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At least 1,171 records · Page 65Linked to original sources

PubMed1993

Dry-land resistance training for competitive swimming.

To determine the value of dry-land resistance training on front crawl swimming performance, two groups of 12 intercollegiate male swimmers were equated based upon preswimming performance, swim power values, and stroke specialties. Throughout the 14 wk of their competitive swimming season, both swim training group (SWIM, N = 12) and combined swim and resistance training group (COMBO, N = 12) swam together 6 d a week. In addition, the COMBO engaged in a 8-wk resistance training program 3 d a week. The resistance training was intended to simulate the muscle and swimming actions employed during front crawl swimming. Both COMBO and SWIM had significant (P < 0.05) but similar power gains as measured on the biokinetic swim bench and during a tethered swim over the 14-wk period. No change in distance per stroke was observed throughout the course of this investigation. No significant differences were found between the groups in any of the swim power and swimming performance tests. In this investigation, dry-land resistance training did not improve swimming performance despite the fact that the COMBO was able to increase the resistance used during strength training by 25-35%. The lack of a positive transfer between dry-land strength gains and swimming propulsive force may be due to the specificity of training.

Adult↗

PubMed2004

Prototype of simulation of orthognathic surgery using a virtual reality haptic device.

A maxillofacial simulator can support education and training. In the present study, cutting, separation, and quantitative rearrangement of bone during orthognathic surgery were simulated by means of a haptic device with virtual tactile perception. Computed tomographic (CT) images of two patients with severe jaw deformity, one women and one man, were input into the device. In the woman, Le Fort I osteotomy of the maxilla and sagittal splitting ramus osteotomy of the mandible were initially simulated. During surgery with the haptic device, separation and rearrangement of the maxilla and the ramus of the mandible were initially processed. However, there was discrepancy and overlapping of the ramus with the mandible. Intraoral vertical osteotomy of the right ramus was then performed, with satisfactory results and less discrepancy and interference. The simulation was referred to at surgery, and satisfactory surgical assistance was postoperatively confirmed on CT images. The male patient had severe jaw deformity due to unequal growth between the ramuses, resulting in anterior crossbite. Sagittal splitting ramus osteotomy with rotation of the mandible was successfully simulated. Because of its versatility and functions, the present device was found to be useful for simulating various procedures for orthognathic surgery and thereby three-dimensionally determine surgical movements.

Adult↗

PubMed1993

An assessment of air quality impacts of fires associated with fire fighting operations.

Fire fighters in Canada's navy must undergo regular training with fires from simulated helicopter crashes. Visible emissions from these fires often create health concerns in surrounding communities. This paper presents air quality implications of plume dispersion associated with "helicopter fires." Evaluations involved measuring plume rise, estimating emissions, dispersion modeling and ambient monitoring. Results of the evaluation provided ground-level concentration estimates of plume particulate matter, oxides of nitrogen, hydrogen fluoride, carbon monoxide, 22 metals, 15 PAH and 13 VOC. The study showed that the air quality impact of the fire fighting training is much lower than the relevant time-weighted averages established to protect workers' health. This paper will be of interest to people in environmental protection agencies because it demonstrates the effects of fire fighting operations that must frequently occur as part of training exercises.

Air Pollutants↗

PubMed1998

Development of the force-feedback model for an epidural needle insertion simulator.

The Ohio Supercomputer Center and the Department of Anesthesiology at the OSU Medical Center have developed a computer-based simulation system for use in training anesthesiology residents in the technique of placing a needle for an epidural block. Although the simulator has been well regarded, the fidelity of the haptic feedback is limited because it is based on subjective expert-user evaluation and not on objective model-based or data-based empirical methods. Only a single degree of freedom for force-feedback is required. However, the simulation must be able to accurately portray the force required to puncture each layer of tissue in order to feel realistic. The purpose of the research described in this paper was to devise a methodology for creating empirically based realistic force-feedback models for the epidural needle insertion procedure using MRI data and biomechanical data from materials testing.

Anesthesia, Epidural↗

PubMed1994

The European Association for Endoscopic Surgery recommendations for training in laparoscopic surgery.

A questionnaire among surgeons in Europe on minimal access surgery (MAS) was carried out. 96% of the responders were of the opinion that the resident or trainee should take training courses before embarking on MAS. 81% recognized a need for basic training and 96.5% for advanced courses. Registrars should be trained in MAS according to 96% of the responders. The recommendations of the European Association of Endoscopic Surgery (E.A.E.S.) for training and privileging in MAS are presented. In one of the centres that fulfills the requirements of the E.A.E.S. there were 602 surgeons from January 1992 to March 1993 who attended teaching courses in laparoscopic surgery. They came from all European countries (except Iceland) and participated in courses in basic and advanced MAS. The courses were rated with high marks and may serve as a model for similar courses elsewhere in Europe. In Europe, standardised and well organised teaching in MAS is currently available, both for surgeons and registrars. Skills laboratories will play an important role in teaching MAS. In the future, training in virtual reality surgical simulations will become central in teaching MAS and with this development, the need for animals for training will be reduced. Preceptorship and proctoring is becoming established. Still, the apprenticeship system remains the cornerstone of surgical training also in MAS.

Curriculum↗

PubMed2001

Surgical education and surgical simulation.

The science of virtual reality provides an entirely new opportunity in the area of simulation of surgical skills using computers for training, evaluation, and eventually certification. A taxonomy of the types of simulators is proposed based upon the level of complexity of the task which is being simulated. These tasks are precision placement, simple manipulation, complex manipulation, and integrated procedure. Representative simulators in each category are illustrated and discussed in the context of their contribution to the education and training of a surgeon. The importance of a curriculum is to give content to the role of simulators as another advanced tool for education. Simulators must be integrated into a comprehensive curriculum and not considered as a stand-alone system. The current accomplishments as well as challenges are discussed.

Clinical Competence↗

PubMed2005

Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.

OBJECTIVE: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. METHODS: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n = 10,000) and sensitivity analyses (n = 40) were used to assess median and the empiric 95% confidence intervals [CIs] for incremental survival with either intervention. RESULTS: The baseline model, calibrated to the characteristics of the input-data community, established that, for private-residence cardiac arrests, 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR. This yielded 4.81% survival (95% CI = 4.72 to 4.89). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of private-residence trained bystanders would need to perform CPR in order to reach a minimally significant improvement in survival (5.02%; 95% CI = 4.94 to 5.15). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI = 4.93 to 5.09) would require that 70.8% of bystanders be trained. CONCLUSIONS: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.

Aged↗

PubMed1996

Neural networks as a tool for compact representation of ab initio molecular potential energy surfaces.

Ab initio quantum chemical calculations of molecular properties such as, e.g., torsional potential energies, require massive computational effort even for moderately sized molecules, if basis sets with a reasonable quality are employed. Using ab initio data on conformational properties of the cofactor (6R,1'R,2'S)-5,6,7,8-tetrahydrobiopterin, we demonstrate that error backpropagation networks can be established that efficiently approximate complicated functional relationships such as torsional potential energy surfaces of a flexible molecule. Our pilot simulations suggest that properly trained neural networks might provide an extremely compact storage medium for quantum chemically obtained information. Moreover, they are outstandingly comfortable tools when it comes to making use of the stored information. One possible application is demonstrated, namely, computation of relaxed torsional energy surfaces.

Biopterins↗

PubMed1992

Control of rabbit nictitating membrane movements. II. Analysis of the relation of motoneuron activity to behavior.

The objective of this study is to understand more precisely the relationship of motoneuron activity to movements of the rabbit nictitating membrane (NM). We use a model of the oculomotor plant to investigate what NM movements are generated by a given pattern of neural input and what inputs are required to generate particular NM movements. Simulated peak NM extensions can occur well over 50 ms after the end of motoneuron activity. The neural input required for the model to generate full amplitude NM extension responses is more consistent with single accessory abducens unit recordings from awake rabbits than recordings from anesthetized rabbits. An initial high frequency burst of neural activity followed by a rapid decay is required for simulations of conditioned responses (CRs) trained at a 125 ms interstimulus interval (ISI). For CRs trained with a 250 ms ISI, a more slowly rising and decaying neural activity is required. Model simulations show that the linear correlation between the shape of histogrammed motoneuron activity and the shape of NM movements can be high for long duration responses (> 400 ms) but is low for short duration responses (< 200 ms). Simulations are also consistent with the hypothesis that NM retraction is generally passive.

Animals↗

PubMed2000

Anesthesia simulators--technology and applications.

Anesthesia simulators are rapidly becoming more prevalent worldwide. Several types of anesthesia simulators utilizing a variety of technologies are available. High fidelity mannequin-based simulators, low fidelity screen-based simulators, and relatively inexpensive intermediate fidelity simulators have found applications in training, assessment of clinical competence, and research. A number of recent studies support the use of anesthesia simulators and may lead to widespread adoption of simulation in other fields of medicine.

Anesthesia↗

PubMed2001

The interaction between membrane kinetics and membrane geometry in the transmission of action potentials in non-uniform excitable fibres: a finite element approach.

By solving the partial differential equations for an axonal segment using a finite element method, the interaction between membrane kinetics and axonal inhomogeneities, measured by their influence on propagated action potentials and stochastic spike trains, is investigated for Morris-Lecar and Hodgkin-Huxley membrane models. To facilitate comparisons of both kinetic models, parameter values are matched to give approximately the same speed for propagated action potentials. In all cases examined, the Morris-Lecar membrane model is more sensitive to geometric inhomogeneities than the comparable Hodgkin-Huxley membrane model. This difference in sensitivity can, in part, be attributed to significant differences in the membrane current supplied by each kinetic model ahead of the action potential. Also, the Morris-Lecar membrane model did not generate reflected action potentials whereas these were observed over a narrow range of geometric parameters for the comparable Hodgkin-Huxley membrane model. Simulations using stochastic spike train input showed that the presence of a sharp flare could significantly modify the statistical characteristics of the spike train output. The behaviour of action potentials governed by Morris-Lecar kinetics were more sensitive to changes in axonal geometry than those generated by comparable Hodgkin-Huxley kinetics. As a consequence of the fine balance between membrane kinetics and axon geometry, local changes in membrane properties, such as those caused by synaptic activity, can be expected to have a strong influence on the behaviour of stochastic spike trains at regions of changing axonal geometry.

Action Potentials↗

PubMed2003

Stimulated Raman scattering of intense laser pulses in air.

Stimulated rotational Raman scattering (SRRS) is known to be one of the processes limiting the propagation of high-power laser beams in the atmosphere. In this paper, SRRS, Kerr nonlinearity effects, and group velocity dispersion of short laser pulses and pulse trains are analyzed and simulated. Fully time-dependent, three-dimensional, nonlinear propagation equations describing the Raman interaction, optical Kerr nonlinearity due to bound electrons, and group velocity dispersion are presented and discussed. The effective time-dependent nonlinear refractive index containing both Kerr and Raman processes is derived. Linear stability analysis is used to obtain growth rates and phase matching conditions for the SRRS, modulational, and filamentation instabilities. Numerical solutions of the propagation equations in three dimensions show the detailed evolution of the Raman scattering instability for various pulse formats. The dependence of the growth rate of SRRS on pulse duration is examined and under certain conditions it is shown that short (approximately psec) laser pulses are stable to the SRRS instability. The interaction of pulses in a train through the Raman polarization field is also illustrated.

Journal Article↗

PubMed1997

An emergency department simulation and a neural network metamodel.

This paper describes a discrete event stochastic simulation of a hospital emergency department, and the development of a metamodel of that simulation. The metamodeling technique used is artificial neural networks, which are trained utilizing the output of the simulation. The performance of the neural network metamodel is compared to the simulation performance for estimating the mean and variance of patient time in the emergency department.

Appointments and Schedules↗

PubMed1998

Female exposure to high G: performance of simulated flight after 24 hours of sleep deprivation.

BACKGROUND: Ground-based research has investigated the loss of cognitive function in the extreme conditions of G-induced loss of consciousness, however, little is known about pilots' abilities to maintain cognitive performance throughout prolonged conscious exposure in the high-G environment. The effects of fatigue and G layoff on performance during exposure to high G are mostly unknown for the female population. METHODS: This research was conducted on the centrifuge Dynamic Environment Simulator. Active-duty personnel (8 male and 8 female) were trained to fly the F-16 simulation while 30 performance measures were recorded. Performance was re-evaluated after 24 h of sleep deprivation. RESULTS: Neither male nor female overall performance was affected significantly by sleep status, although individual tasks showed sensitivity; call-sign reaction time was longer by 33%, and missile survival was less likely. Also, when sleep deprived, perceived effort and physical demand were higher while perceived performance was lower. No differences in performance were found in either gender due to lay-off, although some physiologic deconditioning was apparent. Women commanded and endured the same amount of G load as men, however, on average they could not perform the tracking task quite as well. CONCLUSIONS: Sleep deprivation (24 h) produced sensations of fatigue and frustration, but overall performance was not reduced. The ability of personnel to complete a complex defensive maneuver was reduced when they were sleep deprived. The women that we tested apparently could not optimize the tracking task as well as their male counterparts when Gz was in the simulation. None of these results were sufficient to suggest that women should not be allowed to compete for flying assignments in high-performance aircraft.

Aerospace Medicine↗

PubMed1994

Measurement of the forces and movements involved in neonatal hip testing.

The screening for Developmental Dysplasia of the Hip in infants relies on the two manipulative tests developed by Ortolani and Barlow which are often poorly performed. This study investigated the forces applied and the sequences of physical manoeuvres underlying the tests in order to define a standard of safe practice. Eight subjects examined the hips of two training models that closely simulated the behaviour of a range of infant hip pathologies. The forces applied and the manoeuvres employed during each examination were recorded using a purpose-built force and displacement transducer system. The analysis concentrated on the peak forces and the biomechanical conditions necessary to detect an abnormality. The models' legs had to be abducted beyond certain critical angles in order to dislocate and relocate an unstable femoral head and the magnitude of the force required to dislocate the femoral head was significantly less than the peak force applied (12 N vs 33 N, p < 0.001). Also, the Palmen test, a less well known technique, provided the same level of diagnostic performance as the Barlow test but with a lower peak applied force (28 N vs 47 N, p < 0.001). Changes are therefore necessary to the training programmes for medical staff to ensure that the range of abduction during the manoeuvres is large enough to encompass the likely range of critical angles and that the forces applied are just sufficient so as not to overstress the joints.

Biomechanical Phenomena↗

PubMed2004

Respiratory system simulations and modeling.

Simulators and models of the respiratory system range from simple mechanical devices to complex systems that include sophisticated computers. These systems have considerable utility in clinician education, guiding therapies, evaluating new devices and techniques, and in improving our understanding of the cardiorespiratory system. Simulators and models are of 3 types: signs-and-symptoms simulators, anatomic models, and physiologic models. Signs-and-symptoms simulators range from human actors to computer-controlled patient mannequins. Clinical scenarios, from minor abnormalities to catastrophic emergencies, can be simulated. As has been found with aircraft cockpit simulators, improved clinician performance in simulated emergencies should translate into improved performance in real patient-care situations. Anatomic modeling can simulate basic anatomy for training clinicians. Three-dimensional reconstruction of the airways, using real patient data, can help to plan therapy, understand the disease process, and warn of safety issues. Anatomic modeling with radiographs and magnetic resonance images, sometimes created using radiolabeled tracer gases, can create 3-dimensional images of regional lung anatomy and function. Physiologic signals such as carbon dioxide production, oxygen consumption, and washout/washin of various tracer gases can be used to model ventilation-perfusion and ventilation-volume relationships, and those models can improve understanding of disease processes and guide therapies.

Computer Graphics↗

PubMed1999

A neural network model with dopamine-like reinforcement signal that learns a spatial delayed response task.

This study investigated how the simulated response of dopamine neurons to reward-related stimuli could be used as reinforcement signal for learning a spatial delayed response task. Spatial delayed response tasks assess the functions of frontal cortex and basal ganglia in short-term memory, movement preparation and expectation of environmental events. In these tasks, a stimulus appears for a short period at a particular location, and after a delay the subject moves to the location indicated. Dopamine neurons are activated by unpredicted rewards and reward-predicting stimuli, are not influenced by fully predicted rewards, and are depressed by omitted rewards. Thus, they appear to report an error in the prediction of reward, which is the crucial reinforcement term in formal learning theories. Theoretical studies on reinforcement learning have shown that signals similar to dopamine responses can be used as effective teaching signals for learning. A neural network model implementing the temporal difference algorithm was trained to perform a simulated spatial delayed response task. The reinforcement signal was modeled according to the basic characteristics of dopamine responses to novel stimuli, primary rewards and reward-predicting stimuli. A Critic component analogous to dopamine neurons computed a temporal error in the prediction of reinforcement and emitted this signal to an Actor component which mediated the behavioral output. The spatial delayed response task was learned via two subtasks introducing spatial choices and temporal delays, in the same manner as monkeys in the laboratory. In all three tasks, the reinforcement signal of the Critic developed in a similar manner to the responses of natural dopamine neurons in comparable learning situations, and the learning curves of the Actor replicated the progress of learning observed in the animals. Several manipulations demonstrated further the efficacy of the particular characteristics of the dopamine-like reinforcement signal. Omission of reward induced a phasic reduction of the reinforcement signal at the time of the reward and led to extinction of learned actions. A reinforcement signal without prediction error resulted in impaired learning because of perseverative errors. Loss of learned behavior was seen with sustained reductions of the reinforcement signal, a situation in general comparable to the loss of dopamine innervation in Parkinsonian patients and experimentally lesioned animals. The striking similarities in teaching signals and learning behavior between the computational and biological results suggest that dopamine-like reward responses may serve as effective teaching signals for learning behavioral tasks that are typical for primate cognitive behavior, such as spatial delayed responding.

Animals↗

PubMedDate not supplied

Virtual reality training for the operating room and cardiac catheterisation laboratory.

CONTEXT: High-profile cases of medical errors in the USA and UK, and major reports from organisations such as the US Institute of Medicine and UK Senate of Surgery, have sensitised the public and medical profession. Training is a key area that must be tackled to positively affect the problem of medical errors, especially in surgery and interventional cardiology. Despite the radically novel skills required for minimally invasive surgery or interventional cardiology, current training has gone largely unchanged. At the end of the 20th century, the public and the medical profession have concluded that training on patients is no longer acceptable. STARTING POINT: Recently, Teodor Grantcharov and colleagues (Br J Surg 2004; 91: 146-50) did a randomised double-blind trial which showed that training by virtual reality (VR) significantly reduces objectively assessed intraoperative errors in laparoscopic cholecystectomy. They used a low-fidelity VR simulator. Much more sophisticated VR simulators exist for endoscopy, gynaecology, laparoscopy, orthopaedics, otolaryngology, robotics, and urology. There are few studies on the efficacy of these simulators in improving the safety of procedures on patients. WHERE NEXT: There needs to be more large and multicentre studies. Technical skills training for procedural based medicine continues to be an ad-hoc mentor-based experience for the trainee, with experience gained by practising on patients. The skills required now are so difficult to learn that this type of training is no longer acceptable. VR-simulator-based training does work, but further empirical evidence is required to convince the more conservative members of the medical community.

Cardiac Catheterization↗