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The development of an interactive game-based tool for learning surgical management algorithms via computer.

BACKGROUND: We have previously demonstrated the potential efficacy of a computer-assisted board game as a tool for medical education. The next logical step was to transfer the entire game on to the computer, thus increasing accessibility to students and allowing for a richer and more accurate simulation of patient scenarios. METHODS: First, a general game model was developed using Microsoft Visual Basic. A breast module was then created using 3-D models, radiographs, and pathology and cytology images. The game was further improved by the addition of an animated facilitator, who directs the players via gestures and speech. Thirty-three students played the breast module in a variety of team configurations. After playing the game, the students completed surveys regarding its value as both an educational tool and as a form of entertainment. 10-question tests were also administered before and after playing the game, as a preliminary investigation into its impact on student learning. RESULTS: After playing the game, mean test scores increased from 6.43 (SEM +/- 0.30) to 7.14 (SEM +/- 0.30; P = 0.006). The results of the five-question survey were extremely positive. Students generally agreed that the game concept has value in increasing general knowledge regarding the subject matter of breast disease and that the idea of following simultaneously the work-up of numerous patients with similar problems is a helpful way to learn a work-up algorithm. CONCLUSIONS: Postgame surveys demonstrate the efficacy of our computer game model as a tool for surgical education. The game is an example of problem based learning because it provides students with an initial set of problems and requires them to collect information and reason on their own in order to solve the problems. Individual game modules can be developed to cover material from different diagnostic areas.

Algorithms↗

A system for the measurement of grip forces and applied moments during hand tool use.

Quantification of the forces applied with or by hand tools can be a difficult but important component of an ergonomic evaluation. This paper describes a device for measuring gripping forces and the moments generated by a hand tool. Laboratory characterization indicated that the device had good linearity (r2 = 0.999) with minimal hysteresis or creep. The working range exceeds 700N for gripping forces, and 28 and 16Nm for the two applied moment axes. The device, configured as a boning knife, was sensitive to differences in grip forces and applied moments in a simulated meat cutting task requiring distinct levels of precision. Significant individual variation in the "efficiency" of grip force was also observed. The system design is flexible, allowing for additional tool configurations.

Adult↗

Abnormal semantic network for "animals" but not "tools" in patients with Alzheimer's disease.

The effects of Alzheimer's disease (AD) on the organization of semantic knowledge (i.e., the semantic network) for living (e.g., animals) and non-living (e.g., tools) categories was examined. Multidimensional scaling and Pathfinder analyses of data from triadic comparison tasks showed that the semantic network for "animals", but not the network for "tools", was abnormal in patients with AD. Specifically, patients with AD tended to use a different primary dimension than control subjects for categorizing animals and their network was characterized by atypical associations between concepts. The differences in the integrity of the AD patients' networks for "animals" and "tools" was not likely to be an artifact of differences in the difficulty in identifying the stimuli in the two categories as all stimuli were identified on simple naming or matching tasks. These findings support the results of previous studies that have shown the presence of category-specific semantic deficits in patients with AD.

Aged↗

Client relevant care and quality of life: the trial of a Client Generated Index (CGI) tool for community nursing.

Community nursing organisations worldwide seek optimal ways to ensure adequate measurement of health outcomes for the client following nursing care, and to facilitate a consumer focus. This article presents a trial of the Client Generated Index (CGI) tool that subjectively assesses and measures the quality of life outcomes pertaining to a client's health status, whilst also facilitating individualised care. Sixty district nursing clients participated in the trial, which ascertained that the CGI tool effectively directs the client to list, grade and prioritise personally relevant quality of life issues. Consequently, this tool is being incorporated into client admission and discharge assessment within the organisation.

Activities of Daily Living↗

A case definition and photographic screening tool for the facial phenotype of fetal alcohol syndrome.

OBJECTIVES: The purpose of this study was to demonstrate that a quantitative, multivariate case definition of the fetal alcohol syndrome (FAS) facial phenotype could be derived from photographs of individuals with FAS and to demonstrate how this case definition and photographic approach could be used to develop efficient, accurate, and precise screening tools, diagnostic aids, and possibly surveillance tools. STUDY DESIGN: Frontal facial photographs of 42 subjects (from birth to 27 years of age) with FAS were matched to 84 subjects without FAS. The study population was randomly divided in half. Group 1 was used to identify the facial features that best differentiated individuals with and without FAS. Group 2 was used for cross validation. RESULTS: In group 1, stepwise discriminant analysis identified three facial features (reduced palpebral fissure length/inner canthal distance ratio, smooth philtrum, and thin upper lip) as the cluster of features that differentiated individuals with and without FAS in groups 1 and 2 with 100% accuracy. Sensitivity and specificity were unaffected by race, gender, and age. CONCLUSIONS: The phenotypic case definition derived from photographs accurately distinguished between individuals with and without FAS, demonstrating the potential of this approach for developing screening, diagnostic, and surveillance tools. Further evaluation of the validity and generalizability of this method will be needed.

Adolescent↗

The Poseidon operational tool for the prediction of floating pollutant transport.

In this work the development and the application of an operational management tool for the Greek Seas is described. This tool consists of a three-dimensional floating pollutant prediction model coupled with a weather, a hydrodynamic and a wave model in order to track the movements and the spreading of the pollutants and indicate those coastal areas which might be affected. The tool is part of the Poseidon system which has been designed to provide real time data and forecasts for marine environmental conditions in the Greek Seas. In this paper, we present four case studies based on realistic scenarios that show the value of the application for long-term strategic planning and short-term decision making in oil spill accidents.

Decision Making↗

A contribution of sparse matrices tools to matrix population model analysis.

When one wants to study the dynamics of structured populations, matrix type models are widely used. The complexity of such models increases with the number of classes of individuals considered, and a mathematical analysis becomes difficult to perform when a further heterogeneous spatial structure is introduced. The use of efficient computational tools is also required for numerical simulations. In this note we deal with the contribution of sparse matrices tools which allow to numerically simulate and to numerically perform stability analysis of large sized structured population models including density dependence and spatial heterogeneities. Our main motivation through this work is to show that such numerical tools can be useful when mathematical methods become difficult to employ.

Age Factors↗

Naming tools and animals: asymmetries observed during direct electrical cortical stimulation.

Semantically bounded disorders of verbal processing that result in selective dysnomias for items belonging to specific semantic categories have been well documented in lesion studies. Most commonly dissociations between the categories of living versus non-living things have been reported. Processing of living things such as animals seems to be impaired after bilateral lesions, whereas lesions resulting in impairment of processing of non-living things such as tools seem to be restricted to the left hemisphere. In this study, we tested the naming capabilities of epilepsy patients with subdural electrodes implanted for localization of the epileptogenic zone and preoperative mapping of cognitive functions. Tool and animal items were used, and the results show that during stimulation of the left hemisphere dysnomias for tool items were more pronounced than for animal items. This asymmetry is discussed within a model of more widely bilaterally distributed processing of living category members as compared to more restricted left-sided representation of non-living category members.

Adolescent↗

Some aspects of AE application in tool condition monitoring

Acoustic emission (AE) is rather a well-known form of non-destructive testing. In the last few years the technology of the AE measurement has been expanded to cover the area of tool condition monitoring. The paper presents some experience of Warsaw University of Technology (WUT) in such applications of AE. It provides an interpretation of common AE signal distortions and possible solutions to avoid them. Furthermore, a characteristic study of several different AE and ultrasonic sensors being used in WUT is furnished. Evaluation of the applicability of some basic measures of acoustic emission for tool condition monitoring is also presented in the paper. Finally paper presents a method of the catastrophic tool failure detection in turning, which uses symptoms other than the direct magnitude AERMS signal. The method is based on the statistical analysis of the distributions of the AERMS signal.

Journal Article↗

A discovery of new features of gastropod local field potentials by application of wavelet tools.

Odor input evokes characteristic, time-evolving (non-stationary) events in the spontaneously active central ganglia of the snail Helix pomatia. Assuming stationarity for the signals, one could, as the first approach, apply the Fourier-based methods, frequency amplitude characteristics (FAC) measures, for analyzing such events. We could thus for the first time describe such events in frequency and amplitude and show that the frequency, at which power increases most, is specific to the odor or its class [Comp. Biochem. Physiol. 123A (1999a) 95; Comp. Biochem. Physiol. 124A (1999b) 297]. Wavelet tools assume no record stationarity and are suitable for describing the dynamically evolving brain electrical signals precisely and quantitatively. We, therefore, tested these tools for the typical odor experiments with the procerebrum (PC), the pedal ganglion (PG) and the visceral ganglion (VG) of the Helix, which we earlier analyzed by the FAC measures and compared both results. The two basic findings of the present wavelet analysis are as follows: (i) the wavelet energy fluctuations clearly visualize dynamical interactions among the major bands (0.1-3.1 Hz), implying a possible 'mutual exclusion' between slow components < 0.8 Hz and faster ones > 0.8 Hz. (ii) Entropy behavior was characteristically different for each of the three brain regions. Only in PC the response to aversive odorants (decrease of entropy = more ordered state) is differentiated in entropy from that to attractive ones (increase of entropy=more disordered or more complexly ordered state) indicating the odor-discriminating function of this region. In VG entropy of the intrinsic activity is so high (highly disordered state) due to the strong wideband activity reaching > 50 Hz that odor stimulation results mainly in lowering of entropy (= more ordered state) regardless of the nature of the odor. In PG, however, odor presentation generally increases entropy due to the robust, wide-band activation at > 3 Hz (sensorimotor function) that is generated as a secondary, but dominant and robust, response. In respect to describing time evolution of different frequency band components the present wavelet tools can much more sensitively do so, as compared with the FAC measures. They can also characterize a change in the neuroelectrical state in terms of entropy.

Animals↗

The use of phylogenetic data to develop molecular tools for the detection and genotyping of Yam mosaic virus. Potential application in molecular epidemiology.

Molecular detection of Yam mosaic virus (YMV), the most important potyvirus for yam plants (Dioscorea spp.) has been limited by its high genetic diversity. According to recent phylogenetic data, suitable molecular tools were developed for detection and genotyping. A reliable and rapid molecular test is described using single-tube immunocapture (IC)-RT-PCR combining the use of a monoclonal antibody able to recognise all YMV serotypes and primers designed to take into account the whole variability of YMV. Phylogenetic data were then used to develop an uncoupled IC-RT-PCR procedure adapted to the genotyping of the three major phylogenetic groups and the two recombinants implicated in the YMV epidemics in the Caribbean and French Guiana. A third exploitation of phylogenetic data was carried out with the development of a typing test based on the analysis of short nucleotide sequences. The direct sequencing of a 450 nts fragment constituted a reliable complementary typing tool as the resulting information was quite similar to that obtained with sequences of the complete coat protein gene. The approach, consisting in a robust study of YMV variability followed by the use of phylogenetic data to develop reliable detection and genotyping tools, offers new perspectives for powerful molecular epidemiological studies.

Enzyme-Linked Immunosorbent Assay↗

Gene-expression tools for the metabolic engineering of bacteria.

Recent advances in metabolic engineering have led to new methods for the synthesis of novel molecules, improved production of existing compounds and improved degradation of recalcitrant environmental contaminants. Increasing the flux through an existing pathway and introducing a new pathway into a host organism demand coordinated expression of the genes that encode the enzymes, tight control over gene expression and consistent expression in all cells. Although several gene-expression tools have been developed for the overproduction of proteins, they may not be ideal for pathway redirection. Metabolic engineering requires certain characteristics of gene-expression tools, and some new tools meet these needs.

Base Sequence↗

Tools for genetic engineering in the amino acid-producing bacterium Corynebacterium glutamicum.

During the last decades, the gram-positive soil bacterium Corynebacterium glutamicum has been shown to be a very versatile microorganism for the large-scale fermentative production of L-amino acids. Up to now, a vast amount of techniques and tools for genetic engineering and amplification of relevant structural genes have been developed. The objectives of this study are to summarize the published literature on tools for genetic engineering in C. glutamicum and to focus on new sophisticated and highly efficient methods in the fields of DNA transfer techniques, cloning vectors, integrative genetic tools, and antibiotic-free self-cloning. This repertoire of C. glutamicum methodology provides an experimental basis for efficient genetic analyses of the recently completed genome sequence.

Amino Acids↗

Genomic sequence analysis tools: a user's guide.

The wealth of information from various genome sequencing projects provides the biologist with a new perspective from which to analyze, and design experiments with, mammalian systems. The complexity of the information, however, requires new software tools, and numerous such tools are now available. Which type and which specific system is most effective depends, in part, upon how much sequence is to be analyzed and with what level of experimental support. Here we survey a number of mammalian genomic sequence analysis systems with respect to the data they provide and the ease of their use. The hope is to aid the experimental biologist in choosing the most appropriate tool for their analyses.

Internet↗

HeiDATAProVIT-Heidelberg data archiving, tag assembling, processing and visualization tool.

The demands that have to be met by software tools for biomedical data evaluation strongly differ depending on the background of their application. In clinical routine emphasis is placed on ease of handling and application of standardized procedures, whereas in biomedical research the main focus lies on flexibility and extensibility. These contradictory requirements are reflected by the design principles of existing software solutions: programs for routine application are barely extensible or modifiable by the user and the complexity of highly flexible data processing tools for research purposes hampers the application of new methods to larger data volumes. This gap poses technical difficulties to the transfer of methods from research into clinical routine. The software we present in this paper bridges this discrepancy by incorporating two different levels of application. The lower level offers options to integrate custom written MATLAB((R)) processing routines and to add new evaluation schemes to a pool of existing procedures. The higher level allows for performing standard evaluations by accessing and applying these previously defined procedures. Four basic concepts were introduced to ensure that the program is both maximally flexible on a lower level and readily applicable on a higher level: the tag concept, the concept of modularized visualization, the dummy file concept, and the batchjob concept. These concepts are the key to flexibly assemble and apply the three universal stages of data evaluation: (1) archiving of acquired data, (2) processing the data using signal processing algorithms and (3) visualizing the results in appropriate graphical formats. The present paper illustrates the four concepts within the two levels of the software architecture. The basic functionality and usefulness of the program are demonstrated using an evaluation of gait analysis data as sample application. In summary, this software tool closely integrates a database for biomedical datasets and an extensible pool of evaluation and visualization procedures realized using MATLAB((R)). It is well suited both for data processing in clinical routine and for evaluation of measurement data in any medical research project.

Information Storage and Retrieval↗

New tools for diagnosis and monitoring of bancroftian filariasis parasitism: the Polynesian experience.

Bancroftian filariasis is endemic in French Polynesia and control programs with diethylcarbamazine, started in the 1950s, led to a sharp reduction of the microfilaria prevalence. Consequently, the control program was interrupted in 1982. Ten years later, however, the incidence of the parasitism again reached pre-control levels (20-30% microfilaremia in some islands), indicating that the adult worms (for which no diagnostic tool was available) had persisted. Apart from research on chemotherapy strategies, the Institut Malardé has been actively involved in developing and evaluating more-powerful diagnostic tools than the unique detection of microfilariae by blood smear examination. These include: (1) the detection of adult worm circulating antigens in humans, and (2) the detection of Wuchereria bancrofti larvae in mosquitoes, using DNA probes. In this paper, Luc Nicolas reviews the available diagnostic tools to detect W. bancrofti and their implementation in epidemiological areas, based on the Polynesian experience.

Journal Article↗

[Local evaluation of quality using generic measurement tools].

Performance measurement and accountability are the most frequently encountered concepts across healthcare systems, although the tools used to put these concepts into practice vary. The aim of the present article was to discuss the tools (e.g., indicators) and user expectations (e.g., quality versus performance) of these tools in fulfilling healthcare's accountability mandate. In particular, the developments within the Spanish health system are discussed to illustrate how Spain has addressed, in a stepwise manner, the determinants of a national accountability model. Finally, a multinational project, The Maryland Quality Indicator Project, is presented as a popular framework for measuring performance.

Delivery of Health Care↗

[A critical review of available tools for evaluating memory enhancers in Alzheimer's disease].

The study reviews critically the neuropsychological measurement tools available to assess the efficacy of potential memory enhancers in patients with Alzheimer's disease (AD). A review of some concepts concerning the characteristics of memory impairment in AD patients and of problems related to the selection of a study population provides a framework for this analysis. The tools available for efficacy evaluations are then classified according to their conceptual and formal characteristics: psychometric tests, rating scales and clinician global assessment tools. In each category the instruments were assessed according to several criteria: construct and ecological validity; sensitivity to changes in symptomatology; inter-rater reliability and the reliability of equivalent forms; feasibility for use with AD patients, especially brevity, to encourage their cooperation. Examining advantages, drawbacks and limitations of instruments in each category yields two conclusions: no single instrument scale or test battery fills all the criteria for a clinical trial, but these imperfect instruments are complementary. Accordingly, a battery including the three categories of instruments and allowing for investigation of the different memory systems has been proposed.

Alzheimer Disease↗