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At least 1,243 records · Page 69Linked to original sources
PubMed1989

Simulator sickness in U.S. Navy flight simulators.

Flight simulators have become a major factor in pilot training. A general finding from Navy research on simulator design is that equipment features that offer faithful representation improve pilot performance and promote pilot acceptance. To the extent that an aircraft produces motion sickness, its simulator should induce the same result. However, reports of simulator sickness appear to be increasing and a shortcoming in simulation is implied when these effects occur in simulators during maneuvers that do not occasion them in the aircraft. This article presents incidence data from surveys of the 10 simulators at 6 different Naval/Marine Corps Air Stations. Approximately 1,200 simulator flights were recorded. Some severe motion sickness symptoms were recorded and some simulators induced unsteadiness afterwards. Individuals experiencing effects may be at risk if they drive themselves home or return to demanding activities at work. The simulators which exhibited the highest incidences of sickness were helicopter simulators with cathode ray tube (CRT) infinity optics and six-degrees-of-freedom moving base systems. Of those studied, fixed-wing, fixed-base, dome displays had relatively low incidence of simulator sickness.

Aircraft↗
PubMed1981

Comparison of Eustachian tube function measured by the microflow method and a new quantitative impedance method.

Eustachian tube function in 25 applicants for flight training was tested during simulated flights using two methods alternately; the integrating microflow method with a stationary pressure chamber, and a new quantitative impedance method in combination with a new mobile pressure chamber. All ears were tested by both methods. The results of the various tests did not differ significantly between methods. The reliability of the measurements was good and almost equal in both methods. Several practical advantages with the new impedance method in combination with the mobile pressure chamber make it preferable.

Acoustic Impedance Tests↗
PubMed1995

Exocytosis in peptidergic nerve terminals exhibits two calcium-sensitive phases during pulsatile calcium entry.

The link between electrical activity, Ca2+ entry through voltage-gated channels, and transmitter or hormone secretion is a central issue in neurobiology. In peptidergic nerve terminals of the mammalian neurohypophysis (NHP), secretion is elicited by patterned bursts of action potentials (APs). All parameters of the bursts are important to elicit efficient secretion, including AP frequency, AP broadening, burst duration, and interburst interval (Leng, 1988). We have studied Ca(2+)-secretion coupling of peptide-containing large dense-core vesicles (LDCV) in isolated rat NHP terminals. Ca2+ influx through voltage-gated Ca2+ channels was elicited and recorded by the whole-cell patch-clamp technique. Exocytosis was monitored on line with high temporal resolution by the capacitance detection technique (Neher and Marty, 1982). AP bursts were simulated by depolarizing pulse trains that mimic pulsatile submembrane Ca2+ elevations predicted for physiological stimuli. The characteristic capacitance response (delta Cm) to a train of depolarizing pulses was triphasic. It consisted of a threshold phase during which early pulses did not elicit secretion, a subsequent secretory phase during which Cm increases were coupled to depolarizing pulses, and a fatigued or inactivated state during which additional Ca2+ entry was ineffective. Both the threshold phase and secretory phase were correlated with the integrals of Ca2+ current. Ca2+ chelators affect both the threshold and secretory phase at submillimolar concentrations. Thus, a "shell" rather than "microdomain" model of Ca2+ elevation is appropriate for analyzing Ca(2+)-secretion coupling in NHP terminals (Nowycky and Pinter, 1993). We propose a two-step model, with a ca(2+)-dependent preparatory step followed by a final exocytotic step that is coupled to active Ca2+ influx. The results suggest that under physiological conditions, APs early in a burst prepare an NHP terminal for secretion, but later APs actually trigger exocytosis. Since NHP terminals do not possess a readily releasable pool of vesicles that require only a single Ca2+ step for exocytosis as seen in chromaffin cells (Neher and Zucker, 1993) and melanotrophs (Thomas et al, 1993a), Ca(2+)-secretion coupling mechanisms may be heterologous even within a single class of vesicles.

Action Potentials↗
PubMed1994

[Results of training in communication skills at the First Medical School of Charles University in Prague].

Consistent with new trends in medical training the First Medical Faculty, Charles University Prague included in its curriculum of general medicine a mandatory programme devoted to communication skills. The main objective is to teach students to establish valuable contact with the patient and elucidate the problem presented by the patient. Another objective is to show the therapeutic potential of a well conducted interview. All hitherto trained students who attended the classes on communication skills acquired within the repertoire of skills used in discussions with patients the skill of a non-directive interview focused on elucidation of the problem on which the patient saw his doctor. It proved possible to demonstrate that integration of theoretical knowledge into practical procedures used in diagnosis, treatment and supportive psychotherapy of somatic and psychosomatic diseases and reactive conditions is a relatively demanding and long-term process which can be mastered during training which uses acting (simulated doctor, simulated patient) and feedback by videorecording.

Communication↗
PubMed1998

[Mastering surgical treatment methods for patients with paralytic laryngeal stenosis].

Endoscopic laryngoplasty used in reconstructive surgery of the upper respiratory tracts for paralytic laryngeal stenoses is maximally sparing in relation to laryngeal structures. Mastering of the skill of the endoscopic intervention necessitated application of the device for training surgeons. The device simulates the operative situation of microsurgical manipulations on the larynx.

Endoscopy↗
PubMed2005

Construct validation of the ProMIS simulator using a novel laparoscopic suturing task.

BACKGROUND: The use of simulation for minimally invasive surgery (MIS) skills training has many advantages over current traditional methods. One advantage of simulation is that it enables an objective assessment of technical performance. The purpose of this study was to determine whether the ProMIS augmented reality simulator could objectively distinguish between levels of performance skills on a complex laparoscopic suturing task. METHODS: Ten subjects--five laparoscopic experts and five laparoscopic novices--were assessed for baseline perceptual, visio-spatial, and psychomotor abilities using validated tests. After three trials of a novel laparoscopic suturing task were performed on the simulator, measures for time, smoothness of movement, and path distance were analyzed for each trial. Accuracy and errors were evaluated separately by two blinded reviewers to an interrater reliability of >0.8. Comparisons of mean performance measures were made between the two groups using a Mann-Whitney U test. Internal consistency of ProMIS measures was assessed with coefficient alpha. RESULTS: The psychomotor performance of the experts was superior at baseline assessment (p < 0.001). On the laparoscopic suturing task, the experts performed significantly better than the novices across all three trials (p < 0.001). They performed the tasks between three and four times faster (p < 0.0001), had three times shorter instrument path length (p < 0.0001), and had four times greater smoothness of instrument movement (p < 0.009). Experts also showed greater consistency in their performance, as demonstrated by SDs across all measures, which were four times smaller than the novice group. Observed internal consistency of ProMIS measures was high (alpha = 0.95, p < 0.00001). CONCLUSIONS: Preliminary results of construct validation efforts of the ProMIS simulator show that it can distinguish between experts and novices and has promising psychometric properties. The attractive feature of ProMIS is that a wide variety of MIS tasks can be used to train and assess technical skills.

Clinical Competence↗
PubMed2003

How to optimize physicians' communication skills in cancer care: results of a randomized study assessing the usefulness of posttraining consolidation workshops.

PURPOSE: Although there is wide recognition of the usefulness of improving physicians' communication skills, no studies have yet assessed the efficacy of post-training consolidation workshops. This study aims to assess the efficacy of six 3-hour consolidation workshops conducted after a 2.5-day basic training program. METHODS: Physicians, after attending the basic training program, were randomly assigned to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual patient interviews that were audiotaped at baseline and after consolidation workshops for the consolidation-workshop group, and approximately 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' perceptions of communication skills improvement were assessed using a 14-item questionnaire. RESULTS: Sixty-three physicians completed the training program. Communication skills improved significantly more in the consolidation-workshop group compared with the waiting-list group. In simulated interviews, group-by-time repeated measures analysis of variance showed a significant increase in open and open directive questions (P =.014) and utterances alerting patients to reality (P =.049), as well as a significant decrease in premature reassurance (P =.042). In actual patient interviews, results revealed a significant increase in acknowledgements (P =.022) and empathic statements (P =.009), in educated guesses (P =.041), and in negotiations (P =.008). Patients interacting with physicians who benefited from consolidation workshops reported higher scores concerning their physicians' understanding of their disease (P =.004). CONCLUSION: Consolidation workshops further improve a communication skills training program's efficacy and facilitate the transfer of acquired skills to clinical practice.

Communication↗
PubMed2005

The 50 ml syringe training aid should be utilized immediately before cricoid pressure application.

OBJECTIVE: Cricoid pressure, applied during rapid sequence induction of anaesthesia, should be performed only by trained staff. Recommended training intervals vary from weekly to every 3 months, but this is unrealistic in day-to-day practice. Performance, when assessed, is often shown to be unacceptable before training. Unfortunately, most training aids are either expensive or unavailable. Assessment and training in previous studies was carried out on the same cricoid pressure simulator, introducing learning bias. In our study, we tested whether a 50 ml syringe utilized as a training aid immediately before the assessment of simulated rapid sequence induction on a different cricoid pressure simulator would improve staff performance. METHODS: A total of 64 volunteers were randomly allocated into two equal groups. Group 1 (control group) was assessed on the cricoid pressure simulator only. Group 2 (training group) was pretrained to defined criteria using the 50 ml syringe. Next, the group was assessed on the cricoid pressure simulator. RESULTS: A satisfactory force was applied in only 19% (6/32) of the control group, but in 47% (15/32) of the syringe pretrained group (P=0.03). Both groups applied, on average, excessive force. CONCLUSION: Brief training with a 50 ml syringe will increase the likelihood of satisfactory force application during Sellick's manoeuvre. Applied to clinical practice, this will make cricoid pressure both more effective and reliable, and may improve patient safety. Therefore, the 50 ml syringe should be utilized before any clinical application of cricoid pressure.

Anesthesiology↗
PubMed2004

Development and transferability of a cost-effective laparoscopic camera navigation simulator.

BACKGROUND: Laparoscopic camera navigation (LCN) is vital for the successful performance of laparoscopic operations, yet little time is spent on training. This study aimed to develop an inexpensive LCN simulator, to design a structured curriculum, and to determine the transferability of skills acquired. METHODS: In this study, 0 degrees and 30 degrees LCN simulators were developed for use on a videotrainer platform. Transferability was tested by enrolling 20 medical students in an institutional review board-approved, randomized, controlled, blinded protocol. Subjects viewed a video tutorial and were pretested in LCN on a porcine Nissen model. Procedures were videotaped and the LCN performance was scored by a blinded rater according to the number of standardized verbal cues required and the percentage of time an optimal surgical view (%OSV) was obtained. Procedure time also was recorded. Subjects were stratified and randomized. The trained group practiced on the LCN simulator until competency was demonstrated. The control group received no training. Both groups were posttested on the porcine Nissen model. RESULTS: The constructed simulators required 35 man hours for development, cost $25 per board for materials, and proved to be durable. The trained group demonstrated significant improvement in verbal cues (p = 0.001), %OSV (p < 0.001), and procedure time (p = 0.001), whereas the control group showed improvement only in verbal cues (p < 0.02). At posttesting, the training group demonstrated significantly better scores for verbal cues (2.1 vs 8.0; p = 0.02) and %OSV (64% vs 45% p = 0.01) than the control group. CONCLUSION: These data suggest that the LCN simulator is cost effective and provides trainees with skills that translate to the operating room.

Adult↗
PubMed2001

Porcine urinary tract as a training model for ureteroscopy.

OBJECTIVES: Endourological procedures as ureteroscopy require an advanced level of skills. To facilitate the training of the proper technique, simulators are helpful. Nonbiological models, useful to learn the basic steps, do not represent the clinical situation in an ideal way. We therefore looked for a biological but nevertheless easily available model. METHODS: The complete urinary tract is dissected off the retroperitoneal organ package of freshly slaughtered pigs. RESULTS: The porcine urinary tract model allows for training all aspects of diagnostic and therapeutic ureteroscopy including lithotripsy and stenting in a way which is almost identical to the clinical situation in humans. CONCLUSIONS: The porcine urinary tract model is an ideal ex vivo model. Concerning 'tissue feeling' and anatomic relations, it is superior to nonbiological simulators. Nevertheless, it is quite easily available and inexpensive. In training courses, we have used it with great success.

Animals↗
PubMed2001

Use of ultrasound to improve the safety of postgraduate training in obstetrics and gynaecology.

Supervised clinical work is perhaps the most valuable component of postgraduate training and has a long-term impact. Senior clinicians not only take the responsibility of teaching and supervising junior doctors but also most of them take the consequences of any clinical failures or mistakes associated with the training. Despite the introduction of simulators and computer-assisted learning, practice on real patients is still required to learn many skills in obstetrics and gynaecology. Training must be safe, because trainees or trainers must not put our patients at risk as part of the process of learning to heal others. Ultrasound can be used to demonstrate and guide several procedures that have been performed 'blindly' in the past. This technology can reduce the risks associated with training and supervision of junior doctors.

Education, Medical, Continuing↗
PubMed2005

Ex vivo training model for percutaneous renal surgery.

Percutaneous endourological procedures require an advanced level of skills. To facilitate training in the proper technique, simulators are helpful. Non-biological models, useful for learning the basic steps, do not represent the clinical situation in an ideal way. Recently, we developed a porcine urinary tract model for ureteroscopy. Proceeding from this experience, we developed a further ex vivo model for training percutaneous endourological procedures. The kidney with the ureter is dissected off of the retroperitoneal organ package of freshly slaughtered pigs. It is embedded in silicon. The renal pelvis can be filled with saline to simulate hydronephrosis, stones can be implanted for percutaneous nephrolithotomy. This ex vivo model allows training of all percutaneous endourological procedures (e.g. percutaneous nephrostomy, percutaneous lithotomy, endopyelotomy). It is an ideal way to train these techniques, being superior to non-biological models in terms of "tissue feeling" for anatomic relations, and the great variety of procedures that can be trained. Nevertheless, it is readily available and inexpensive.

Animals↗
PubMedDate not supplied

An introduction to simulation and visualization of biological systems at multiple scales: a summer training program for interdisciplinary research.

Advances in biomedical research require a new generation of researchers having a strong background in both the life and physical sciences and a knowledge of computational, mathematical, and engineering tools for tackling biological problems. The NIH-NSF Bioengineering and Bioinformatics Summer Institute at the University of Pittsburgh (BBSI @ Pitt; www.ccbb.pitt.edu/bbsi) is a multi-institutional 10-week summer program hosted by the University of Pittsburgh, Duquesne University, the Pittsburgh Supercomputing Center, and Carnegie Mellon University, and is one of nine Institutes throughout the nation currently participating in the NIH-NSF program. Each BBSI focuses on a different area; the BBSI @ Pitt, entitled "Simulation and Computer Visualization of Biological Systems at Multiple Scales", focuses on computational and mathematical approaches to understanding the complex machinery of molecular-to-cellular systems at three levels, namely, molecular, subcellular (microphysiological), and cellular. We present here an overview of the BBSI @ Pitt, the objectives and focus of the program, and a description of the didactic training activities that distinguish it from other traditional summer research programs. Furthermore, we also report several challenges that have been identified in implementing such an interdisciplinary program that brings together students from diverse academic programs for a limited period of time. These challenges notwithstanding, presenting an integrative view of molecular-to-system analytical models has introduced these students to the field of computational biology and has allowed them to make an informed decision regarding their future career prospects.

Computational Biology↗
PubMed2007

Modification and optimization of the united-residue (UNRES) potential energy function for canonical simulations. I. Temperature dependence of the effective energy function and tests of the optimization method with single training proteins.

We report the modification and parametrization of the united-residue (UNRES) force field for energy-based protein structure prediction and protein folding simulations. We tested the approach on three training proteins separately: 1E0L (beta), 1GAB (alpha), and 1E0G (alpha + beta). Heretofore, the UNRES force field had been designed and parametrized to locate native-like structures of proteins as global minima of their effective potential energy surfaces, which largely neglected the conformational entropy because decoys composed of only lowest-energy conformations were used to optimize the force field. Recently, we developed a mesoscopic dynamics procedure for UNRES and applied it with success to simulate protein folding pathways. However, the force field turned out to be largely biased toward -helical structures in canonical simulations because the conformational entropy had been neglected in the parametrization. We applied the hierarchical optimization method, developed in our earlier work, to optimize the force field; in this method, the conformational space of a training protein is divided into levels, each corresponding to a certain degree of native-likeness. The levels are ordered according to increasing native-likeness; level 0 corresponds to structures with no native-like elements, and the highest level corresponds to the fully native-like structures. The aim of optimization is to achieve the order of the free energies of levels, decreasing as their native-likeness increases. The procedure is iterative, and decoys of the training protein(s) generated with the energy function parameters of the preceding iteration are used to optimize the force field in a current iteration. We applied the multiplexing replica-exchange molecular dynamics (MREMD) method, recently implemented in UNRES, to generate decoys; with this modification, conformational entropy is taken into account. Moreover, we optimized the free-energy gaps between levels at temperatures corresponding to a predominance of folded or unfolded structures, as well as to structures at the putative folding-transition temperature, changing the sign of the gaps at the transition temperature. This enabled us to obtain force fields characterized by a single peak in the heat capacity at the transition temperature. Furthermore, we introduced temperature dependence to the UNRES force field; this is consistent with the fact that it is a free-energy and not a potential energy function. beta

Biophysics↗
PubMed2005

Enhancement of temporal periodicity cues in cochlear implants: effects on prosodic perception and vowel identification.

Standard continuous interleaved sampling processing, and a modified processing strategy designed to enhance temporal cues to voice pitch, were compared on tests of intonation perception, and vowel perception, both in implant users and in acoustic simulations. In standard processing, 400 Hz low-pass envelopes modulated either pulse trains (implant users) or noise carriers (simulations). In the modified strategy, slow-rate envelope modulations, which convey dynamic spectral variation crucial for speech understanding, were extracted by low-pass filtering (32 Hz). In addition, during voiced speech, higher-rate temporal modulation in each channel was provided by 100% amplitude-modulation by a sawtooth-like wave form whose periodicity followed the fundamental frequency (F0) of the input. Channel levels were determined by the product of the lower- and higher-rate modulation components. Both in acoustic simulations and in implant users, the ability to use intonation information to identify sentences as question or statement was significantly better with modified processing. However, while there was no difference in vowel recognition in the acoustic simulation, implant users performed worse with modified processing both in vowel recognition and in formant frequency discrimination. It appears that, while enhancing pitch perception, modified processing harmed the transmission of spectral information.

Adult↗