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PubMed2003

Responding to a fire emergency in a virtual environment: different patterns of action for different situations.

This paper presents an experimental study of participants' response to the sudden appearance of a fire emergency in a virtual environment (VE) and of the adaptivity of their response pattern. A VE has been built in which participants meet two situations: first an explorative navigation and afterwards a hurried escape from the unexpected outbreak of fire. Fire intensity and participants' distance from the exit at the outbreak of fire have been varied as well, to create different degrees of danger and different degrees of difficulty in the task of leaving the premises. Participants' action has been collected automatically for quantitative analysis by registering each individual activation of the interaction devices (a triple button joystick). In addition, the movements in both virtual and real environment of additional groups of participants have been videorecorded for qualitative analysis. Results show that the appearance of the fire emergency triggers important changes in the way people move in the VE, and that such changes are all adaptive responses to an emergency situation. In conclusion, people show recognition of a dangerous situation in a VE and readily produce adaptive responses, making the VE suitable for emergency simulations and for use as an effective training tool.

Adaptation, Psychological↗

PubMed1993

Effects of a 10-week exercise intervention programme on exercise and work capacities in Belfast's ambulance-men.

The objective of the present study was to investigate the occupational benefits of an exercise intervention programme, including changes in physical working capacity and other physical fitness measures on a group of Belfast ambulancemen. Physical training was performed twice weekly for 10 weeks and consisted primarily of indoor soccer and circuit-training sessions. Both experimental (n = 8) and control subjects (n = 6) were assessed for height (HT), weight (WT), body composition (percentage fat), standing broad jump (SBJ), flexibility (Flex), and sit-up performance (SU). The experimental group was further assessed for blood pressure (BP), hand grip strength (HGS), maximal oxygen consumption (VO2 max), end lactate concentration (EL), anaerobic threshold (AT) and leg strength (LS). Working capacity was also assessed during a staged emergency incident, using a portable telemetric gas analyser. Significant changes in the experimental group were found following training for Flex, SU, SBJ, VO2 max (all P < 0.05), EL and AT (P < 0.01). A significant drop in the metabolic cost of the simulated emergency incident was also noted following training. No significant differences were found for the control group over the experimental period. The present study indicated that a twice-weekly exercise intervention programme was effective in improving the physical fitness of Belfast's ambulancemen. Such a programme could prove cost-effective by increasing work capacity and decreasing absenteeism related to musculoskeletal injury.

Ambulances↗

PubMed1990

Prevention of transmission of infection during mouth-to-mouth resuscitation.

The risk of infection transmitted during mouth-to-mouth or mouth-to-nose resuscitation procedures is difficult to define but is possibly quite low. However, the perceived risk is sufficient to cause serious concern for many individuals, including trained hospital personnel as well as the general public, and may preclude prompt and effective action. A novel airway device was evaluated for the retention of infective droplets and fluid permeability under simulated resuscitation conditions using a cardiopulmonary resuscitation training manikin. Retention of a 0.5-5.0 micron aerosol of Staphylococcus aureus cells was greater than 80% at flow rates of 6 l/min while under simulated resuscitation conditions the trapping of bacteria, originating predominantly from saliva, was over 90%. These data suggest that this device may afford significant protection against transmission of infection during exhaled air resuscitation manoeuvres.

Bacterial Infections↗

PubMed2002

Effects of short-term endurance training on muscle deoxygenation trends using NIRS.

PURPOSE: This study examined changes in cardiorespiratory responses and muscle deoxygenation trends to test the hypothesis that both central and peripheral adaptations would contribute to the improvements in VO(2max) and simulated cycling performance after short-term high-intensity training. METHODS: Eight male cyclists performed an incremental cycle ergometer test to voluntary exhaustion, and a simulated 20-km time trial (20TT) on wind-loaded rollers before and after training (60 min x 5 d x wk(-1) x 3 wk at 85-90% VO(2max). Near-infrared spectroscopy (NIRS) was used to evaluate the trend in vastus medialis hemoglobin/myoglobin deoxygenation (Hb/Mb-O(2) during both tests pre- and post-training. RESULTS: Training induced significant increases (P </= 0.05) in maximal power output (367 +/- 63 to 383 +/- 60 W), VO(2max) (4.39 +/- 0.66 to 4.65 +/- 0.57 L x min(-1)), and maximal O(2) pulse (22.7 +/- 3.2 to 24.6 +/- 2.8 mL O(2) x beat(-1)) during the incremental test, but maximal muscle deoxygenation was unchanged. 20TT performance was significantly faster (27:32 +/- 1:43 to 25:46 +/- 1:44 min:s; P </= 0.05) after training without a significant increase (P > 0.05) in the VO(2) (4.02 +/- 0.52 to 4.04 +/- 0.51), heart rate (176 +/- 9 to 173 +/- 8 beats x min ) or O pulse (22.4 +/- 3.2 to 23.5 +/- 2.8 mL O(2) x beat(-1)). However, mean muscle deoxygenation during the 20TT was significantly lower after training (-550 +/- 292 to -707 +/- 227 mV, P </= 0.05), and maximal deoxygenation showed a trend toward significance (-807 +/- 344 to -1,009 +/- 331 mV, P = 0.08), suggesting a greater release of oxygen from Hb/Mb-O(2) via the Bohr effect. CONCLUSION: The significant improvement in VO(max) induced by short-term endurance training in well-trained cyclists was due primarily to central adaptations, whereas the simulated 20TT performance was enhanced due to localized changes in muscle oxygenation.

Adolescent↗

PubMed2006

Learning opportunities for Australian prevocational hospital doctors: exposure, perceived quality and desired methods of learning.

OBJECTIVE: To survey prevocational doctors working in Australian hospitals on aspects of postgraduate learning. PARTICIPANTS AND SETTING: 470 prevocational doctors in 36 health services in Australia, August 2003 to October 2004. DESIGN: Cross-sectional cohort survey with a mix of ordinal multicategory questions and free text. MAIN OUTCOME MEASURES: Perceived preparedness for aspects of clinical practice; perceptions of the quantity and usefulness of current teaching and learning methods and desired future exposure to learning methods. RESULTS: 64% (299/467) of responding doctors felt generally prepared for their job, 91% (425/469) felt prepared for dealing with patients, and 70% (325/467) for dealing with relatives. A minority felt prepared for medicolegal problems (23%, 106/468), clinical emergencies (31%, 146/469), choosing a career (40%, 188/468), or performing procedures (45%, 213/469). Adequate contact with registrars was reported by 90% (418/465) and adequate contact with consultants by 56% (257/466); 20% (94/467) reported exposure to clinical skills training and 11% (38/356) to high-fidelity simulation. Informal registrar contact was described as useful or very useful by 94% (433/463), and high-fidelity simulation by 83% (179/216). Most prevocational doctors would prefer more formal instruction from their registrars (84%, 383/456) and consultants (81%, 362/447); 84% (265/316) want increased exposure to high-fidelity simulation and 81% (283/350) to professional college tutorials. CONCLUSION: Our findings should assist planning and development of training programs for prevocational doctors in Australian hospitals.

Attitude of Health Personnel↗

PubMed1976

Visual elements in flight simulation.

Flight simulators have been in use for many years and their value has been amply proven. Many of today's simulators are very expensive, but they can pay for themselves by decreasing cost and increasing safety in training pilots to fly complex and expensive modern aircraft. Some aspects of aircraft control depend on an exterior view from the aircraft to the outside visual world. Training in these aspects of flight in a simulator requires simulation of the visual world to the extent that cues derived from it need to be employed by the pilot. A number of maneuvers cannot be performed without direct visual contact under normal circumstances in commercial as well as in military aviation. The importance of including a simulation of the external world is not acknowledged. Unfortunately, there is currently no solid scientific basis for cataloging visual cues with respect to their importance in aircraft control. This report recommends research topics, techniques, and strategies that should receive more attention.

Aerospace Medicine↗

PubMed2006

Endoscopic retrograde cholangiopancreatography simulation.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a mainly diagnostic to a mainly therapeutic endoscopic technique. Training in ERCP is labor-intensive and time-consuming. Computer- and animal-model-based simulations have been developed in the hope of standardizing and accelerating training. They also may be useful for evaluating trainees. Early efforts to develop computer simulations of endoscopic procedures were hampered by lack of processing power and memory and the cost of software development. Biologic systems seem to offer more realism at lower cost. Hybrid computer-biologic systems seem likely to be the next generation of ERCP simulators.

Animals↗

PubMed2000

Development of colonoscopy teaching simulation.

After 17 years of prototyping, a first release version of the St Mark's Hospital teaching simulator is in final preparation. Advances in computer processing power and graphics cards make it possible to achieve real-time processing of colon and endoscope characteristics and a simulated endoscopic view at an acceptable cost. Realistic feel or "force feedback" for all instrument controls and shaft movements is incorporated. To make the simulator more than a "video game", a package of teaching and assessment features is to be incorporated, including interactive animated graphics to explain particular endoscope loops and situations and the variations of colonic anatomy that are typically encountered. Simulation should spare patients from being used for the early phases of training and should speed up and quantify the learning process. Simulators may introduce even experienced endoscopists to some of the advanced options available in current or future endoscopes or accessories, as well as the use of imminent new technology such as the magnetic imaging system.

Colonoscopy↗

PubMed1997

Role of pilot instrument proficiency in the safety of helicopter emergency medical services.

OBJECTIVES: To determine whether instrument-proficient pilots would more safely manage a flight into unplanned instrument meteorologic conditions (IMC) than would nonproficient pilots. METHODS: A controlled experimental study was performed using a full-motion helicopter simulator. Participants were emergency medical services (EMS) pilots with commercial licenses and previous simulator experience who were blinded to the study design and hypothesis. During a simulated EMS mission, cloud ceiling and visibility were decreased until IMC prevailed, and pilot actions were recorded. Data included the altitude at which the aircraft entered IMC, and whether the pilots maintained control of the aircraft, flew within aviation standards (i.e., bank angle, airspeed), and safely landed. RESULTS: Twenty-eight pilots (13 instrument-proficient, 15 nonproficient) participated; they had a median of 6,300 hours of helicopter experience. Two pilots crashed, both from the nonproficient group. The instrument-proficient pilots lost control less often (15% vs 67%, p < 0.05), maintained instrument standards more often (77% vs 40%, p < 0.05), and entered IMC at a higher altitude (689 feet vs 517 feet, p < 0.05) compared with the nonproficient pilots. Instructor comments indicated that the nonproficient pilots made more errors than did the instrument-proficient pilots. CONCLUSIONS: Instrument-proficient pilots more safely manage an unexpected encounter with IMC. Helicopter EMS programs should strongly consider maintaining instrument proficiency to enhance safety.

Accidents, Aviation↗

PubMed1996

Analyzing components of work samples to evaluate performance.

A method is described in which work sample data were analyzed to reveal how aircraft maintenance technicians differed in troubleshooting performance after a training intervention. During the training phase of the study, approximately half the technicians received troubleshooting instruction from an intelligent tutoring system, and the remaining technicians received informal on-the-job training. Data from work samples, in which technicians verbally isolated simulated equipment failures, were collected from both groups before and after the training. The work sample data were then examined by subject matter experts who scored performance for overall proficiency and noted specific violations of good troubleshooting practice. These violations provided the basis for the components of performance examined in the work sample data. The results of this componential analysis allow more specific conclusions to be drawn regarding the effectiveness of the training intervention by revealing how the tutoring system improved technicians' troubleshooting (e.g., tutored technicians were more likely than untutored technicians to test components thoroughly to ensure they were faulty before replacing them).

Aerospace Medicine↗

PubMedDate not supplied

Athletes, astronauts and orthostatic tolerance.

Specific alterations in autonomic functions induced by endurance training may lead to a reduced ability to withstand orthostatic stress. This possibility has caused some authorities to suggest that, because of potentially greater pooling of blood in the lower extremities during gravitational loading, endurance-trained athletes may make poor astronauts. Although results from spaceflight studies have provided little evidence to support this suggestion, data from water-immersion studies indicate that endurance-trained athletes do become more orthostatically intolerant following a few hours of simulated weightlessness. Unfortunately, other evidence supporting the hypothesis that endurance training reduces orthostatic tolerance has not received adequate publication in the open scientific literature. On the other hand, a number of studies which have been openly reported clearly refute this hypothesis. Nevertheless, the established physiological differences between endurance athletes and non-athletes are themselves sufficient to suggest that the hypothesis could be tenable. Consequently, it has to be concluded that the presently available information is both qualitatively and quantitatively inadequate to permit any definite statement regarding a possible relationship between aerobic power (VO2max) and orthostatic tolerance.

Aerospace Medicine↗

PubMed2006

Flow visualization for interactive simulation of drugs injection during chemoembolization.

Chemoembolization is an important therapeutic procedure. A catheter was navigated to the artery that feeds the tumor, and chemotherapy drugs and embolus are injected directly into the tumor. There is a risk that embolus may lodge incorrectly and deprive normal tissue of its blood supply. This paper focuses on visualization of the flow particles in simulation of chemotherapy drugs injection for training of hand-eye coordination skills. We assume that the flow follows a defined path in the hepatic vascular system from the catheter tip. The vascular model is constructed using sweeping and blending operations. Quadrilaterals which are aligned to face the viewer are drawn for the trail of each particle. The quadrilateral in the trail is determined using bilinear interpolation. On simulated fluoroscopic image, the flow is rendered as overlaying and semitransparent quadrilaterals representing the particles' trails. This visualization model achieves a good visual approximation of the flow of particles inside the vessels under fluoroscopic imaging.

Antineoplastic Agents↗

PubMedDate not supplied

Training simultaneous recurrent neural network with resilient propagation for static optimization.

This paper proposes a non-recurrent training algorithm, resilient propagation, for the Simultaneous Recurrent Neural network operating in relaxation-mode for computing high quality solutions of static optimization problems. Implementation details related to adaptation of the recurrent neural network weights through the non-recurrent training algorithm, resilient backpropagation, are formulated through an algebraic approach. Performance of the proposed neuro-optimizer on a well-known static combinatorial optimization problem, the Traveling Salesman Problem, is evaluated on the basis of computational complexity measures and, subsequently, compared to performance of the Simultaneous Recurrent Neural network trained with the standard backpropagation, and recurrent backpropagation for the same static optimization problem. Simulation results indicate that the Simultaneous Recurrent Neural network trained with the resilient backpropagation algorithm is able to locate superior quality solutions through comparable amount of computational effort for the Traveling Salesman Problem.

Algorithms↗

PubMed2002

Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study.

BACKGROUND: Anesthesia simulators can generate reproducible, standardized clinical scenarios for instruction and evaluation purposes. Valid and reliable simulated scenarios and grading systems must be developed to use simulation for evaluation of anesthesia residents. METHODS: After obtaining Human Subjects approval at each of the 10 participating institutions, 99 anesthesia residents consented to be videotaped during their management of four simulated scenarios on MedSim or METI mannequin-based anesthesia simulators. Using two different grading forms, two evaluators at each department independently reviewed the videotapes of the subjects from their institution to score the residents' performance. A third evaluator, at an outside institution, reviewed the videotape again. Statistical analysis was performed for construct- and criterion-related validity, internal consistency, interrater reliability, and intersimulator reliability. A single evaluator reviewed all videotapes a fourth time to determine the frequency of certain management errors. RESULTS: Even advanced anesthesia residents nearing completion of their training made numerous management errors; however, construct-related validity of mannequin-based simulator assessment was supported by an overall improvement in simulator scores from CB and CA-1 to CA-2 and CA-3 levels of training. Subjects rated the simulator scenarios as realistic (3.47 out of possible 4), further supporting construct-related validity. Criterion-related validity was supported by moderate correlation of simulator scores with departmental faculty evaluations (0.37-0.41, P < 0.01), ABA written in-training scores (0.44-0.49, < 0.01), and departmental mock oral board scores (0.44-0.47, P < 0.01). Reliability of the simulator assessment was demonstrated by very good internal consistency (alpha = 0.71-0.76) and excellent interrater reliability (correlation = 0.94-0.96; P < 0.01; kappa = 0.81-0.90). There was no significant difference in METI versus MedSim scores for residents in the same year of training. CONCLUSIONS: Numerous management errors were identified in this study of anesthesia residents from 10 institutions. Further attention to these problems may benefit residency training since advanced residents continued to make these errors. Evaluation of anesthesia residents using mannequin-based simulators shows promise, adding a new dimension to current assessment methods. Further improvements are necessary in the simulation scenarios and grading criteria before mannequin-based simulation is used for accreditation purposes.

Anaphylaxis↗

PubMed1977

[Mathematical model of transient long-term adaptation processes of the heart].

A mathematical model of the heart's long-term adaptation to changing load is described. The model is based on the long-term adaptation concept which assumes the phosphorylation potential changing in the heart muscle cells with the load to control the genetic apparatus activity and thus determine structural alterations ensuring adaptation. The computerized model reproduces the transient process in four major types of the heart's long-term adaptation, i.e. in a compensatory hypertrophy development and hypertrophy regression, as well as in the training and detraining states formation. The simulation results are in agreement with the available data and predict the phenomena that are not as yet substantiated by experiments.

Adaptation, Physiological↗

PubMedDate not supplied

Actors play patients. Using surrogate patients to look into private practice.

The authors describe a prospective research design in which actors serve as surrogate patients; this approach can be used to study health care delivery in providers' private offices. A previously published study -- in which an actor with actual dental pathology played the roles of a heterosexual, a homosexual, and an intravenous drug user to learn how dentists would respond to a new patient who appeared to belong to a group at hgh risk for AIDS -- offers an example of the design methodology. The authors discuss the benefits and limitations of the design and note that the behavior of other health care practitioners can be examined using simulated patients. Using carefully selected and trained professional actors rather than untrained patients or students can increase the reliability of findings and protect the rigor of the research.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Virtual reality: teaching tool of the twenty-first century?

Virtual reality (VR) is gaining recognition for its enormous educational potential. While not yet in the mainstream of academic medical training, many prototype and first-generation VR applications are emerging, with target audiences ranging from first- and second-year medical students to residents in advanced clinical training. Visualization tools that take advantage of VR technologies are being designed to provide engaging and intuitive environments for learning visually and spatially complex topics such as human anatomy, biochemistry, and molecular biology. These applications present dynamic, three-dimensional views of structures and their spatial relationships, enabling users to move beyond "real-world" experiences by interacting with or altering virtual objects in ways that would otherwise be difficult or impossible. VR-based procedural and surgical simulations, often compared with flight simulators in aviation, hold significant promise for revolutionizing medical training. Already a wide range of simulations, representing diverse content areas and utilizing a variety of implementation strategies, are either under development or in their early implementation stages. These new systems promise to make broad-based training experiences available for students at all levels, without the risks and ethical concerns typically associated with using animal and human subjects. Medical students could acquire proficiency and gain confidence in the ability to perform a wide variety of techniques long before they need to use them clinically. Surgical residents could rehearse and refine operative procedures, using an unlimited pool of virtual patients manifesting a wide range of anatomic variations, traumatic wounds, and disease states. Those simulated encounters, in combination with existing opportunities to work with real patients, could increase the depth and breadth of learners' exposure to medical problems, ensure uniformity of training experiences, and enhance the acquisition of clinical skills.

Anatomy↗

PubMed2000

Sensitivity of CPT I to malonyl-CoA in trained and untrained human skeletal muscle.

The present study examined the sensitivity of carnitine palmitoyltransferase I (CPT I) activity to its inhibitor malonyl-CoA (M-CoA), and simulated metabolic conditions of rest and exercise, in aerobically trained and untrained humans. Maximal CPT I activity was measured in mitochondria isolated from resting human skeletal muscle. Mean CPT I activity was 492.8 +/- 72.8 and 260.8 +/- 33.6 micromol. min(-1). kg wet muscle(-1) in trained and untrained subjects, respectively (pH 7.0, 37 degrees C). The sensitivity to M-CoA was greater in trained muscle; the IC(50) for M-CoA was 0.17 +/- 0.04 and 0.49 +/- 0.17 microM in trained and untrained muscle, respectively. The presence of acetyl-CoA, free coenzyme A (CoASH), and acetylcarnitine, in concentrations simulating rest and exercise conditions did not release the M-CoA-induced inhibition of CPT I activity. However, CPT I activity was reduced at pH 6.8 vs. pH 7.0 in both trained and untrained muscle in the presence of physiological concentrations of M-CoA. The results of this study indicate that aerobic training is associated with an increase in the sensitivity of CPT I to M-CoA. Accumulations of acetyl-CoA, CoASH, and acetylcarnitine do not counteract the M-CoA-induced inhibition of CPT I activity. However, small decreases in pH produce large reductions in the activity of CPT I and may contribute to the decrease in fat metabolism that occurs during moderate and intense aerobic exercise intensities.

Acetyl Coenzyme A↗