quantized Monte Carlo method identifies and establishes significance for favored patterns whose detailed timing may vary but that do not have extra or missing spikes. The template method identifies favored patterns whose occurrences may have extra or missing spikes. This method is useful when employed after the results of the first method are known. Studies with simulated spike trains containing known interpolated patterns are used to establish the sensitivity and accuracy of the quantized Monte Carlo method. Certain trends with regard to parameters of the detected patterns and of the analysis methods are described. Application of these methods to neurophysiological data has shown that a large proportion of spike trains have favored patterns. These findings are described in the accompanying paper (3).

Action Potentials↗

Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.

PURPOSE: We evaluated the durability of laboratory based technical skills training in urological microsurgery using bench model simulators. METHODS AND MATERIALS: A total of 50 junior surgery residents (post-graduate years 1 to 3) were recruited to participate in a focused training program in urological microsurgery. Prior to training subjects were randomized to receive hands-on training with bench model simulators (silicone tubing or live rat vas deferens, 40) or didactic training alone (10). Four months following the original training program the technical performance of 18 returning subjects (13 from the bench model and 5 from the didactic training group) was reevaluated using a high fidelity, live animal model (vasovasostomy and rat vas deferens). Outcome measures included blinded, expert assessment of videotaped performance using checklists and global rating scores, and evaluation of anastomotic patency. RESULTS: The retention test checklist (p <0.001), global rating scores (p <0.001) and anastomotic patency rates (p = 0.05) in the live animal model remained significantly higher for subjects who originally received hands-on bench model training compared with those who received didactic training alone. The number of interim practice opportunities with microsurgery correlated significantly with expert global ratings of surgical performance irrespective of the nature of training (r = 0.54, p = 0.02). CONCLUSIONS: Laboratory based technical skills training with bench models can lead to a significant retention of technical skill by novice surgeons. Measured performance improvements appear to be durable with time. However, the opportunity for repeat hands-on practice appears to maximize the retention of technical skill.

Adult↗

Intracorporeal suturing and knot tying in surgical simulation.

Intracorporeal suturing and knot tying is one of the most difficult tasks to perform during minimally invasive surgery. To master these tasks the student requires extensive training in a real or simulated environment. Realistic simulation of suturing and knot tying is a challenging task, the dynamic behaviors of the needle and thread are complicated to calculate efficiently in real time. We present our approach to simulated training of intracorporeal suturing and knot tying as well as our method for performance assessment. Different algorithms for physical modeling of suture thread dynamics are examined and evaluated.

Computer Simulation↗

A joint interspike interval difference stochastic spike train analysis: detecting local trends in the temporal firing patterns of single neurons.

We introduce a stochastic spike train analysis method called joint interspike interval difference (JISID) analysis. By design, this method detects changes in firing interspike intervals (ISIs), called local trends, within a 4-spike pattern in a spike train. This analysis classifies 4-spike patterns that have similar incremental changes. It characterizes the higher-order serial dependence in spike firing relative to changes in the firing history. Mathematically, this spike train analysis describes the statistical joint distribution of consecutive changes in ISIs, from which the serial dependence of the changes in higher-order intervals can be determined. It is similar to the joint interspike interval (JISI) analysis, except that the joint distribution of consecutive ISI differences (ISIDs) is quantified. The graphical location of points in the JISID scatter plot reveals the local trends in firing (i.e., monotonically increasing, monotonically decreasing, or transitional firing). The trajectory of these points in the serial-JISID plot traces the time evolution of these trends represented by a 5-spike pattern, while points in the JISID scatter plot represent trends of a 4-spike pattern. We provide complete theoretical interpretations of the JISID analysis. We also demonstrate that this method indeed identifies firing trends in both simulated spike trains and spike trains recorded from cultured neurons.

Animals↗

[Laparoscopic training in urology. An essential principle of laparoscopic interventions in the retroperitoneum].

The main problem with clinical introduction of laparoscopic techniques in urology is that despite experience with endoscopy no significant endoscopic training is given. Laparoscopic nephrectomy, in particular, is a rather complicated procedure and needs an adequate training concept: The beginner should have the possibility of practising in vitro in a closed "pelvi-trainer" to learn video-optical coordination and orientation; then it is necessary to get used to handling the instruments and practise the different steps of the procedure (i.e. clipping of vessels, sacking of the kidney) either in phantom models or in explanted animal organs. On this basis, we performed laparoscopic nephrectomy in an animal model (n = 18 porcine kidneys). We were able to standardize the technique of creating a pneumoperitoneum, the positioning of the animal, the site and size of the trocars, and preparation and clipping techniques (i.e. Endo-GIA) and entrapment of the kidney (testing different organ bags). A step-by-step approach was used for the introduction to clinical application. For simulation and training of video-assisted preparation techniques in patients and step-wise introduction to laparoscopy (instruments, endocoagulation, trocars), we created a "lap-tent", which was placed over the wound after exposition of Gerota's fascia. Further preparation was performed under laparoscopic conditions (without pneumoperitoneum) with a limited time allowed (1 h). Thereafter, we started with time-limited laparoscopy and laparoscopic lymphadenectomy prior to pelvic surgery (prostatectomy, cystectomy) to introduce the staff to the technique of pneumoperitoneum and placement of the trocars and to the use of the instruments in general. Based on this step-by-step training concept, after a 6-months period we were successful in introducing transperitoneal laparoscopic nephrectomy (TLN) to our clinical routine. So far, we have performed 20 laparoscopic nephrectomies, 1 nephro-ureterectomy, 4 tumour nephrectomies (inducing adrenalectomy), 2 adrenalectomies, and 6 modified retroperitoneal lymphadenectomies. In the lesser pelvis we have experience with 20 laparoscopic varicocelectomies, 23 pelvic lymphadenectomies, and 5 diagnostic laparoscopies for cryptorchidism (February 1993).

Adrenalectomy↗

Editing trains of action potentials from multi-electrode arrays.

When recording from multi-electrode arrays, only a short period around the time of a threshold crossing is generally saved for later analysis. Then, waveforms are often sorted automatically to identify templates of spikes from individual neurons near an electrode. As spikes sum from different neurons and noise is present, some spikes may be missed and others erroneously accepted. This paper describes methods for identifying and correcting errors in recorded spike trains to recover the pattern of spikes from each neuron as faithfully as possible. These methods are complementary to, but distinct from methods to reconstruct waveforms that arise from summation of individual templates that overlap one another. Our methods are based on the local statistics of the firing rates or inter-spike intervals and the methods work best for neurons that fire regularly (small standard deviation relative to the mean interval). First, we test whether accepting more spikes, whose waveforms are close to the templates that have been identified, will increase the regularity or smoothness of the firing rates. Then, after accepting spikes that increase regularity, we test whether individual intervals are sufficiently longer (or shorter) than their neighbors to identify spikes that have been omitted (or accepted) erroneously. The methods are tested on simulated spike trains, where spikes have been inserted or deleted at random, and on spike trains recorded from multi-electrode arrays in dorsal root ganglia of cats walking on a treadmill.

Action Potentials↗

Design of a genome-wide siRNA library using an artificial neural network.

The largest gene knock-down experiments performed to date have used multiple short interfering/short hairpin (si/sh)RNAs per gene. To overcome this burden for design of a genome-wide siRNA library, we used the Stuttgart Neural Net Simulator to train algorithms on a data set of 2,182 randomly selected siRNAs targeted to 34 mRNA species, assayed through a high-throughput fluorescent reporter gene system. The algorithm, (BIOPREDsi), reliably predicted activity of 249 siRNAs of an independent test set (Pearson coefficient r = 0.66) and siRNAs targeting endogenous genes at mRNA and protein levels. Neural networks trained on a complementary 21-nucleotide (nt) guide sequence were superior to those trained on a 19-nt sequence. BIOPREDsi was used in the design of a genome-wide siRNA collection with two potent siRNAs per gene. When this collection of 50,000 siRNAs was used to identify genes involved in the cellular response to hypoxia, two of the most potent hits were the key hypoxia transcription factors HIF1A and ARNT.

Algorithms↗

The role of simulated models in pediatric surgery to acquire diagnostic skills of inguino-scrotal disorders.

BACKGROUND/PURPOSE: Acquisition of clinical skills in medical education requires repeated practice. Current medical education mandates simulator-based clinical skills training programs. The details of our simulator-based clinical skills training on inguino-scrotal disorders (ISD) of the childhood, and the feedbacks obtained from the trainees are reported METHODS: From 1999 to 2001, simulator-based skill training on ISD is given to second- and fourth-year students (n = 207 and n = 128, respectively) and to primary health care physicians during postgraduate continuing medical education program (n = 80). Feedback forms filled out by each participant after the training were evaluated. RESULTS: A total of 55% to 66% of the second-year medical school students had judged 5 points, whereas 6% to 9% of them had judged 1 point on their feedback forms. A total of 79% to 84% of the fourth-year students had judged 5 points, whereas 1% to 5% of them had judged 1 point on their feedback forms. A total of 87% to 91% of the primary health care physicians had judged 5 points, whereas 1% to 2% of them had judged 1 point on their feedback forms. CONCLUSIONS: Simulated models of inguino-scrotal disorders constructed from readily available materials are effective in clinical skills training.

Adult↗

Estimating receptive fields in the presence of spike-time jitter.

Neurons in sensory systems are commonly characterized by their receptive fields. These are experimentally often obtained by reverse-correlation analyses, for example, by calculating the spike-triggered average. The reverse-correlation approach, however, generally assumes a fixed temporal relation between spike-generating stimulus features and measured spikes. Temporal jitter of spikes will therefore distort the estimated receptive fields. Here, a novel extension of widely used reverse-correlation techniques (spike-triggered average as well as spike-triggered covariance) is presented that allows accurate measurements of receptive fields even in the presence of considerable spike-time jitter. It is shown that the method correctly recovers the receptive fields from simulated spike trains. When applied to recordings from auditory receptor cells of locusts, a considerable sharpening of receptive fields as compared to standard spike-triggered averages is observed. In addition, the multiple filters that are obtained from a conventional spike-triggered covariance analysis of these data can be collapsed into a single component if spike jitter is accounted for. Finally, it is shown how further effects on spike timing, such as systematic shifts in spike latency, can be included in the approach.

Acoustic Stimulation↗

Visual guidance during competition performance and run-through training in long jumping.

To ensure precise foot placement on the take-off board, long jumpers visually regulate their stride pattern during their run-up. A relationship between how much visual guidance they use and the horizontal distance they jump has not, however, been quantified. Run-up precision is often practiced using run-throughs, which exclude the take-off and, therefore, the high physical stress of the complete long jump. The validity with which this common training method simulates the long jump approach remains, however, to be verified. Four state-standard long jumpers and two heptathletes completed two sessions, each comprising six runthroughs and six competition long jumps. A 50 Hz video camera was manually panned from an elevated platform to film each trial, to enable subsequent gait characteristic evaluations. Linear regression analyses identified that a longer visual regulation phase, measured in time, distance or number of strides, was a key predictor of long jump distance. The number of strides that were visually regulated during the long jump approach was, accordingly, positively correlated with long jump distance (r = 0.67, p = 0.001). The amount of visual regulation used during run-throughs was, however, less than half (p = 0.001) of that observed during long jump approaches. Our results should compel long jump coaches to supplement run-through training with additional visual guidance exercises, to encourage their athletes to visually regulate more of their long jump approach.

Adult↗

Teaching risk-factor counseling skills: a comparison of two instructional methods.

The effectiveness of a class-wide lecture coupled with small group discussions was compared to the outcome of clinical instruction provided by patient instructors (PIs) who were specially trained to teach behavioral counseling skills for health promotion and lifestyle risk-factor modification. PIs are nonprofessionals trained to simulate a medical encounter in order to evaluate clinical competency and provide individual feedback. Each PI enacted the role of an ambulatory patient at high risk for coronary artery disease because of the presence of multiple risk factors. Two groups of medical students were studied using the entire second-year class in two consecutive academic years. In group 1 (n = 92), students received a lecture on risk-factor modification and attended a small group discussion. In group 2 (n = 91), students performed the PI exercise as their primary source of risk-factor counseling instruction. Six months after receiving the initial instruction (at time 2), all students completed the clinical exercise with the PI, who objectively rated each student's counseling skills using the University of Rochester Risk Factor Interview Scale (URRFIS). Differences between groups 1 and 2 at time 2 were significant for total URRFIS and all subscale scores, indicating that students who had received PI training as their form of instruction performed the risk-factor counseling more skillfully. For students in group 2, within-student performance from time 1 to time 2 also was significantly improved. This study demonstrates that instruction in risk-factor counseling for medical students who are early in their formal medical training may be taught more effectively by PIs; the learning appears durable when measured six months after instruction.

Adult↗

Are surgery training programs ready for virtual reality? A survey of program directors in general surgery.

BACKGROUND: The use of advanced technology, such as virtual environments and computer-based simulators (VR/CBS), in training has been well established by both industry and the military. In contrast the medical profession, including surgery, has been slow to incorporate such technology in its training. In an attempt to identify factors limiting the regular incorporation of this technology into surgical training programs, a survey was developed and distributed to all general surgery program directors in the United States. STUDY DESIGN: A 22-question survey was sent to 254 general surgery program directors. The survey was designed to reflect attitudes of the program directors regarding the use of computer-based simulation in surgical training. Questions were scaled from 1 to 5 with 1 = strongly disagree and 5 = strongly agree. RESULTS: A total of 139 responses (55%) were returned. The majority of respondents (58%) had seen VR/CBS, but only 19% had "hands-on" experience with these systems. Respondents strongly agreed that there is a need for learning opportunities outside of the operating room and a role for VR/CBS in surgical training. Respondents believed both staff and residents would support this type of training. Concerns included VR/CBS' lack of validation and potential requirements for frequent system upgrades. CONCLUSIONS: Virtual environments and computer-based simulators, although well established training tools in other fields, have not been widely incorporated into surgical education. Our results suggest that program directors believe this type of technology would be beneficial in surgical education, but they lack adequate information regarding VR/CBS. Developers of this technology may need to focus on educating potential users and addressing their concerns.

Clinical Competence↗

The relationship between synchronization among neuronal populations and their mean activity levels.

In the past decade the importance of synchronized dynamics in the brain has emerged from both empirical and theoretical perspectives. Fast dynamic synchronous interactions of an oscillatory or nonoscillatory nature may constitute a form of temporal coding that underlies feature binding and perceptual synthesis. The relationship between synchronization among neuronal populations and the population firing rates addresses two important issues: the distinction between rate coding and synchronization coding models of neuronal interactions and the degree to which empirical measurements of population activity, such as those employed by neuroimaging, are sensitive to changes in synchronization. We examined the relationship between mean population activity and synchronization using biologically plausible simulations. In this article, we focus on continuous stationary dynamics. (In a companion article, Chawla (forthcoming), we address the same issue using stimulus-evoked transients.) By manipulation parameters such as extrinsic input, intrinsic noise, synaptic efficacy, density of extrinsic connections, the voltage-sensitive nature of postsynaptic mechanisms, the number of neurons, and the laminar structure within the populations, we were able to introduce variations in both mean activity and synchronization under a variety of simulated neuronal architectures. Analyses of the simulated spike trains and local field potentials showed that in nearly every domain of the model's parameter space, mean activity and synchronization were tightly coupled. This coupling appears to be mediated by an increase in synchronous gain when effective membrane time constants are lowered by increased activity. These observations show that under the assumptions implicit in our models, rate coding and synchrony coding in neural systems with reciprocal interconnections are two perspectives on the same underlying dynamic. This suggests that in the absence of specific mechanisms decoupling changes in synchronization from firing levels, indexes of brain activity that are based purely on synaptic activity (e.g., functional magnetic resonance imaging) may also be sensitive to changes in synchronous coupling.

Brain↗

Ultrasound simulators: experience with the SonoTrainer and comparative review of other training systems.

Ultrasound has become indispensable in prenatal diagnosis. Ultrasound training, however, still lacks proper quality assessment and control. Moreover, most fetal anomalies which must be diagnosed during pregnancy are extremely rare. Ultrasound simulators could provide an opportunity to overcome this dilemma. This review summarizes the potential benefits of simulator-based ultrasound training, briefly describes the properties of a variety of ultrasound simulators that have been developed for various applications including prenatal diagnosis, and presents the SonoTrainer sonography simulation system which makes it possible to run a real-time simulation of a complete prenatal ultrasound examination. We evaluated the system for the training of first- and second-trimester screening for both normal and pathological findings and found that physicians who received theoretical training and were additionally trained with the simulator (T + S) significantly improved their skills in measurements of nuchal translucency thickness (NT) and crown-rump length (CRL) as compared with colleagues who only underwent theoretical instruction (T) [mean +/- SD NT deviation: 0.31 +/- 0.1 mm (T + S) vs. 0.62 +/- 0.2 mm (T), P < 0.05; mean +/- SD CRL deviation: 1.48 +/- 2.0 mm (T + S) vs. 3.27 +/- 2.5 (T), P < 0.05]. Simulator-based training enabled physicians to diagnose rare fetal anomalies in the second trimester with a sensitivity of 86% and a specificity of 100%. In a study in which second-trimester scans including fetal anomalies were presented to physicians, 96% of the participants subjectively estimated their training effect as being good. We therefore conclude that simulator-based training would provide an ideal educational tool to test, improve and monitor a physician's or technician's ultrasound skills in detecting fetal anomalies.

Education, Medical, Graduate↗