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PubMed1997

Discovering Neural Nets with Low Kolmogorov Complexity and High Generalization Capability.

Many neural net learning algorithms aim at finding "simple" nets to explain training data. The expectation is that the "simpler" the networks, the better the generalization on test data (--> Occam's razor). Previous implementations, however, use measures for "simplicity" that lack the power, universality and elegance of those based on Kolmogorov complexity and Solomonoff's algorithmic probability. Likewise, most previous approaches (especially those of the "Bayesian" kind) suffer from the problem of choosing appropriate priors. This paper addresses both issues. It first reviews some basic concepts of algorithmic complexity theory relevant to machine learing, and how the Solomonoff-Levin distribution (or universal prior) deals with the prior problem. The universal prior leads to a probabilistic method for finding "algorithmically simple" problem solutions with high generalization capability. The method is based on Levin complexity (a time-bounded generalization of Kolmogorov complexity) and inspired by Levin's optimal universal search algorithm. For a given problem, solution candidates are computed by efficient "self-sizing" programs that influence their own runtime and storage size. The probabilistic search algorithm finds the "good" programs (the ones quickly computing algorithmically probable solutions fitting the training data). Simulations focus on the task of discovering "algorithmically simple" neural networks with low Kolmogorov complexity and high generalization capability. It is demonstrated that the method, at least with certain toy problems where it is computationally feasible, can lead to generalization results unmatchable by previous neural network algorithms. Much remains to be done, however, to make large scale applications and "incremental learning" feasible. Copyright 1997 Elsevier Science Ltd.

Journal Article↗
PubMedDate not supplied

A literature review of the prehospital use of neuromuscular blocking agents by air medical personnel to facilitate endotracheal intubation.

Air medical personnel in the United States have used neuromuscular blocking agents to facilitate endotracheal intubation in the field for more than a decade. This literature review examines 15 studies to investigate their experience and explores the following specific areas: the intubation success rate in patients who did or did not receive these agents, the intubation success rate of air medical personnel before and after they incorporated these agents into their practice, the neuromuscular blocking agents and adjunct medications used by air medical personnel, and the disposition of patients who could not be intubated after an agent was given. The data suggest that, overall, air medical personnel use these agents safely and effectively. Suggestions are offered for future studies, including examining ground time when agents are used to facilitate intubation, complications of their use in this setting, and the use of simulators to train personnel in the administration of these medications.

Air Ambulances↗
PubMed2001

Measurements and modelling of the compliance of human and porcine organs.

Stress-strain data obtained from animal and human tissue have several applications including medical diagnosis, assisting in surgical instrument design and the production of realistic computer-based simulators for training in minimal access surgery. Such data may also be useful for corroborating mathematical models of tissue response. This paper presents data obtained from ex-vivo and in-vivo tissue indentation tests using a small indentor that is similar to instruments used in minimal access surgery. In addition, uniform stress tests provide basic material property data, via an exponential stress-strain law, to allow a finite element method to be used to predict the response for the non-uniform stresses produced by the small indentor. Data are obtained from harvested pig liver and spleen using a static compliance probe. Data for human liver are obtained from volunteer patients, undergoing minor open surgery, using a sterile hand-held compliance probe. All the results demonstrate highly non-linear stress-strain behaviour. Pig spleen is shown to be much more compliant than pig liver with mean elastic moduli of 0.11 and 4.0 MPa respectively. The right lobe of human liver had a mean elastic modulus of about 0.27 MPa. However, a single case of a diseased liver had a mean modulus of 0.74 MPa--nearly three times the stiffness. It was found that an exponential stress-strain law could accurately fit uniform stress test data and that subsequent finite element modelling for non-uniform stress around a small indentor matched measured force characteristics.

Animals↗
PubMed1994

Temporal bone dissection for display.

Increasing concern with medicolegal issues has heightened the need for surgical simulation in training. Familiarity with the surgical anatomy of the temporal bone is essential for effective and safe otological surgery. Refinement of surgical technique and intimate knowledge of temporal bone anatomy can be gained by accurate dissection. The products of such endeavours are both illustrative and instructive. The issues, methods and techniques necessary for display of anatomical dissections are discussed.

Connective Tissue↗
PubMed1999

The effects of blood lactate concentration on perception of effort during graded and steady state treadmill exercise.

Studies have reported that ratings of perceived exertion (RPE) are a valid tool for exercise prescription when blood lactate concentration (BLC) is used as the intensity criterion. However, few have studied the relationship between RPE and BLC during commonly used graded exercise tests (GXTs) and simulated exercise training. The purpose of this study was to determine if the RPE: BLC relationship is transferable across GXTs and a steady state exercise trial (SST). Thirteen healthy males (25+/-5.3yrs) completed two maximal treadmill tests (Bruce and Balke protocols) followed by a SST which consisted of approximately 8 minutes of exercise at each of two intensities (approximately 40% and 70% maximal heart rate reserve). BLCs and other physiological measures were compared at matched RPEs across the GXTs and SST trial at each exercise intensity using a two-way repeated measures ANOVA. There were no significant differences in BLC at a matched RPE across the exercise trials at the lower exercise intensity with the BLCs being 1.5+/-0.3, 1.6+/-0.6 and 1.3+/-0.3 mM, respectively. However, at the higher exercise intensity BLCs were significantly lower during the Balke GXT compared to the Bruce GXT and SST (1.8+/-0.6, 2.8+/-1.8 and 3.0+/-0.8 mM, p < 0.05). These results suggest that the RPE: BLC relationship may be protocol dependent during graded exercise testing as it was only transferable from the Bruce GXT to the exercise training setting at intensities in the typical prescription range of 50-85% of VO2max.

Adult↗
PubMed1987

Task versus socioemotional behaviors in physicians.

This paper investigates associations among physicians' task-oriented and socioemotional behaviors during the medical encounter. The study is an analogue, using as source data the audiotapes and transcripts of two standardized patient cases presented by trained patient simulators to 43 primary care practitioners. Transcripts were scored for physician proficiency and were content-analyzed to assess the process of communication and information content. Physicians' speech errors were counted, and vocal affect ratings were made of filtered audiotape excerpts. Physician communications reflected by these measures were classified as task-oriented or socioemotional. Findings indicated: 1) Most aspects of physician style were reliable across visits. 2) Physicians adopted either a patient-oriented or a physician-oriented approach to task performance, as characterized by giving information and counseling versus giving directions and asking questions, respectively. 3) Verbal and nonverbal socioemotional measures were not related. 4) Physicians tended to adopt either a style characterized by information-giving and proficiency or a social orientation with patients. 5) Physicians who were more medically informative had more interested and anxious voices compared with the less informative physicians. Thus, although the more medically informative physicians spent less time making socioemotional utterances, they had a voice quality that may compensate for that neglect.

Affect↗
PubMed1997

Maintenance of aerobic capacity during recovery from right foot Jones fracture: a case report.

PURPOSE: We sought to evaluate the effectiveness of continued training with deep water running (DWR) on the healing process from a lower leg fracture in maintaining aerobic fitness. CASE SUMMARY: An elite male middle distance runner presented with a Jones fracture of the right foot. The patient opted for nonsurgical treatment. Non-weight-bearing immobilization in a cast proceeded for 14 weeks. The patient continued training by simulating land running and team land workouts with DWR. DWR was the principal mode of exercise through week 24. Physiological and race performance assessments noted a progressive and complete return to preinjury fitness and performance levels. DISCUSSION: DWR can be used by competitive runners during a rehabilitative period to maintain fitness and does not impede the healing process. In developing a DWR regimen, it should be noted that the exercise heart rate when working above the ventilatory threshold will be approximately 12 bpm lower in water. RELEVANCE: DWR may be feasible for maintenance of competitive edge during lower trunk injury rehabilitation.

Adult↗
PubMed2002

Excitable front geometry in reaction-diffusion systems with anomalous dispersion.

Two-dimensional excitable systems with anomalous dispersion provide a discrete set of interpulse distances for the stable propagation of planar wave trains. Numerical simulations show that the trailing front of a pulse pair can undergo transitions between these stable distances. In response to localized perturbations, the trailing front converges towards one of numerous, sigmoidal shapes. Their transition segments move at constant speeds and can collide and fuse with each other. A complementing kinematic analysis of the front dynamics yields a reaction-diffusion-like equation.

Action Potentials↗
PubMed1999

Virtual surgery in a (tele-)radiology framework.

This paper presents telemedicine as an extension of a teleradiology framework through tools for virtual surgery. To classify the described methods and applications, the research field of virtual reality (VR) is broadly reviewed. Differences with respect to technical equipment, methodological requirements and areas of application are pointed out. Desktop VR, augmented reality, and virtual reality are differentiated and discussed in some typical contexts of diagnostic support, surgical planning, therapeutic procedures, simulation and training. Visualization techniques are compared as a prerequisite for virtual reality and assigned to distinct levels of immersion. The advantage of a hybrid visualization kernel is emphasized with respect to the desktop VR applications that are subsequently shown. Moreover, software design aspects are considered by outlining functional openness in the architecture of the host system. Here, a teleradiology workstation was extended by dedicated tools for surgical planning through a plug-in mechanism. Examples of recent areas of application are introduced such as liver tumor resection planning, diagnostic support in heart surgery, and craniofacial surgery planning. In the future, surgical planning systems will become more important. They will benefit from improvements in image acquisition and communication, new image processing approaches, and techniques for data presentation. This will facilitate preoperative planning and intraoperative applications.

Surgical Procedures, Operative↗
PubMed1977

Simulated patients as a learning resource in the study of reproductive medicine.

Simulated patients have been used to foster active learning and problem solving skills in an undergraduate programme of reproductive medicine. These simulators were trained to present a series of clinical problems and were used in a variety of approaches. They served to highlight communication skills and to force attention on the recognition, assessment and management of patient problems.

Clinical Competence↗
PubMed1996

Morbidity and mortality associated with anaesthesia.

The incidence of serious complications associated with Anaesthesia appears to have decreased in recent years. There are many reasons for this-better anaesthetic drugs and equipment, widespread availability of modern monitoring devices, improved standards of pre-, intra- and postoperative care, increasing interest in techniques to identify and control common risk factors and increased number of qualified anaesthetists. Nevertheless, accidents continue to occur. The most common cause of death or serious injury is still failure to ventilate the patient. All recent studies agree that the majority of accidents in modern practice are the consequence, not of equipment failure or adverse drug reactions, but of human error. Mistake, lack of vigilance, inexperience, inadequate supervision and failure of communication are identified as recurring problems. These problems need to be addressed if anaesthesia-related complications are to be further decreased. It seems reasonable to suggest that the use of anaesthesia simulators to train and test anaesthetists in difficult situations should be given a higher priority-both in basic training and in continued postgraduate education. Furthermore, since anaesthesia-related adverse outcomes are rare, strict safety procedures must be applied to thousands of patients in order to prevent one catastrophe. During times of increasing competition for health care money, anaesthetists must be resolute in defending and improving standards of training, monitoring and clinical care. Otherwise the substantial improvement in anaesthesia practice accomplished over recent years may quickly be lost again.

Anesthesia↗
PubMedDate not supplied

Standardized patients for teaching geriatric dentistry.

Effectively managing geriatric dental patients requires behavioral, communication, and assessment skills which are not easily taught or evaluated by traditional methods. Standardized patients (SPs) are persons trained to simulate real patients. The advantages of using SPs instead of real patients are that student experiences can be realistic, yet predetermined and controlled. In a program at the University of Illinois College of Dentistry, SPs are used to provide practice and to evaluate dental students regarding their performance in managing specific geriatric dental patients. In the past three years, over 1500 student-SP interactions specific to geriatric dentistry have been conducted with a wide variety of cases, including examination, diagnosis, and treatment planning. Additionally, program outcomes are discussed.

Education, Dental↗
PubMed2004

The human factor: the critical importance of effective teamwork and communication in providing safe care.

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

Communication↗