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PubMed1996

[Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"].

INTRODUCTION: Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. MATERIAL AND METHODS: Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. RESULTS: The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection of illustrations and text allows for quick access to learning content. The program is designed in such a way that working with and through it is done in a manner conducive to learning. Student response to the learning program as an accompaniment to instruction has been positive. CONCLUSION: Independent, supplemental student learning by means of an interactive learning program has raised the quality of study within the sciences. The use of a pedagogically sound multimedia program, that is oriented toward problem solving and based on actual cases offers students the opportunity to actively work ophthalmological material. An additional benefit is the development of competence in working with computer-support information systems, something that is playing an ever-increasing role within the medical profession.

Computer-Assisted Instruction↗

PubMed1997

Characterization of air quality problems in five Finnish indoor ice arenas.

The air quality in five Finnish ice arenas with different volumes, ventilation systems, and resurfacer power sources (propane, gasoline, electric) was monitored during a usual training evening and a standardized, simulated ice hockey game. The measurements included continuous recording of carbon monoxide (CO), nitric oxide (NO), and nitrogen dioxide (NO2) concentrations, and sampling and analysis of volatile organic compounds (VOCs). Emissions from the ice resurfacers with combustion engines caused indoor air quality problems in all ice arenas. The highest 1-hour average CO and NO2 concentrations ranged from 20 to 33 mg/m3 (17 to 29 ppm) and 270 to 7440 micrograms/m3 (0.14 to 3.96 ppm), respectively. The 3-hour total VOC concentrations ranged from 150 to 1200 micrograms/m3. The highest CO and VOC levels were measured in the arena in which a gasoline-fueled resurfacer was used. The highest NO2 levels were measured in small ice arenas with propane-fueled ice resurfacers and insufficient ventilation. In these arenas, the indoor NO2 levels were about 100 times the levels measured in ambient outdoor air, and the highest 1-hour concentrations were about 20 times the national and World Health Organization (WHO) health-based air quality guidelines. The air quality was fully acceptable only in the arena with an electric resurfacer. The present study showed that the air quality problems of indoor ice arenas may vary with the fuel type of resurfacer and the volume and ventilation of arena building. It also confirmed that there are severe air quality problems in Finnish ice arenas similar to those previously described in North America.

Air Pollution, Indoor↗

PubMed1998

Multifocal rod electroretinograms.

PURPOSE: To assess the feasibility of obtaining reliable multifocal rod electroretinograms (ERGS) and to compare them to full-field ERGs. METHODS: Multifocal rod ERGs were recorded using a stimulus array of 61 hexagons. The minimum number of dark, blank frames between flashes was varied from 0 (a minimum of 13.3 msec between flashes) to 21 (a minimum of 293 msec between flashes). Full-field ERGs were obtained using trains of flashes designed to simulate the multifocal sequences. Flashes were blue (W47B), except in a few cases in which red (W26) was used to check for cone intrusion. Flash intensities varied from -1 to 1.7 log scot td-s. RESULTS: Dark-adapted, multifocal ERGs to blue flashes had a small, early component followed by a larger, late component. The early component showed little change in amplitude with increasing intensity. Comparisons with the full-field ERGs indicated that the early component was the focal response. The larger, late component was the response to stray light, and it can be suppressed with the addition of a surround. The focal response was from a relatively circumscribed retinal region. This is shown by comparing the multifocal rod responses from a patient with retinitis pigmentosa to her behaviorally measured rod visual field. CONCLUSIONS: By choosing conditions (namely, flashes of moderate intensity with a surround) to minimize the effects of stray light, multifocal rod ERGs can be recorded with sufficient localization to be clinically useful. However, the signal-to-noise ratio of these multifocal rod ERGs was poorer than for multifocal cone responses for comparable recording periods because of the need for blank frames and the slower recovery of the rods to successive presentations.

Adult↗

PubMed2006

Simulating deformations of MR brain images for validation of atlas-based segmentation and registration algorithms.

Simulated deformations and images can act as the gold standard for evaluating various template-based image segmentation and registration algorithms. Traditional deformable simulation methods, such as the use of analytic deformation fields or the displacement of landmarks followed by some form of interpolation, are often unable to construct rich (complex) and/or realistic deformations of anatomical organs. This paper presents new methods aiming to automatically simulate realistic inter- and intra-individual deformations. The paper first describes a statistical approach to capturing inter-individual variability of high-deformation fields from a number of examples (training samples). In this approach, Wavelet-Packet Transform (WPT) of the training deformations and their Jacobians, in conjunction with a Markov random field (MRF) spatial regularization, are used to capture both coarse and fine characteristics of the training deformations in a statistical fashion. Simulated deformations can then be constructed by randomly sampling the resultant statistical distribution in an unconstrained or a landmark-constrained fashion. The paper also describes a model for generating tissue atrophy or growth in order to simulate intra-individual brain deformations. Several sets of simulated deformation fields and respective images are generated, which can be used in the future for systematic and extensive validation studies of automated atlas-based segmentation and deformable registration methods. The code and simulated data are available through our Web site.

Algorithms↗

PubMed1999

Simulation and virtual reality in surgical education: real or unreal?

Rapid change is under way on several fronts in medicine and surgery. Advances in computing power have enabled continued growth in virtual reality, visualization, and simulation technologies. The ideal learning opportunities afforded by simulated and virtual environments have prompted their exploration as learning modalities for surgical education and training. Ongoing improvements in this technology suggest an important future role for virtual reality and simulation in surgical education and training.

Computer Simulation↗

PubMed1985

Thermoregulation during prolonged actual and laboratory-simulated bicycling.

Thermoregulatory and cardiorespiratory responses to bicycling 55 km (mean speed 9.7 m X s-1) outdoors (15 degrees C DB) were compared to equivalent cycle ergometry (90 min at 65% VO2max) in the laboratory (20-23 degrees C DB, 50% RH) in 7 trained cyclists. Outdoor environmental conditions were simulated with fans and lamps, and were contrasted with standard no-wind, no-sun laboratory conditions. Sweating rate was similar during outdoor and laboratory simulated outdoor cycling (0.90 and 0.87 to 0.94 1 X h-1 respectively). During outdoor bicycling, mean heart rate (161 bt X min-1) was 7-13% higher (p less than .05) than under laboratory conditions, suggesting a greater strain for a similar external work rate. The increase in rectal temperature (0.8 degrees C) was 33-50% less (p less than 0.05) at the cooler outdoor ambient temperature than in the laboratory. Thermoregulatory stress was greater under the no-fan, no-lamp laboratory condition than during simulated outdoor conditions (36-38% greater (p less than 0.05) sweating rate, 15-18% greater (p less than 0.01) mean skin temperature, 6.4 to 7.8 fold greater (p less than 0.01) amount of clothing-retrained sweat). The cooling wind encountered in actual road bicycling apparently reduces thermoregulatory and circulatory demands compared with stationary cycle ergometry indoors. Failure to account for this enhanced cooling may result in overestimation of the physiological stress of actual road cycling.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

The impact of error training and individual differences on training outcomes: an attribute-treatment interaction perspective.

The authors examined the effectiveness of error training for trainees with different levels of cognitive ability, openness to experience, or conscientiousness. Participants (N = 181) were randomly assigned to control, error-encouragement, or error-avoidance conditions and trained to perform a decision-making simulation. Declarative knowledge, task performance, and self-efficacy were measured posttraining. Findings suggest the effectiveness of error training is dependent on the cognitive ability or dispositional traits of trainees. High cognitive ability or more open individuals benefit more from error-encouragement training than low cognitive ability or less open individuals. Conscientiousness has a negative effect on self-efficacy when trainees are encouraged to make errors.

Adult↗

PubMed1988

Age, alcohol, and simulated altitude: effects on performance and breathalyzer scores.

Trained men in two age groups, 30-39 (n = 12) and 60-69 (n = 13), each performed at the Multiple Task Performance Battery in four separate full-day sessions with and without alcohol (2.2 ml of 100-proof vodka per kilogram of body weight) at ground level and at a simulated altitude of 12,500 ft (3,810 m). Subjects breathed appropriate gas mixtures through oxygen masks at both ground level and altitude. Mean breathalyzer readings peaked near 88 mg% and did not differ between age groups or altitude conditions. Younger subjects performed better than older subjects; performance of both age groups was significantly impaired by alcohol but these adverse effects were greater for the older subjects. No significant effects on performance were obtained due to altitude or to the interaction of altitude with alcohol. These results and those from several other studies suggest that prevalent views regarding the nature of the combined effects of alcohol and altitude on blood alcohol levels and on performance need to be redefined.

Adult↗

PubMedDate not supplied

Artificial neural networks can distinguish novice and expert strategies during complex problem solving.

OBJECTIVE: To determine whether expert problem-solving strategies can be identified within a large number of student performances of complex medical diagnostic simulations. METHODS: Self-organizing artificial neural networks were trained to categorize the performances of infectious disease subspecialists on six computer-based clinical diagnostic simulation that used the sequence of diagnostic tests requested as the input data. Six hundred seventy-six student solutions to these problems were presented to these trained neural networks to determine which, if any, of the student solutions represented those of the experts. RESULTS: For each simulation, the expert performances clustered around one dominant output neurode, indicating that there were common problem-specific features associated with the experts' problem-solving performances. When the performances of students who also made correct problem diagnoses were tested on these expert-trained neural networks, 17% were classified as representing expert strategies, indicating that expert performance was a somewhat rare and inconsistent occurrence among the students. CONCLUSIONS: The ability to identify a small number of expert-like strategies within a large body of student performances may provide an opportunity to study the dynamics of complex learning at both individual and population levels as well as the emergence of medical diagnostic expertise.

Diagnostic Tests, Routine↗

PubMed1993

A simple network model simulates hippocampal place fields: parametric analyses and physiological predictions.

Hippocampal place cells may be the computational units of a neuronal cognitive mapping system. A network model trained to compute locations from distal cues simulated the defining properties of hippocampal place cells (i.e., place-specific activation). The model produced units with detailed properties of place cells, including multiple subfields, "silent" and "noisy" cells, fields that persisted after cue removal, and groups of simulated fields that overlapped in multiple clusters. Quantitative variants of the model showed that different properties of the fields were influenced by the complexity of the visual input (the number of spatial cues), the available computational resources (the number of hidden units), and the output encoding used to represent location. The simulations provide a framework for testing relationships between place field properties, variations in spatial environments, and the integrity of the hippocampal system.

Animals↗

PubMed2004

LUCY: a 3-D pelvic model for surgical simulation.

Development of 3-D models of human anatomy for use in virtual reality simulators is anticipated to enhance surgical training. These models may be a valuable resource for gaining mastery of minimal-access procedures. The pelvis portion (hip to upper-thigh) of a 32-year-old female cadaver was frozen and sectioned axially in approximately 2-mm increments as the first step in producing an accurately representative 3-D model of the human female pelvis. Photographic exposures of the entire series of 95 sections were then converted to digital format. Adobe PhotoShop masks for each structure were created and converted into wire-frame and surface-textured models; this aggregate model set was named "LUCY." To date, 3-D representations of 40 pelvic structures (over 2200 individual masks) have been modeled In conjunction with haptic technology, these virtual anatomic models will enable users to practice fundamental surgical manipulations and procedures such as tubal ligation and ovariectomy. The deployment of surgical-simulation models such as LUCY may facilitate technical-performance aspects of surgical training, particularly those associated with minimal-access procedures. Manipulations and procedures can be practiced over the Internet, providing a host of flexible options to enhance the surgical curricula.

Adult↗

PubMed1988

Teaching clinical skills to medical students: the use of simulated patients and videotaping in general practice.

This paper describes the use of simulated patients in a problem-based teaching programme designed to develop the clinical skills of medical students during a 5-week course in general practice in the University of Leicester. The logistics of training and the advantages of using simulated patients are discussed. Simulated patients are practicable and acceptable in a United Kingdom medical school, and the reaction of students to their use is favourable.

Clinical Competence↗

PubMed1991

Iliad training enhances medical students' diagnostic skills.

Iliad is a computerized, expert system for internal medical diagnosis. The system is designed to teach diagnostic skills by means of simulated patient case presentations. We report the results of a controlled trial in which junior students were randomly assigned to received Iliad training on one of two different simulated case mixes. Each group was subsequently tested in both their "trained" and "untrained" case domain. The testing consisted of computerized, simulated patient cases for which no training feedback was provided. Outcome variables were designed to measure the students' performance on these test cases. The results indicate that students made fewer diagnostic errors and more conclusively confirmed their diagnostic hypotheses when they were tested in their trained domain. We conclude that expert systems such as Iliad can effectively teach diagnostic skills by supplementing trainees' actual case experience with computerized simulations.

Clinical Clerkship↗

PubMed1995

The acquisition of the English past tense in children and multilayered connectionist networks.

The apparent very close similarity between the learning of the past tense by Adam and the Plunkett and Marchman model is exaggerated by several misleading comparisons--including arbitrary, unexplained changes in how graphs were plotted. The model's development differs from Adam's in three important ways: Children show a U-shaped sequence of development which does not depend on abrupt changes in input; U-shaped development in the simulation occurs only after an abrupt change in training regimen. Children overregularize vowel-change verbs more than no-change verbs; the simulation overregularizes vowel-change verbs less often than no-change verbs. Children, including Adam, overregularize more than they irregularize; the simulation overregularized less than it irregularized. Interestingly, the RM model--widely criticized as being inadequate--does somewhat better, correctly overregularizing vowel-change verbs more often than no-change verbs, and overregularizing more often than it irregularizes. Although Plunkett and Marchman's (1993) state of the art model incorporated hidden layers and back-propagation, used a more realistic phonological coding scheme, and explored a broader range of parameters than Rumelhart and McClelland's model, their results are farther from psychological reality. It is unknown whether any connectionist model can mimic a child's performance without resorting to unrealistic exogenous changes in the training or input, but it is clear that adding a hidden-layer and back-propagation does not ensure a solution.

Child Language↗

PubMed2006

Human adaptation to interaction forces in visuo-motor coordination.

We tested whether humans can learn to sense and compensate for interaction forces in contact tasks. Many tasks, such as use of hand tools, involve significant interaction forces between hand and environment. One control strategy would be to use high hand impedance to reduce sensitivity to these forces. But an alternative would be to learn feedback compensation for the extrinsic dynamics and associated interaction forces, with the potential for lower control effort. We observed subjects as they learned control of a ball-and-beam system, a visuo-motor task where the goal was to quickly position a ball rolling atop a rotating beam, through manual rotation of the beam alone. We devised a ball-and-beam apparatus that could be operated in a real mode, where a physical ball was present; or in a virtual training mode, where the ball's dynamics were simulated in real time. The apparatus presented the same visual feedback in all cases, and optionally produced haptic feedback of the interaction forces associated with the ball's motion. Two healthy adult subject groups, vision-only and vision-haptics (each n= 10), both trained for 80 trials on the simulated system, and then were evaluated on the real system to test for skill transfer effects. If humans incorporate interaction forces in their learning, the vision-haptics group would be expected to exhibit a smoother transfer, as quantified by changes in completion time of a ball-positioning task. During training, both groups adapted well to the task, with reductions of 64%-70% in completion time. At skill transfer to the real system, the vision-only group had a significant 35% increase in completion time (p < 0.05). There was no significant change in the vision-haptics group, indicating that subjects had learned to compensate for interaction forces. These forces could potentially be incorporated in virtual environments to assist with motor training or rehabilitation.

Adaptation, Physiological↗

PubMed1999

The ability of trained nurses to detect lumps in a test set of silicone breast models.

BACKGROUND: Screening for breast carcinoma is a Healthy People 2000 objective and physical examination is an important component of the screening process. However, many women do not have access to a high quality breast examination. To help address this problem for Native American women, the authors developed the Nurses Providing Annual Cancer Screening (NPACS) training program, a week-long training session conducted at the nurses' clinical site. The goal of the current study was to demonstrate that, after receiving training, the nurses can detect masses in breast models at acceptably high rates. METHODS: Thirty-four nurses who had completed the NPACS training program performed examinations of a test set of six silicone breast models. True-positive and false-positive rates of lump detection were calculated. RESULTS: The nurses were able to detect more lumps in the simulated breasts than both untrained and trained physicians tested in previous trials using the same methodology. On the average, nurses found 76% of the 18 lumps in the 6 breast models. However, their rate of false-positive detections also was somewhat higher. Although the modal number of false-positive detections for both physicians and nurses was 0, the median number of false-positive detections was 0 for the physicians and 1.0 for the nurses. CONCLUSIONS: In the current study, trained nurses were able to detect masses in breast models at high rates. This observation suggests that widespread training of nurses to perform screening breast examinations might be considered as a response to the breast carcinoma screening needs of adult women.

Breast Neoplasms↗

PubMed1993

Automated external defibrillator training and skills maintenance in Air Force emergency medical services systems.

In April 1989, we initiated a test program to evaluate the use of semi-automated external defibrillators in five United States Air Force Medical Treatment Facilities. The objectives of the study were 2-fold. First, the feasibility of conducting a uniform training program in a number of geographically separated basic life support emergency medical services (EMS) systems was assessed. The second objective was evaluation of psychomotor skills maintenance by Air Force Emergency Department emergency medical technicians (EMTs) in simulated resuscitations 6 months after initial training. Performance was evaluated in each of six areas for the 48 EMTs completing retesting. Forty-three of the 48 EMTs were assessed to have properly completed the resuscitations. Three of the remaining five failed to clear prior to defibrillating, and in two cases the delivery of three defibrillatory shocks was delayed for 6-8 minutes from the time of arrival at the patient's side. These results demonstrate the feasibility of providing training and maintaining proficiency in military EMS systems.

Aerospace Medicine↗

PubMed2001

Ski jumping boots limit effective take-off in ski jumping.

In this study, we measured the vertical and horizontal take-off forces, plantar pressures and activation patterns of four muscles (vastus lateralis, gluteus maximus, tibialis anterior, gastrocnemius) in 10 ski jumpers in simulated laboratory conditions when wearing either training shoes or ski jumping boots. We found significant differences in vertical (P < 0.001), horizontal (P < 0.05) and resultant (P < 0.001) take-off velocities and vertical force impulse (P < 0.01). We found no significant differences in the jumpers' initial take-off positions; however, the jumping boots condition resulted in a smaller displacement in the final position of the following joint angles: ankle angle (P < 0.001), knee angle (P < 0.001), hip angle (P < 0.01) and shank angle relative to the horizontal (P < 0.01). This corresponds with less electromyographic activity during take-off in both the gastrocnemius (300 to 200 ms and 200 to 100 ms before take-off) and gluteus maximus (300 to 200 ms and 100 to 0 ms before take-off). During the early take-off in the jumping boots condition, significantly more pressure was recorded under the heel (P < 0.001), whereas the forefoot was more highly loaded at the end of the take-off. Differences in take-off velocity (representing the final output of the take-off) can be accounted for in the main by the different use of plantar flexion, emphasizing the role of the knee and hip extensors when wearing jumping boots. We conclude that the stiffness of the structure of the jumping boots may result in a forward shift of pressure, thus limiting the effective vertical force. To avoid this pressure shift, the pattern of movement of simulated take-offs should be carefully controlled, particularly when wearing training shoes.

Adult↗