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PubMed1973

Some psychological and engineering aspects of the extravehicular activity of astronauts.

One of the main in-flight problems being fulfilled by astronauts is the preparation for and realization of egress into open space for the purpose of different kinds of extravehicular activity, such as, the performance of scientific experiments, repairing and dismantling operations etc. The astronaut's activity outside the space vehicle is the most difficult item of the space flight programme, which is complicated by a number of space factors affecting a man, viz. dynamic weightlessness, work in a space suit under conditions of excessive pressure, difficulties of space orientation etc. The peculiarities mentioned require special training of the cosmonaut. The physical training involves a series of exercises forming the body-control habits necessary for work in a state of weightlessness. In a new kind of training use is made of equipment simulating the state of weightlessness. From analysis of the available data and the results of my own investigations during ground training and the Soyuz 4 and 5 flights one can establish the following peculiarities of the astronaut's extravehicular activity: (1) Operator response lag in the planned algorithm; (ii) systematic appearance of some stereotype errors in the mounting and dismantling of the outer equipment and in scientific-technical experiments; (iii) a high degree of emotional strain and 30-35% decrease in in-flight working capacity of the astronaut compared with the ground training data; (iv) a positive influence of space adaptation on the cosmonaut and the efficiency of his work in open space; (v) the necessity for further engineering and psychological analysis of the astronaut's activity under conditions of the long space flight of the multi-purpose orbital station. One of the main reasons for the above peculiarities is the violation of the control-coordination functions of the astronaut in the course of the dynamical operations. The paper analyses the extravehicular activity of the astronaut and presents some recommendations for its more efficient realization. Proposals are given concerning the complex engineering, psychological and technical investigations to be made during in-flight egress.

Aerospace Medicine↗

PubMed2000

Training software for high-performance liquid chromatography.

A computer simulation program of reversed-phase high-performance liquid chromatography was developed for training purposes. Experimental retention values of 75 organic compounds on a reversed-phase column at four different percentages of organic modifiers were reduced to a two-parameter retention model with the modifier content as variable. Modifiers used were acetonitrile, methanol and tetrahydrofuran. Isocratic and programmed solvent composition were included together with the usual experimental parameters available in modern HPLC equipment, such as UV diode array and refractive index detection. Instrument specifications were made variable within wide ranges. Detailed dispersion data were made available as tabulated output.

Chromatography, High Pressure Liquid↗

PubMed2002

How to test mode switching in pacemakers implanted in patients: the MOST study.

Optimal management of atrial arrhythmias with dual chamber pacemakers requires proper performance of automatic mode switching (AMS). The aim of this study was to develop a reliable technique to test the AMS function by using an external electronic device capable of mimicking the occurrence of supraventricular arrhythmias (Supraventricular Arrhythmia Simulator [SAS]). The SAS delivers low voltage pulse trains (200 mV, 20 ms) through two skin electrodes. Each pulse train lasts 15 seconds and starts synchronously with a pacing pulse of the implanted pacemaker to avoid interference from the operator. The pulse train rate is set at 350, 250, and 160 beats/min to simulate AF, atrial flutter, and atrial tachycardia (AT), respectively. Thirty-five patients implanted with Vitatron pacemakers, whose AMS system has been previously validated, were enrolled. Atrial and ventricular sensing were programmed in unipolar mode at 0.5 mV and in bipolar mode at > 2 mV, respectively. All pulses from the SAS were detected by the atrial channel at an amplitude ranging from 1 to 3 mV. The test proved to be safe and reliable at rest and during exercise. AMS occurred immediately at onset or at offset of atrial arrhythmias, and no adverse interference on pacemaker function was seen from the SAS. In conclusion, the described technique and the SAS are safe and reliable for patient and pacemaker function and can be proposed as a useful method to verify proper performance of AMS function irrespective of the type of implanted devices.

Aged↗

PubMed2000

Staging simulated accidents.

Realistic simulated accidents are essential for wilderness emergency care training. Staging them requires good scene setting, acting, evaluation, and makeup. Training your students in moulage will not only help you stage simulated accidents for the class, it will also give the students valuable insights into emergency care by playing the roles of victims. Equipment can be cheap and simple, or more elaborate. With good scripts and good coaching of the victims, you can use moulage to help your students put all their skills together, bringing them as close as possible to the experience of a real wilderness emergency.

Accidents↗

PubMed2006

Metrics for an interventional radiology curriculum: a case for standardisation?

Interventional radiology training and assessment would benefit greatly from the introduction of simulation. Assessment methods should facilitate the highest standards of training and therefore must be chosen on the basis of evidence of impact on learning. A study of assessment in a training model shows the need for specialty specific metrics which were derived from a task analysis of interventional procedures.

Computer Simulation↗

PubMed2006

AccuTouch Endoscopy Simulator: development, applications and early experience.

These studies suggest that there are several potential advantages to use of the AccuTouch simulators, including (1) improvement of the endoscopic training of trainees before patient contact, (2) possible evaluation for procedural competency, and (3) possible cost savings, increasing the productivity of faculty while the trainees are developing competency using the trainers. Other potential advantages might include the training of endoscopists in new diagnostic and therapeutic techniques and even new devices before patient contact. With continued improvement in software and hardware, endoscopic simulators will become an integral part of endoscopic training programs.

Clinical Competence↗

PubMed2003

Using simulated patients in a multiprofessional communications skills programme: reflections from the programme facilitators.

This paper discusses a multiprofessional, 4-day communication skills programme in which participants explore the challenges of communicating with cancer patients and their families. Effective communication and skilled emotional support are essential prerequisites for high quality care in oncology and palliative care settings. This aspect of care presents major challenges to nurses and other health care professionals. It is acknowledged that health professionals often lack the requisite skills to communicate meaningfully with this patient group and that tangible benefits accrue from training in this area. Using simulated patients, structured feedback and small group discussions, this multiprofessional programme seeks to provide a forum that enables participants to acquire confidence and competence in a safe, comfortable and non-threatening environment. The programme structure presents several challenges in terms of providing a learning experience that addresses the diverse educational of a heterogeneous learning group. Participants' comments and programme facilitators reflections suggest that the programme is successful in addressing these challenges and providing a meaningful learning experience.

Clinical Competence↗

PubMed2001

Simulation and new learning technologies.

Changes in medical practice that limit patient availability and instructors' time have resulted in poor physical diagnosis skills by learners at all levels. Advanced simulation technology, including the use of sophisticated multimedia computer systems, helps to address this problem. For many years 'Harvey', the Cardiology Patient Simulator, and the UMedic Multimedia Computer system have proven to be effective tools to teach and assess bedside cardiovascular skills when they are integrated into the required curriculum of medical school and postgraduate training. In the future, virtual reality technology, based initially on data from the Visible Human Data set, will provide the majority of simulation-based training. Models that provide a high level of visual fidelity and use sophisticated haptic devices that simulate the 'touch' and 'feel' of a procedure or examination are now being used in selected medical centers. The presence of these tools is not enough. Evidence-based outcomes must show these systems to be effective instruments for teaching and assessment, and medical educators must be willing to effect change in medical education to ensure the appropriate use of these systems in the next millennium.

Journal Article↗

PubMed2005

Hematologic response to four weeks of intermittent hypobaric hypoxia in highly trained athletes.

We investigated changes induced by four weeks of intermittent hypobaric hypoxia (IHH) at a simulated altitude of 4000-5500 m in highly trained athletes. Serum erythropoietin increased significantly (p<0.001) after the sessions of IHH, but reticulocyte and red cell parameters did not. Our IHH protocol stimulated endogenous erythropoietin secretion without producing the subsequent erythropoietic response.

Acclimatization↗

PubMed1994

Effect of carbohydrate ingestion on performance of non-fasted cyclists during a simulated 80-mile time trial.

The purpose of this study was to determine the effect of carbohydrate supplementation on finishing time of a realistically simulated 80 mile bicycle time trial. Fourteen trained cyclists pedalled at self-selected pace on their own bicycles on windload simulators. Two trials were performed one week apart. Each trial was preceded by two days of prescribed diet, with a final feeding 3-4 h prior to exercise. Following each 10 mile segment, subjects ingested either a non-caloric placebo (PL) or the carbohydrate maltodextrin supplement (MD; 5% maltodextrin +2% fructose) at dosage of 0.25 g.kg-1 body weight (mean intake rate, total: 37 g.h-1, 148 g) in a double blind, counter-balanced design. Mean (+/- SEM) finishing times were faster by 5% with MD (241.0 +/- 2.1 minutes versus 253.2 +/- 2.1 minutes), p < 0.05. With MD, serum glucose levels rose sharply after 40 miles and were significantly higher than PL (p < 0.05). Final glucose values were 6.0 +/- 0.2 mmol.l-1 and 4.1 +/- 0.2 mmol.l-1 for MD and PL, respectively. With MD, free fatty acid levels were significantly lower (p < 0.05), and riders sustained higher average intensity over the entire distance. At the finish, intensities were 64.7 +/- 1.9% VO2max and 55.3 +/- 1.9% VO2max for GP and PL, respectively. Mean carbohydrate oxidation was significantly higher (p < 0.05) for MD, 2.01 +/- 0.2 g.min-1 and 1.64 +/- 0.2 g.min-1 for MD and PL, respectively. These data show that ingestion of MD, during ultraendurance exercise, in comparison to PL, decreases the time to finish a self-paced bicycle time trial.

Adult↗

PubMed1997

Training for minor surgery in general practice: is it adequate?

To assess training and operative practice in minor surgery a postal questionnaire was sent to all general practitioners practising in the Scottish Highlands and Western Isles in 1992. Information was requested regarding the type and adequacy of surgical training, operations performed, the desire for surgical skills training and possible methods of assessment. Seventy per cent (144/205) of general practitioners (GPs) replied to the questionnaire. Teaching in minor surgery had been received by 74% of GPs (107/144), yet 43% (62) considered their training inadequate. Although confident to suture simple wounds or excise skin lesions from the trunk, significantly fewer were confident to excise such lesions from the face (P < 0.001, 1 df, Chi square test). From 86% of GPs (124/144) who wished to attend a training course on minor surgery, 62% (77) would prefer to be taught on patients and 36% (45) on a realistic skin simulator. Assessment of technical competence by a hospital consultant was considered desirable by 56% (80/144) either on patients 40% (57), or using a skin simulator 38% (54). While most GPs receive some training in minor surgery, there is a perceived need for improved training. The use of a skin simulator may allow both the teaching and assessment of surgical competence for GPs who undertake minor surgery.

Adult↗

PubMed1997

Optimal, unsupervised learning in invariant object recognition.

A means for establishing transformation-invariant representations of objects is proposed and analyzed, in which different views are associated on the basis of the temporal order of the presentation of these views, as well as their spatial similarity. Assuming knowledge of the distribution of presentation times, an optimal linear learning rule is derived. Simulations of a competitive network trained on a character recognition task are then used t highlight the success of this learning rule in relation to simple Hebbian learning and to show that the theory can give accurate quantitative predictions for the optimal parameters for such networks.

Animals↗

PubMed2002

Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer system.

BACKGROUND: We hypothesized that the Minimally Invasive Surgery Trainer (MIST-VR; VP Medical R, London, U.K.) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills. MATERIALS AND METHODS: Each student made six attempts to tie a knot laparoscopically. Students were then randomized to train on the MIST-VR for five sessions (six skills/session) or the Yale Skills for five sessions (three skills/session) over 5 days. On completion of training, all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot. RESULTS: The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group (30 +/- 21%) (from 443 +/- 135 to 311 +/- 137 seconds) and the MIST-VR group (39 +/- 21%) (from 409 +/- 109 to 256 +/- 140 seconds) (P = 0.308). CONCLUSIONS: The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing.

Adult↗

PubMed2002

Factorial hidden Markov models and the generalized backfitting algorithm.

Previous researchers developed new learning architectures for sequential data by extending conventional hidden Markov models through the use of distributed state representations. Although exact inference and parameter estimation in these architectures is computationally intractable, Ghahramani and Jordan (1997) showed that approximate inference and parameter estimation in one such architecture, factorial hidden Markov models (FHMMs), is feasible in certain circumstances. However, the learning algorithm proposed by these investigators, based on variational techniques, is difficult to understand and implement and is limited to the study of real-valued data sets. This chapter proposes an alternative method for approximate inference and parameter estimation in FHMMs based on the perspective that FHMMs are a generalization of a well-known class of statistical models known as generalized additive models (GAMs; Hastie & Tibshirani, 1990). Using existing statistical techniques for GAMs as a guide, we have developed the generalized backfitting algorithm. This algorithm computes customized error signals for each hidden Markov chain of an FHMM and then trains each chain one at a time using conventional techniques from the hidden Markov models literature. Relative to previous perspectives on FHMMs, we believe that the viewpoint taken here has a number of advantages. First, it places FHMMs on firm statistical foundations by relating them to a class of models that are well studied in the statistics community, yet it generalizes this class of models in an interesting way. Second, it leads to an understanding of how FHMMs can be applied to many different types of time-series data, including Bernoulli and multinomial data, not just data that are real valued. Finally, it leads to an effective learning procedure for FHMMs that is easier to understand and easier to implement than existing learning procedures. Simulation results suggest that FHMMs trained with the generalized backfitting algorithm are a practical and powerful tool for analyzing sequential data.

Algorithms↗

PubMed2000

Knowledge of cardiopulmonary resuscitation protocols and level of anaesthetic training.

Inadequate recall of resuscitation protocols has contributed to poor performance of resuscitation in simulation studies. We asked, does the level of anaesthesia training affect knowledge of cardiopulmonary resuscitation protocols? We used a questionnaire that covered the areas of basic life support, advanced adult life support and paediatric life support. The proportions of correct answers were hospital medical officers 50%, junior registrars 62%, senior registrars 84% and consultants 42%. The consultant group performed worse than all other groups for the basic life support and advanced life support questions. We suggest yearly resuscitation training for all anaesthetists and anaesthesia trainees.

Anesthesiology↗

PubMed2004

Bayesian estimation of stimulus responses in Poisson spike trains.

A Bayesian method is developed for estimating neural responses to stimuli, using likelihood functions incorporating the assumption that spike trains follow either pure Poisson statistics or Poisson statistics with a refractory period. The Bayesian and standard estimates of the mean and variance of responses are similar and asymptotically converge as the size of the data sample increases. However, the Bayesian estimate of the variance of the variance is much lower. This allows the Bayesian method to provide more precise interval estimates of responses. Sensitivity of the Bayesian method to the Poisson assumption was tested by conducting simulations perturbing the Poisson spike trains with noise. This did not affect Bayesian estimates of mean and variance to a significant degree, indicating that the Bayesian method is robust. The Bayesian estimates were less affected by the presence of noise than estimates provided by the standard method.

Action Potentials↗

PubMed2004

Acceleration with exercise during head-down bed rest preserves upright exercise responses.

INTRODUCTION: This study was designed to elucidate the effect of short-arm centrifuge-induced artificial gravity with exercise training during ground-based simulated spaceflight, i.e., prolonged head-down bed rest (HDBR), on respiratory and cardiovascular responses to upright exercise. METHODS: There were 10 healthy men who underwent 20 d of -6 degrees HDBR, and were assigned to either a countermeasure (CM) group (n = 5) or a no countermeasure (No-CM) group (n = 5). The subjects in the CM group performed two sessions (20 min each session, 40 min total) of short-arm centrifuge-induced artificial gravity with exercise training in a supine position on alternate days (10 d total) during HDBR. The first session was set at 0.8-1.4 G load at heart level with a constant exercise intensity (60 W), and the second session began with a 0.3 G load at heart level with an interval exercise protocol (40-80% peak oxygen uptake; VO2peak). The measurements of respiratory and cardiovascular responses to incremental exercise were performed pre- and post-HDBR. RESULTS: The 20 d of HDBR increased minute expired ventilation, heart rate, and respiratory exchange ratio and decreased stroke volume during submaximal exercise in the No-CM group, whereas these parameters were unchanged in the CM group. In the No-CM group, VO2peak decreased significantly (47.0 +/- 8.6 to 34.8 +/- 6.8 ml x kg(-1) x min(-1), p < 0.05), whereas VO2peak in the CM group did not show a significant decrease following 20 d of HDBR (47.7 +/- 10.0 to 43.9 +/- 8.9 ml x kg(-1) x min(-1)). These results suggest that short-arm centrifuge-induced artificial gravity with exercise training is effective in maintaining respiratory and cardiovascular responses to upright exercise.

Adolescent↗

PubMed2005

Advances in colonic imaging: technical improvements in colonoscopy.

Colonoscopy has been available since the early 1970s and has become critical to the diagnosis and management of colorectal disorders. Features of the modern colonoscope and its variants are discussed, including the role of paediatric and variable stiffness colonoscopes for difficult insertion. The place of magnetic endoscope imaging systems and simulators in routine colonoscopy and training are examined. Finally, several recent innovations are used to illustrate how colonoscopy may evolve in the future, including new takes on the current instrument as well as potentially revolutionary pain-free, technically-easy, robotic devices for examination of the bowel.

Child↗