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PubMed1998

Cell-based model of the Limulus lateral eye.

We present a cell-based model of the Limulus lateral eye that computes the eye's input to the brain in response to any specified scene. Based on the results of extensive physiological studies, the model simulates the optical sampling of visual space by the array of retinal receptors (ommatidia), the transduction of light into receptor potentials, the integration of excitatory and inhibitory signals into generator potentials, and the conversion of generator potentials into trains of optic nerve impulses. By simulating these processes at the cellular level, model ommatidia can reproduce response variability resulting from noise inherent in the stimulus and the eye itself, and they can adapt to changes in light intensity over a wide operating range. Programmed with these realistic properties, the model eye computes the simultaneous activity of its ensemble of optic nerve fibers, allowing us to explore the retinal code that mediates the visually guided behavior of the animal in its natural habitat. We assess the accuracy of model predictions by comparing the response recorded from a single optic nerve fiber to that computed by the model for the corresponding receptor. Correlation coefficients between recorded and computed responses were typically >95% under laboratory conditions. Parametric analyses of the model together with optic nerve recordings show that animal-to-animal variation in the optical and neural properties of the eye do not alter significantly its response to objects having the size and speed of horseshoe crabs. The eye appears robustly designed for encoding behaviorally important visual stimuli. Simulations with the cell-based model provide insights about the design of the Limulus eye and its encoding of the animal's visual world.

Animals↗
PubMed2005

[IMOLA -- a new larynx model for surgical training. Education in transoral laser microsurgery of the upper airways].

BACKGROUND: Education in laser microsurgery is generally acquired under the supervision of an experienced surgeon. During training phases, however, increased complication rates may occur. Viable models for training are therefore important. METHODS: Larynx models should be anatomically accurate in size, form and texture, and be able to simulate normal as well as pathological findings. RESULTS: The main component is gelatin. Elasticity and thermal qualities can be modified by additives. We have been able to develop a synthetic larynx model for CO(2)-laser surgery that closely resembles the physical and tactile qualities of human tissue. Further modification of the material produced cutting characteristics for CO(2)-laser similar to human tissue. CONCLUSION: The new larynx model allows the simulation of typical surgical situations. Surgeons in training can practice even difficult surgical procedures at low costs and without putting patients at risk, before carrying out the procedure on patients.

Biomimetics↗
PubMed2002

Using simulated consultations to develop communications skills for neurology trainees.

Communication skills are essential for clinical medicine yet, unlike in general practice, trainees in specialist and general medicine are not formally trained in them. We have used videotaped recording of simulated consultations to evaluate their acceptability and usefulness for training neurology specialist registrars. Twelve specialist registrars in neurology participated; their perceptions of the method were assessed using quantified scales and focus groups. All but one of the 12 trainees found the exercise useful both for improving clinical skills and for the imparting of information. The median visual analogue scores (0=useless, 100=very useful) for history taking and for imparting information were 91 and 90%, respectively. The median scores [and interquartile range (IQR)] of perceived usefulness for communication skills increased before to after (for use of video) from 68 (58-78) to 88 (80-92)% (P < 0.02), and (for use of simulated patients) from 51 (40-71) to 86 (79-89)% (P < 0.02). The focus groups provided additional qualitative data supporting the technique. We conclude that videotaped consultations with simulated patients are valued by most neurology trainees, both for improving their history-taking skills and for imparting information. The technique could be used more widely in neurology training, and may have a role in assessment.

Adult↗
PubMed2006

Communication skills in psychiatry residents-- how do they handle patient concerns? An application of sequence analysis to interviews with simulated patients.

BACKGROUND: The main focus of the training of psychiatrists is on diagnosis and treatment based on the traditional doctor-centered approach to the psychiatric interview. Less attention is given to the correct handling of patients' emotional concerns, which is crucial for the patient-physician relationship, but also for improving diagnostic and treatment decisions. The aim of this study is to assess psychiatrists' responses to patients' concerns and worries. METHOD: 118 consultations, conducted by 10 residents in psychiatry with 20 simulated patients, have been coded using the Verona Psychiatric Interview Classification System. Lag1 sequential analysis and a multinomial logit regression analysis were performed to investigate the relationship between patients' expressions of concern and psychiatrists' subsequent interventions in terms of patient-centered skills. RESULTS: Compared to doctor-centered interventions, all patients' expressions of concern increased the probability of passive listening (odds ratios between 2.4 and 4.2). They also increased the occurrence of emotion focusing interventions (odds ratios between 3.3 and 1.7), which however remained rare (4% of residents' total responses). A small although significant increase in the likelihood of active listening expressions was observed as a response to two types of patient expressions of concern: statements of feelings (odds ratio 1.4) and expression of opinions regarding problematic psychosocial issues (odds ratio of 1.7). CONCLUSIONS: Young psychiatrists are good passive listeners but need to improve active listening skills which, together with emotion focusing skills, should be a major learning target in psychiatry. These patient-centered interviewing skills should integrate those traditionally used for attributing ICD-10 and/or DSM-IV categories.

Adult↗
PubMed2006

Oculomotor rehabilitation for reading in acquired brain injury.

The purpose of this study was to assess reading-related oculomotor rehabilitation in individuals with acquired brain injury. Adults with either stroke (n=5) or traumatic brain injury (n=9) participated. Training paradigms included single-line and multiple-line simulated reading, as well as basic versional tracking (fixation, saccade, and pursuit), twice per week over an 8 week period. Training modes included normal internal oculomotor visual feedback either in isolation (4 weeks) or concurrent with external oculomotor auditory feedback (4 weeks). Training effects were assessed objectively using infrared eye movement recording technology for simulated and actual reading, with the assessments occurring before, midway, and after training. In addition, the individuals were assessed subjectively using a reading rating-scale questionnaire. All reported considerably improved reading ability, and this was confirmed by several of the objective oculomotor measures. There was a trend for improvement to be better with the combined visual and auditory oculomotor feedback. Reading-related oculomotor rehabilitation produced significant gains in both the subjective and objective domains. It is believed that rapid saccadic oculomotor adaptation, as well as the training of rhythmicity and automaticity, were involved in modifying eye movement behavior to produce a more systematic approach and resultant improved reading profile.

Acoustic Stimulation↗
PubMed1997

Oxygen consumption and ventilation during simulated escape from an offshore oil platform.

Twenty-six male workers from the North Sea offshore oil industry took part in a simulated escape exercise at the Offshore Fire Training Centre. The course was 370 m long and had 19.4 m of vertical ascent and descent using the stairs on simulated offshore structures. Inspired ventilation and oxygen consumption were measured using the P. K. Morgan "Oxylog' and subjects breathed through the apparatus by mouthpiece and one-way valve assembly while wearing a nose clip. On comparison with anthropometric data from larger studies, this sample of the offshore work-force was thought to be representative. The mean duration of the exercise period was 371 s (SD = 24 s, range = 325-424 s). Mean oxygen consumption standing still at the start of the trial was 0.421 min-1 (SD = 0.101 min-1, max. = 0.611 min-1) and mean ventilation 12.351 min-1 (SD = 4.251 min-1, max. = 22.271 min-1). During exercise, the mean oxygen consumption rose to 2.711 min-1 (SD = 0.641 min-1, max = 4.051 min-1) and mean ventilation reached 46.341 min-1 (SD = 15.831 min-1, max = 87.361 min-1) during the fifth minute of exercise. At the end of the exercise period, oxygen consumption returned to resting values after 2 min and ventilation after 3 min. There was no indication of an oxygen debt. Oxygen consumption and ventilation were related to body weight and the maximum figures for ventilation and oxygen consumption were seen in individuals of over the 95th centile for weight who completed the exercise more quickly than other subjects. Draft standards for respiratory protective equipment for use during escape from fire do not specify the breathing volumes identified in this study, and which are considerably higher than those being currently considered. Additionally, the atmospheric conditions near a fire are likely to stimulate ventilation to considerably higher levels than those identified here. Accordingly, such equipment is likely to limit physical performance if a similar intensity of exercise is necessary during an escape. The architecture of offshore installations and protocols for escape from them should be structured to minimize exercise, and stair climbing should be avoided if emergency respirators are to be used. Workers should be trained in the use of escape breathing equipment and instruction should include information regarding its limitations and the need to limit exercise to an appropriate level.

Body Weight↗
PubMed1998

[Development of a surgical simulator for interventions of the paranasal sinuses. Technical principles and initial prototype].

BACKGROUND: Traditional training methods for surgeons include anatomical studies on human cadavers. Limited availability and ethical problems led to the consideration of alternatives. The surgeon's level of training could be significantly increased by a interactive training system trough computer graphics and virtual reality (VR). METHODS: Two main issues addressed are the 3-D reconstruction process and 3-D interaction to guide the surgical instruments. To provide the virtual environment, a realistic representation of the region of interest with all relevant anatomical parts is required. This model has to be suitable for computer simulation, while preserving as accurately as possible important anatomic features. Therefore the concept of creating a 3-D representation semi-automatically was developed. Textures derived from endoscopic images are superimposed on the virtual anatomic structures and provide better realism. RESULTS: Intuitive handling of the surgical instruments is ensured by using the tracking technique. The system allows navigation via a virtual camera and interaction with the virtual anatomical structures. Currently the use of a force feedback system and the simulation of deformations of tissues is critical. CONCLUSIONS: The VR based simulation system offers an alternative to conventional training methods. The future role of surgical simulation depends on overcoming the current drawbacks to provide greater interactive realism: the integration of a force feedback system to simulate the resistance of anatomical structures and the simulation of tissue deformations--both currently under development.

Artificial Intelligence↗
PubMed1997

Anaesthetists' attitudes towards an anaesthesia simulator. A comparative survey: U.S.A. and Australia.

Anaesthesia simulation has been suggested as a method to enhance the training of clinicians without exposing patient to risk. Recently, two anaesthesia simulators have become commercially available in the U.S.A. Attitudes towards anaesthesia simulators have not been previously surveyed. With institutional approval, a survey questionnaire was given to 1. all clinical staff of the Department of Anesthesiology, University of Pittsburgh Medical Center, and 2. all anaesthetists attending the Annual General Meeting of the Australian Society of Anaesthetists. An information sheet containing details about anaesthesia simulation in general and the special capabilities of a particular commercial anaesthesia simulator was included with the survey instrument. The survey was anonymous and contained 15 questions. Attitudinal responses were recorded using an anchored visual analog 100 mm scale. We surveyed anaesthetists during September-October 1993. Completed forms were returned by 183 anaesthetists. Respondents were aged 25-67 years (mean age 41 +/- 10 yr) and were grouped by staff position (78% faculty, 22% trainees), sex (79% male; 21% female), country of practice (44% Aust, 56% U.S.A.) and years in practice. Seventy-three per cent staff were in favour (VAS > 60) of departmental purchase of a simulator (with no significant difference between countries) and 76% expressed willingness (VAS > 60) to undergo testing in their own time (with Australian anaesthetists significantly more willing to do so). However, 65% were not in favour (VAS < 40) of the compulsory use of a simulator for re-certification or re-accreditation of anaesthesia practitioners, with American anaesthetists (anesthesiologists) significantly more opposed to it. The most frequent comment related to the cost. There is majority support for the purchase of an anaesthesia simulator but there is widespread concern for its high cost. In general, anaesthesia simulation is perceived more as an education tool rather than an instrument for (re)certification.

Accreditation↗
PubMed2002

Interactive computer simulations of knee-replacement surgery.

OBJECTIVE: Current surgical training programs in the United States are based on an apprenticeship model. This model is outdated because it does not provide conceptual scaffolding, promote collaborative learning, or offer constructive reinforcement. Our objective was to create a more useful approach by preparing students and residents for operative cases using interactive computer simulations of surgery. Total-knee-replacement surgery (TKR) is an ideal procedure to model on the computer because there is a systematic protocol for the procedure. Also, this protocol is difficult to learn by the apprenticeship model because of the multiple instruments that must be used in a specific order. We designed an interactive computer tutorial to teach medical students and residents how to perform knee-replacement surgery. We also aimed to reinforce the specific protocol of the operative procedure. Our final goal was to provide immediate, constructive feedback. DESCRIPTION: We created a computer tutorial by generating three-dimensional wire-frame models of the surgical instruments. Next, we applied a surface to the wire-frame models using three-dimensional modeling. Finally, the three-dimensional models were animated to simulate the motions of an actual TKR. The tutorial is a step-by-step tutorial that teaches and tests the correct sequence of steps in a TKR. The student or resident must select the correct instruments in the correct order. The learner is encouraged to learn the stepwise surgical protocol through repetitive use of the computer simulation. Constructive feedback is acquired through a grading system, which rates the student's or resident's ability to perform the task in the correct order. The grading system also accounts for the time required to perform the simulated procedure. We evaluated the efficacy of this teaching technique by testing medical students who learned by the computer simulation and those who learned by reading the surgical protocol manual. Both groups then performed TKR on manufactured bone models using real instruments. Their technique was graded with the standard protocol. The students who learned on the computer simulation performed the task in a shorter time and with fewer errors than the control group. They were also more engaged in the learning process. DISCUSSION: Surgical training programs generally lack a consistent approach to preoperative education related to surgical procedures. This interactive computer tutorial has allowed us to make a quantum leap in medical student and resident teaching in our orthopedic department because the students actually participate in the entire process. Our technique provides a linear, sequential method of skill acquisition and direct feedback, which is ideally suited for learning stepwise surgical protocols. Since our initial evaluation has shown the efficacy of this program, we have implemented this teaching tool into our orthopedic curriculum. Our plans for future work with this simulator include modeling procedures involving other anatomic areas of interest, such as the hip and shoulder.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Motion sickness-like syndrome among tank simulator drivers.

A military tank driving simulator has recently been introduced as a training aid for tank drivers in the Israel Defense Forces. Reports of nausea and vomiting among the first users of the simulator launched our investigation of the possible existence of a motion sickness-like syndrome among simulator drivers. Although the 59 subjects drove the simulator without any report of vomiting, other motion sickness-like symptoms were frequently reported. A comparison of symptoms reported after simulator and real tank driving show that dizziness, nausea, disorientation and hypersalivation were more frequently reported by simulator drivers and were of greater intensity. However, sweating and drowsiness were more prevalent among real tank drivers. The objective effect of driving the simulator was evaluated by instability and performance tests that were conducted before, during and after driving the simulator. A greater decrement in test results was observed among subjects reporting higher frequency of motion sickness-like symptoms.

Adult↗
PubMed1996

On the relation between personality and job performance of airline pilots.

The validity of a personality questionnaire for the prediction of job success of airline pilots is compared to validities of a simulator checkflight and of flying experience data. During selection, 274 pilots applying for employment with a European charter airline were examined with a multidimensional personality questionnaire (Temperature Structure Scales; TSS). Additionally, the applicants were graded in a simulator checkflight. On the basis of training records, the pilots were classified as performing at standard or below standard after about 3 years of employment in the hiring company. In a multiple-regression model, this dichotomous criterion for job success can be predicted with 73.8% accuracy through the simulator checkflight and flying experience prior to employment. By adding the personality questionnaire to the regression equation, the number of correct classifications increases to 79.3%. On average, successful pilots score substantially higher on interpersonal scales and lower on emotional scales of the TSS.

Adult↗
PubMed2004

Laparoscopic virtual reality and box trainers: is one superior to the other?

BACKGROUND: Virtual reality (VR) simulators now have the potential to replace traditional methods of laparoscopic training. The aim of this study was to compare the VR simulator with the classical box trainer and determine whether one has advantages over the other. METHODS: Twenty four novices were tested to determine their baseline laparoscopic skills and then randomized into the following three group: LapSim, box trainer, and no training (control). After 3 weekly training sessions lasting 30-min each, all subjects were reassessed. Assessment included motion analysis and error scores. Nonparametric tests were applied, and p < 0.05 was deemed significant. RESULTS: Both trained groups made significant improvements in all parameters measured ( p < 0.05). Compared to the controls, the box trainer group performed significantly better on most of the parameters, whereas the LapSim group performed significantly better on some parameters. There were no significant differences between the LapSim and box trainer groups. CONCLUSIONS: LapSim is effective in teaching skills that are transferable to a real laparoscopic task. However, there appear to be no substantial advantages of one system over the other.

Adult↗
PubMed2005

Cardiovascular, hormone, and lipid responses to stress induced by virtual crane handling.

OBJECTIVES: The aim of the study was to test whether a mixed-mock-up-simulator (MMU-simulator) is suitable for on-the-job training by measuring stress reactions induced by handling a crane in a virtual environment in subjects not experienced in crane operation. MATERIALS AND METHODS: A MMU-simulator in a virtual environment was developed. Twenty three individuals were randomly divided into Group 1 (n = 13) and Group 2 (n = 10). They had the task of transporting a weight over barriers with a virtual crane twice in two 15-min intervals with a 15-min break in between. Acoustical and optical disturbances were generated as an additional strain for Group 1 in the second interval and for Group 2 in the first interval. Heart rate (HR) and blood pressure (BP) were measured consecutively in both groups, blood sampling was performed in Group 1. Plasma concentrations of stress hormones and lipids were analyzed. Data were calculated as the percentage of baseline values. RESULTS: Compared to rest courses, strain led to a significant increase in HR and BP except diastolic BP in Group 2. Apart from an increased systolic BP under additional stress in Group 2, no significant differences were found between the two strain courses. Concentrations of epinephrine showed the highest increase under strain with a mean of 67%. The mean increase in norepinephrine and cortisol was 23% and 7%, respectively, whereas a 4% increase was observed for total cholesterol and high density lipoprotein cholesterol. These differences between "Rest" and "Strain" were significant. After adjusting for total plasma protein concentration, stress hormones, but not lipids, were still significantly higher during strain. CONCLUSIONS: The elevation in lipids during acute stress could be interpreted as an effect of hemoconcentration due to vasoconstriction by catecholamines. The significant increase in cardiovascular parameters and stress hormones during the tasks demonstrate that working in a virtual environment generates mental strain and that the developed MMU-simulator appears to be a promising device for on-the-job training. However, further research is necessary to validate the usefulness of virtual training by means of a comparative study of virtual and real-world training.

Adult↗
PubMed2005

Preflight virtual reality training as a countermeasure for space motion sickness and disorientation.

INTRODUCTION: Research suggests that preflight training in virtual reality devices can simulate certain aspects of microgravity and may prove to be an effective countermeasure for space motion sickness (SMS) and spatial disorientation (SD). It is hypothesized that exposing subjects preflight to variable virtual orientations, similar to those encountered during spaceflight, will reduce the incidence and/or severity of SMS and SD. METHODS: Subjects were assigned to either a variable training (VT) or nonvariable training (NVT) condition to perform a simple navigation and switch activation task in a virtual space station. VT subjects performed the task starting in several different orientations, whereas NVT subjects always performed the task starting in the same orientation. On a separate day, all subjects then performed the same task in a transfer of training session starting from a novel orientation. RESULTS: When exposed to the novel test orientation, VT subjects performed the tasks more quickly (12%) and with fewer nausea symptoms (53%) than during the training session, compared with NVT subjects who performed more slowly (6%) and with more nausea symptoms (28%). Both VT and NVT conditions were effective in reducing the number of wall hits in the novel orientation (39% and 34%, respectively). DISCUSSION: These results demonstrate the effectiveness of using variable training in a virtual environment for reducing nausea and improving task performance in potentially disorienting surroundings, and suggest that such training may be developed into an effective countermeasure for SMS, SD, and associated performance decrements that occur in spaceflight.

Adult↗
PubMed1998

Dynamics of membrane excitability determine interspike interval variability: a link between spike generation mechanisms and cortical spike train statistics.

We propose a biophysical mechanism for the high interspike interval variability observed in cortical spike trains. The key lies in the nonlinear dynamics of cortical spike generation, which are consistent with type I membranes where saddle-node dynamics underlie excitability (Rinzel & Ermentrout, 1989). We present a canonical model for type I membranes, the theta-neuron. The theta-neuron is a phase model whose dynamics reflect salient features of type I membranes. This model generates spike trains with coefficient of variation (CV) above 0.6 when brought to firing by noisy inputs. This happens because the timing of spikes for a type I excitable cell is exquisitely sensitive to the amplitude of the suprathreshold stimulus pulses. A noisy input current, giving random amplitude "kicks" to the cell, evokes highly irregular firing across a wide range of firing rates; an intrinsically oscillating cell gives regular spike trains. We corroborate the results with simulations of the Morris-Lecar (M-L) neural model with random synaptic inputs: type I M-L yields high CVs. When this model is modified to have type II dynamics (periodicity arises via a Hopf bifurcation), however, it gives regular spike trains (CV below 0.3). Our results suggest that the high CV values such as those observed in cortical spike trains are an intrinsic characteristic of type I membranes driven to firing by "random" inputs. In contrast, neural oscillators or neurons exhibiting type II excitability should produce regular spike trains.

Algorithms↗
PubMed1999

Effects of large excitatory and inhibitory inputs on motoneuron discharge rate and probability.

We elicited repetitive discharge in hypoglossal motoneurons recorded in slices of rat brain stem using a combination of a suprathreshold injected current step with superimposed noise to mimic the synaptic drive likely to occur during physiological activation. The effects of repetitive en mass stimulation of afferent nerves were simulated by the further addition of trains of injected current transients of varying shapes and sizes. The effects of a given current transient on motoneuron discharge timing and discharge rate were measured by calculating a peristimulus time histogram (PSTH) and a peristimulus frequencygram (PSF). The amplitude and time course of the simulated postsynaptic potentials (PSPs) produced by the current transients were calculated by convolving the current transient with an estimate of the passive impulse response of the motoneuron. We then compared the shape of the injected current transient and the simulated PSP to the profiles of the PSTH and the PSF records. The PSTHs produced by excitatory PSPs (EPSPs) were characterized by a large, short-latency increase in firing probability that lasted slightly longer than the rising phase of the EPSP, followed by a reduced discharge probability during the falling phase of the EPSP. In contrast, the PSF analysis revealed a proportionate increase in discharge rate over the entire profile of the EPSP, even though relatively few spikes occurred during the falling phase. The PSTHs associated with inhibitory PSPs (IPSPs) indicated a reduction in discharge probability during the initial, hyperpolarizing phase of the IPSP, followed by an increase in the discharge probability during its subsequent repolarizing phase. Using the PSF analysis, the initial phase of the IPSP appeared as a large hole in the record where a very small number or no discharges occurred. The subsequent phase of the IPSP was associated with frequency values that were lower than the background values. The primary features of both PSTHs and PSFs can be used to estimate the relative amplitudes of the underlying EPSPs and IPSPs. However, PSTHs contain secondary peaks and troughs that are not directly related to the underlying PSP but instead reflect the regular recurrence of spikes following those affected by the PSP. The PSF analysis is more useful for indicating the total duration and the profile of the underlying PSP. The shape of the underlying PSP can be obtained directly from the PSF records because the discharge frequency of the spikes follow the PSPs very closely, especially for EPSPs.

Animals↗
PubMed1998

Development and evaluation of a spine biopsy simulator.

A spine biopsy simulator is being developed to 1) train surgeons on the current method for CT-directed needle biopsy and 2) provide a testbed for developing new image-guided and robot-assist methodologies. A task analysis and function allocation assessment provide the needed information for the first stage of the simulator development and evaluation.

Biopsy, Needle↗