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At least 937 records · Page 52Linked to original sources
PubMed1991

Iliad training effects: a cognitive model and empirical findings.

Iliad is a diagnostic expert system consisting of an "inference engine" (collection of rules and procedures for making decisions) and a "knowledge base" (collection of medical facts). Iliad's internal medicine knowledge base recognizes 5000 medical findings and covers 1150 diagnostic conditions in 10 subspecialty fields. We used Iliad's simulator mode to train diagnostic skills in junior-year medical students. The results corroborate previous findings documenting Iliad's teaching efficacy. Recent developments in cognitive psychology provide a framework for explaining Iliad's training effects.

Clinical Clerkship↗
PubMedDate not supplied

Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: A pilot study.

OBJECTIVES: Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents are low frequency, high impact events that require specialized training outside of usual clinical practice. Educational modalities must recreate these clinical scenarios in order to provide realistic first responder/receiver training. METHODS: High fidelity, mannequin-based (HFMB) simulation and video clinical vignettes were used to create a simulation-based CBRNE course directed at the recognition, triage, and resuscitation of contaminated victims. The course participants, who consisted of first responders and receivers, were evaluated using a 43-question pre- and post-test that employed 12 video clinical vignettes as scenarios for the test questions. The results of the pre-test were analyzed according to the various medical training backgrounds of the participants to identify differences in baseline performance. A Scheffe post-hoc test and an ANOVA were used to determine differences between the medical training backgrounds of the participants. For those participants who completed both the pre-course and post-course test, the results were compared using a paired Student's t-test. RESULTS: A total of 54 first responders/receivers including physicians, nurses, and paramedics completed the course. Pre-course and post-course test results are listed by learner category. For all participants who took the pre-course test (n = 67), the mean value of the test scores was 53.5 +/- 12.7%. For all participants who took the post-course test (n = 54), the mean value of the test scores was 78.3 +/-10.9%. The change in score for those who took both the pre- and post-test (n = 54) achieved statistical significance at all levels of learner. CONCLUSIONS: The results suggest that video clinical vignettes and HFMB simulation are effective methods of CBRNE training and evaluation. Future studies should be conducted to determine the educational and cost-effectiveness of the use of these modalities.

Bioterrorism↗
PubMed2005

A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting.

OBJECTIVE: To test whether basic skills acquired on a virtual endoscopic surgery simulator are transferable from virtual reality to physical reality in a comparable training setting. SUMMARY BACKGROUND DATA: For surgical training in laparoscopic surgery, new training methods have to be developed that allow surgeons to first practice in a simulated setting before operating on real patients. A virtual endoscopic surgery trainer (VEST) has been developed within the framework of a joint project. Because of principal limitations of simulation techniques, it is essential to know whether training with this simulator is comparable to conventional training. METHODS: Devices used were the VEST system and a conventional video trainer (CVT). Two basic training tasks were constructed identically (a) as virtual tasks and (b) as mechanical models for the CVT. Test persons were divided into 2 groups each consisting of 12 novices and 4 experts. Each group carried out a defined training program over the course of 4 consecutive days on the VEST or the CVT, respectively. To test the transfer of skills, the groups switched devices on the 5th day. The main parameter was task completion time. RESULTS: The novices in both groups showed similar learning curves. The mean task completion times decreased significantly over the 4 training days of the study. The task completion times for the control task on Day 5 were significantly lower than on Days 1 and 2. The experts' task completion times were much lower than those of the novices. CONCLUSIONS: This study showed that training with a computer simulator, just as with the CVT, resulted in a reproducible training effect. The control task showed that skills learned in virtual reality are transferable to the physical reality of a CVT. The fact that the experts showed little improvement demonstrates that the simulation trains surgeons in basic laparoscopic skills learned in years of practice.

Clinical Competence↗
PubMed2001

Development of a model for training and evaluation in subfascial endoscopic perforator surgery (SEPS).

We describe a training method with objective evaluation that enhances video-assisted surgical skills. Training is via a simulator for subfascial endoscopic perforator surgery (SEPS) and can assess whether specific training exercises are helpful in the acquisition of skills for video-assisted surgical techniques. Twenty-five surgeons, with or without experience in video-assisted surgical techniques, were asked to perform standardised drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space in a leg, in which false perforator veins had to be localised, clipped and cut. The participants performed two sequences of actions three times, in order to improve their dexterity. The time required to perform each sequence was recorded. All trainees showed a steady improvement in skill-acquisition of the SEPS technique; the difference was statistically significant (p < 0.004). Despite its obvious importance in teaching programmes, the assessment and training of technical ability has not been fully developed. If virtual reality simulators are to become more important in the future, simulation models will have to approximate more closely the real operating theatre, and thus will become more valid in the training and evaluation of surgical technique.

Journal Article↗
PubMed2026

IQ-NET: fast and accurate quartet phylogenetic inference using deep learning trained on empirical DNA alignments.

Phylogenetic inference is fundamental to modern biology, with many applications including evolutionary biology, epidemiology, and comparative genomics. While maximum likelihood and Bayesian methods remain the gold standard for phylogenetic analysis, they rely on simplifying assumptions and are computationally intensive. Recent machine learning approaches for phylogenetics offer speed advantages, but have several limitations: exclusive reliance on simulated data for training, inadequate handling of gaps, and sensitivity to input sequence order. Here, we introduce IQ-NET (Intelligent Quartet NETwork), a deep learning framework that solves these limitations to infer four-taxon trees. IQ-NET estimates both tree topology and branch lengths directly from gapped alignments. IQ-NET outperforms existing machine learning methods in terms of accuracy, and obtained a 24-fold speedup compared with the widely used maximum likelihood software, IQ-TREE. We finally introduce a pipeline using IQ-NET and the ASTRAL software to reconstruct a larger species tree, i.e., with more than four taxa.

Empirical data training↗
PubMed1999

Military free fall training injuries.

Military free fall or HALO (high altitude-low opening) is a distinct form of tactical parachuting used by the elite forces of the U.S. military. This study was undertaken to examine the type, location, and mechanism of injuries sustained by the military HALO parachutist during training. A retrospective study identified 134 parachutists with 141 injuries attributed to HALO training. The most common injuries were fractures (35.5%) and sprains/strains (34.7%). The sites most commonly injured were the lower extremities (52.5%), upper extremities (19.8%), and spine (14.9%). Landing was the most frequently encountered mechanism of injury (61.2%), followed by ground free fall simulation (wind tunnel training) and canopy deployment. Night jumping, wearing of combat equipment, and use of oxygen during high-altitude jumps were all variables that contributed to injury. The military free fall parachutist is predisposed to a wide array of musculoskeletal injuries at different training phases.

Accidents, Aviation↗
PubMed2007

Perception of training needs and opportunities in advanced airway skills: a survey of British and Irish trainees.

BACKGROUND AND OBJECTIVE: We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed). METHODS: Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues. RESULTS: We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10-20); the median number performed was 2 (IQR 0-4). This was statistically significant for the groups' senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0-1 and 0-0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent. CONCLUSION: Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.

Anesthesiology↗
PubMedDate not supplied

A phenomenological model of visually evoked spike trains in cat geniculate nonlagged X-cells.

The visual information that first-order cortical cells receive is contained in the visually evoked spike trains of geniculate relay cells. To address functional issues such as the ON/OFF structure of visual cortical receptive fields with modelling studies, a geniculate cell model is needed where the spatial and temporal characteristics of the visual response are described quantitatively. We propose a model simulating the spike trains produced by cat geniculate nonlagged X-cells, based on a review of the electrophysiological literature. The level of description chosen is phenomenological, fitting the dynamics and amplitude of phasic and tonic responses, center/surround antagonism, surround excitatory responses, and the statistical properties of both spontaneous and visually evoked spike trains. The model, which has been constrained so as to reproduce the responses to centered light spots of expanding size and optimal light and dark annuli, predicts responses to thin and large bars flashed in various positions of the receptive field. The switching gamma renewal process method has been introduced for modelling spontaneous and visually evoked spike trains within the same mathematical framework. The statistical structure of the spike process is assumed to be more regular during phasic than tonic visual responses. On the whole, this model generates more realistic geniculate input to cortex than the currently used retinal models.

Animals↗
PubMed1998

Excitability of the squid giant axon revisited.

The electrical properties of the giant axon from the common squid Loligo pealei have been reexamined. The primary motivation for this work was the observation that the refractoriness of the axon was significantly greater than the predictions of the standard model of nerve excitability. In particular, the axon fired only once in response to a sustained, suprathreshold stimulus. Similarly, only a single action potential was observed in response to the first pulse of a train of 1-ms duration current pulses, when the pulses were separated in time by approximately 10 ms. The axon was refractory to all subsequent pulses in the train. The underlying mechanisms for these results concern both the sodium and potassium ion currents INa and IK. Specifically, Na+ channel activation has long been known to be coupled to inactivation during a depolarizing voltage-clamp step. This feature appears to be required to simulate the pulse train results in a revised model of nerve excitability. Moreover, the activation curve for IK has a significantly steeper voltage dependence, especially near its threshold (approximately -60 mV), than in the standard model, which contributes to reduced excitability, and the fully activated current-voltage relation for IK has a nonlinear, rather than a linear, dependence on driving force. An additional aspect of the revised model is accumulation/depeletion of K+ in the space between the axon and the glial cells surrounding the axon, which is significant even during a single action potential and which can account for the 15-20 mV difference between the potassium equilibrium potential EK and the maximum afterhyperpolarization of the action potential. The modifications in IK can also account for the shape of voltage changes near the foot of the action potential.

Action Potentials↗
PubMed1999

Use of a pulsatile beating heart model for training surgeons in beating heart surgery.

BACKGROUND: Coronary artery bypass on the beating heart has undergone resurgence with the introduction of minimally invasive techniques and new stabilizing devices. It is important to develop a method for training surgeons to perform accurate anastomoses despite cardiac motion and to develop the skills needed for consistent results in this demanding field. METHODS: A prosthetic model of the beating heart was created by Limbs and Things, Ltd. (Bristol, UK) and used in our center to simulate clinical situations of beating heart surgery. Anastomotic quality was evaluated using a pre-established set of criteria on patency and suturing with each anastomosis graded on a 12-point scale. RESULTS: The average scores for trainees using the Pulsatile Beating Heart Model were 8.5 while that of the expert surgeon with MIDCAB experience was 11. Defects seen included cross-wall suturing and significant narrowing of the toe of the anastomosis. Scores improved with increasing practice during each session. Operators with more clinical experience scored higher. All surgeons felt the model duplicated the exposure and feel of the tissue characteristic of clinical cases. CONCLUSIONS: The beating heart simulator provides excellent training for new as well as experienced surgeons, provides visual feedback of anastomotic errors, and instills increasing confidence in the participants in their ability to construct accurate anastomoses on the beating heart.

Cardiopulmonary Bypass↗
PubMed2001

Training-induced increases in sea-level performance are enhanced by acute intermittent hypobaric hypoxia.

The goal of this study was to investigate to what extent intermittent exposure to altitude in a hypobaric chamber can improve performance at sea-level. Over a 10-day period, elite male triathletes trained for 2 h each day on a cycle ergometer placed in a hypobaric chamber. Training intensity was 60-70% of the heart rate reserve. Eight subjects trained at a simulated altitude of 2.500 m (hypoxia group), the other eight remained at sea-level (sea-level group). Baseline measurements were done on a cycle ergometer at sea-level, which included an incremental test until exhaustion and a Wingate Anaerobic Test. Nine days after training in hypoxia, significant increases were seen in all important parameters of the maximal aerobic as well as the anaerobic test. A significant increase of 7.0% was seen in the mean maximal oxygen uptake per kilogram body weight (VO2max), and the mean maximal power output per kilogram body weight (Wmax) increased significantly by 7.4%. The mean values of both mean power per kilogram body weight and peak power per kilogram body weight increased significantly by 5.0%, and the time-to-peak decreased significantly by 37.7%. In the sea-level group, no significant changes were seen in the abovementioned parameters of both the maximal aerobic and the maximal anaerobic test at the second post-test. The results of this study indicate that intermittent hypobaric training can improve both the aerobic and the anaerobic energy-supply systems.

Adult↗
PubMed1998

Improving quality of sexually transmitted disease case management in rural South Africa.

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.

Case Management↗