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PubMed1993

Effect of pacing strategy on cycle time trial performance.

Despite interest in competitive strategy by coaches and athletes, there are no systematically collected data regarding the effect of differences in pacing strategy on the outcome of middle distance (2-4 min duration) events. In this study different pacing strategies were evaluated using a 2-km time trial on a bicycle attached to a wind load simulator. Well-trained subjects (N = 9) performed five separate time trials with the pace during the first 50% of the trial experimentally constrained within the usual real world range from very slow (approximately 55% of best time) to very fast (approximately 48% of best time). Serial VO2 was measured to estimate the oxidative contributions to the trial and accumulated O2 deficit and postexercise blood lactate measured to estimate the anaerobic contribution to the trial. The evenly paced trial (first 1 km = 50.9% final time) produced the fastest total time. The starting pace to final time relationship was described by a U shaped second order polynomial curve with the nadir for final time at a starting pace of 51% of best total time. There were no systematic differences in serial VO2, accumulated O2 deficit, or postexercise lactate that could account for the pacing related variations in performance. The data support the concept of relatively even pacing in middle distance events with negative consequences for even small variations in this strategy.

Analysis of Variance↗
PubMed1996

The effect of different types of exercise on gastro-oesophageal reflux.

Sportsmen and women frequently experience abdominal and chest pain during exertion. The symptoms could be cardiac but may be caused by gastro-oesophageal reflux (GOR). The aim of our study was to investigate the effect of the two activities on GOR in 17 fit, healthy adults. GOR, assessed by intraoesophageal pH, was recorded on portable monitoring equipment before, during and after rowing and running. GOR was also measured after a light meal to simulate pre-training hydration. Three studies were performed: rowing, fasted running, and post-prandial running. GOR was infrequent before exercise, being seen in only 2 subjects. However, GOR was induced in 70% of rowers, 45% of fasted runners, and 90 % of fed runners during and immediately after exercise. The presence of food in the stomach greatly increased the amount of reflux during post-prandial running, (p < 0.006 against control) but reflux was also significantly higher in those who refluxed during fasted running (p < 0.03) and rowing (p < 0.08). There was no statistical difference in the amount of GOR between the two exercise periods. This study shows that both running and rowing induce significant amounts of GOR in a normally asymptomatic group of athletes. GOR should be considered in the investigation of exertional chest pain in patients attending a sports clinic.

Adult↗
PubMed2006

Microneurosurgical training model in fresh cadaveric cow brain: a laboratory study simulating the approach to the circle of Willis.

BACKGROUND: Residents of neurosurgery need many years to develop microneurosurgical skills, and laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. A simple simulation model is needed for young residents to learn how to handle microneurosurgical instruments, and to perform safe dissection of intracranial vessels and nerves. METHODS: The material consists of a 2-year-old fresh cadaveric cow cranium. A 4-step approach was designed to dissect the internal carotid artery and its proximal branches, the optic nerve, the optic chiasm, and the pituitary stalk. RESULTS: The model simulates standard microneurosurgery using a variety of approaches to vessels and neural structures in and around the circle of Willis of the human brain. CONCLUSION: The cadaveric cow brain, besides being cost-effective, represents a fairly useful method to accustom residents of neurosurgery, especially junior residents, to dissecting intracranial vessels and nerves, and it simulates intracranial microneurosurgical procedures performed in the human brain.

Animals↗
PubMed2005

A review of surgical simulation with attention to validation methodology.

The use of simulation technology for teaching and evaluating surgical skills has gained considerable attention in recent years. This is driven by interest in quality of care, concerns over increasing operative complexity, constraints on the use of animal models, limited available patient material, medicolegal pressures, and fiscal mandates for cost-effective performance. Traditional mechanical models are yielding to techniques dependent on electronic technology, including virtual reality. Data to support the validity of simulation techniques for surgical training, assessment, and certification represent only a fraction of the literature available on the subject. Literature searches were conducted in MEDLINE and ERIC, covering the period from 1966 to the present. The electronic and bioengineering literature was not surveyed due to the extensive literature on technology development, distinct from assessment of context specific validity. The search results and the bibliographies of key review articles were examined to identify articles that contained original data, measured performance between cohorts, defined performance measures, and described a standard against which performance was compared. Most of the literature pertaining to simulation techniques for surgical training has been published within the past 5 years and consist of review, opinion, and feasibility articles. There is an emerging body of evidence to establish the validity of simulation techniques for assessing surgical skills. Further refinement of simulation techniques, identification of specific performance measures, longitudinal evaluations, and comparison to practice outcomes are still needed to establish the validity and the value of surgical simulation for teaching and assessing surgical skills prior to considering implementation for certification purposes.

Animals↗
PubMed1998

Pulse sequences for steady-state saturation of flowing spins.

It is useful to be able to suppress the NMR signal from spins in a flowing fluid, for example for "black-blood" visualization of blood vessels in vivo, for the suppression of flow artifacts, and for the estimation of tissue perfusion by continuous labeling of inflowing arterial spins. This work considers the flow of fluid through a region in which it is subjected to a train of saturation pulses. Computer simulations and in vitro measurements show that a train of equal-duration spoiler pulses produces less effective suppression than does a train of pulses of geometrically increasing duration. It is shown analytically that a long train of ideal equal-duration spoiler pulses converts initial magnetization (0, 0, M0) into a combination of longitudinal and transverse magnetization equal to 0. 29 (-M0, 0, M0) and is therefore unsatisfactory for continuous saturation.

Algorithms↗
PubMed1997

Effects of heart rate on vulnerability to fibrillation in a computer model.

Effects of heart rate on refractory period (RP) duration and disparity have opposing actions on vulnerability to fibrillation. Both bradycardia and tachycardia have been reported to increase vulnerability to fibrillation, and the role of their effects on RP duration and disparity in producing that effect is uncertain. That role has been investigated with a computer model of propagated excitation having nonuniform, cycle length-dependent refractoriness and slow propagation during incomplete recovery of excitability. Vulnerability was assessed as fibrillation threshold (FT), defined as the duration of train stimulation required to initiate simulated fibrillation. When measured as a function of train onset time during a cycle, FT initially decreased to a minimum and then increased to the original level. Slower rates shifted that curve upward and to the right, so that the FT was higher during early portions of the cycle but lower in later portions. Longer mean duration of RPs increased FT during all portions of the cycle, increased the difference of FT at various rates during early portions of the cycle, and decreased differences later in the cycle. Greater RP range reduced the FT and decreased the difference of FT with varied rate in early portions of the cycle, while increasing the difference in later portions. Accelerating rate had additional effects on FT-related to nonuniform propagation of responses prior to train stimulation. The findings defined mechanisms based on established effects of rate on RP, by which either tachycardia or bradycardia could increase vulnerability to fibrillation, and demonstrated the effects of RP range and duration on the mechanisms.

Atrial Fibrillation↗
PubMed2005

Condition monitoring of 3G cellular networks through competitive neural models.

We develop an unsupervised approach to condition monitoring of cellular networks using competitive neural algorithms. Training is carried out with state vectors representing the normal functioning of a simulated CDMA2000 network. Once training is completed, global and local normality profiles (NPs) are built from the distribution of quantization errors of the training state vectors and their components, respectively. The global NP is used to evaluate the overall condition of the cellular system. If abnormal behavior is detected, local NPs are used in a component-wise fashion to find abnormal state variables. Anomaly detection tests are performed via percentile-based confidence intervals computed over the global and local NPs. We compared the performance of four competitive algorithms [winner-take-all (WTA), frequency-sensitive competitive learning (FSCL), self-organizing map (SOM), and neural-gas algorithm (NGA)] and the results suggest that the joint use of global and local NPs is more efficient and more robust than current single-threshold methods.

Algorithms↗
PubMed2004

The compact Erlangen Active Simulator for Interventional Endoscopy: a prospective comparison in structured team-training courses on "endoscopic hemostasis" for doctors and nurses to the "Endo-Trainer" model.

BACKGROUND: In 1997 Hochberger and Neumann presented the "Erlangen Biosimulation Model" (commercialized as the "Erlangen Endo-Trainer") at various national and international meetings. The new compactEASIE is a simplified version of the original "Biosimulation Model" (Endo-Trainer) and is specially designed for easy handling. CompactEASIE is reduced in its features, focusing exclusively on flexible endoscopy training. The acceptance of training in endoscopic hemostasis is accepted by workshop participants, as evaluated by a questionnaire on both models. METHODS: Eleven structured courses on endoscopic hemostasis for doctors and nurses organized by the same endoscopists from 3/1998 to 5/1999 were evaluated using one of both models. The questionnaires were filled in by 207/291 trainees (71%). The Endo-Trainer was used in 4 (n = 103) and the compactEASIE in 7 courses (n = 104). Both simulators were equipped with identical types of specially prepared pig-organ packages consisting of esophagus, stomach and duodenum, including artificial sewn-in vessels, polyps and varices. Blood perfusion was done with a roller pump connected to the sewn-in vessels and blood surrogate. All workshops were identical concerning the course structure: a 30-min theoretical introduction on ulcer bleeding was followed by 2 h of practical training in injection techniques and hemoclip application. The second part of variceal therapy consisted of a 30-min theoretical introduction prior to 2 h of practical training on sclerotherapy, band ligation and cyanoacrylate application. Finally, a questionnaire on the trainees' pre-experience and their rating of the different workshop sections was handed out to each participant. RESULTS: Previous endoscopic experience was comparable in both groups. The training in both simulators was highly accepted by the trainees (compactEASIE 95% excellent and good versus EASIE (Endo-Trainer) 97%) and did not show any significant difference (P = 0.493). Even in the assessment of the single techniques, no statistical difference was observed. Furthermore, the assessments of the closeness to reality and the endoscopic environment in both simulators were identical. CONCLUSIONS: Both simulators (Endo-Trainer, compactEASIE) are excellent educational tools for interventional endoscopy with a high level of acceptance. The easy-to-handle, "lightweight" compactEASIE is a significant, progress tool for the future.

Clinical Competence↗
PubMed2003

Trailer loading stress in horses: behavioral and physiological effects of nonaversive training (TTEAM).

Resistance in the horse to trailer loading is a common source of stress and injury to horses and their handlers. The objective of this study was to determine whether nonaversive training based on the Tellington-Touch Equine Awareness Method (TTEAM; Tellington-Jones &Bruns, 1988) would decrease loading time and reduce stress during loading for horses with a history of reluctance to load. Ten horses described by their owners as "problem loaders" were subjected to pretraining and posttraining assessments of loading. Each assessment involved two 7-min loading attempts during which heart rate and saliva cortisol were measured. The training consisted of six 30-min sessions over a 2-week period during which the horse and owner participated in basic leading exercises with obstacles simulating aspects of trailering. Assessment showed heart rate and saliva cortisol increased significantly during loading as compared to baseline (p <.001 and p <.05, respectively). Reassessment after training showed a decrease in loading time (p <.02), reduced heart rate during loading (p <.002), and reduced saliva cortisol as compared to pretraining assessments. Seven "good loaders" also were subject to loading assessment for physiological comparison. Increases in heart rate during loading were significantly higher in the good loaders (p <.001). Nonaversive training simulating aspects of loading may effectively reduce loading time and stress during loading for horses with a history of resistance to trailer loading.

Animals↗
PubMed2005

Correlation between perceptual, visuo-spatial, and psychomotor aptitude to duration of training required to reach performance goals on the MIST-VR surgical simulator.

Given the dynamic nature of modern surgical education, determining factors that may improve the efficiency of laparoscopic training is warranted. The objective of this study was to analyze whether perceptual, visuo-spatial, or psychomotor aptitude are related to the amount of training required to reach specific performance-based goals on a virtual reality surgical simulator. Sixteen MS4 medical students participated in an elective skills course intended to train laparoscopic skills. All were tested for perceptual, visuo-spatial, and psychomotor aptitude using previously validated psychological tests. Training involved as many instructor-guided 1-hour sessions as needed to reach performance goals on a custom designed MIST-VR manipulation-diathermy task (Mentice AB, Gothenberg, Sweden). Thirteen subjects reached performance goals by the end of the course. Two were excluded from analysis due to previous experience with the MIST-VR (total n = 11). Perceptual ability (r = -0.76, P = 0.007) and psychomotor skills (r = 0.62, P = 0.04) significantly correlated with the number of trials required. Visuo-spatial ability did not significantly correlate with training duration. The number of trials required to train subjects to performance goals on the MIST-VR manipulation diathermy task is significantly related to perceptual and psychomotor aptitude.

Adult↗
PubMed2005

Assessment of simulated surgical skills in parabolic microgravity.

BACKGROUND: During spaceflight crew health is paramount in the success of flight missions. The delivery of healthcare during flight requires crew readiness for medical and surgical response. METHODS: There were 20 participants who were evaluated for accurate performance of 4 basic laparoscopic surgical skills (clip applying, cutting, grasping, and suturing) during parabolic weightlessness using an inanimate workstation aboard the NASA KC-135 aircraft. RESULTS: Data indicate that motor skill performance decreased within the parabolic microgravity flight environment. Performance in parabolic microgravity flight included futile effort with an increase in number of tasks attempted and a decrease in tasks completed successfully. CONCLUSIONS: There is a decreased frequency of accurate task completion in parabolic microgravity flight, but it is not an obstacle to implementation of effective training for providing in-flight medical care. The data reveal that individuals perform basic laparoscopic surgical simulation with greater effort in microgravity following simulation training.

Aerospace Medicine↗
PubMed1994

Basic simulations for anaesthetists. A pilot study of the ACCESS system.

This paper describes the design and initial testing of the ACCESS (Anaesthetic Computer Controlled Emergency Situation Simulator) system, which has been designed to simulate anaesthetic emergencies with the aim of providing training for junior doctors. The simulations require little or no capital expenditure with minimal use of time by staff or trainees. They are based on standard anaesthetic equipment, with a microcomputer providing an image of commonly used instruments. Problems are presented as scenarios administered by the teacher, and test the skills of the pupil. During 64 scenarios, five trainees caused two 'deaths' and solved the problems in a median time of 2.5 min, while an experienced group of anaesthetists caused one 'death' and took 1.8 min. The simulation was rated by the pupils as easy to use, realistic and a valuable educational tool.

Anesthesiology↗
PubMed1996

Applied virtual reality for simulation of endoscopic retrograde cholangio-pancreatography (ERCP).

Researchers from the Georgia Institute of Technology and the Medical College of Georgia (GIT/MCG) have developed an interactive computer simulation of Endoscopic Retrograde Cholangio-Pancreatography (ERCP). ERCP is a minimally invasive technique for evaluating and treating pathologic conditions of the biliary and pancreatic ducts. While ERCP provides the patient with substantial advantages over traditional methods, ERCP requires advanced skills and extensive experience to minimize the risk of complications. Computer simulation offers many advantages for efficiently and safely training physicians in ERCP. The GIT/MCG proof of concept simulation provides realistic training with both visual and force feedback while an endoscopist practices the ERCP procedure.

Biliary Tract Diseases↗
PubMedDate not supplied

Simulated and community-based instruction involving persons with mild and moderate mental retardation.

In this study of simulated instruction and/or community training of four functional living tasks was compared across groups of adolescents and young adults with mild and moderate retardation. Forty individuals participated in the assessment and training activities of this study, including 20 participants with mild retardation and 20 individuals with moderate retardation. A mixed factorial design was used to evaluate differences associated with level of mental retardation, simulated versus community-based instruction, and assessments in school and community settings. Participants with mild retardation performed better than their counterparts with moderate retardation on the simulated tasks and in the community settings. Participants with mild retardation were more successful in generalizing from the simulated instructional experiences to the community settings than were their counterparts with moderate retardation. However, in many of the situations, community training was sufficiently powerful to eliminate any advantage associated with some of the participants having experienced prior simulated instruction. Results are discussed in relation to the need to more closely examine the design and delivery of functional living skills instruction involving individuals with different levels of mental retardation. Specifically, the effectiveness of instructional simulations for teaching functional living skills does not appear to be uniform across level of retardation and targeted tasks. The highest priority question no longer appears to be whether or not simulated versus community-based instruction is more efficacious. Future research might more productively focus on the quality of different instructional simulations in combination with community assessment and/or training opportunities for teaching functional living skills to persons who experience different levels of mental retardation.

Adult↗
PubMed1990

[ISA--Information System Anesthesia. Decision support by a computer-based information system].

"ISA"-Information System Anesthesia-will support the anesthesiologist by presenting information concerning the anesthesia approach. In addition to computing patient data (monitoring), there are three special fields where computers are used in anesthesia: (1) simulation systems for anesthesia training (preventing critical incidents); (2) critiquing systems to comment on the planned anesthesia decisions; and (3) reference systems for rapid information gathering. Simulation and critiquing systems are mainly useful for personal training. Reference systems present information concerning the anesthesia problems to aid in decision-making. ISA is a reference system designed to support the decision process for neurosurgical operations; a new method of presenting information by personal computer in the surgical working area. For each neurosurgical operation there is a graduation of condensed and detailed information with the option of also obtaining general anesthesia knowledge.

Anesthesiology↗
PubMed1999

A computer generated interactive transurethral prostatic resection simulator.

PURPOSE: We developed a computer generated model of the prostate gland and an interactive simulator for use in training urologists in transurethral resection of the prostate. MATERIALS AND METHODS: Software was developed on a standard personal computer which allowed images of the lumen of the prostatic urethra and resectoscope loop to be generated and interacted with using a magnetic position sensor input device attached to a dummy resectoscope. RESULTS: An anatomically accurate computer model of the prostate was generated at low cost which permitted user interaction and which simulated key elements of transurethral prostatic resection. CONCLUSIONS: Although not a substitute for learning transurethral prostatic resection on patients, the simulator enabled the user to become familiar with the technique of transurethral prostatic resection in the absence of time constraints and without risk to patients. The simulator may become an important tool in training and assessing surgeon competency, and may reduce the costs of training. Further development is needed to refine the transurethral prostatic resection simulator and expand its surgical range.

Computer Simulation↗
PubMed2004

[Computer simulation of a clinical magnet resonance tomography scanner for training purposes].

PURPOSE: The idea for this project was born by the necessity to offer medical students an easy approach to the theoretical basics of magnetic resonance imaging. The aim was to simulate the features and functions of such a scanner on a commercially available computer by means of a computer program. MATERIALS AND METHODS: The simulation was programmed in pure Java under the GNU General Public License and is freely available for a commercially available computer with Windows, Macintosh or Linux operating system. The graphic user interface is oriented to a real scanner. In an external program parameter, images for the proton density and the relaxation times T1 and T2 are calculated on the basis of clinical examinations. From this, the image calculation is carried out in the simulation program pixel by pixel on the basis of a pulse sequence chosen and modified by the user. The images can be stored and printed. In addition, it is possible to display and modify k-space images. RESULTS: Seven classes of pulse sequences are implemented and up to 14 relevant sequence parameters, such as repetition time and echo time, can be altered. Aliasing and motion artifacts can be simulated. As the image calculation only takes a few seconds, interactive working is possible. CONCLUSION: The simulation has been used in the university education for more than 1 year, successfully illustrating the dependence of the MR images on the measuring parameters. This should facititate the approach of students to the understanding MR imaging in the future.

Computer Simulation↗