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PubMed2005

Sleep disturbance at simulated altitude indicated by stratified respiratory disturbance index but not hypoxic ventilatory response.

At high altitudes, the clinically defined respiratory disturbance index (RDI) and high hypoxic ventilatory response (HVR) have been associated with diminished sleep quality. Increased RDI has also been observed in some athletes sleeping at simulated moderate altitude. In this study, we investigated relationships between the HVR of 14 trained male endurance cyclists with variable RDI and sleep quality responses to simulated moderate altitude. Blood oxygen saturation (SpO2%), heart rate, RDI, arousal rate, awakenings, sleep efficiency, rapid eye movement (REM) sleep, non-REM sleep stages 1, 2 and slow wave sleep as percentages of total sleep time (%TST) were measured for two nights at normoxia of 600 m and one night at a simulated altitude of 2,650 m. HVR and RDI were not significantly correlated with sleep stage, arousal rate or awakening response to nocturnal simulated altitude. SpO2 was inversely correlated with total RDI (r = -0.69, P = 0.004) at simulated altitude and with the change in arousal rate from normoxia (r = -0.65, P = 0.02). REM sleep response to simulated altitude correlated with the change, relative to normoxia, in arousal (r = -0.63, P = 0.04) and heart rate (r = -0.61, P = 0.04). When stratified, those athletes at altitude with RDI >20 h(-1) (n = 4) and those with <10 h(-1) (n = 10) exhibited no difference in HVR but the former had larger falls in SpO2 (P = 0.05) and more arousals (P = 0.03). Neither RDI (without stratification) nor HVR were sufficiently sensitive to explain any deterioration in REM sleep or arousal increase. However, the stratified RDI provides a basis for determining potential sleep disturbance in athletes at simulated moderate altitude.

Adult↗
PubMed1999

Cricoid pressure: knowledge and performance amongst anaesthetic assistants.

We investigated the cricoid pressure technique of 135 anaesthetic assistants attending the annual conference of the British Association of Operating Department Assistants in May 1997. Their knowledge and training were assessed using a structured interview. Technique was assessed using a simulator measuring applied force during sham cricoid pressure. Our additional aims were to see whether a knowledge of the required force and practical training in the application of a target force would affect performance. Our results highlight a lack of knowledge relating to the manoeuvre. Only about one-third of subjects could quote an appropriate force and fewer than half could give a single contraindication to its use. Very few subjects had been trained on a model before practising the technique on a patient. Technique was poor and we observed a large variation in the force actually applied. Performance, as assessed by the variability of forces applied and proportion of subjects applying force within our target range (30-44 N), was improved markedly by providing simple instruction about the required force in an understandable form. Performance was further improved by practical training in the application of target force on a simulator.

Anesthesia, General↗
PubMed1993

Quasi-transfer as a predictor of transfer from simulator to airplane.

Simulators have emerged as important components of flight-training programs. Nevertheless, the development of design principles that can maximize training transfer and cost-benefit trade-offs are not well established. The most significant challenge to research that would bear on simulator design principles is the difficulty and expense of flight transfer experiments. This difficulty and expense can be reduced by the use of an insimulator transfer design, designated here as a quasi-transfer study, in which transfer is to a high-fidelity configuration of a simulator. Of primary concern for such studies is whether the implied assumption of correspondence between quasi-transfer and transfer effects is well founded. In this article, we review evidence that bears on this issue. The evidence is not entirely supportive but does indicate some correspondence between quasi-transfer and transfer.

Aircraft↗
PubMed1994

Respiratory care practitioners as secondary providers of endotracheal intubation: one hospital's experience.

UNLABELLED: The management staff of the Respiratory Care Department at the suggestion of the Department of Anesthesiology determined that there was a need for respiratory care practitioners (RCPs) to be trained to perform endotracheal intubation. This need was demonstrated by the frequency with which anesthesia personnel were called away from the operating room (OR) to perform endotracheal intubations in other hospital areas. METHODS: The training program included didactic instruction followed by written examination, simulations, and intubation experience in the OR under the direct supervision of a staff anesthesiologist. RESULTS: Initially 15 therapists, from all shifts were trained. Currently, there are 20 fully-trained RCPs on staff. These therapists have successfully intubated 160 patients in 178 attempts over a 49 month period. All attempts followed failed attempts by other professionals. No major complications were observed in the patients intubated by RCPs. DISCUSSION: This training program has successfully provided support for endotracheal intubation procedures, sparing the anesthesiology staff and expanding the role of RCPs in our hospital.

Allied Health Personnel↗
PubMed2005

Training with mannequins improves safety, efficiency.

Mannequin training offers viable alternative to more standard training approaches. Staff has ability to respond to the same challenging scenarios over and over again. Simulation can be used for pure teaching or for competency examinations. Training also can be used to monitor compliance with patient safety accreditation standards.

Efficiency, Organizational↗
PubMed2000

Information theoretical probe selection for hybridisation experiments.

MOTIVATION: The choice of probes is an important feature of hybridisation experiments. In this paper we present an algorithm that optimises probes with respect to a training set of sequences based on Shannon entropy as a quality criterion. The practical motivation for our algorithm is oligonucleotide fingerprinting, a method for the simultaneous identification of sequences (cDNA or genomic DNA) by their hybridisation tags according to a set of short probes such as octamers, although the algorithm is of course not restricted to that application. RESULTS: We can show that our method is superior to the selection of probes according to their frequencies, which is a widely used strategy, and to randomly chosen probe sets. The quality of probe sets is assessed by a simulation pipeline that entails the set of probes as a simulation parameter. The performance of probe sets trained on sequences from different organisms shows additionally that probes should be chosen with regard to the organism under analysis. Case studies are presented on how constraints (G+C-content, complexity of the individual probes) influence the selection process. AVAILABILITY: A description of the oligonucleotide fingerprinting pipeline is published on our web-page http://www.molgen.mpg.de/ approximately ag_onf/met.htm. An executable of the algorithm and probe lists designed for human and rodents can be downloaded from the ftp-site ftp://ftp.molgen.mpg.de/pub/mpimg/probe_design/.

Algorithms↗
PubMed2005

Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.

BACKGROUND AND STUDY AIMS: This study was conducted to test a method of measuring the depth of insertion into the small bowel during push-and-pull enteroscopy using the Erlangen Endo-Trainer. Furthermore, the Erlangen Endo-Trainer model for training in the new method of push-and-pull enteroscopy using the double-balloon technique was also evaluated. MATERIALS AND METHODS: Specially prepared packages of porcine upper visceral organs were used, including the esophagus, stomach, duodenum, and small bowel, implanted into the Erlangen Endo-Trainer. In the first step of this study, all of the modifications needed to obtain a model useful for training in the new enteroscopy technique were tested, including different lengths of small bowel. In the next step, the Erlangen Endo-Trainer was used to evaluate a special method of measuring the depth of insertion during push-and-pull enteroscopy by comparing estimated insertion depths of 100 cm and 200 cm, marked on the porcine small bowel, with endoscopic insertion depths determined afterwards by measuring the length of the small bowel from the pylorus to the mark on the porcine small bowel. Additionally, the Endotrainer was used to demonstrate the principle of double-balloon enteroscopy and to provide training in this new enteroscopy technique with a lifelike simulation. RESULTS: The modified Erlangen Endo-Trainer proved its value for demonstrating the principle of push-and-pull enteroscopy and for providing training in this enteroscopic technique as well as for testing the measurement method. The evaluation of the measurement method showed that the estimation of the insertion depths was accurate, with a mean deviation of less than 10 %. A total of 13 workshops (seven national and six international), including a total of 97 participants, were carried out between January and August 2004. Under the supervision of one of the authors, pairs of trainees were able to reach the ileal valve or the end of the small bowel from the oral route. CONCLUSIONS: The modified Erlangen Endo-Trainer is useful for training in the push-and-pull enteroscopy technique. The new specially developed method of measuring the depth of insertion during push-and-pull enteroscopy seems to be valid.

Animals↗
PubMed1990

Postural stability in shooters.

Ten competition shooters were tested during simulated race using the force platform technique to investigate the effect of training on postural stability. The shooters were tested at 30-min intervals during a race simulating actual race conditions. Sway velocity was calculated during 27-second periods. The postural stability was evaluated with and without competition clothing. The shooters had significantly better stability than untrained control subjects, when tested without supportive clothing. The competition clothing reduced the sway velocity further both in visual and nonvisual conditions. The Romberg quotient was higher in shooters than in normal controls, indicating that the shooters used to an increased amount proprioceptive and vestibular cues to stabilize their posture. The good postural stability of the shooters apparently results from assiduous training aimed to improve postural stability.

Adolescent↗
PubMed2005

[A virtual reality simulator for objective assessment of surgeons' laparoscopic skill].

BACKGROUND: The aim of this study was to validate computed virtual reality simulation as a tool to assess laparoscopic skills and to establish whether the simulator allows differentiating between surgeons with different laparoscopic experience. METHODS: 27 physicians at the surgical department of the University of Marburg, Germany, with different experience in laparoscopic surgery were divided into three groups: experienced (group I), intermediate (group II), and novices (group III). Following a brief introduction to the virtual reality simulator (LapSim), each participant performed twice a training program consisting of seven tasks (examinations I and II). RESULTS: Comparison of experienced surgeons with less experienced laparoscopic physicians showed a significant (P<0.05) superiority of group I at examinations I and II in most exercises. The groups' difference was more obvious in examination II, since the technique was new for all participants during examination I. Tasks of low complexity in virtual reality such as camera navigation, which are performed by young, not yet responsible surgeons in real surgery, did not show significantly different results between the three groups. CONCLUSION: Differences in laparoscopic experience can be visualised with a virtual reality simulator, and thus a simulator is helpful for assessing surgeons' laparoscopic skills.

Clinical Competence↗
PubMed1993

Simulated operations by pulsatile organ-perfusion in minimally invasive surgery.

The rapid amplification of indications and areas of application of laparoscopic or thoracoscopic techniques leads to increasing problems and needs in surgical training. Pulsatile perfusion of organs (POP) and organ groups in laparoscopic training devices (pelvitrainers) aids in creating optimum conditions for the simulation of difficult intraoperative situations and complications. Simple applicability, low cost, and the possibility of a noticeable reduction of the currently required animal experiments render POP an ideal training method for minimally invasive surgery.

Animals↗
PubMedDate not supplied

Virtual reality surgical simulator. The first steps.

The virtual-reality surgical simulator signals the beginning of an era of computer simulation for surgery. The surgical resident of the future will learn new perspectives on surgical anatomy and repeatedly practice surgical procedures until they are perfect before performing surgery on patients. Primitive though these initial steps are, they represent the foundation for an educational base that will be as important to surgery as the flight simulator is to aviation. It is anticipated that the full development of the surgical simulator will take less than the 40 years which was required for flight simulators to become an indispensable ingredient of pilot training. As the system evolves, many new and yet-to-be-imagined applications will arise, but we must have understanding and patience as we wait for computer power to improve to a point where VR surgical simulation can emerge from its PacMan era.

Computer Graphics↗
PubMed2000

[Effects of different training methods on cardiovascular autonomic regulation during bedrest].

Objective. To investigate the effects of different training methods on cardiovascular autonomic regulation under bedrest. Method. 15 healthy male volunteers aged 19-22 participated tests in head-down tilt (HDT) -6 degrees bedrest in order to observe the changes of cardiovascular system under simulated weightlessness. They were divided into control (5 men), hypoxia training (5 men) and Fangsong training (5 men) groups. 24 h dynamic ECG were recorded on the 2nd day of pre-bedrest, on the 3rd, 14th and 18th day of bedrest and on the 7th day of the post- bedrest. All spectra were estimated from entire 24 h HRV, before, during and after Fangsong and hypoxia training by autoregressive (AR) modeling method. Normalized low-frequency (LF%) was a quantitative marker of cardiac sympathetic activity, normalized high-frequency (HF%) reflected the changes in cardiac vagal activity, and LF/HF was considered to be related to sympathovagal balance or sympathetic activity. Result. In control group, LF% and HF% were all significantly reduced (P<0.05), LF/HL showed no significant changed during bedrest. In Fangsong group, HF% increased markedly (P< 0.05), while in hypoxia group, LF% increased markedly (P< 0.05). Conclusion. Fangsong training counteracted markedly the reduction in vagal activity, while hypoxia training counteracted markedly the decrease in sympathetic activity. It was possible that HRV indices could be used to evaluate the efficiency of countermeasures counteracting the adverse effects of weightlessness.

Adaptation, Physiological↗
PubMed2004

On the influence of training data quality in k-t BLAST reconstruction.

This work investigated how the quality of prior information (i.e., data acquired during the training stage) influences k-t BLAST reconstruction. The impact of several factors, such as the amount of training data, the presence of spatial misregistration in the training data, and the effects of filtering, was investigated with simulations and in vivo data. It is shown that k-t BLAST outperforms sliding window reconstruction, even with very limited training data. By increasing the amount of training data, reconstruction error continues to decrease, albeit by a diminishing amount. However, an increased amount of training data also increases susceptibility to misregistration of the training data. Filtering of the training data with the goal of reducing truncation artifacts had only minor impact on reconstruction errors. Considering the balance among obtaining the most benefit from the training data, minimizing susceptibility to misregistration, and keeping data acquisition to a minimum, it is concluded that in cardiac imaging the training datasets should be limited to 10-20 profiles in k-space for a typical field of view. The training data may be acquired in a separate breathhold without much penalty, if care is taken to minimize misregistration, such as with a navigator.

Adult↗
PubMed2002

Virtual temporal bone dissection: an interactive surgical simulator.

OBJECTIVE: Our goal was to integrate current and emerging technology in virtual systems to provide a temporal bone dissection simulator that allows the user interactivity and realism similar to the cadaver laboratory. STUDY DESIGN: Iterative design and validation of a virtual environment for simulating temporal bone dissection. SETTING: University otolaryngology training program with interdisciplinary interaction in a high-performance computer facility. RESULTS: The system provides visual, force feedback (haptic), and aural interfaces. Unlike previous "fly through" virtual systems, this environment provides a richer emulation of surgical experience. CONCLUSION: The system provides a high level of functional utility and, through initial evaluations, demonstrates promise in adding to traditional training methods. SIGNIFICANCE: The system provides an environment to learn temporal bone surgery in a way similar to the experience with cadaver material where the subject is able to interact with the data without constraints (nondeterministic). Eventually, it may provide the "front end" to a large repository of various temporal bone pathologies that can be accessed through the Internet.

Algorithms↗
PubMed1998

Computational studies of lateralization of phoneme sequence generation.

The mechanisms underlying cerebral lateralization of language are poorly understood. Asymmetries in the size of hemispheric regions and other factors have been suggested as possible underlying causal factors, and the corpus callosum (interhemispheric connections) has also been postulated to play a role. To examine these issues, we created a neural model consisting of paired cerebral hemispheric regions interacting via the corpus callosum. The model was trained to generate the correct sequence of phonemes for 50 monosyllabic words (simulated reading aloud) under a variety of assumptions about hemispheric asymmetries and callosal effects. After training, the ability of the full model and each hemisphere acting alone to perform this task was measured. Lateralization occurred readily toward the side having larger size, higher excitability, or higher-learning-rate parameter. Lateralization appeared most readily and intensely with strongly inhibitory callosal connections, supporting past arguments that the effective functionality of the corpus callosum is inhibitory. Many of the results are interpretable as the outcome of a "race to learn" between the model's two hemispheric regions, leading to the concept that asymmetric hemispheric plasticity is a critical common causative factor in lateralization. To our knowledge, this is the first computational model to demonstrate spontaneous lateralization of function, and it suggests that such models can be useful for understanding the mechanisms of cerebral lateralization.

Algorithms↗
PubMed1976

Reduction of adolescent misperceptions of the aged.

Forty adolescent girls simulated the responses of an elderly woman on Jackson's Personality Research Form (PRF, Form A) in pre-test and were then randomly assigned to one of four training conditions involving items of PRF Form B. In Specific training, feedback information of the actual self-endorsements of 10 elderly women was given with regard to the three PRF scales which showed largest misperceptions during pre-test simulation; under General Training, feedback information was given with regard to all PRF scales; two further conditions (No Feedback Training, No Training) served as controls. Training was partially effective. Increased accuracy of perception was observed during post-test for the most misperceived personality dimension (dominance) both immediately after specific training and after 2 weeks in a delayed post-test.

Adolescent↗
PubMed2006

Computer-assisted learning and simulation systems in dentistry--a challenge to society.

INTRODUCTION: Computer technology is increasingly used in practical training at universities. However, in spite of their potential, computer-assisted learning (CAL) and computer-assisted simulation (CAS) systems still appear to be underutilized in dental education. MATERIALS AND METHODS: Advantages, challenges, problems, and solutions of computer-assisted learning and simulation in dentistry are discussed by means of MEDLINE, open Internet platform searches, and key results of a study among German dental schools. RESULTS: The advantages of computer-assisted learning are seen for example in self-paced and self-directed learning and increased motivation. It is useful for both objective theoretical and practical tests and for training students to handle complex cases. CAL can lead to more structured learning and can support training in evidence-based decision-making. The reasons for the still relatively rare implementation of CAL/CAS systems in dental education include an inability to finance, lack of studies of CAL/CAS, and too much effort required to integrate CAL/CAS systems into the curriculum. CONCLUSION: To overcome the reasons for the relative low degree of computer technology use, we should strive for multicenter research and development projects monitored by the appropriate national and international scientific societies, so that the potential of computer technology can be fully realized in graduate, postgraduate, and continuing dental education.

Computer Simulation↗