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Sample records for simulated patients evaluation

  1. Using a formative simulated patient exercise for curriculum evaluation

    PubMed Central

    Solomon, David J; Laird-Fick, Heather S; Keefe, Carole W; Thompson, Margaret E; Noel, Mary Margaret

    2004-01-01

    Background It is not clear that teaching specific history taking, physical examination and patient teaching techniques to medical students results in durable behavioural changes. We used a quasi-experimental design that approximated a randomized double blinded trial to examine whether a Participatory Decision-Making (PDM) educational module taught in a clerkship improves performance on a Simulated Patient Exercise (SPE) in another clerkship, and how this is influenced by the time between training and assessment. Methods Third year medical students in an internal medicine clerkship were assessed on their use of PDM skills in an SPE conducted in the second week of the clerkship. The rotational structure of the third year clerkships formed a pseudo-randomized design where students had 1) completed the family practice clerkship containing a training module on PDM skills approximately four weeks prior to the SPE, 2) completed the family medicine clerkship and the training module approximately 12 weeks prior to the SPE or 3) had not completed the family medicine clerkship and the PDM training module at the time they were assessed via the SPE. Results Based on limited pilot data there were statistically significant differences between students who received PDM training approximately four weeks prior to the SPE and students who received training approximately 12 weeks prior to the SPE. Students who received training 12 weeks prior to the SPE performed better than those who received training four weeks prior to the SPE. In a second comparison students who received training four weeks prior to the SPE performed better than those who did not receive training but the differences narrowly missed statistical significance (P < 0.05). Conclusion This pilot study demonstrated the feasibility of a methodology for conducting rigorous curricular evaluations using natural experiments based on the structure of clinical rotations. In addition, it provided preliminary data suggesting

  2. Verification and validation of a patient simulator for test and evaluation of a laser doppler vibrometer

    NASA Astrophysics Data System (ADS)

    Byrd, Kenneth A.; Yauger, Sunny

    2012-06-01

    In the medical community, patient simulators are used to educate and train nurses, medics and doctors in rendering dierent levels of treatment and care to various patient populations. Students have the opportunity to perform real-world medical procedures without putting any patients at risk. A new thrust for the U.S. Army RDECOM CERDEC Night Vision and Electronic Sensors Directorate (NVESD), is the use of remote sensing technologies to detect human vital signs at stando distances. This capability will provide medics with the ability to diagnose while under re in addition to helping them to prioritize the care and evacuation of battleeld casualties. A potential alternative (or precursor) to human subject testing is the use of patient simulators. This substitution (or augmenting) provides a safe and cost eective means to develop, test, and evaluate sensors without putting any human subjects at risk. In this paper, we present a generalized framework that can be used to accredit patient simulator technologies as human simulants for remote physiological monitoring (RPM). Results indicate that we were successful in using a commercial Laser Doppler Vibrometer (LDV) to exploit pulse and respiration signals from a SimMan 3G patient simulator at stando (8 meters).

  3. Emergency birth hybrid simulation with standardized patients in midwifery education: implementation and evaluation.

    PubMed

    Lindsay Miller, Jane; Avery, Melissa D; Larson, Karin; Woll, Anne; VonAchen, Alison; Mortenson, Angela

    2015-01-01

    Structured simulations have become a critical part of health professions education at every level, particularly for high-risk, low-incidence scenarios. This article describes the implementation and evaluation of a hybrid simulation of emergency birth situations in a graduate midwifery program. In the fall of 2011 and spring of 2012, nurse-midwifery students twice participated in 2 simulated emergencies-shoulder dystocia and postpartum hemorrhage-using hybrid simulation (a standardized patient paired with a birth task trainer). Students found the simulations to be realistic. The use of best practices (ie, repetitive practice, team learning, small group debriefing, and large group debriefing) enhanced the quality of the simulation experience and the learners' reflection about their professional skills, strengths, weaknesses, and confidence in managing these 2 obstetric emergencies. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. PMID:25963413

  4. E-simulation: preregistration nursing students' evaluation of an online patient deterioration program.

    PubMed

    Cant, Robyn; Young, Susan; Cooper, Simon J; Porter, Joanne

    2015-03-01

    This study explores preregistration nursing students' views of a Web-based simulation program: FIRST ACTWeb (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends-Web). The multimedia program incorporating three videoed scenarios portrayed by a standardized patient (human actor) aims to improve students' recognition and management of hospital patient deterioration. Participants were 367 final-year nursing students from three universities who completed an online evaluation survey and 19 students from two universities who attended one of five focus groups. Two researchers conducted a thematic analysis of the transcribed narratives. Three core themes identified were as follows: "ease of program use," "experience of e-Simulation," and "satisfaction with the learning experience." The Web-based clinical learning environment was endorsed as functional, feasible, and easy to use and was reported to have high fidelity and realism. Feedback in both focus groups and surveys showed high satisfaction with the learning experience. Overall, evaluation suggested that the Web-based simulation program successfully integrated elements essential for blended learning. Although Web-based educational applications are resource intensive to develop, positive appraisal of program quality, plus program accessibility and repeatability, appears to provide important educational benefits. Further research is needed to determine the transferability of these learning experiences into real-world practice. PMID:25650961

  5. Evaluation of clinical margins via simulation of patient setup errors in prostate IMRT treatment plans

    SciTech Connect

    Gordon, J. J.; Crimaldi, A. J.; Hagan, M.; Moore, J.; Siebers, J. V.

    2007-01-15

    This work evaluates: (i) the size of random and systematic setup errors that can be absorbed by 5 mm clinical target volume (CTV) to planning target volume (PTV) margins in prostate intensity modulated radiation therapy (IMRT); (ii) agreement between simulation results and published margin recipes; and (iii) whether shifting contours with respect to a static dose distribution accurately predicts dose coverage due to setup errors. In 27 IMRT treatment plans created with 5 mm CTV-to-PTV margins, random setup errors with standard deviations (SDs) of 1.5, 3, 5 and 10 mm were simulated by fluence convolution. Systematic errors with identical SDs were simulated using two methods: (a) shifting the isocenter and recomputing dose (isocenter shift), and (b) shifting patient contours with respect to the static dose distribution (contour shift). Maximum tolerated setup errors were evaluated such that 90% of plans had target coverage equal to the planned PTV coverage. For coverage criteria consistent with published margin formulas, plans with 5 mm margins were found to absorb combined random and systematic SDs{approx_equal}3 mm. Published recipes require margins of 8-10 mm for 3 mm SDs. For the prostate IMRT cases presented here a 5 mm margin would suffice, indicating that published recipes may be pessimistic. We found significant errors in individual plan doses given by the contour shift method. However, dose population plots (DPPs) given by the contour shift method agreed with the isocenter shift method for all structures except the nodal CTV and small bowel. For the nodal CTV, contour shift DPP differences were due to the structure moving outside the patient. Small bowel DPP errors were an artifact of large relative differences at low doses. Estimating individual plan doses by shifting contours with respect to a static dose distribution is not recommended. However, approximating DPPs is acceptable, provided care is taken with structures such as the nodal CTV which lie close

  6. Use of Simulated Patients to Evaluate Combined Oral Contraceptive Dispensing Practices of Community Pharmacists

    PubMed Central

    Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Marusic, Srecko; de Lyra-Júnior, Divaldo Pereira; de Almeida, Kelsen Luis; Pazete, Ana Claudia Montolezi; do Nascimento, Janaina Dutra; Kos, Mitja; Girotto, Edmarlon; Cuman, Roberto Kenji Nakamura

    2013-01-01

    Background Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. Objective To evaluate the COC dispensing practices of CPs in a developing country. Method A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients’ medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Results Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., “do you smoke?” (n = 2) and “what is your age?” (n = 1). None of the CPs measured the patient’s blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. Conclusion The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure. PMID:24324584

  7. Development and evaluation of a high-fidelity canine patient simulator for veterinary clinical training.

    PubMed

    Fletcher, Daniel J; Militello, Roberta; Schoeffler, Gretchen L; Rogers, Catherine L

    2012-01-01

    High-fidelity human patient simulators have been used for decades in medical education to provide opportunities for students to practice technical skills, diagnostic and therapeutic planning, and communication skills in a safe environment. A high-fidelity canine patient simulator (CPS) was developed using components from a human patient simulator and a low-fidelity foam core canine mannequin. Ninety-six veterinary students participated in cardiopulmonary arrest scenarios in groups of three to five students. Afterwards, participants were asked to complete an anonymous online survey describing their experiences. A total of 70 students (73%) completed the survey. All of the students (100%) felt that the simulator session expanded their cardiopulmonary resuscitation (CPR) knowledge base, and 97% responded that their skills and abilities had improved. Students also expressed positive opinions about the CPS, with 89% agreeing or strongly agreeing that the CPS was realistic and 73% agreeing or strongly agreeing that the scenarios generated emotions similar to real clinical situations. Most participants (98.5%) agreed or strongly agreed that the simulator was an engaging learning experience. Students commonly commented that the simulations allowed them to practice communication and teamwork skills and were more effective than paper-based, problem-oriented learning opportunities and lecture. Students also commented that they wanted more opportunities to participate in simulation exercises. These results suggest that high-fidelity veterinary simulation is an engaging educational methodology that addresses some limitations of other forms of problem-based learning. More studies are needed to quantitatively determine the effectiveness of this novel veterinary educational technology in comparison with more traditional approaches. PMID:22433738

  8. Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices.

    PubMed

    Isetta, Valentina; Montserrat, Josep M; Santano, Raquel; Wimms, Alison J; Ramanan, Dinesh; Woehrle, Holger; Navajas, Daniel; Farré, Ramon

    2016-01-01

    Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients' characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient's night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment. PMID:26978077

  9. Human Patient Simulations: Evaluation of Self-Efficacy and Anxiety in Clinical Skills Performance

    ERIC Educational Resources Information Center

    Onovo, Grace N.

    2013-01-01

    The relationship between self-efficacy (self-confidence) and anxiety levels, and the use of Human Patient Simulations (HPS) as a teaching-learning strategy, has not been sufficiently studied in the area of clinical nursing education. Despite the evidence in the literature indicating that HPS increases self-efficacy/self-confidence and decreases…

  10. Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices

    PubMed Central

    Isetta, Valentina; Montserrat, Josep M.; Santano, Raquel; Wimms, Alison J.; Ramanan, Dinesh; Woehrle, Holger; Navajas, Daniel; Farré, Ramon

    2016-01-01

    Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients’ characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient’s night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment. PMID:26978077

  11. High fidelity patient silicone simulation: a qualitative evaluation of nursing students' experiences.

    PubMed

    Reid-Searl, Kerry; Happell, Brenda; Vieth, Lea; Eaton, Anne

    2012-01-01

    Clinical experience is recognised as a source of fear and anxiety for undergraduate nursing students. Simulated learning experiences have been identified as potentially increasing confidence, however most techniques do not always reflect clinical reality or are too costly. The aim of the current study is to explore nursing students' perceptions of the use of High Fidelity Silicone Simulation, developed by one university academic to overcome these limitations. A simulated patient with a personal and medical history is developed and brought to life through wearing life-like silicone props including face, hands and torso. The academic is able to adapt responses to direct student learning. This paper presents the findings from a qualitative exploratory study of nursing students' responses to this technique. Twenty-one students in second or third year of the nursing program participated in one of three focus groups to discuss their experiences. Data were analysed using a thematic approach. Data analysis revealed three main themes: preparation for clinical reality, reducing fear/increasing confidence, and taking out of comfort zone. These findings suggest that this technique has the potential to increase nursing students' sense of preparedness for their clinical experience, thus reducing the negative impact of fear and apprehension. PMID:22774349

  12. Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment – Web-SP

    PubMed Central

    Zary, Nabil; Johnson, Gunilla; Boberg, Jonas; Fors, Uno GH

    2006-01-01

    Background The Web-based Simulation of Patients (Web-SP) project was initiated in order to facilitate the use of realistic and interactive virtual patients (VP) in medicine and healthcare education. Web-SP focuses on moving beyond the technology savvy teachers, when integrating simulation-based education into health sciences curricula, by making the creation and use of virtual patients easier. The project strives to provide a common generic platform for design/creation, management, evaluation and sharing of web-based virtual patients. The aim of this study was to evaluate if it was possible to develop a web-based virtual patient case simulation environment where the entire case authoring process might be handled by teachers and which would be flexible enough to be used in different healthcare disciplines. Results The Web-SP system was constructed to support easy authoring, management and presentation of virtual patient cases. The case authoring environment was found to facilitate for teachers to create full-fledged patient cases without the assistance of computer specialists. Web-SP was successfully implemented at several universities by taking into account key factors such as cost, access, security, scalability and flexibility. Pilot evaluations in medical, dentistry and pharmacy courses shows that students regarded Web-SP as easy to use, engaging and to be of educational value. Cases adapted for all three disciplines were judged to be of significant educational value by the course leaders. Conclusion The Web-SP system seems to fulfil the aim of providing a common generic platform for creation, management and evaluation of web-based virtual patient cases. The responses regarding the authoring environment indicated that the system might be user-friendly enough to appeal to a majority of the academic staff. In terms of implementation strengths, Web-SP seems to fulfil most needs from course directors and teachers from various educational institutions and disciplines

  13. Evaluation of patient dose using a virtual CT scanner: Applications to 4DCT simulation and Kilovoltage cone-beam imaging

    NASA Astrophysics Data System (ADS)

    DeMarco, J. J.; McNitt-Gray, M. F.; Cagnon, C. H.; Angel, E.; Agazaryan, N.; Zankl, M.

    2008-02-01

    This work evaluates the effects of patient size on radiation dose from simulation imaging studies such as four-dimensional computed tomography (4DCT) and kilovoltage cone-beam computed tomography (kV-CBCT). 4DCT studies are scans that include temporal information, frequently incorporating highly over-sampled imaging series necessary for retrospective sorting as a function of respiratory phase. This type of imaging study can result in a significant dose increase to the patient due to the slower table speed as compared with a conventional axial or helical scan protocol. Kilovoltage cone-beam imaging is a relatively new imaging technique that requires an on-board kilovoltage x-ray tube and a flat-panel detector. Instead of porting individual reference fields, the kV tube and flat-panel detector are rotated about the patient producing a cone-beam CT data set (kV-CBCT). To perform these investigations, we used Monte Carlo simulation methods with detailed models of adult patients and virtual source models of multidetector computed tomography (MDCT) scanners. The GSF family of three-dimensional, voxelized patient models, were implemented as input files using the Monte Carlo code MCNPX. The adult patient models represent a range of patient sizes and have all radiosensitive organs previously identified and segmented. Simulated 4DCT scans of each voxelized patient model were performed using a multi-detector CT source model that includes scanner specific spectra, bow-tie filtration, and helical source path. Standard MCNPX tally functions were applied to each model to estimate absolute organ dose based upon an air-kerma normalization measurement for nominal scanner operating parameters.

  14. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  15. Interprofessional Communication Skills Training for Serious Illness: Evaluation of a Small-Group, Simulated Patient Intervention

    PubMed Central

    Bays, Alison M.; Engelberg, Ruth A.; Back, Anthony L.; Ford, Dee W.; Downey, Lois; Shannon, Sarah E.; Doorenbos, Ardith Z.; Edlund, Barbara; Christianson, Phyllis; Arnold, Richard W.; O'Connor, Kim; Kross, Erin K.; Reinke, Lynn F.; Cecere Feemster, Laura; Fryer-Edwards, Kelly; Alexander, Stewart C.; Tulsky, James A.

    2014-01-01

    Abstract Background: Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. Objective: The objective was to investigate the effect of an experiential communication skills building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' and nurse practitioner students' ability to communicate bad news and express empathy. Design: Trainees participated in Codetalk; skill improvement was evaluated through pre- and post- standardized patient (SP) encounters. Setting and subjects: The subjects were internal medicine residents and nurse practitioner students at two universities. Intervention and measurements: The study was carried out in anywhere from five to eight half-day sessions over a month. The first and last sessions included audiotaped trainee SP encounters coded for effective communication behaviors. The primary outcome was change in communication scores from pre-intervention to post-intervention. We also measured trainee characteristics to identify predictors of performance and change in performance over time. Results: We enrolled 145 trainees who completed pre- and post-intervention SP interviews—with participation rates of 52% for physicians and 14% for nurse practitioners. Trainees' scores improved in 8 of 11 coded behaviors (p<0.05). The only significant predictors of performance were having participated in the intervention (p<0.001) and study site (p<0.003). The only predictor of improvement in performance over time was participating in the intervention (p<0.001). Conclusions: A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee

  16. Evaluation Training: Simulation Exercises.

    ERIC Educational Resources Information Center

    Smith, Carl B.; Farr, Roger

    The preparation of this simulation material package is guided by the concept of an evaluator as a decision-maker, based on the definition of evaluation as a continuous assessment concerned with answering decision-making questions. The continuous concept of evaluation is based on the model created by Egon Guba and Daniel Stufflebeam, named by its…

  17. Simulating Patterns of Patient Engagement, Treatment Adherence, and Viral Suppression: A System Dynamics Approach to Evaluating HIV Care Management

    PubMed Central

    Schwartz, Brian; Palma, Anton

    2015-01-01

    Abstract System dynamics (SD) modeling belongs to the rapidly evolving, interdisciplinary field of system science research. This field adds value to more traditional health research by contributing to the design and testing of complex integrated models of change, to examine health system performance and patient outcomes. Using selected milestones in HIV care management to frame our simulation research, we created a SD model to examine three patient subgroups of women of color (WOC) represented in our multi-site cohort, classified by their health care seeking status at baseline. Asked to reflect on their circumstance 6 months prior to enrollment in the MSE cohort, 53% noted they were receiving some care (In Care, n=341), 31% that they had been seeking care (Seeking Care, n=201), and 16% that they were undecided about seeking care (i.e., answered that they may or may not look for care) for treatment of their HIV (May or May Not Seek Care, n=103). Our SD model compared simulated patterns of patient retention over 24 months in relation to: (1) access to antiretroviral therapy (ART), (2) adherence to ART, and (3) viral suppression. Assessed patterns yielded insights about system capacities and constraints in the context of the SPNS initiative under evaluation. PMID:25561309

  18. Evaluating the impact of scenario-based high-fidelity patient simulation on academic metrics of student success.

    PubMed

    Sportsman, Susan; Schumacker, Randall E; Hamilton, Patti

    2011-01-01

    Despite the ongoing nursing shortage, nurse educators are responsible for preparing students to practice in highly complex health care systems. As nurse educators explore new learning strategies to support an increase in student admissions, they must also evaluate the impact of these strategies on the quality of the educational experience. The study reported here evaluated the impact of scenario-based, high-fidelity patient simulation used to increase student admissions in an associate degree and baccalaureate nursing program in north-central Texas upon students' sense of their own clinical competence, graduating grade point average (GPA), and performance on standardized exit examinations. These are measures commonly used by nurse educators as metrics of success. PMID:21923008

  19. Is high fidelity human patient (mannequin) simulation, simulation of learning?

    PubMed

    McGarry, Denise; Cashin, Andrew; Fowler, Cathrine

    2014-08-01

    This paper explores the application of evaluation of high fidelity human patient (mannequin) simulation emerging in nursing education. The ramifications for use in mental health nursing are examined. A question is posed: Is high fidelity human patient (mannequin) simulation limited to being a "simulation of learning"? Explicit research that traces learning outcomes from mannequin, to clinical practice and hence consumer outcomes, is absent in mental health. Piecing together research from psychology addressing cognitive load theory and considering the capacity for learners to imitate desired behaviour without experiencing deep learning, the possibility is real that simulation of learning is the outcome of high fidelity human patient (mannequin) simulation applications to mental health nursing. PMID:24837517

  20. Patient Simulators Train Emergency Caregivers

    NASA Technical Reports Server (NTRS)

    2014-01-01

    Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.

  1. Evaluating respiratory patient disability.

    PubMed

    Ruiz Manzano, Juan; Alfageme Michavila, Inmaculada; Chiner Vives, Eusebi; Martínez González, Cristina

    2012-08-01

    The evaluation of the disabilities of patients with respiratory disease is regulated by the Spanish Ministry of Labor and Social Security, as are disabilities of any other type. We believe, however, that in respiratory pathologies this evaluation is especially complicated because, as they are chronic processes, they inter-relate with other systems. Furthermore, they tend to have occasional exacerbations; therefore, normal periods may alternate with other periods of important functional limitations. The present document arises from the desire of SEPAR to update this topic and to respond to the requests of respiratory disease patient associations who have asked us to do so. In this paper, we analyze the current situation of work disability legislation as well as the determination of degrees and percentages, including the current criteria for assigning disabilities due to respiratory tract deficiencies. Lastly, we propose work guidelines that would improve the existing scenario and outline this evaluation for specific pathologies. PMID:22341300

  2. Evaluation of the effect of patient dose from cone beam computed tomography on prostate IMRT using Monte Carlo simulation

    SciTech Connect

    Chow, James C. L.; Leung, Michael K. K.; Islam, Mohammad K.; Norrlinger, Bernhard D.; Jaffray, David A.

    2008-01-15

    The aim of this study is to evaluate the impact of the patient dose due to the kilovoltage cone beam computed tomography (kV-CBCT) in a prostate intensity-modulated radiation therapy (IMRT). The dose distributions for the five prostate IMRTs were calculated using the Pinnacle3 treatment planning system. To calculate the patient dose from CBCT, phase-space beams of a CBCT head based on the ELEKTA x-ray volume imaging system were generated using the Monte Carlo BEAMnrc code for 100, 120, 130, and 140 kVp energies. An in-house graphical user interface called DOSCTP (DOSXYZnrc-based) developed using MATLAB was used to calculate the dose distributions due to a 360 deg. photon arc from the CBCT beam with the same patient CT image sets as used in Pinnacle3. The two calculated dose distributions were added together by setting the CBCT doses equal to 1%, 1.5%, 2%, and 2.5% of the prescription dose of the prostate IMRT. The prostate plan and the summed dose distributions were then processed in the CERR platform to determine the dose-volume histograms (DVHs) of the regions of interest. Moreover, dose profiles along the x- and y-axes crossing the isocenter with and without addition of the CBCT dose were determined. It was found that the added doses due to CBCT are most significant at the femur heads. Higher doses were found at the bones for a relatively low energy CBCT beam such as 100 kVp. Apart from the bones, the CBCT dose was observed to be most concentrated on the anterior and posterior side of the patient anatomy. Analysis of the DVHs for the prostate and other critical tissues showed that they vary only slightly with the added CBCT dose at different beam energies. On the other hand, the changes of the DVHs for the femur heads due to the CBCT dose and beam energy were more significant than those of rectal and bladder wall. By analyzing the vertical and horizontal dose profiles crossing the femur heads and isocenter, with and without the CBCT dose equal to 2% of the

  3. "The Virtual Patient"--Development, Implementation and Evaluation of an Innovative Computer Simulation for Postgraduate Nursing Students

    ERIC Educational Resources Information Center

    Kiegaldie, Debra; White, Geoff

    2006-01-01

    The Virtual Patient, an interactive multimedia learning resource using a critical care clinical scenario for postgraduate nursing students, was developed to enhance flexible access to learning experiences and improve learning outcomes in the management of critically ill patients. Using real-time physiological animations, authentic content design…

  4. Evaluations of lunar regolith simulants

    NASA Astrophysics Data System (ADS)

    Taylor, Lawrence A.; Pieters, Carle M.; Britt, Daniel

    2016-07-01

    Apollo lunar regolith samples are not available in quantity for engineering studies with In-Situ Resource Utilization (ISRU). Therefore, with expectation of a return to the Moon, dozens of regolith (soil) simulants have been developed, to some extent a result of inefficient distribution of NASA-sanctioned simulants. In this paper, we review many of these simulants, with evaluations of their short-comings. In 2010, the NAC-PSS committee instructed the Lunar Exploration Advisory Group (LEAG) and CAPTEM (the NASA committee recommending on the appropriations of Apollo samples) to report on the status of lunar regolith simulants. This report is reviewed here-in, along with a list of the plethora of lunar regolith simulants and references. In addition, and importantly, a special, unique Apollo 17 soil sample (70050) discussed, which has many of the properties sought for ISRU studies, should be available in reasonable amounts for ISRU studies.

  5. Human Patient Simulators in Nursing Education: An Overview.

    ERIC Educational Resources Information Center

    Nehring, Wendy M.; Ellis, Wayne E.; Lashley, Felissa R.

    2001-01-01

    Describes the human patient simulator and discusses the value of this technology for undergraduate and graduate nursing education, research, and evaluation. Highlights include an example of the use of the simulator; critical incident nursing management as a framework for instruction using the simulator; and administrative considerations. (LRW)

  6. A Review and Comparison of Methods for Recreating Individual Patient Data from Published Kaplan-Meier Survival Curves for Economic Evaluations: A Simulation Study

    PubMed Central

    Wan, Xiaomin; Peng, Liubao; Li, Yuanjian

    2015-01-01

    Background In general, the individual patient-level data (IPD) collected in clinical trials are not available to independent researchers to conduct economic evaluations; researchers only have access to published survival curves and summary statistics. Thus, methods that use published survival curves and summary statistics to reproduce statistics for economic evaluations are essential. Four methods have been identified: two traditional methods 1) least squares method, 2) graphical method; and two recently proposed methods by 3) Hoyle and Henley, 4) Guyot et al. The four methods were first individually reviewed and subsequently assessed regarding their abilities to estimate mean survival through a simulation study. Methods A number of different scenarios were developed that comprised combinations of various sample sizes, censoring rates and parametric survival distributions. One thousand simulated survival datasets were generated for each scenario, and all methods were applied to actual IPD. The uncertainty in the estimate of mean survival time was also captured. Results All methods provided accurate estimates of the mean survival time when the sample size was 500 and a Weibull distribution was used. When the sample size was 100 and the Weibull distribution was used, the Guyot et al. method was almost as accurate as the Hoyle and Henley method; however, more biases were identified in the traditional methods. When a lognormal distribution was used, the Guyot et al. method generated noticeably less bias and a more accurate uncertainty compared with the Hoyle and Henley method. Conclusions The traditional methods should not be preferred because of their remarkable overestimation. When the Weibull distribution was used for a fitted model, the Guyot et al. method was almost as accurate as the Hoyle and Henley method. However, if the lognormal distribution was used, the Guyot et al. method was less biased compared with the Hoyle and Henley method. PMID:25803659

  7. Patient-specific simulation of tidal breathing

    NASA Astrophysics Data System (ADS)

    Walters, M.; Wells, A. K.; Jones, I. P.; Hamill, I. S.; Veeckmans, B.; Vos, W.; Lefevre, C.; Fetitia, C.

    2016-03-01

    Patient-specific simulation of air flows in lungs is now straightforward using segmented airways trees from CT scans as the basis for Computational Fluid Dynamics (CFD) simulations. These models generally use static geometries, which do not account for the motion of the lungs and its influence on important clinical indicators, such as airway resistance. This paper is concerned with the simulation of tidal breathing, including the dynamic motion of the lungs, and the required analysis workflow. Geometries are based on CT scans obtained at the extremes of the breathing cycle, Total Lung Capacity (TLC) and Functional Residual Capacity (FRC). It describes how topologically consistent geometries are obtained at TLC and FRC, using a `skeleton' of the network of airway branches. From this a 3D computational mesh which morphs between TLC and FRC is generated. CFD results for a number of patient-specific cases, healthy and asthmatic, are presented. Finally their potential use in evaluation of the progress of the disease is discussed, focusing on an important clinical indicator, the airway resistance.

  8. Moving the Needle: Simulation's Impact on Patient Outcomes.

    PubMed

    Cox, Tiffany; Seymour, Neal; Stefanidis, Dimitrios

    2015-08-01

    This review investigates the available literature that addresses the impact simulator training has on patient outcomes. The authors conducted a comprehensive literature search of studies reporting outcomes of simulation training and categorized studies based on the Kirkpatrick model of training evaluation. Kirkpatrick level 4 studies reporting patient outcomes were identified and included in this review. Existing evidence is promising, demonstrating patient benefits as a result of simulation training for central line placement, obstetric emergencies, cataract surgery, laparoscopic inguinal hernia repair, and team training. PMID:26210974

  9. [Patient evaluation and outcome measures].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

    Both the initial evaluation and follow-up of patients with osteoarthritis require systematic evaluation of the indicators that provide information on the degree of involvement of the disease and allow its quantification. Reliable measures of disease progression help decision-making by clinicians and provide valid information on treatment response and the effectiveness of the distinct therapeutic interventions. The instruments recommended in research, as outcome measures in osteoarthritis, are pain evaluation, assessment of physical function, and self-reported global evaluation. In studies lasting more than 1 year, structural changes are evaluated through simple X-ray. Self-reported quality of life assessment and physician global assessment are also recommended as options. These indicators should be incorporated into routine clinical practice for adequate evaluation and correct follow-up of patients with osteoarthritis. The recommended pain evaluation method for use in clinical practice is the visual analog scale (VAS). The best instrument to evaluate physical function in patients with hip or knee osteoarthritis is the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index). For patient-reported global assessment in routine practice, the recommended scales are VAS or the SF-12 (12-item short-form health survey). PMID:24467959

  10. Bedside evaluation of dizzy patients.

    PubMed

    Huh, Young-Eun; Kim, Ji-Soo

    2013-10-01

    In recent decades there has been marked progress in the imaging and laboratory evaluation of dizzy patients. However, detailed history taking and comprehensive bedside neurotological evaluation remain crucial for a diagnosis of dizziness. Bedside neurotological evaluation should include examinations for ocular alignment, spontaneous and gaze-evoked nystagmus, the vestibulo-ocular reflex, saccades, smooth pursuit, and balance. In patients with acute spontaneous vertigo, negative head impulse test, direction-changing nystagmus, and skew deviation mostly indicate central vestibular disorders. In contrast, patients with unilateral peripheral deafferentation invariably have a positive head impulse test and mixed horizontal-torsional nystagmus beating away from the lesion side. Since suppression by visual fixation is the rule in peripheral nystagmus and is frequent even in central nystagmus, removal of visual fixation using Frenzel glasses is required for the proper evaluation of central as well as peripheral nystagmus. Head-shaking, cranial vibration, hyperventilation, pressure to the external auditory canal, and loud sounds may disclose underlying vestibular dysfunction by inducing nystagmus or modulating the spontaneous nystagmus. In patients with positional vertigo, the diagnosis can be made by determining patterns of the nystagmus induced during various positional maneuvers that include straight head hanging, the Dix-Hallpike maneuver, supine head roll, and head turning and bending while sitting. Abnormal smooth pursuit and saccades, and severe imbalance also indicate central pathologies. Physicians should be familiar with bedside neurotological examinations and be aware of the clinical implications of the findings when evaluating dizzy patients. PMID:24285961

  11. Simulators for corporate pilot training and evaluation

    NASA Technical Reports Server (NTRS)

    Treichel, Curt

    1992-01-01

    Corporate aviation relies heavily on simulation to meet training and evaluation requirements. It appreciates the savings in fuel, money, noise, and time, and the added safety it provides. Also, simulation provides opportunities to experience many emergencies that cannot be safely practiced in the aircraft. There is a need to focus on the advantages of simulator training over aircraft training and to provide appropriate changes in the regulations to allow the community to make it possible for users to take full advantage of simulation.

  12. The Design, Development, and Evaluation of an Evaluative Computer Simulation.

    ERIC Educational Resources Information Center

    Ehrlich, Lisa R.

    This paper discusses evaluation design considerations for a computer based evaluation simulation developed at the University of Iowa College of Medicine in Cardiology to assess the diagnostic skills of primary care physicians and medical students. The simulation developed allows for the assessment of diagnostic skills of physicians in the…

  13. Evaluation of gowns and coveralls used by medical personnel working with Ebola patients against simulated bodily fluids using an Elbow Lean Test.

    PubMed

    Jaques, Peter A; Gao, Pengfei; Kilinc-Balci, Selcen; Portnoff, Lee; Weible, Robyn; Horvatin, Matthew; Strauch, Amanda; Shaffer, Ronald

    2016-11-01

    Gowns and coveralls are important components of protective ensembles used during the management of known or suspected Ebola patients. In this study, an Elbow Lean Test was used to obtain a visual semi-quantitative measure of the resistance of medical protective garments to the penetration of two bodily fluid simulants. Tests were done on swatches of continuous and discontinuous regions of fabrics cut from five gowns and four coveralls at multiple elbow pressure levels (2-44 PSI). Swatches cut from the continuous regions of one gown and two coveralls did not have any strike-through. For discontinuous regions, only the same gown consistently resisted fluid strike-through. As hypothesized, with the exception of one garment, fluid strike-through increased with higher applied elbow pressure, was higher for lower fluid surface tension, and was higher for the discontinuous regions of the protective garments. PMID:27171285

  14. Aided targeting system simulation evaluation

    NASA Technical Reports Server (NTRS)

    Demaio, Joe; Becker, Curtis

    1994-01-01

    Simulation research was conducted at the Crew Station Research and Development Facility on the effectiveness and ease of use of three targeting systems. A manual system required the aviator to scan a target array area with a simulated second generation forward looking infrared (FLIR) sensor, locate and categorize targets, and construct a target hand-off list. The interface between the aviator and the system was like that of an advanced scout helicopter (manual mode). Two aided systems detected and categorized targets automatically. One system used only the FLIR sensor and the second used FLIR fused with Longbow radar. The interface for both was like that of an advanced scout helicopter aided mode. Exposure time while performing the task was reduced substantially with the aided systems, with no loss of target hand-off list accuracy. The fused sensor system showed lower time to construct the target hand-off list and a slightly lower false alarm rate than the other systems. A number of issues regarding system sensitivity and criterion, and operator interface design are discussed.

  15. An R package for simulation experiments evaluating clinical trial designs.

    PubMed

    Wang, Yuanyuan; Day, Roger

    2010-01-01

    This paper presents an open-source application for evaluating competing clinical trial (CT) designs using simulations. The S4 system of classes and methods is utilized. Using object-oriented programming provides extensibility through careful, clear interface specification; using R, an open-source widely-used statistical language, makes the application extendible by the people who design CTs: biostatisticians. Four key classes define the specifications of the population models, CT designs, outcome models and evaluation criteria. Five key methods define the interfaces for generating patient baseline characteristics, stopping rule, assigning treatment, generating patient outcomes and calculating the criteria. Documentation of their connections with the user input screens, with the central simulation loop, and with each other faciliates the extensibility. New subclasses and instances of existing classes meeting these interfaces can integrate immediately into the application. To illustrate the application, we evaluate the effect of patient pharmacokinetic heterogeneity on the performance of a common Phase I "3+3" design. PMID:21347151

  16. What can virtual patient simulation offer mental health nursing education?

    PubMed

    Guise, V; Chambers, M; Välimäki, M

    2012-06-01

    This paper discusses the use of simulation in nursing education and training, including potential benefits and barriers associated with its use. In particular, it addresses the hitherto scant application of diverse simulation devices and dedicated simulation scenarios in psychiatric and mental health nursing. It goes on to describe a low-cost, narrative-based virtual patient simulation technique which has the potential for wide application within health and social care education. An example of the implementation of this technology in a web-based pilot course for acute mental health nurses is given. This particular virtual patient technique is a simulation type ideally suited to promoting essential mental health nursing skills such as critical thinking, communication and decision making. Furthermore, it is argued that it is particularly amenable to e-learning and blended learning environments, as well as being an apt tool where multilingual simulations are required. The continued development, implementation and evaluation of narrative virtual patient simulations across a variety of health and social care programmes would help ascertain their success as an educational tool. PMID:22070549

  17. Simulated Patient Studies: An Ethical Analysis

    PubMed Central

    Rhodes, Karin V; Miller, Franklin G

    2012-01-01

    Context In connection with health care reform, the U.S. Department of Health and Human Services commissioned a “mystery shopper,” or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over “government spying” on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. Methods We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Findings Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. Conclusions As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate

  18. Accessing primary care: a simulated patient study

    PubMed Central

    Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

    2013-01-01

    Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

  19. Rotorcraft Damage Tolerance Evaluated by Computational Simulation

    NASA Technical Reports Server (NTRS)

    Chamis, Christos C.; Minnetyan, Levon; Abdi, Frank

    2000-01-01

    An integrally stiffened graphite/epoxy composite rotorcraft structure is evaluated via computational simulation. A computer code that scales up constituent micromechanics level material properties to the structure level and accounts for all possible failure modes is used for the simulation of composite degradation under loading. Damage initiation, growth, accumulation, and propagation to fracture are included in the simulation. Design implications with regard to defect and damage tolerance of integrally stiffened composite structures are examined. A procedure is outlined regarding the use of this type of information for setting quality acceptance criteria, design allowables, damage tolerance, and retirement-for-cause criteria.

  20. Collision Avoidance for Airport Traffic Simulation Evaluation

    NASA Technical Reports Server (NTRS)

    Jones, Denise R.; Prinzel, Lawrence J., III; Shelton, Kevin J.; Bailey, Randall E.; Otero, Sharon D.; Barker, Glover D.

    2010-01-01

    A Collision Avoidance for Airport Traffic (CAAT) concept for the airport Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate pilot reaction to conflict events in the TMA near the airport, different alert timings for various scenarios, alerting display concepts, and directive alerting concepts. This paper gives an overview of the conflict detection and resolution (CD&R) concept, simulation study, and test results

  1. Runway Incursion Prevention System Simulation Evaluation

    NASA Technical Reports Server (NTRS)

    Jones, Denise R.

    2002-01-01

    A Runway Incursion Prevention System (RIPS) was evaluated in a full mission simulation study at the NASA Langley Research center in March 2002. RIPS integrates airborne and ground-based technologies to provide (1) enhanced surface situational awareness to avoid blunders and (2) alerts of runway conflicts in order to prevent runway incidents while also improving operational capability. A series of test runs was conducted in a high fidelity simulator. The purpose of the study was to evaluate the RIPS airborne incursion detection algorithms and associated alerting and airport surface display concepts. Eight commercial airline crews participated as test subjects completing 467 test runs. This paper gives an overview of the RIPS, simulation study, and test results.

  2. Physical fitness of young women: carrying simulated patients.

    PubMed

    von Restorff, W

    2000-06-01

    An evaluation of physical fitness prior to employment appears to be mandatory for several occupations in order to protect the employee from overburdening and the employer from placing excess demands on the employee. One such occupation seems to be that of the field medical specialist who needs special physical strength since terrain conditions deny wheel-assisted transport of stretcher patients. The anthropometric and isometric force data of a total of 62 female and 48 male recruits for the medical service of the Bundeswehr were evaluated, together with their ability to carry a patient on a stretcher (weight = 14 kg) within a gymnasium. Initially the 'casualties' were simulated by sandbags weighing 60, 70, 80 and 90 kg each on stretchers; subsequently equivalent-weight water cans were used. The tests were administered at the beginning and at the end of the general Basic Military Training (BMT). While all males were able to carry the simulated 90 kg patient, only 22 out of 62 female recruits were able to do so at the beginning of BMT. At the end, the number had improved to 29 out of 55 women soldiers completing training. At the beginning of BMT 22.5% of the women soldiers were unable to rescue a simulated 70 kg patient; at the end of BMT the number had fallen to 18%. The isometric force values as measured revealed the hand grip strength as the best predictor for the capacity to carry simulated 90 kg patients. It is, therefore, suggested that a hand strength test be administered prior to field medical specialist training in order to channel unsuitable candidates into other training schemes. PMID:10902883

  3. Simulation and evaluation of nuclear reaction spectra

    NASA Astrophysics Data System (ADS)

    Vizkelethy, G.

    1990-01-01

    A RUMP-like-[1] computer code was written for PCs in order to simulate and evaluate nuclear reaction spectra. The code was written in Turbo Pascal. Any particle-target combination can be used; the stopping power calculation based on the ZBL algorithm [2] and the cross sections are taken from experimental data. The effects of straggling and geometrical spread are included in the simulation. Examples are given for the 16O(d,P) 17O, 18O(P,α) 15N, 16O( 3He,α) 15O and 16O(α,α) 16O reactions and for ERDA measurements.

  4. Test of a Cardiology Patient Simulator with Students in Fourth-Year Electives.

    ERIC Educational Resources Information Center

    Ewy, Gordon A.; And Others

    1987-01-01

    Students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS), a life-size mannequin capable of simulating a wide variety of cardiovascular conditions. The CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation. (Author/MLW)

  5. Scripting Scenarios for the Human Patient Simulator

    NASA Technical Reports Server (NTRS)

    Bacal, Kira; Miller, Robert; Doerr, Harold

    2004-01-01

    The Human Patient Simulator (HPS) is particularly useful in providing scenario-based learning which can be tailored to fit specific scenarios and which can be modified in realtime to enhance the teaching environment. Scripting these scenarios so as to maximize learning requires certain skills, in order to ensure that a change in student performance, understanding, critical thinking, and/or communication skills results. Methods: A "good" scenario can be defined in terms of applicability, learning opportunities, student interest, and clearly associated metrics. Obstacles to such a scenario include a lack of understanding of the applicable environment by the scenario author(s), a desire (common among novices) to cover too many topics, failure to define learning objectives, mutually exclusive or confusing learning objectives, unskilled instructors, poor preparation , disorganized approach, or an inappropriate teaching philosophy (such as "trial by fire" or education through humiliation). Results: Descriptions of several successful teaching programs, used in the military, civilian, and NASA medical environments , will be provided, along with sample scenarios. Discussion: Simulator-based lessons have proven to be a time- and cost-efficient manner by which to educate medical personnel. Particularly when training for medical care in austere environments (pre-hospital, aeromedical transport, International Space Station, military operations), the HPS can enhance the learning experience.

  6. A Hierarchical Evaluation of Regional Climate Simulations

    SciTech Connect

    Leung, Lai-Yung R.; Ringler, Todd; Collins, William D.; Taylor, Mark; Ashfaq, Moetasim

    2013-08-20

    Global climate models (GCMs) are the primary tools for predicting the evolution of the climate system. Through decades of development, GCMs have demonstrated useful skill in simulating climate at continental to global scales. However, large uncertainties remain in projecting climate change at regional scales, which limit our ability to inform decisions on climate change adaptation and mitigation. To bridge this gap, different modeling approaches including nested regional climate models (RCMs), global stretch-grid models, and global high-resolution atmospheric models have been used to provide regional climate simulations (Leung et al. 2003). In previous efforts to evaluate these approaches, isolating their relative merits was not possible because factors such as dynamical frameworks, physics parameterizations, and model resolutions were not systematically constrained. With advances in high performance computing, it is now feasible to run coupled atmosphere-ocean GCMs at horizontal resolution comparable to what RCMs use today. Global models with local refinement using unstructured grids have become available for modeling regional climate (e.g., Rauscher et al. 2012; Ringler et al. 2013). While they offer opportunities to improve climate simulations, significant efforts are needed to test their veracity for regional-scale climate simulations.

  7. Does Training Learners on Simulators Benefit Real Patients?

    ERIC Educational Resources Information Center

    Teteris, Elise; Fraser, Kristin; Wright, Bruce; McLaughlin, Kevin

    2012-01-01

    Despite limited data on patient outcomes, simulation training has already been adopted and embraced by a large number of medical schools. Yet widespread acceptance of simulation should not relieve us of the duty to demonstrate if, and under which circumstances, training learners on simulation benefits real patients. Here we review the data on…

  8. Digital autopilots: Design considerations and simulator evaluations

    NASA Technical Reports Server (NTRS)

    Osder, S.; Neuman, F.; Foster, J.

    1971-01-01

    The development of a digital autopilot program for a transport aircraft and the evaluation of that system's performance on a transport aircraft simulator is discussed. The digital autopilot includes three axis attitude stabilization, automatic throttle control and flight path guidance functions with emphasis on the mode progression from descent into the terminal area through automatic landing. The study effort involved a sequence of tasks starting with the definition of detailed system block diagrams of control laws followed by a flow charting and programming phase and concluding with performance verification using the transport aircraft simulation. The autopilot control laws were programmed in FORTRAN 4 in order to isolate the design process from requirements peculiar to an individual computer.

  9. Presurgical Pulmonary Evaluation in Renal Transplant Patients

    PubMed Central

    Sahni, Sonu; Molmenti, Ernesto; Bhaskaran, Madhu C.; Ali, Nicole; Basu, Amit; Talwar, Arunabh

    2014-01-01

    Patients with chronic renal failure (CRF) due to various mechanisms are prone to significant pulmonary comorbidities. With the improvements in renal replacement therapy (RRT), patients with CRF are now expected to live longer, and thus may develop complications in the lung from these processes. The preferred treatment of CRF is kidney transplantation and patients who are selected to undergo transplant must have a thorough preoperative pulmonary evaluation to assess pulmonary status and to determine risk of postoperative pulmonary complications. A MEDLINE®/PubMed® search was performed to identify all articles outlining the course of pre-surgical pulmonary evaluation with an emphasis on patients with CRF who have been selected for renal transplant. Literature review concluded that in addition to generic pre-surgical evaluation, renal transplant patients must also undergo a full cardiopulmonary and sleep evaluation to investigate possible existing pulmonary pathologies. Presence of any risk factor should then be aggressively managed or treated prior to surgery. PMID:25599047

  10. Evaluating a Sexual Health Patient Education Resource

    PubMed Central

    Matzo, Marianne; Troup, Sandi; Hijjazi, Kamal; Ferrell, Betty

    2015-01-01

    This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncology professionals are committed to addressing quality-of-life concerns for patients across the trajectory of illness. Sexuality is a key concern for patients and impacts relationships and overall quality of life. Through careful assessment, patient education, and support, clinicians can ensure that sexuality is respected as an essential part of patient-centered care. PMID:26557411

  11. Does training learners on simulators benefit real patients?

    PubMed

    Teteris, Elise; Fraser, Kristin; Wright, Bruce; McLaughlin, Kevin

    2012-03-01

    Despite limited data on patient outcomes, simulation training has already been adopted and embraced by a large number of medical schools. Yet widespread acceptance of simulation should not relieve us of the duty to demonstrate if, and under which circumstances, training learners on simulation benefits real patients. Here we review the data on performance of healthcare providers or trainees following simulation training, and discuss ways of enhancing transfer of learning from simulated to real patients. While there is tremendous potential for simulation in medical education and healthcare, further studies are needed to identify if and when simulation training improves the quality of care delivered to patients, and to compare the cost-effectiveness of simulated learning experiences to lower fidelity and less expensive interventions. PMID:21630128

  12. Randomized controlled trial of high fidelity patient simulators compared to actor patients in a pandemic influenza drill scenario.

    PubMed

    Wallace, David; Gillett, Brian; Wright, Brian; Stetz, Jessica; Arquilla, Bonnie

    2010-07-01

    During disaster drills hospitals traditionally use actor victims. This has been criticized for underestimating true provider resource burden during surges; however, robotic patient simulators may better approximate the challenges of actual patient care. This study quantifies the disparity between the times required to resuscitate simulators and actors during a drill and compares the times required to perform procedures on simulator patients to published values for real patients. A randomized controlled trial was conducted during an influenza disaster drill. Twelve severe influenza cases were developed for inclusion in the study. Case scenarios were randomized to either human actor patients or simulator patients for drill integration. Clinical staff participating in the drill were blinded to the study objectives. The study was recorded by trained videographers and independently scored using a standardized form by two blinded attending physicians. All critical actions took longer to perform on simulator patients compared to actor patients. The median time to provide a definitive airway (8.9min vs. 3.2min, p=0.013), to initiate vasopressors through a central line (17.4min vs. 5.2min, p=0.01) and time to disposition (16.9min vs. 5.2min, p=0.01) were all significantly longer on simulator patients. Agreement between video reviewers was excellent, ranging between 0.95 and 1 for individual domain scores. Times required to perform procedures on simulators were similar to published results on real-world patients. Patient actors underestimate resource utilization in drills. Integration of high fidelity simulator patients is one way institutions can create more realistic challenges and better evaluate disaster scenario preparedness. PMID:20398993

  13. Critical Incident Nursing Management Using Human Patient Simulators.

    ERIC Educational Resources Information Center

    Nehring, Wendy M.; Lahsley, Felissa R.; Ellis, Wayne E.

    2002-01-01

    Human patient simulators are computerized mannequins that present patient scenarios in which nursing students learn to assess critical health incidents. Their use involves faculty time and commitment, maintenance and upgrading investment, and careful scenario preparation. (Contains 20 references.) (SK)

  14. Assessment of Human Patient Simulation-Based Learning

    PubMed Central

    Schwartz, Catrina R.; Odegard, Peggy Soule; Hammer, Dana P.; Seybert, Amy L.

    2011-01-01

    The most common types of assessment of human patient simulation are satisfaction and/or confidence surveys or tests of knowledge acquisition. There is an urgent need to develop valid, reliable assessment instruments related to simulation-based learning. Assessment practices for simulation-based activities in the pharmacy curricula are highlighted, with a focus on human patient simulation. Examples of simulation-based assessment activities are reviewed according to type of assessment or domain being assessed. Assessment strategies are suggested for faculty members and programs that use simulation-based learning. PMID:22345727

  15. Acoustic simulation of a patient's obstructed airway.

    PubMed

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound. PMID:25567545

  16. Computational tool for modeling and simulation of mechanically ventilated patients.

    PubMed

    Serna, Leidy Y; Hernandez, Alher M; Mananas, Miguel A

    2010-01-01

    The mechanical ventilator settings in patients with respiratory diseases like chronic obstructive pulmonary disease (COPD) during episodes of acute respiratory failure (ARF) is not a simple task that in most cases is successful based on the experience of physicians. This paper describes an interactive tool based in mathematical models, developed to make easier the study of the interaction between a mechanical ventilator and a patient. It describes all stages of system development, including simulated ventilatory modes, the pathologies of interest and interaction between the user and the system through a graphical interface developed in Matlab and Simulink. The developed computational tool allows the study of most widely used ventilatory modes and its advantages in the treatment of different kind of patients. The graphical interface displays all variables and parameters in the common way of last generation mechanical ventilators do and it is totally interactive, making possible its use by clinical personal, hiding the complexity of implemented mathematical models to the user. The evaluation in different clinical simulated scenes adjusts properly with recent findings in mechanical ventilation scientific literature. PMID:21096101

  17. Evaluations of CMIP5 simulations over cropland

    NASA Astrophysics Data System (ADS)

    Xu, Min; Hoffman, Forrest

    2015-09-01

    Cropland is the major source of carbon lost to the atmosphere and contribute directly to emissions of greenhouse gases. There is, however, large potential for cropland to reduce its carbon ux to the atmosphere and sequester soil carbon through soil and crop managements. The managements include no-tillage, perennial and/or deep root crops, irrigation, and organic fertilization etc. But these estimations over cropland remain largest uncertain among all other terrestrial biomes. In most models in CMIP5, the cropland is generally treated similarly as grassland without accounting for realistic crop phenology and physiology processes and crop and soil manage- ments. In this study, we will evaluate how well cropland is represented in CMIP5 simulations and how to improve the representations and reduce the uncertainties over cropland. We will compare the modeled biogeochemical variables against multiple observational data including various remote sensing products and in-situ data.

  18. JT15D simulated flight data evaluation

    NASA Technical Reports Server (NTRS)

    Holm, R. G.

    1984-01-01

    The noise characteristics of the JT15D turbofan engine was analyzed with the objectives of: (1) assessing the state-of-art ability to simulate flight acoustic data using test results acquired in wind tunnel and outdoor (turbulence controlled) environments; and (2) predicting the farfield noise directivity of the blade passage frequency (BPF) tonal components using results from rotor blade mounted dynamic pressure instrumentation. Engine rotor tip speeds at subsonic, transonic, and supersonic conditions were evaluated. The ability to simulate flight results was generally within 2-3 dB for both outdoor and wind tunnel acoustic results. Some differences did occur in the broadband noise level and in the multiple-pure-tone harmonics at supersonic tip speeds. The prediction of blade passage frequency tone directivity from dynamic pressure measurements was accomplished for the three tip speed conditions. Predictions were made of the random and periodic components of the tone directivity. The technique for estimating the random tone component used hot wire data to establish a correlation between dynamic pressure and turbulence intensity. This prediction overestimated the tone level by typically 10 dB with the greatest overestimates occurring at supersonic conditions.

  19. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

    PubMed Central

    2011-01-01

    Background Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. Methods A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team. Results Data from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p < 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery. Conclusion The main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient

  20. Rituals of verification: the role of simulation in developing and evaluating empathic communication.

    PubMed

    Wear, Delese; Varley, Joseph D

    2008-05-01

    The use of simulation and standardized patients in medical education is firmly established. In this "point-counterpoint" format we debate not their important function but the extent to which they are used to establish "evidence" for trainees' empathic communication skills beyond their surface manifestations. We also question such issues as the power dynamics implicit in simulation when patients are not really worried or dependent but rather students who are under the evaluative surveillance gaze, often relying on formulaic and superficial behaviors associated with good communication. We offer educative experiences in narrative domains as opportunities to develop the habits of thinking and authentic feeling often absent in evaluative-based simulations. PMID:18282681

  1. The Impact of Human Patient Simulation on Nursing Clinical Knowledge

    ERIC Educational Resources Information Center

    Shinnick, Mary Ann

    2010-01-01

    Public health relies on well trained nurses and clinical experience is an important component of that training. However, clinical experience training for student nurses also has significant challenges, as it can place patients at risk. Also it is difficult to schedule/predict patient conditions and procedures. Human patient simulation (HPS) can…

  2. Preoperative Evaluation of the Surgical Patient.

    PubMed

    O'Donnell, Frederick T

    2016-01-01

    Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative testing and health care expenditures. Physicians have additional incentives to improve health care delivery and reduce costs. The perioperative surgical home concept involves coordinating all aspects of patient care, including behavioral modifications, during the perioperative period. Evidence-based guidelines on preoperative evaluation are available to assist practitioners in managing cardiovascular disease, and communicating surgical risks. Shared decision making in the preoperative period can improve surgical outcomes and patient satisfaction. PMID:27443045

  3. Do Simulations Enhance Student Learning? An Empirical Evaluation of an IR Simulation

    ERIC Educational Resources Information Center

    Shellman, Stephen M.; Turan, Kursad

    2006-01-01

    There is a nascent literature on the question of whether active learning methods, and in particular simulation methods, enhance student learning. In this article, the authors evaluate the utility of an international relations simulation in enhancing learning objectives. Student evaluations provide evidence that the simulation process enhances…

  4. Improving Patient Safety through Simulation Training in Anesthesiology: Where Are We?

    PubMed

    Green, Michael; Tariq, Rayhan; Green, Parmis

    2016-01-01

    There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement in patient outcomes are needed to justify the integration of simulation training in resident education but ample number of studies in the past 5 years do show a definite benefit of using simulation in anesthesiology training. This paper gives a brief overview of the history and evolution of use of simulation in anesthesiology and highlights some of the more recent studies that have advanced simulation-based training. PMID:26949389

  5. Developing and Evaluating Patient Education Materials.

    ERIC Educational Resources Information Center

    Monsivais, Diane; Reynolds, Audree

    2003-01-01

    Discusses the rationale for nurse involvement in the development of patient education materials. Presents guidelines for evaluating existing material, including print and web resources, for credibility and readability. Makes recommendations for rewriting material at an easier-to-read level. (SK)

  6. Allergic contact dermatitis: Patient diagnosis and evaluation.

    PubMed

    Mowad, Christen M; Anderson, Bryan; Scheinman, Pamela; Pootongkam, Suwimon; Nedorost, Susan; Brod, Bruce

    2016-06-01

    Allergic contact dermatitis resulting from exposure to a chemical or chemicals is a common diagnosis in the dermatologist's office. We are exposed to hundreds of potential allergens daily. Patch testing is the criterion standard for diagnosing the causative allergens responsible for allergic contact dermatitis. Patch testing beyond standard trays is often needed to fully diagnose patients, but not all dermatology practices have access to this testing procedure or these allergens. In order to adequately evaluate patients, physicians must understand the pathophysiology of the disease process and be well versed in the proper evaluation of patients, indications for patch testing, proper testing procedure, and other diagnostic tools available and be aware of new and emerging allergens. PMID:27185421

  7. Use of simulated patients and reflective video analysis to assess occupational therapy students' preparedness for fieldwork.

    PubMed

    Giles, Amanda K; Carson, Nancy E; Breland, Hazel L; Coker-Bolt, Patty; Bowman, Peter J

    2014-01-01

    Educators must determine whether occupational therapy students are adequately prepared for Level II fieldwork once they have successfully completed the didactic portion of their coursework. Although studies have shown that students regard the use of video cameras and simulated patient encounters as useful tools for assessing professional and clinical behaviors, little has been published in the occupational therapy literature regarding the practical application of simulated patients or reflective video analysis. We describe a model for a final Comprehensive Practical Exam that uses both simulated patients and reflective video analysis to assess student preparedness for Level II fieldwork, and we report on student perceptions of these instructional modalities. We provide recommendations for designing, implementing, and evaluating simulated patient experiences in light of existing educational theory. PMID:25397940

  8. Simulation in nursing practice: the impact on patient care.

    PubMed

    Aebersold, Michelle; Tschannen, Dana

    2013-01-01

    Simulation has a well-known history in the military, nuclear power, and aviation. It is also a recommended teaching and learning strategy supported by several landmark studies. Although in the past 20 years simulation has become more integrated into the education of nurses and physicians, it has not been as well integrated into the development of skills for practicing nurses. This article will provide an overview of simulation techniques and uses and review of selected simulation research. Despite recommendations for using simulation and growing integration of simulation into education, we still lack empirical evidence of its impact on patient outcomes. Our discussion provides a review of the current uses of simulation in the nursing practice environment with several exemplars and offers recommendations to develop a simulation program. PMID:23758424

  9. Field Evaluation of a General Purpose Simulator.

    ERIC Educational Resources Information Center

    Spangenberg, Ronald W.

    The use of a general purpose simulator (GPS) to teach Air Force technicians diagnostic and repair procedures for specialized aircraft radar systems is described. An EC II simulator manufactured by Educational Computer Corporation was adapted to resemble the actual configuration technicians would encounter in the field. Data acquired in the…

  10. Criterion Standards for Evaluating Computer Simulation Courseware.

    ERIC Educational Resources Information Center

    Wholeben, Brent Edward

    This paper explores the role of computerized simulations as a decision-modeling intervention strategy, and views the strategy's different attribute biases based upon the varying primary missions of instruction versus application. The common goals associated with computer simulations as a training technique are discussed and compared with goals of…

  11. Feasibility of patient specific aortic blood flow CFD simulation.

    PubMed

    Svensson, Johan; Gårdhagen, Roland; Heiberg, Einar; Ebbers, Tino; Loyd, Dan; Länne, Toste; Karlsson, Matts

    2006-01-01

    Patient specific modelling of the blood flow through the human aorta is performed using computational fluid dynamics (CFD) and magnetic resonance imaging (MRI). Velocity patterns are compared between computer simulations and measurements. The workflow includes several steps: MRI measurement to obtain both geometry and velocity, an automatic levelset segmentation followed by meshing of the geometrical model and CFD setup to perform the simulations follwed by the actual simulations. The computational results agree well with the measured data. PMID:17354898

  12. Evaluating uncertainty in stochastic simulation models

    SciTech Connect

    McKay, M.D.

    1998-02-01

    This paper discusses fundamental concepts of uncertainty analysis relevant to both stochastic simulation models and deterministic models. A stochastic simulation model, called a simulation model, is a stochastic mathematical model that incorporates random numbers in the calculation of the model prediction. Queuing models are familiar simulation models in which random numbers are used for sampling interarrival and service times. Another example of simulation models is found in probabilistic risk assessments where atmospheric dispersion submodels are used to calculate movement of material. For these models, randomness comes not from the sampling of times but from the sampling of weather conditions, which are described by a frequency distribution of atmospheric variables like wind speed and direction as a function of height above ground. A common characteristic of simulation models is that single predictions, based on one interarrival time or one weather condition, for example, are not nearly as informative as the probability distribution of possible predictions induced by sampling the simulation variables like time and weather condition. The language of model analysis is often general and vague, with terms having mostly intuitive meaning. The definition and motivations for some of the commonly used terms and phrases offered in this paper lead to an analysis procedure based on prediction variance. In the following mathematical abstraction the authors present a setting for model analysis, relate practical objectives to mathematical terms, and show how two reasonable premises lead to a viable analysis strategy.

  13. Evaluation of internet derived patient information

    PubMed Central

    Ward, JBM; Leach, P

    2012-01-01

    INTRODUCTION The internet is a widely used, powerful resource for patients to research medical conditions. There is an extensive amount of information available on the internet. It is important for patient information to be accurate and in an easily accessible format. This article aims to assess the quality of patient information on hydrocephalus and compares the findings with recent evaluations in other surgical specialties. METHODS The term ‘hydrocephalus’ was searched for on the search engines http://www.google.com/, http://www.bing.com/ and http://www.yahoo.com/. The top 20 results of these searches were assessed using the University of Michigan consumer health website evaluation checklist. RESULTS The quality of patient information websites on hydrocephalus is highly variable. Websites rarely provide sufficient authorship information, do not review their information regularly enough and only reference material occasionally. The background of the provider was found to influence the quality of the website, with academic and care providers creating the best websites. CONCLUSIONS On comparing our findings with those of recent studies from other surgical specialties, it was found that there was often a conflict of interest between the background of the provider and the information supplied. It is recommended that clinicians personally research material for their patients to be able to guide them to suitable, accurate websites. PMID:22943222

  14. Evaluation of Computer Simulations for Teaching Apparel Merchandising Concepts.

    ERIC Educational Resources Information Center

    Jolly, Laura D.; Sisler, Grovalynn

    1988-01-01

    The study developed and evaluated computer simulations for teaching apparel merchandising concepts. Evaluation results indicated that teaching method (computer simulation versus case study) does not significantly affect cognitive learning. Student attitudes varied, however, according to topic (profitable merchandising analysis versus retailing…

  15. Psychological Evaluation of Patients Seeking Rhinoplasty

    PubMed Central

    Kucur, Cuneyt; Kuduban, Ozan; Ozturk, Ahmet; Gozeler, Mustafa Sitki; Ozbay, Isa; Deveci, Erdem; Simsek, Eda; Kaya, Zulkuf

    2016-01-01

    Objective: The aim of this study was to evaluate different determinants of the patient’s psychosocial functioning that might possibly affect the outcome of rhinoplastic surgery. Materials and Methods: Forty-one patients undergoing rhinoplasty, consecutively admitted to and operated upon at the Department of Otolaryngology, Erzurum Regional Training and Research Hospital, Turkey, were studied with regard to their psychological characteristics. Results: In the patient group, Liebowitz anxiety, Liebowitz/avoidance, and Liebowitz/total scores were significantly higher than the control group (p<0.001). No significant differences were found between the patient and control groups according to Rosenberg self-esteem scale and The Hospital Anxiety and Depression Scale. In the Quality of Life SF-36 results, significant differences were found between the patient and control groups apart from SF-36 scores of pain (p<0.05), vitality (p<0.05), social functioning (p<0.05) and emotional role difficulties (p<0.05). Conclusion: Patient selection must be done very carefully to obviate not only physical, but also psychological postoperative complications. The SF-36 questionnaire may be of value in screening-patients for psychological problems prior to rhinoplasty. PMID:27551172

  16. Evaluating rotational diffusion from protein MD simulations.

    PubMed

    Wong, Vance; Case, David A

    2008-05-15

    It is now feasible to carry out molecular dynamics simulations of proteins in water that are long compared to the overall tumbling of the molecule. Here, we examine rotational diffusion in four small, globular proteins (ubiquitin, binase, lysozyme, and fragment B3 of protein G) with the TIP3P, TIP4P/EW, and SPC/E water models, in simulations that are 6 to 60 times as long as the mean rotational tumbling time. We describe a method for extracting diffusion tensors from such simulations and compare the results to experimental values extracted from NMR relaxation measurements. The simulation results accurately follow a diffusion equation, even for spherical harmonic correlation functions with l as large as 8. However, the best-fit tensors are significantly different from experiment, especially for the commonly used TIP3P water model. Simulations that are 20 to 100 times longer than the rotational tumbling times are needed for good statistics. A number of residues exhibit internal motions on the nanosecond time scale, but in all cases examined here, a product of internal and overall time-correlation functions matches the total time-correlation function well. PMID:18052365

  17. Evaluation of atopy in patients with COPD*

    PubMed Central

    Neves, Margarida Célia Lima Costa; Neves, Yuri Costa Sarno; Mendes, Carlos Mauricio Cardeal; Bastos, Monalisa Nobre; Camelier, Aquiles Assunção; Queiroz, Cleriston Farias; Mendoza, Bernardo Fonseca; Lemos, Antônio Carlos Moreira; Junior, Argemiro D'Oliveira

    2013-01-01

    OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. PMID:23857681

  18. Evaluations of others by borderline patients.

    PubMed

    Arntz, A; Veen, G

    2001-08-01

    This study investigated evaluations of other people in specific emotional situations by patients with borderline personality disorder (BPD). BPD patients (N = 16), control patients with cluster C personality disorder (PD; N = 12) and normal controls (N = 15) saw film clips with emotional themes centering on abandonment, rejection and abuse, hypothesized to be specific for borderline pathology. Subjects wrote down their spontaneous reactions to six film personalities, divided over three clips, including what they thought to be characteristic traits of these persons. Spontaneous reactions were coded on two dimensions, based on earlier studies by Westen and colleagues: a) affect-tone of ascribed qualities and b) complexity of evaluations of people. The number of trait dimensions constituted the third scale. The overall pattern of findings suggests that the BPD group, as well as the cluster C group, show poorly differentiated evaluations with a low number of dimensions. Thus, this seems characteristic for personality disorders in general. The BPD group shows a lower affect-tone, reflecting a stronger tendency to view others negatively, compared with both control groups. PMID:11531203

  19. Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

    PubMed Central

    Meyer, Susan M.

    2014-01-01

    Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

  20. Evaluation of coupling approaches for thermomechanical simulations

    DOE PAGESBeta

    Novascone, S. R.; Spencer, B. W.; Hales, J. D.; Williamson, R. L.

    2015-08-10

    Many problems of interest, particularly in the nuclear engineering field, involve coupling between the thermal and mechanical response of an engineered system. The strength of the two-way feedback between the thermal and mechanical solution fields can vary significantly depending on the problem. Contact problems exhibit a particularly high degree of two-way feedback between those fields. This paper describes and demonstrates the application of a flexible simulation environment that permits the solution of coupled physics problems using either a tightly coupled approach or a loosely coupled approach. In the tight coupling approach, Newton iterations include the coupling effects between all physics,more » while in the loosely coupled approach, the individual physics models are solved independently, and fixed-point iterations are performed until the coupled system is converged. These approaches are applied to simple demonstration problems and to realistic nuclear engineering applications. The demonstration problems consist of single and multi-domain thermomechanics with and without thermal and mechanical contact. Simulations of a reactor pressure vessel under pressurized thermal shock conditions and a simulation of light water reactor fuel are also presented. Here, problems that include thermal and mechanical contact, such as the contact between the fuel and cladding in the fuel simulation, exhibit much stronger two-way feedback between the thermal and mechanical solutions, and as a result, are better solved using a tight coupling strategy.« less

  1. Evaluation of coupling approaches for thermomechanical simulations

    SciTech Connect

    Novascone, S. R.; Spencer, B. W.; Hales, J. D.; Williamson, R. L.

    2015-08-10

    Many problems of interest, particularly in the nuclear engineering field, involve coupling between the thermal and mechanical response of an engineered system. The strength of the two-way feedback between the thermal and mechanical solution fields can vary significantly depending on the problem. Contact problems exhibit a particularly high degree of two-way feedback between those fields. This paper describes and demonstrates the application of a flexible simulation environment that permits the solution of coupled physics problems using either a tightly coupled approach or a loosely coupled approach. In the tight coupling approach, Newton iterations include the coupling effects between all physics, while in the loosely coupled approach, the individual physics models are solved independently, and fixed-point iterations are performed until the coupled system is converged. These approaches are applied to simple demonstration problems and to realistic nuclear engineering applications. The demonstration problems consist of single and multi-domain thermomechanics with and without thermal and mechanical contact. Simulations of a reactor pressure vessel under pressurized thermal shock conditions and a simulation of light water reactor fuel are also presented. Here, problems that include thermal and mechanical contact, such as the contact between the fuel and cladding in the fuel simulation, exhibit much stronger two-way feedback between the thermal and mechanical solutions, and as a result, are better solved using a tight coupling strategy.

  2. Using Simulated Patients to Train Physicians in Sexual Risk Assessment and Risk Reduction.

    ERIC Educational Resources Information Center

    Gonzalez-Willis, Angela; And Others

    1990-01-01

    The objectives of this preliminary study were to evaluate the feasibility and acceptability of using trained simulated patient instructors (N=6) as an office-based continuing medical education method and to assess the current sexually transmitted diseases/human immunodeficiency virus risk assessment and counseling practices of primary care…

  3. Lost in translation: using bilingual simulated patients to improve consulting across language barriers.

    PubMed

    Escott, Sarah; Lucas, Beverley; Pearson, David

    2009-03-01

    In the light of rapid demographic change and increased globalisation of health, ways to consult effectively across language barriers are increasingly important. This article describes the development, organisation and evaluation of a UK workshop designed to develop the skills of undergraduate medical students consulting with patients with limited English proficiency, using specially recruited and trained bilingual simulated patients. The authors discuss the advantages and areas for development of the approach, before considering possible future developments. PMID:19519992

  4. Energy Navigation: Simulation Evaluation and Benefit Analysis

    NASA Technical Reports Server (NTRS)

    Williams, David H.; Oseguera-Lohr, Rosa M.; Lewis, Elliot T.

    2011-01-01

    This paper presents results from two simulation studies investigating the use of advanced flight-deck-based energy navigation (ENAV) and conventional transport-category vertical navigation (VNAV) for conducting a descent through a busy terminal area, using Continuous Descent Arrival (CDA) procedures. This research was part of the Low Noise Flight Procedures (LNFP) element within the Quiet Aircraft Technology (QAT) Project, and the subsequent Airspace Super Density Operations (ASDO) research focus area of the Airspace Project. A piloted simulation study addressed development of flight guidance, and supporting pilot and Air Traffic Control (ATC) procedures for high density terminal operations. The procedures and charts were designed to be easy to understand, and to make it easy for the crew to make changes via the Flight Management Computer Control-Display Unit (FMC-CDU) to accommodate changes from ATC.

  5. Patient Simulation Software to Augment an Advanced Pharmaceutics Course

    PubMed Central

    Schonder, Kristine

    2011-01-01

    Objective To implement and assess the effectiveness of adding a pharmaceutical care simulation program to an advanced therapeutics course. Design PharmaCAL (University of Pittsburgh), a software program that uses a branched-outcome decision making model, was used to create patient simulations to augment lectures given in the course. In each simulation, students were presented with a challenge, given choices, and then provided with consequences specific to their choices. Assessments A survey was administered at the end of the course and students indicated the simulations were enjoyable (92%), easy to use (90%), stimulated interest in critically ill patients (82%), and allowed for application of lecture material (91%). A 5-item presimulation and postsimulation test on the anemia simulation was administered to assess learning. Students answered significantly more questions correctly on the postsimulation test than on the presimulation test (p < 0.001). Seventy-eight percent of students answered the same 5 questions correctly on the final examination. Conclusion Patient simulation software that used a branched-outcome decision model was an effective supplement to class lectures in an advanced pharmaceutics course and was well-received by pharmacy students. PMID:21519411

  6. Development and Formative Evaluation of Computer Simulated College Chemistry Experiments.

    ERIC Educational Resources Information Center

    Cavin, Claudia S.; Cavin, E. D.

    1978-01-01

    This article describes the design, preparation, and initial evaluation of a set of computer-simulated chemistry experiments. The experiments entailed the use of an atomic emission spectroscope and a single-beam visible absorption spectrophometer. (Author/IRT)

  7. Using Simulation for Launch Team Training and Evaluation

    NASA Technical Reports Server (NTRS)

    Peaden, Cary J.

    2005-01-01

    This document describes some of the histor y and uses of simulation systems and processes for the training and evaluation of Launch Processing, Mission Control, and Mission Management teams. It documents some of the types of simulations that are used at Kennedy Space Center (KSC) today and that could be utilized (and possibly enhanced) for future launch vehicles. This article is intended to provide an initial baseline for further research into simulation for launch team training in the near future.

  8. Evaluating a Cross-Continent EU Simulation

    ERIC Educational Resources Information Center

    Jones, Rebecca

    2008-01-01

    Assessment of learning outcomes and evaluation of teaching methods are necessary in order to ensure that students are learning the lessons that faculty believe they are conveying. Quantitative data on the effectiveness of various pedagogical methods allows faculty to make adjustments to classes over time. Regular assessment of student learning…

  9. Preliminary Evaluation of a Computer Simulation of Long Cane Use.

    ERIC Educational Resources Information Center

    Chubon, Robert A.; Keith, Ashley D.

    1989-01-01

    Developed and evaluated long cane mobility computer simulation as visual rehabilitation training device and research tool in graduate students assigned to instruction (BI) (N=10) or enhanced instruction (EI) (N=9). Found higher percentage of EI students completed simulation task. Concluded that students registered positive understanding changes,…

  10. Wavefront error simulator for evaluating optical testing instrumentation

    NASA Technical Reports Server (NTRS)

    Golden, L. J.

    1975-01-01

    A wavefront error simulator has been designed and fabricated to evaluate experimentally test instrumentation for the Large Space Telescope (LST) program. The principal operating part of the simulator is an aberration generator that introduces low-order aberrations of several waves magnitude with an incremented adjustment capability of lambda/100. Each aberration type can be introduced independently with any desired spatial orientation.

  11. Scheduling Patients' Appointments: Allocation of Healthcare Service Using Simulation Optimization.

    PubMed

    Chenl, Ping-Shun; Robielos, Rex Aurelius C; Palaña, Philline Kate Vera C; Valencia, Pierre Lorenzo L; Chen, Gary Yu-Hsin

    2015-01-01

    In the service industry, scheduling medical procedures causes difficulties for both patients and management. Factors such as fluctuations in customer demand and service time affect the appointment scheduling systems' performance in terms of, for example, patients' waiting time, idle time of resources, and total cost/profits. This research implements four appointment scheduling policies, i.e., constant arrival, mixed patient arrival, three-section pattern arrival, and irregular arrival, in an ultrasound department of a hospital in Taiwan. By simulating the four implemented policies' optimization procedures, optimal or near-optimal solutions can be obtained for patients per arrival, patients' inter-arrival time, and the number of the time slots for arrived patients. Furthermore, three objective functions are tested, and the results are discussed. The managerial implications and discussions are summarized to demonstrate how outcomes can be useful for hospital managers seeking to allocate their healthcare service capacities. PMID:26288890

  12. Test and evaluation of the generalized gate logic system simulator

    NASA Technical Reports Server (NTRS)

    Miner, Paul S.

    1991-01-01

    The results of the initial testing of the Generalized Gate Level Logic Simulator (GGLOSS) are discussed. The simulator is a special purpose fault simulator designed to assist in the analysis of the effects of random hardware failures on fault tolerant digital computer systems. The testing of the simulator covers two main areas. First, the simulation results are compared with data obtained by monitoring the behavior of hardware. The circuit used for these comparisons is an incomplete microprocessor design based upon the MIL-STD-1750A Instruction Set Architecture. In the second area of testing, current simulation results are compared with experimental data obtained using precursors of the current tool. In each case, a portion of the earlier experiment is confirmed. The new results are then viewed from a different perspective in order to evaluate the usefulness of this simulation strategy.

  13. Shuttle rendezvous radar performance evaluation and simulation

    NASA Technical Reports Server (NTRS)

    Griffin, John W.; Lindberg, Andrew C.; Ahn, Thomas B.; Harton, Paul L.

    1988-01-01

    The US Space Shuttle's Ku-band system was specifically designed for communications and tracking functions which are required during on-orbit operations with other spacecraft. Operating modes permit search and acquisition to be accomplished by computer designation or under manual control by the astronaut. Ku-band system data channels drive on-board dedicated displays and are incorporated into state vector updates by Shuttle guidance and navigation computers. Radar-cross-section estimates were used in computer simulations to predict the range at which radar detection and acquisition can be expected. Validity of the simulationi model and the radar design and performance were verified by flight tests on the White Sands test range. It is concluded that results of the testing established confidence in the capability of the system to provide the relative position and rate information which is needed for Shuttle work involving other spacecraft.

  14. Assessment of robotic patient simulators for training in manual physical therapy examination techniques.

    PubMed

    Ishikawa, Shun; Okamoto, Shogo; Isogai, Kaoru; Akiyama, Yasuhiro; Yanagihara, Naomi; Yamada, Yoji

    2015-01-01

    Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard. PMID:25923719

  15. Assessment of Robotic Patient Simulators for Training in Manual Physical Therapy Examination Techniques

    PubMed Central

    Ishikawa, Shun; Okamoto, Shogo; Isogai, Kaoru; Akiyama, Yasuhiro; Yanagihara, Naomi; Yamada, Yoji

    2015-01-01

    Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard. PMID:25923719

  16. [Evaluation and first aid of burned patients].

    PubMed

    Wassermann, Daniel

    2002-12-15

    First cares of burned patients depend of an accurate evaluation of the injury severity. Total body surface area burned can be estimated taking into account the fact that the area of one hand face is equivalent to 1% of the total body surface (TBS) of the individual. Second-degree burns are characterized by the occurrence of phlyctena, third-degree burns appear like adhering necrosis without any sensibility. Smoke inhalation injuries are frequent and can be recognized on the presence of tare deposits inside the mouse and on the respiratory conducts. Taking care of the patient begins with making the victim safe from the thermal aggression. Then, cooling the burn is to be performed. The emergency medical care consists in securing respiratory function, and, as early as possible, in beginning perfusions of Ringer Lactate Lavoisier exceeding 20 mL/kg during the first post-burn hours for patient suffering of burns exceeding 10% of the total body area. Pain must be controlled using preferentially morphine or related products. Transport to the specialized unit, in case of severe injury, will be performed assuring thermal comfort, wound protection and vital function monitoring. PMID:12621940

  17. Evaluation of effective dose with chest digital tomosynthesis system using Monte Carlo simulation

    NASA Astrophysics Data System (ADS)

    Kim, Dohyeon; Jo, Byungdu; Lee, Youngjin; Park, Su-Jin; Lee, Dong-Hoon; Kim, Hee-Joung

    2015-03-01

    Chest digital tomosynthesis (CDT) system has recently been introduced and studied. This system offers the potential to be a substantial improvement over conventional chest radiography for the lung nodule detection and reduces the radiation dose with limited angles. PC-based Monte Carlo program (PCXMC) simulation toolkit (STUK, Helsinki, Finland) is widely used to evaluate radiation dose in CDT system. However, this toolkit has two significant limits. Although PCXMC is not possible to describe a model for every individual patient and does not describe the accurate X-ray beam spectrum, Geant4 Application for Tomographic Emission (GATE) simulation describes the various size of phantom for individual patient and proper X-ray spectrum. However, few studies have been conducted to evaluate effective dose in CDT system with the Monte Carlo simulation toolkit using GATE. The purpose of this study was to evaluate effective dose in virtual infant chest phantom of posterior-anterior (PA) view in CDT system using GATE simulation. We obtained the effective dose at different tube angles by applying dose actor function in GATE simulation which was commonly used to obtain the medical radiation dosimetry. The results indicated that GATE simulation was useful to estimate distribution of absorbed dose. Consequently, we obtained the acceptable distribution of effective dose at each projection. These results indicated that GATE simulation can be alternative method of calculating effective dose in CDT applications.

  18. Debriefing after Human Patient Simulation and Nursing Students' Learning

    ERIC Educational Resources Information Center

    Benhuri, Gloria

    2014-01-01

    Human Patient Simulation (HPS) exercises with life-like computerized manikins provide clinical experiences for nursing students in a safe environment followed by debriefing that promotes learning. Quantitative research in techniques to support learning from debriefing is limited. The purpose of the quantitative quasi-experimental study using a…

  19. Methodology development for evaluation of selective-fidelity rotorcraft simulation

    NASA Technical Reports Server (NTRS)

    Lewis, William D.; Schrage, D. P.; Prasad, J. V. R.; Wolfe, Daniel

    1992-01-01

    This paper addressed the initial step toward the goal of establishing performance and handling qualities acceptance criteria for realtime rotorcraft simulators through a planned research effort to quantify the system capabilities of 'selective fidelity' simulators. Within this framework the simulator is then classified based on the required task. The simulator is evaluated by separating the various subsystems (visual, motion, etc.) and applying corresponding fidelity constants based on the specific task. This methodology not only provides an assessment technique, but also provides a technique to determine the required levels of subsystem fidelity for a specific task.

  20. Vestibular models for design and evaluation of flight simulator motion

    NASA Technical Reports Server (NTRS)

    Bussolari, S. R.; Sullivan, R. B.; Young, L. R.

    1986-01-01

    The use of spatial orientation models in the design and evaluation of control systems for motion-base flight simulators is investigated experimentally. The development of a high-fidelity motion drive controller using an optimal control approach based on human vestibular models is described. The formulation and implementation of the optimal washout system are discussed. The effectiveness of the motion washout system was evaluated by studying the response of six motion washout systems to the NASA/AMES Vertical Motion Simulator for a single dash-quick-stop maneuver. The effects of the motion washout system on pilot performance and simulator acceptability are examined. The data reveal that human spatial orientation models are useful for the design and evaluation of flight simulator motion fidelity.

  1. Development and validation of virtual driving simulator for the spinal injury patient.

    PubMed

    Ku, Jeong H; Jang, Dong P; Lee, Bum S; Lee, Jae H; Kim, In Y; Kim, Sun I

    2002-04-01

    We developed a virtual reality (VR) driving simulator in order to safely evaluate and improve the driving ability of spinal injury patients. The simulator is composed of an actual car, a beam projector, and a large screen. For the interface of our driving simulator, an actual car was adapted and then connected to a computer. We equipped the car with hand control driving devices especially adapted for spinal injury patients. A beam projector was used so that the subjects could see the virtual scene on a large screen set up in front of them. The virtual environment (VE) consisted of 18 sections (e.g., a speed-limited road, a straight road, a curved road, a left turn) and each section was linked naturally to the next. The subjects selected for this trial were 10 normal drivers with valid driving licenses and 15 patients with thoracic or lumbar cord injuries who had prior driving experience. For evaluation, five driving skills were measured, including average speed, steering stability, centerline violations, traffic signal violations, and driving time in various road conditions such as straight and curved roads. The normal subjects manipulated the gas pedal and the brake with their feet, while the patients manipulated a hand control with their hands. After they finished driving the whole course, the participants answered the questions such as "How realistic did the virtual reality driving simulator seem to you?" and "How much was your fear reduced?" In this study, we found that the difference in manipulation method (i.e., the patient group's hand control versus the normal driver's foot controls) does not seem to influence relative performance in the VR driving simulator, though training to improve the use of hand controls in the VR driving simulator would be useful to reduce the fear that the patients feel while driving. PMID:12025882

  2. Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement

    PubMed Central

    Gallimore, Casey E.; Pitterle, Michael; Morrill, Josh

    2016-01-01

    Objective. To evaluate online case simulation vs a paper case on student confidence and engagement. Design. Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. Assessment. A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. Conclusion. Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management. PMID:26941442

  3. Effectiveness evaluation of simulative workshops for newly licensed drivers.

    PubMed

    Rosenbloom, Tova; Eldror, Ehud

    2014-02-01

    The current study set to examine the effects of simulator use in driving instruction on newly licensed drivers, comparing the road safety knowledge and reported intended behavior, as well as the actual driving performance of new drivers. Participants consisted of 280 newly licensed driver, of which 140 whose drivers license training included additional simulator-based lessons, and 140 drivers whose training precluded simulator-based lessons. All drivers answered questionnaires pertaining to their intended safe driving behaviors (according to Ajzen's (2000) theory of planned behavior), and to their traffic safety knowledge. Of the initial sample, 40 drivers received actual driving performance evaluation by an expert driving instructor, as well as by in-vehicle data recorders (IVDRs). We assumed that safer drivers report safer driving intentions, demonstrate greater traffic safety knowledge, evaluated as safer drivers by the driving instructor, and display lower and stable driving parameters on the IVDRs. We hypothesized that theoretical driving studies combined with practical training on simulators will elevate the safety level of novices driving. Hierarchical regression analyses on driving intentions indicated that drivers who did not receive simulator-based lessons demonstrated safer driving intentions compared to drivers who received simulator-based lessons. This pattern possibly indicating the drivers who received simulator-based lessons felt more confident in their driving abilities compared to drivers who did not receive simulated training. No significant difference was found in traffic safety knowledge, or in the evaluation of the expert driving instructor. IDVR data comparisons indicated drivers who received simulator-based lessons braked more often and were less prone to headway events, suggesting a more responsive driving style. These findings do not point to any significant advantage or disadvantage of the current simulator-based driving training over

  4. Evaluation of a clinical simulation-based assessment method for EHR-platforms.

    PubMed

    Jensen, Sanne; Rasmussen, Stine Loft; Lyng, Karen Marie

    2014-01-01

    In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement. PMID:25160323

  5. Virtual patient simulator for the perfusion resource management drill.

    PubMed

    Ninomiya, Shinji; Tokaji, Megumi; Tokumine, Asako; Kurosaki, Tatsuya

    2009-12-01

    Perfusionists require a detailed understanding of a patient's physiological status while comprehending the mechanics and engineering of the cardiopulmonary bypass system, so it is beneficial for them to obtain relevant practical skills using extracorporeal circulation technology and educational physiological simulators. We designed a perfusion simulator system (ECCSIM: Extracorporeal Circulation SIMulator system) based on a hybrid of a simple hydraulic mock circulation loop linked to a computer simulation model. Patient physiological conditions (height, weight, and cardiac indices) were determined by a parameter estimation procedure and used to accurately reproduce hemodynamic conditions. Extracorporeal circulation trainees in pre-clinical education were able to maintain venous oxygen saturation levels above 50%, except during cardiac standstill and a brief resumption of pulsation. Infant amplitudes of reservoir volume oscillation and flow rate were greatly increased compared with adult cardiovascular parameters, this enabled the instructor to control the difficulty level of the operation using different hemodynamic variations. High-fidelity simulator systems with controllable difficulty levels and high physiological reproducibility are useful in constructing a perfusion resource management environment that enable basic training and periodic crisis management drills to be performed. PMID:20092074

  6. Knowledge-Driven Design of Virtual Patient Simulations

    ERIC Educational Resources Information Center

    Vergara, Victor; Caudell, Thomas; Goldsmith, Timothy; Panaiotis; Alverson, Dale

    2009-01-01

    Virtual worlds provide unique opportunities for instructors to promote, study, and evaluate student learning and comprehension. In this article, Victor Vergara, Thomas Caudell, Timothy Goldsmith, Panaiotis, and Dale Alverson explore the advantages of using virtual reality environments to create simulations for medical students. Virtual simulations…

  7. Rifaximin Improves Driving Simulator Performance in a Randomized Trial of Patients with Minimal Hepatic Encephalopathy

    PubMed Central

    Bajaj, Jasmohan S; Heuman, Douglas M; Wade, James B; Gibson, Douglas P; Saeian, Kia; Wegelin, Jacob A; Hafeezullah, Muhammad; Bell, Debulon E; Sterling, Richard K; Stravitz, R. Todd; Fuchs, Michael; Luketic, Velimir; Sanyal, Arun J

    2010-01-01

    Background & Aims Patients with cirrhosis and minimal hepatic encephalopathy (MHE) have driving difficulties but the effects of therapy on driving performance have not been assessed. We evaluated whether performance on a driving simulator improves in patients with MHE following treatment with rifaximin. Methods Patients with MHE who were current drivers were randomly assigned to placebo or rifaximin groups and followed for 8 weeks (n=42). Patients underwent driving simulation (driving and navigation tasks) at the start (baseline) and end of the study. We evaluated patients’ cognitive abilities, quality-of-life (using the Sickness Impact Profile [SIP]), serum levels of ammonia, levels of inflammatory cytokines, and MELD scores. The primary outcome was percent who improved in driving performance, calculated by: total driving errors=speeding + illegal turns + collisions. Results Over the 8-week study period, patients given rifaximin made significantly greater improvements than those given placebo in avoiding total driving errors (76% vs. 31%, P=0.013), speeding (81% vs. 33%, P=0.005), and illegal turns (62% vs. 19%, P=0.01). Of patients given rifaximin, 91% improved their cognitive performance, compared with 61% of patients given placebo (P=0.01); they also made improvements in the psycho-social dimension of the SIP, compared with the placebo group (P=0.04). Adherence to the assigned drug averaged 92%. Neither group had changes in ammonia levels or MELD scores, but patients in the rifaximin group had increased levels of the anti-inflammatory cytokine interleukin-10. Conclusions Patients with MHE significantly improve driving simulator performance following treatment with rifaximin, compared with placebo. PMID:20849805

  8. Tools for evaluating team performance in simulation-based training

    PubMed Central

    Rosen, Michael A; Weaver, Sallie J; Lazzara, Elizabeth H; Salas, Eduardo; Wu, Teresa; Silvestri, Salvatore; Schiebel, Nicola; Almeida, Sandra; King, Heidi B

    2010-01-01

    Teamwork training constitutes one of the core approaches for moving healthcare systems toward increased levels of quality and safety, and simulation provides a powerful method of delivering this training, especially for face-paced and dynamic specialty areas such as Emergency Medicine. Team performance measurement and evaluation plays an integral role in ensuring that simulation-based training for teams (SBTT) is systematic and effective. However, this component of SBTT systems is overlooked frequently. This article addresses this gap by providing a review and practical introduction to the process of developing and implementing evaluation systems in SBTT. First, an overview of team performance evaluation is provided. Second, best practices for measuring team performance in simulation are reviewed. Third, some of the prominent measurement tools in the literature are summarized and discussed relative to the best practices. Subsequently, implications of the review are discussed for the practice of training teamwork in Emergency Medicine. PMID:21063558

  9. Improving Bariatric Patient Transport and Care with Simulation

    PubMed Central

    Gable, Brad D.; Gardner, Aimee K.; Celik, Dan H.; Bhalla, Mary Colleen; Ahmed, Rami A.

    2014-01-01

    Introduction Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions

  10. Evaluation of a Computer Simulation in a Therapeutics Case Discussion.

    ERIC Educational Resources Information Center

    Kinkade, Raenel E.; And Others

    1995-01-01

    A computer program was used to simulate a case presentation in pharmacotherapeutics. Students (n=24) used their knowledge of the disease (glaucoma) and various topical agents on the computer program's formulary to "treat" the patient. Comparison of results with a control group found the method as effective as traditional case presentation on…

  11. Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

    PubMed

    Allaire, Joanna L

    2015-09-01

    Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study. PMID:26329033

  12. Simulation laboratory for evaluating dynamic traffic management systems

    SciTech Connect

    Ban-Akiva, M.E.; Mishalani, R.G.; Yang, Q.; Koutsopoulos, H.N.

    1997-08-01

    This paper presents a simulation laboratory for performance evaluation and design refinement of dynamic traffic management systems. The laboratory consists of four integrated components: (1) a traffic management simulator, which mimics the generation of route guidance and operations of traffic signals and signs; (2) a traffic flow simulator, which models individual vehicle movements and drivers` route choice decisions in the presence of real-time traffic information; (3) a surveillance system module, which collects real-time traffic data from sensors and probe vehicles in the simulated network; and (4) a control device module, which implements control strategies and route guidance generated by the traffic management system under evaluation. The simulation laboratory has been implemented in C++ using object-oriented programming and a distributed environment. It features a graphical user interface that allows users to visualize the simulation process, including animation of vehicle movements, state of surveillance sensors, traffic signals, signs, and so on. This modeling system provides a unique tool for evaluating integrated ATIS and ATMS applications in a computer-based laboratory environment.

  13. Evaluation and Treatment of the Patient with Vertigo.

    ERIC Educational Resources Information Center

    Glasscock, Michael E. III; Haynes, David S.

    1997-01-01

    The sensation of vertigo is a complex symptom that patients find difficult to describe, and physicians often find evaluating and treating patients with the vertigo a difficult task. This article outlines types and causes of vertigo and the work up, evaluation, and treatment of a patient with vertigo. (Contains references.) (Author/CR)

  14. Evaluating the GPSS simulation model for the Viking batch computer system. [General Purpose Simulation System

    NASA Technical Reports Server (NTRS)

    Lee, J.-J.

    1976-01-01

    In anticipation of extremely heavy loading requirements by the Viking mission during the post-landing periods, a GPSS model has been developed for the purpose of simulating these requirements on the Viking batch computer system. This paper presents the effort pursued in evaluating such a model and results thereby obtained. The evaluation effort consists of selecting the evaluation approach, collecting actual test run data, making comparisons and deriving conclusions.

  15. Intensive care patients' evaluations of the informed consent process.

    PubMed

    Clark, Paul Alexander

    2007-01-01

    This study examines the informed consent process from the perspective of intensive care patients. Using the largest single-method database of patient-derived information in the United States, we systematically outlined and tested several key factors that influence patient evaluations of the intensive care unit (ICU) informed consent process. Measures of information, understanding, and decision-making involvement were found to predict overall patient satisfaction and patient loyalty intentions. Specific actions supportive of ICU informed consent, such as giving patients information on advance directives, patient's rights, and organ donation, resulted in significantly higher patient evaluation scores with large effect sizes. This research suggests that the effectiveness of the informed consent process in the ICU from the patient's perspective can be measured and evaluated and that ICU patients place a high value on the elements of the informed consent process. PMID:17704678

  16. Dose evaluation of selective collimation effect in cephalography by measurement and Monte Carlo simulation.

    PubMed

    Lee, Boram; Shin, Gwisoon; Kang, Sunjung; Shin, Boram; Back, Ilhong; Park, Hyok; Park, Changseo; Lee, Jeongwoo; Lee, Wonho; Choi, Jonghak; Park, Ryeonghwang; Kim, Youhyun

    2012-01-01

    Recently, simulations based on the Monte Carlo code have been increasingly applied for physics phenomena, patient dose and quality assurance of radiation systems. The objective of this study was to use Monte Carlo simulation and measurement to verify dose and dose reduction in cephalography. The collimator was constructed with 3-mm thick lead plate, and attached to the tube head to remove regions of disinterest in the radiation field. A digital phantom patient was constructed to evaluate patient dose. In addition, detectors of pixel size 1×1 cm² and 0.1×0.1 cm² were constructed to check collimator location. The effective dose according to International Commission on Radiological Protection 103 was calculated with and without collimation. The effective doses for simulation with and without collimation were 5.09 and 11.32 µSv, respectively. The results of the calculated effective dose show 61.7 % reduction of field area and 55 % of effective dose. The Monte Carlo simulation is a good evaluation tool for patient dose. PMID:21335329

  17. Liposculpture. 2: Evaluation of the patient for liposculpture.

    PubMed

    Fischer, G

    1991-09-01

    The author discusses cannula development and patient evaluation and selection for liposculpture. The author recommends that surgeons new to liposculpture should choose their patients carefully to avoid poor cosmetic outcomes. PMID:1890247

  18. Development of walking pattern evaluation system for hypogravity simulation.

    PubMed

    Leães, R; Cambraia, R; Bacim, F; Dalmarco, G; Calder, A; De Azevedo, D F G; Pinho, M; Russomano, T

    2006-01-01

    This study aimed to develop a Walking Pattern Evaluation System during Hypogravity Simulation (SAMSH), which included the adaptation of a body suspension device, the instrumentation of a treadmill and the development of a virtual environment. SAMSH was developed using one subject. Kinematic analyses were performed whilst one individual was walking on the treadmill during body weight reduction simulating the gravitational forces of the Moon (reduction of 60%) and Mars (reduction of 30%) with and without virtual reality glasses (Head Mounted Display, HMD). The walking pattern was evaluated by means of knee and ankle electrogoniometers, foot switches placed on the front and back part of the plantar region, and five video cameras. Results showed that the body weight reduction during Moon simulation alter the walking pattern, including the increase in step time, contact time, step length and aerial time, and the decrease of walking cadence time (steps per minute). The findings of this study also suggested that hypogravity simulation reduces walking effort. The utilization of the HMD allowed the evaluation of the head position three-dimensionally during hypogravity simulation. The virtual environment reduced postural balance, due to the absence of visual input, which was evidenced by a protective extension reaction. PMID:17947187

  19. Design, simulation, evaluation, and technological verification of arrayed waveguide gratings

    NASA Astrophysics Data System (ADS)

    Seyringer, Dana; Schmid, Patrick; Bielik, Michal; Uherek, Frantisek; Chovan, Jozef; Kuzma, Anton

    2014-07-01

    We present the design, simulation, evaluation, and technological verification of various low-index optical demultiplexers based on arrayed waveguide gratings (AWGs). When designing such optical demultiplexers, a set of input geometrical parameters must be first calculated. They are essential to create AWG layout that will be then simulated using commercial photonics tools. However, these tools do not support or support only partially such a fundamental calculation. Therefore, a new stand-alone tool called AWG-Parameters was developed, which strongly reduces the time needed for the design. From the calculated geometrical parameters, the AWG layouts were created and simulated using three commercial photonic tools: Optiwave, (Ottawa, Ontario, Canada), Apollo Photonics, (Ancaster, Ontario, Canada), and R-Soft, (Pasadena, California). The designs were also technologically verified. The simulated/measured transmission characteristics were evaluated by our newly developed AWG-Analyzer tool. This tool provides calculations of AWG transmission parameters, which are also missing in commercial photonic tools. Additionally, the tool provides clear definitions of calculated transmission parameters together with their textual and graphical representations. Finally, the transmission characteristics and parameters achieved from different photonic tools were compared with each other and discussed in detail. The simulated results were also compared with the measurements. Very good agreement was achieved between theoretical (AWG-Parameters tool), simulated (commercial photonic tools), and fabricated AWG transmission parameters.

  20. Simulations in Distance Education: Progress towards an Evaluation Instrument.

    ERIC Educational Resources Information Center

    Dean, Alison M.; Webster, Leonard

    2000-01-01

    Reports on a study in which an interactive computer-based tutorial with a decision support system and simulations is evaluated in the context of a distance education business degree course. Discusses the effect on students' motivation and the impact on their ability to transfer knowledge to the workplace. (Author/LRW)

  1. Evaluation of Visual Computer Simulator for Computer Architecture Education

    ERIC Educational Resources Information Center

    Imai, Yoshiro; Imai, Masatoshi; Moritoh, Yoshio

    2013-01-01

    This paper presents trial evaluation of a visual computer simulator in 2009-2011, which has been developed to play some roles of both instruction facility and learning tool simultaneously. And it illustrates an example of Computer Architecture education for University students and usage of e-Learning tool for Assembly Programming in order to…

  2. Software Platform Evaluation - Verifiable Fuel Cycle Simulation (VISION) Model

    SciTech Connect

    J. J. Jacobson; D. E. Shropshire; W. B. West

    2005-11-01

    The purpose of this Software Platform Evaluation (SPE) is to document the top-level evaluation of potential software platforms on which to construct a simulation model that satisfies the requirements for a Verifiable Fuel Cycle Simulation Model (VISION) of the Advanced Fuel Cycle (AFC). See the Software Requirements Specification for Verifiable Fuel Cycle Simulation (VISION) Model (INEEL/EXT-05-02643, Rev. 0) for a discussion of the objective and scope of the VISION model. VISION is intended to serve as a broad systems analysis and study tool applicable to work conducted as part of the AFCI (including costs estimates) and Generation IV reactor development studies. This document will serve as a guide for selecting the most appropriate software platform for VISION. This is a “living document” that will be modified over the course of the execution of this work.

  3. Evaluating performance of container terminal operation using simulation

    NASA Astrophysics Data System (ADS)

    Nawawi, Mohd Kamal Mohd; Jamil, Fadhilah Che; Hamzah, Firdaus Mohamad

    2015-05-01

    A container terminal is a facility where containers are transshipped from one mode of transport to another. Congestion problem leads to the decreasing of the customer's level of satisfaction. This study presents the application of simulation technique with the main objective of this study is to develop the current model and evaluate the performance of the container terminal. The suitable performance measure used in this study to evaluate the container terminal model are the average waiting time in queue, average of process time at berth, number of vessels enter the berth and resource utilization. Simulation technique was found to be a suitable technique to conduct in this study. The results from the simulation model had proved to solve the problem occurred in the container terminal.

  4. [Simulated patients in health care training: the human side of simulation].

    PubMed

    Moore, Philippa; Leighton, María Inés; Alvarado, Constanza; Bralic, Cecilia

    2016-05-01

    Simulated patients (SP) are now used in the majority of the institutions that train health care professionals in patient-centered care. This article summarizes the information about the use of SP in health education using information from the literature and from the 15 years’ experience in the medical school of the Pontificia Universidad Católica de Chile. It describes the different definitions in use, the roles and scenarios that can be used when teaching with SP and the organization that any institution working with SP should have in order to promote the optimal use of SP. Working with SP allows faculty to center their teaching on their students while keeping the focus on the patient. Students appreciate learning with SP and particularly value feedback from the patients’ perspective. PMID:27552013

  5. Molecular dynamics simulations: Parameter evaluation, application and development

    NASA Astrophysics Data System (ADS)

    Zhou, Jin

    Molecular dynamics (MD) simulation is a theoretical technique for investigating the physical properties of a wide variety of molecules. This dissertation contains my studies on three important parts of the MD simulation: evaluation of parameters in empirical energy functions widely used in MD simulations, application of MD simulation on experimentally interested biological molecules and development of new methods for constraint dynamics simulations. All the work in this thesis made use of CHARMM as an MD simulation tool. The MD simulation uses empirical energy functions parameterized by a set of parameters. These parameters play an important role in the quality of the simulations. I evaluated nine parameter sets from Harvard University and Molecular Simulations, Inc. for protein simulations by the MD simulations of hydrated form of carboxy- myoglobin and interleukin-1/beta, which are rich in two typical protein structure motifs, helix and β sheet structures respectively. It is found that some sets are good at representing helical structure proteins while others are good at β sheet proteins. But all of them need improvement on representing motions at low temperature. Experimental evidence indicates that the 1A coiled-coil domains of the Intermediate Filament (IF) proteins consisting of coiled human keratins 1 and 10 (K1 and K10) are 'hot spots' for substitutional mutations. Some of these mutations are correlated to the human skin diseases-epidermolytic hyperkeratiosis (EH) and epidermolysis bullosa simplex (EBS). The MD simulation technique is used here for the first time to model and simulate these proteins to elucidate the molecular-level effects of these mutations. Lacking the experimental crystal structures, the initial structure of 1A domain of the wild type Intermediate Filament protein and its mutants were modeled from scratch to reproduce the well- known properties of the proteins of this kind followed by identical MD simulations. The important result is

  6. Patient-centered appointment scheduling using agent-based simulation.

    PubMed

    Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N

    2014-01-01

    Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

  7. Postgraduate trainees as simulated patients in psychiatric training: Role players and interviewers perceptions

    PubMed Central

    Chaturvedi, Santosh K.; Chandra, Prabha S.

    2010-01-01

    Background Teaching skills to enhance competence in clinical settings need to have a focus on learning how to do. This paper describes the subjective experiences and feedback of trainees who participated in a teaching technique using postgraduate trainees as simulated patients. Materials and Methods The Objective Structured Clinical Assessment and Feedback was employed for training using trainees as simulated patients and interviewers. This exercise is performed in front of consultants and peers who subsequently provide feedback about the content and process using a structured format. In order to assess the subjective experience of the interviewer and the role players they were requested to provide structured feedback on several aspects. The trainee role player provided feedback on comfort in playing the role, need for further inputs, satisfaction regarding role play, satisfaction with the interview, and the overall effect of the activity. The trainee interviewer gave feedback on his/her level of comfort performing in front of a peer group, being watched, and evaluated in a group. Results The feedback forms from 15 sessions were analyzed. Only two of the role players indicated that they felt very uncomfortable while the rest reported comfort. Twelve of the 15 trainees who simulated patients felt they needed more inputs to improve the clarity of the role play; however they all reported feeling satisfied with the role play or interview. The feedback from the interviewers indicated that most were comfortable in all aspects, i.e. conducting the interview, performing in front of a group, being evaluated, and given feedback in front of a group. Conclusion The trainees report indicates that those simulating patients need more clarity on their roles and majority had no discomfort performing in front of a group. Interviewers were satisfied and comfortable with all aspects. On the whole, simulated interviews and role plays were found to be an acceptable teaching method by

  8. Virtual Patient Simulator for the Perfusion Resource Management Drill

    PubMed Central

    Ninomiya, Shinji; Tokaji, Megumi; Tokumine, Asako; Kurosaki, Tatsuya

    2009-01-01

    Abstract: Perfusionists require a detailed understanding of a patient’s physiological status while comprehending the mechanics and engineering of the cardiopulmonary bypass system, so it is beneficial for them to obtain relevant practical skills using extra-corporeal circulation technology and educational physiological simulators. We designed a perfusion simulator system (ECCSIM: Extracorporeal Circulation SIMulator system) based on a hybrid of a simple hydraulic mock circulation loop linked to a computer simulation model. Patient physiological conditions (height, weight, and cardiac indices) were determined by a parameter estimation procedure and used to accurately reproduce hemodynamic conditions. Extracorporeal circulation trainees in pre-clinical education were able to maintain venous oxygen saturation levels above 50%, except during cardiac standstill and a brief resumption of pulsation. Infant amplitudes of reservoir volume oscillation and flow rate were greatly increased compared with adult cardiovascular parameters, this enabled the instructor to control the difficulty level of the operation using different hemodynamic variations. High-fidelity simula tor systems with controllable difficulty levels and high physiological reproducibility are useful in constructing a perfusion resource management environment that enable basic training and periodic crisis management drills to be performed. PMID:20092074

  9. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    PubMed

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution. PMID:22611722

  10. Simulation of the effectiveness evaluation process of security systems

    NASA Astrophysics Data System (ADS)

    Godovykh, A. V.; Stepanov, B. P.; Sheveleva, A. A.; Sharafieva, K. R.

    2016-06-01

    The paper is devoted to issues of creation of cross-functional analytical complex for simulation of the process of operation of the security system elements. Basic objectives, a design concept and an interrelation of main elements of the complex are described. The proposed conception of the analytical complex provides an opportunity to simulate processes for evaluating the effectiveness of physical protection system of a nuclear facility. The complex uses models, that take into account features of the object, parameters of technical means and tactics of adversaries. Recommendations were made for applying of this conception for training specialists in the field of physical protection of nuclear materials.

  11. Design, development, and performance of an adapter for simulation of ocular melanoma patients in supine position for proton beam therapy

    NASA Astrophysics Data System (ADS)

    Daftari, I.; Phillips, T. L.

    2003-06-01

    A patient assembly adapter system for ocular melanoma patient simulation was developed and its performance evaluated. The aim for the construction of the apparatus was to simulate the patients in supine position using a commercial x-ray simulator. The apparatus consists of a base plate, head immobilization holder, patient assembly system that includes fixation light and collimator system. The reproducibility of the repeated fixation was initially tested with a head phantom. Simulation and verification films were studied for seven consecutive patients treated with proton beam therapy. Patient's simulation was performed in a supine position using a dental fixation bite block and a thermoplastic head mask immobilization device with a patient adapter system. Two orthogonal x rays were used to obtain the x, y, and z coordinates of sutured tantalum rings for treatment planning with the EYEPLAN software. The verification films were obtained in treatment position with the fixation light along the central axis of the eye. The results indicate good agreement within 0.5 mm deviations. The results of this investigation showed that the same planning accuracy could be achieved by performing simulation using the adapter described above with a patient in the supine position as that obtained by performing simulation with the patient in the seated, treatment position. The adapter can also be attached to the head of the chair for simulating in the seated position using a fixed x-ray unit. This has three advantages: (1) this will save radiation therapists time; (2) it eliminates the need for arranging access to the treatment room, thus avoiding potential conflicts in treatment room usage; and (3) it allows the use of a commercial simulator.

  12. Air Force electronic warfare evaluation simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2003-09-01

    The Air Force Electronic Warfare Evaluation Simulator (AFEWES) Infrared Countermeasures (IRCM) test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, point-source flares and lamp- and LASER-based jammer systems. The simulations of IR missiles in flight include missile seeker hardware mounted on a six degree-of-freedom flight simulation table. This paper will focus on recent developments and upgrades to the AFEWES IR capability.

  13. Thermal numerical simulator for laboratory evaluation of steamflood oil recovery

    SciTech Connect

    Sarathi, P.

    1991-04-01

    A thermal numerical simulator running on an IBM AT compatible personal computer is described. The simulator was designed to assist laboratory design and evaluation of steamflood oil recovery. An overview of the historical evolution of numerical thermal simulation, NIPER's approach to solving these problems with a desk top computer, the derivation of equations and a description of approaches used to solve these equations, and verification of the simulator using published data sets and sensitivity analysis are presented. The developed model is a three-phase, two-dimensional multicomponent simulator capable of being run in one or two dimensions. Mass transfer among the phases and components is dictated by pressure- and temperature-dependent vapor-liquid equilibria. Gravity and capillary pressure phenomena were included. Energy is transferred by conduction, convection, vaporization and condensation. The model employs a block centered grid system with a five-point discretization scheme. Both areal and vertical cross-sectional simulations are possible. A sequential solution technique is employed to solve the finite difference equations. The study clearly indicated the importance of heat loss, injected steam quality, and injection rate to the process. Dependence of overall recovery on oil volatility and viscosity is emphasized. The process is very sensitive to relative permeability values. Time-step sensitivity runs indicted that the current version is time-step sensitive and exhibits conditional stability. 75 refs., 19 figs., 19 tabs.

  14. The Impact of Human Patient Simulation on the Attainment of Learning Outcomes

    ERIC Educational Resources Information Center

    Re, Antonio

    2011-01-01

    Human patient simulation, and more specifically, high fidelity patient simulation is a growing teaching technique that enables students in medical and health related professions to learn through interacting with a simulator. This study examined the uses of high fidelity simulation with 106 students enrolled in nursing and respiratory therapist…

  15. Evaluation of abdominal pain in the AIDS patient.

    PubMed Central

    Potter, D A; Danforth, D N; Macher, A M; Longo, D L; Stewart, L; Masur, H

    1984-01-01

    Acquired immune deficiency syndrome (AIDS) is a recently recognized entity characterized by a deficiency in cell mediated immune response. The syndrome is manifested by the development of otherwise rare malignant neoplasms and severe life-threatening opportunistic infections. Case histories of five AIDS patients evaluated for abdominal pain are presented to demonstrate the unusual spectrum of intra-abdominal pathology that may be encountered in the AIDS patient. As the number of patients with AIDS continues to escalate, surgical evaluation and intervention will be required more frequently. An understanding of this syndrome and its complications is mandatory for the surgeon to adequately evaluate AIDS patients with abdominal pain. PMID:6322708

  16. A simulation and evaluation of NATO Standardization Agreement (STANAG) 4214

    NASA Astrophysics Data System (ADS)

    Dorko, Michael A.; Schultz, Robert G.

    1993-09-01

    An object-oriented simulation model is developed to evaluate the effectiveness of NATO Standardization Agreement (STANAG) 4214, which promulgates the protocol for international telephone call routing and directories for tactical communications. The model simulates communication systems using the STANAG 4214 protocol to isolate discrepancies which could lead to the inability to successfully complete calls within the system. The model also simulates protocol modifications created to correct existing discrepancies and verifies their effectiveness in making the protocol more robust. Results show that these modifications improve STANAG call completion rate from a potential low of under 70 percent to 100 percent, while simultaneously easing the restrictions on lateral communication connections. The model is menu-driven with both graphical and hard copy output, making it useful to network planners, protocol designers, and tactical communications officers.

  17. Air Force electronic warfare evaluation simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2001-08-01

    The Air Force Electronic Warfare Evaluation Simulator Infrared Countermeasures (IRCM) lab currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, LASERs, flares, and lamp-based jammer systems. The simulations of IR missiles in flight include real missile seeker hardware mounted in a six degree-of-freedom flight simulation table. The simulations of aircraft signatures and IR countermeasures are accomplished by using eight xenon arc lamps, located in 9' X 3' cylindrical housings, in the presentation foreground. A mirror system keeps the high intensity IR sources in the missile field of view. Range closure is simulated in the background by zooming in on the scene and in the foreground by separating and controlling the irises of the arc lamp sources for proper spatial and intensity characteristics. All relative motion and range closure is controlled by missile flyout software and aircraft flight-profile software models.

  18. Measures for simulator evaluation of a helicopter obstacle avoidance system

    NASA Technical Reports Server (NTRS)

    Demaio, Joe; Sharkey, Thomas J.; Kennedy, David; Hughes, Micheal; Meade, Perry

    1993-01-01

    The U.S. Army Aeroflightdynamics Directorate (AFDD) has developed a high-fidelity, full-mission simulation facility for the demonstration and evaluation of advanced helicopter mission equipment. The Crew Station Research and Development Facility (CSRDF) provides the capability to conduct one- or two-crew full-mission simulations in a state-of-the-art helicopter simulator. The CSRDF provides a realistic, full field-of-regard visual environment with simulation of state-of-the-art weapons, sensors, and flight control systems. We are using the CSRDF to evaluate the ability of an obstacle avoidance system (OASYS) to support low altitude flight in cluttered terrain using night vision goggles (NVG). The OASYS uses a laser radar to locate obstacles to safe flight in the aircraft's flight path. A major concern is the detection of wires, which can be difficult to see with NVG, but other obstacles--such as trees, poles or the ground--are also a concern. The OASYS symbology is presented to the pilot on a head-up display mounted on the NVG (NVG-HUD). The NVG-HUD presents head-stabilized symbology to the pilot while allowing him to view the image intensified, out-the-window scene through the HUD. Since interference with viewing through the display is a major concern, OASYS symbology must be designed to present usable obstacle clearance information with a minimum of clutter.

  19. The Evaluation of ERP Sandtable Simulation Based on AHP

    NASA Astrophysics Data System (ADS)

    Xu, Lan

    Due to the trend of world globalization, many enterprises have extended their business to operate globally. Enterprise resource planning is a powerful management system providing the best business resources information. This paper proposed the theory of AHP, and presented ERP sandtable simulation evaluation to discuss how to make a decision using AHP. Using this method can make enterprises consider factors influence operation of enterprise adequately, including feedback and dependence among the factors.

  20. Technology, design, simulation, and evaluation for SEP-hardened circuits

    NASA Technical Reports Server (NTRS)

    Adams, J. R.; Allred, D.; Barry, M.; Rudeck, P.; Woodruff, R.; Hoekstra, J.; Gardner, H.

    1991-01-01

    This paper describes the technology, design, simulation, and evaluation for improvement of the Single Event Phenomena (SEP) hardness of gate-array and SRAM cells. Through the use of design and processing techniques, it is possible to achieve an SEP error rate less than 1.0 x 10(exp -10) errors/bit-day for a 9O percent worst-case geosynchronous orbit environment.

  1. Implementation of a Web-Based Patient Simulation Program to Teach Dental Students in Oral Surgery.

    PubMed

    Weiner, Carina Kruger; Skålén, Maya; Harju-Jeanty, Dick; Heymann, Robert; Rosén, Annika; Fors, Uno; Lund, Bodil

    2016-02-01

    The aim of this study was to evaluate a web-based simulation of patients (Web-SP) program on learning skills in clinical reasoning and patient evaluation in the oral surgery education of third-year dental students. A secondary aim was to investigate the program's effect on students' learning, knowledge, and attitudes towards virtual patient simulations. Authentic virtual oral surgery patient cases were created at a dental school in Sweden using the Web-SP platform. The Web-SP program was introduced in a two-hour seminar. A 20-minute pre-seminar test (test A) was administered to assess the students' knowledge of oral surgery prior to experiencing the Web-SP program. Ten days after the seminar, another test (test B) was administered to evaluate the increase in oral surgery knowledge as a result of using the program, and an emailed survey of the students was conducted. Of 70 students in the course, 67 (95.7%) agreed to participate in the study and took test A; of these, 59 (88%) took test B. Of the 59 students who took both tests, 28 (42%) completed the survey. The results of the two tests showed a statistically significant increase in knowledge, which was in accordance with the learning goals (p<0.0001). The survey results showed that the students had a positive attitude towards the teaching method. In this study, Web-SP was found to be a valuable tool for teaching clinical reasoning and patient evaluation in an undergraduate oral surgery education setting by improving learning outcomes in comparison with traditional teaching alone. PMID:26834130

  2. POD evaluation using simulation: Progress, practice and perspectives

    NASA Astrophysics Data System (ADS)

    Dominguez, Nicolas; Reverdy, Frédéric

    2016-02-01

    NDT performances evaluation in the aeronautic industry is made by estimating Probability of Detection (POD). It is a statistical estimation of the capability of a given NDT procedure to detect defects as a function of their size. The accuracy of the statistical estimation is directly linked the quality and quantity of collected data. The more data and the more realistic they are, the better the POD estimation. This practical production of data may have very high cost, sometimes obliging to decrease either the quantity or the quality (realistic) of data, or even both. In the last decade MAPOD and simulation-based POD approaches have emerged and been used for concept demonstration as a solution to decrease the cost of evaluating POD. Today tools are available to support these studies and are used in industrial laboratories. This paper reviews some examples of POD evaluation using simulation, describes the actual practice of the tools in the European aeronautical context and also draws some limits and perspectives for a future wider application of the simulation helped POD approach.

  3. in silico Surveillance: evaluating outbreak detection with simulation models

    PubMed Central

    2013-01-01

    Background Detecting outbreaks is a crucial task for public health officials, yet gaps remain in the systematic evaluation of outbreak detection protocols. The authors’ objectives were to design, implement, and test a flexible methodology for generating detailed synthetic surveillance data that provides realistic geographical and temporal clustering of cases and use to evaluate outbreak detection protocols. Methods A detailed representation of the Boston area was constructed, based on data about individuals, locations, and activity patterns. Influenza-like illness (ILI) transmission was simulated, producing 100 years of in silico ILI data. Six different surveillance systems were designed and developed using gathered cases from the simulated disease data. Performance was measured by inserting test outbreaks into the surveillance streams and analyzing the likelihood and timeliness of detection. Results Detection of outbreaks varied from 21% to 95%. Increased coverage did not linearly improve detection probability for all surveillance systems. Relaxing the decision threshold for signaling outbreaks greatly increased false-positives, improved outbreak detection slightly, and led to earlier outbreak detection. Conclusions Geographical distribution can be more important than coverage level. Detailed simulations of infectious disease transmission can be configured to represent nearly any conceivable scenario. They are a powerful tool for evaluating the performance of surveillance systems and methods used for outbreak detection. PMID:23343523

  4. Cost evaluation of alternative pharmaceutical tableting processes by simulation.

    PubMed

    Franz, R M; Banker, G S; Buck, J R; Peck, G E

    1980-06-01

    A simulation model and a subsequent computer program were developed as experimentation methods for evaluating tableting processes with respect to cost. These methods also allow estimation of the various times involved in a tableting operation (e.g., the processing time). The model was programmed in FORTRAN using the GASP IV simulation language. After verification of the program, experiments were run that involved comparing different levels of specific input variables to determine which variable had an effect on the cost-time relationships of a particular processing method. Among the possible input variables chosen for evaluation were the drying method, the type of tableting machine, the batch size, the labor rate, and the operation of the equipment in the process. An analysis of variance was made, and three separate regression equations were developed that described the relationship between the input variables and the dependent variables of processing cost and time. Graphs were developed from the regression equations by manipulating them through series of different independent variables. These graphs then were used in determining minimum costs and times, breakeven points, and rates of change, as well as in simple evaluation of processes through graphic representation. By using the simulation program to run experiments and then by analyzing them, results can be obtained to help in making intelligent decisions about the cost-time relationships of a particular tableting procedure before it is implemented. PMID:7205569

  5. Design and Evaluation of a Simulation for Pediatric Dentistry in Virtual Worlds

    PubMed Central

    Louloudiadis, Konstantinos; Tsiatsos, Thrasyvoulos-Konstantinos

    2013-01-01

    Background Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world’s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. Objective The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. Methods A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents’ interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared. Results A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool. Conclusions This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques. PMID:24168820

  6. [Evaluation methods of HME with tracheostomized patients].

    PubMed

    Li, Min

    2014-03-01

    This paper introduced the measurement methods of heat and moisture exchanger during tracheotomy with two main parameters (water loss and pressure drop) and proposed more heat and moisture exchanger evaluation indicators such as the death chamber, the heat exchange rate, as well as those parameters can be used to evaluate the reasonableness of the heat and moisture exchanger performance. PMID:24941781

  7. Computer Simulation Shows the Effect of Communication on Day of Surgery Patient Flow.

    PubMed

    Taaffe, Kevin; Fredendall, Lawrence; Huynh, Nathan; Franklin, Jennifer

    2015-07-01

    To improve patient flow in a surgical environment, practitioners and academicians often use process mapping and simulation as tools to evaluate and recommend changes. We used simulations to help staff visualize the effect of communication and coordination delays that occur on the day of surgery. Perioperative services staff participated in tabletop exercises in which they chose the delays that were most important to eliminate. Using a day-of-surgery computer simulation model, the elimination of delays was tested and the results were shared with the group. This exercise, repeated for multiple groups of staff, provided an understanding of not only the dynamic events taking place, but also how small communication delays can contribute to a significant loss in efficiency and the ability to provide timely care. Survey results confirmed these understandings. PMID:26119616

  8. A comprehensive validation of patient-specific CFD simulations of cerebral aneurysm flow with virtual angiography

    NASA Astrophysics Data System (ADS)

    Sun, Qi; Groth, Alexandra; Bertram, Matthias; Brina, Olivier; Pereira, Vitor Mendes; Aach, Til

    2011-03-01

    Recently, image-based computational fluid dynamic simulations (CFD) have been proposed to investigate the local hemodynamics inside human cerebral aneurysms. It is suggested that the knowledge of the computed three-dimensional flow fields can be used to assist clinical risk assessment and treatment decision making. However, the reliability of CFD for accurately representing the human cerebral blood flow is difficult to assess due to the impossibility of ground truth measurements. A recently proposed virtual angiography method has been used to indirectly validate CFD results by comparing virtually constructed and clinically acquired angiograms. However, the validations are not yet comprehensive as they lack either from patient-specific boundary conditions (BCs) required for CFD simulations or from quantitative comparison methods. In this work, a simulation pipeline is built up including image-based geometry reconstruction, CFD simulations solving the dynamics of blood flow and contrast agent (CA), and virtual angiogram generation. In contrast to previous studies, the patient-specific blood flow rates obtained by transcranial color coded Doppler (TCCD) ultrasound are used to impose CFD BCs. Quantitative measures are defined to thoroughly evaluate the correspondence between the clinically acquired and virtually constructed angiograms, and thus, the reliability of CFD simulations. Exemplarily, two patient cases are presented. Close similarities are found in terms of spatial and temporal variations of CA distribution between acquired and virtual angiograms. Besides, for both patient cases, discrepancies of less than 15% are found for the relative root mean square errors (rRMSE) in time intensity curve (TIC) comparisons from selected characteristic positions.

  9. Evaluation of Intersection Traffic Control Measures through Simulation

    NASA Astrophysics Data System (ADS)

    Asaithambi, Gowri; Sivanandan, R.

    2015-12-01

    Modeling traffic flow is stochastic in nature due to randomness in variables such as vehicle arrivals and speeds. Due to this and due to complex vehicular interactions and their manoeuvres, it is extremely difficult to model the traffic flow through analytical methods. To study this type of complex traffic system and vehicle interactions, simulation is considered as an effective tool. Application of homogeneous traffic models to heterogeneous traffic may not be able to capture the complex manoeuvres and interactions in such flows. Hence, a microscopic simulation model for heterogeneous traffic is developed using object oriented concepts. This simulation model acts as a tool for evaluating various control measures at signalized intersections. The present study focuses on the evaluation of Right Turn Lane (RTL) and Channelised Left Turn Lane (CLTL). A sensitivity analysis was performed to evaluate RTL and CLTL by varying the approach volumes, turn proportions and turn lane lengths. RTL is found to be advantageous only up to certain approach volumes and right-turn proportions, beyond which it is counter-productive. CLTL is found to be advantageous for lower approach volumes for all turn proportions, signifying the benefits of CLTL. It is counter-productive for higher approach volume and lower turn proportions. This study pinpoints the break-even points for various scenarios. The developed simulation model can be used as an appropriate intersection lane control tool for enhancing the efficiency of flow at intersections. This model can also be employed for scenario analysis and can be valuable to field traffic engineers in implementing vehicle-type based and lane-based traffic control measures.

  10. An economic analysis of patient simulators clinical training in nursing education.

    PubMed

    Harlow, Kirk C; Sportsman, Susan

    2007-01-01

    Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined. PMID:17402675

  11. A MONTE-CARLO SIMULATION FRAMEWORK FOR JOINT OPTIMISATION OF IMAGE QUALITY AND PATIENT DOSE IN DIGITAL PAEDIATRIC RADIOGRAPHY.

    PubMed

    Menser, Bernd; Manke, Dirk; Mentrup, Detlef; Neitzel, Ulrich

    2016-06-01

    In paediatric radiography, according to the as low as reasonably achievable (ALARA) principle, the imaging task should be performed with the lowest possible radiation dose. This paper describes a Monte-Carlo simulation framework for dose optimisation of imaging parameters in digital paediatric radiography. Patient models with high spatial resolution and organ segmentation enable the simultaneous evaluation of image quality and patient dose on the same simulated radiographic examination. The accuracy of the image simulation is analysed by comparing simulated and acquired images of technical phantoms. As a first application example, the framework is applied to optimise tube voltage and pre-filtration in newborn chest radiography. At equal patient dose, the highest CNR is obtained with low-kV settings in combination with copper filtration. PMID:26628612

  12. Evaluation of Driver Stress Using Motor-vehicle Driving Simulator

    NASA Astrophysics Data System (ADS)

    Deguchi, Mitsuo; Wakasugi, Junichi; Ikegami, Tatsuya; Nanba, Shinji; Yamaguchi, Masaki

    This paper proposes a method for evaluating driver stress using a motor-vehicle driving simulator and a biomarker as an index of stress. Software has been developed, which can deliberately control driving tasks, in addition to analyzing driving information, such as frequency of the use of accelerator and/or brakes and the degree of deviation from the driving course. Sympathetic nervous activity was noninvasively evaluated using a hand-held monitor of salivary amylase activity, which chemically measured a biomarker every few minutes. Using healthy 20 female adults, the appropriateness of the proposed method was evaluated in vivo. The experimental results showed that the driving stress might be caused to the drivers in only 20 minutes by adding more severe driving tasks than normally experienced by the subjects without endangering them. Furthermore, the result indicate that frequent measurements of sympathetic nervous activity were possible without putting the subjects under restraint by using salivary amylase activity as the index.

  13. Evaluation of dense-gas simulation models. Final report

    SciTech Connect

    Zapert, J.G.; Londergan, R.J.; Thistle, H.

    1991-05-01

    The report describes the approach and presents the results of an evaluation study of seven dense gas simulation models using data from three experimental programs. The models evaluated are two in the public domain (DEGADIS and SLAB) and five that are proprietary (AIRTOX, CHARM, FOCUS, SAFEMODE, and TRACE). The data bases used in the evaluation are the Desert Tortoise Pressurized Ammonia Releases, Burro Liquefied Natural Gas Spill Tests and the Goldfish Anhydrous Hydroflouric Acid Spill Experiments. A uniform set of performance statistics are calculated and tabulated to compare maximum observed concentrations and cloud half-width to those predicted by each model. None of the models demonstrated good performance consistently for all three experimental programs.

  14. Evaluation of perioperative risk in elderly patients.

    PubMed

    Aubrun, F; Gazon, M; Schoeffler, M; Benyoub, K

    2012-05-01

    From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain. PMID:22269928

  15. Evaluating the Potential Impact of Pharmacist Counseling on Medication Adherence Using a Simulation Activity

    PubMed Central

    Das, Rolee Pathak; Mansukhani, Rupal Patel; Cosler, Leon E.

    2014-01-01

    Objective. To evaluate the impact of counseling in a simulated medication adherence activity. Design. Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity’s value and impact on understanding adherence challenges. Assessment. Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges. Conclusion. This activity demonstrated the challenges and important role of counseling in medication adherence. PMID:26056407

  16. Web-based multimedia courseware for emergency cardiac patient management simulations.

    PubMed

    Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

    2000-01-01

    This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements. PMID:11187619

  17. An Evaluative Review of Simulated Dynamic Smart 3d Objects

    NASA Astrophysics Data System (ADS)

    Romeijn, H.; Sheth, F.; Pettit, C. J.

    2012-07-01

    Three-dimensional (3D) modelling of plants can be an asset for creating agricultural based visualisation products. The continuum of 3D plants models ranges from static to dynamic objects, also known as smart 3D objects. There is an increasing requirement for smarter simulated 3D objects that are attributed mathematically and/or from biological inputs. A systematic approach to plant simulation offers significant advantages to applications in agricultural research, particularly in simulating plant behaviour and the influences of external environmental factors. This approach of 3D plant object visualisation is primarily evident from the visualisation of plants using photographed billboarded images, to more advanced procedural models that come closer to simulating realistic virtual plants. However, few programs model physical reactions of plants to external factors and even fewer are able to grow plants based on mathematical and/or biological parameters. In this paper, we undertake an evaluation of plant-based object simulation programs currently available, with a focus upon the components and techniques involved in producing these objects. Through an analytical review process we consider the strengths and weaknesses of several program packages, the features and use of these programs and the possible opportunities in deploying these for creating smart 3D plant-based objects to support agricultural research and natural resource management. In creating smart 3D objects the model needs to be informed by both plant physiology and phenology. Expert knowledge will frame the parameters and procedures that will attribute the object and allow the simulation of dynamic virtual plants. Ultimately, biologically smart 3D virtual plants that react to changes within an environment could be an effective medium to visually represent landscapes and communicate land management scenarios and practices to planners and decision-makers.

  18. Simulator evaluation of the final approach spacing tool

    NASA Technical Reports Server (NTRS)

    Davis, Thomas J.; Erzberger, Heinz; Green, Steven M.

    1990-01-01

    The design and simulator evaluation of an automation tool for assisting terminal radar approach controllers in sequencing and spacing traffic onto the final approach course is described. The automation tool, referred to as the Final Approach Spacing Tool (FAST), displays speed and heading advisories for arrivals as well as sequencing information on the controller's radar display. The main functional elements of FAST are a scheduler that schedules and sequences the traffic, a 4-D trajectory synthesizer that generates the advisories, and a graphical interface that displays the information to the controller. FAST was implemented on a high performance workstation. It can be operated as a stand-alone in the Terminal Radar Approach Control (TRACON) Facility or as an element of a system integrated with automation tools in the Air Route Traffic Control Center (ARTCC). FAST was evaluated by experienced TRACON controllers in a real-time air traffic control simulation. Simulation results show that FAST significantly reduced controller workload and demonstrated a potential for an increase in landing rate.

  19. Evaluation of color error and noise on simulated images

    NASA Astrophysics Data System (ADS)

    Mornet, Clémence; Vaillant, Jérôme; Decroux, Thomas; Hérault, Didier; Schanen, Isabelle

    2010-01-01

    The evaluation of CMOS sensors performance in terms of color accuracy and noise is a big challenge for camera phone manufacturers. On this paper, we present a tool developed with Matlab at STMicroelectronics which allows quality parameters to be evaluated on simulated images. These images are computed based on measured or predicted Quantum Efficiency (QE) curves and noise model. By setting the parameters of integration time and illumination, the tool optimizes the color correction matrix (CCM) and calculates the color error, color saturation and signal-to-noise ratio (SNR). After this color correction optimization step, a Graphics User Interface (GUI) has been designed to display a simulated image at a chosen illumination level, with all the characteristics of a real image taken by the sensor with the previous color correction. Simulated images can be a synthetic Macbeth ColorChecker, for which reflectance of each patch is known, or a multi-spectral image, described by the reflectance spectrum of each pixel or an image taken at high-light level. A validation of the results has been performed with ST under development sensors. Finally we present two applications one based on the trade-offs between color saturation and noise by optimizing the CCM and the other based on demosaicking SNR trade-offs.

  20. Evaluation of precipitation predictions in a regional climate simulation

    SciTech Connect

    Costigan, K.R.; Bossert, J.E.; Langely, D.L.

    1998-12-01

    The research reported here is part of a larger project that is coupling a suite of environmental models to simulate the hydrologic cycle within river basins (Bossert et al., 1999). These models include the Regional Atmospheric Modeling System (RAMS), which provides meteorological variables and precipitation to the Simulator for Processes of Landscapes, Surface/Subsurface Hydrology (SPLASH). SPLASH partitions precipitation into evaporation, transpiration, soil water storage, surface runoff, and subsurface recharge. The runoff is collected within a simple river channel model and the Finite element Heat and Mass (FEHM) subsurface model is linked to the land surface and river flow model components to simulate saturated and unsaturated flow and changes in aquifer levels. The goal is to produce a fully interactive system of atmospheric, surface hydrology, river and groundwater models to allow water and energy feedbacks throughout the system. This paper focuses on the evaluation of the precipitation fields predicted by the RAMS model at different times during the 1992--1993 water year in the Rio Grande basin. The evaluation includes comparing the model predictions to the observed precipitation as reported by Cooperative Summary of the Day and SNOTEL reporting stations.

  1. Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education

    PubMed Central

    Heiermann, Nadine; Plum, Patrick Sven; Wahba, Roger; Chang, De-Hua; Maus, Martin; Chon, Seung-Hun; Hoelscher, Arnulf H; Stippel, Dirk Ludger

    2015-01-01

    Background Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching Objective It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance. Methods The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students. Results Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use. Conclusions

  2. Assessment of Surgical Effects on Patients with Obstructive Sleep Apnea Syndrome Using Computational Fluid Dynamics Simulations

    PubMed Central

    Cheng, Gary C.; Koomullil, Roy P.; Ito, Yasushi; Shih, Alan M.; Sittitavornwong, Somsak; Waite, Peter D.

    2013-01-01

    Obstructive sleep apnea syndrome is one of the most common sleep disorders. To treat patients with this health problem, it is important to detect the severity of this syndrome and occlusion sites in each patient. The goal of this study is to test the hypothesis that the cure of obstructive sleep apnea syndrome by maxillomandibular advancement surgery can be predicted by analyzing the effect of anatomical airway changes on the pressure effort required for normal breathing using a high-fidelity, 3-D numerical model. The employed numerical model consists of: 1) 3-D upper airway geometry construction from patient-specific computed tomographic scans using an image segmentation technique, 2) mixed-element mesh generation of the numerically constructed airway geometry for discretizing the domain of interest, and 3) computational fluid dynamics simulations for predicting the flow field within the airway and the degree of severity of breathing obstruction. In the present study, both laminar and turbulent flow simulations were performed to predict the flow field in the upper airway of the selected patients before and after maxillomandibular advancement surgery. Patients of different body mass indices were also studied to assess their effects. The numerical results were analyzed to evaluate the pressure gradient along the upper airway. The magnitude of the pressure gradient is regarded as the pressure effort required for breathing, and the extent of reduction of the pressure effort is taken to measure the success of the surgery. The description of the employed numerical model, numerical results from simulations of various patients, and suggestion for future work are detailed in this paper. PMID:25530663

  3. Evaluation of global and regional climate simulations over Africa

    NASA Astrophysics Data System (ADS)

    Nikulin, Grigory; Jones, Colin; Kjellström, Erik; Gbobaniyi, Emiola

    2013-04-01

    Two ensembles of climate simulations, one global and one regional, are evaluated and inter-compared over the Africa-CORDEX domain. The global ensemble includes eight coupled atmosphere ocean general circulation models (AOGCMs) from the CMIP5 project with horizontal resolution varying from about 1° to 3°, namely CanESM2, CNRM-CM5, HadGEM2-ES, NorESM1-M, EC-EARTH, MIROC5, GFDL-ESM2M and MPI-ESM-LR. In the regional ensemble all 8 AOGCMs are downscaled over the Africa-CORDEX domain at the Rossby Centre (SMHI) by a regional climate model - RCA4 at 0.44° resolution. The main focus is on ability of both global and regional ensembles to simulate precipitation in different climate zones of Africa. Precipitation climatology is characterized by seasonal means, inter-annual variability and by various characteristics of the rainy season: onset, cessation, mean intensity and intra-seasonal variability. To see potential benefits of higher resolution in the regional downscaling all precipitation statistics are inter-compared between the individual AOGCM-RCA4(AOGCM) pairs and between the two multi-model ensemble averages. A special attention in the study is on how the AOGCMs simulate teleconnection patterns of large-scale internal variability and how these teleconnection pattern are reproduced in the downscaled regional simulations.

  4. Evaluating illness representations in heart transplant patients.

    PubMed

    Janelle, Caroline; O'Connor, Kieron; Dupuis, Gilles

    2016-09-01

    The aim was to see whether qualitative analysis improved quantitative measurement of illness perception after heart transplant. Two methods of evaluating illness representations were compared: one quantitative (administration of the Illness Perception Questionnaire-Revised) and one qualitative (phenomenological reduction). The qualitative analysis provided greater insight into the idiosyncratic and dynamic nature of the concept of illness representations. Adjustments to the Illness Perception Questionnaire-Revised are suggested to improve the evaluation of illness perception in terms of dispersion of scores, emotional impact, coping strategies and treatment, and social support, and ultimately to enhance interventions designed to promote treatment compliance. PMID:25626700

  5. Simulator evaluation of the Final Approach Spacing Tool

    NASA Technical Reports Server (NTRS)

    Davis, Thomas J.; Erzberger, Heinz; Green, Steven M.

    1990-01-01

    The design and simulator evaluation of an automation tool for assisting terminal radar approach controllers in sequencing and spacing traffic onto the final approach course is described. The automation tool, referred to as the Final Approach Spacing Tool (FAST), displays speed and heading advisories for arrivals and sequencing information on the controller's radar display. The main functional elements of FAST are a scheduler that schedules and sequences the traffic, a four-dimensional trajectory synthesizer that generates the advisories, and a graphical interface that displays the information to the controller. FAST has been implemented on a high-performance workstation. It can be operated stand-alone in the terminal radar approach control (TRACON) facility or as an element of a system integrated with automation tools in the Air Route Traffic Control Center). Simulation results show that FAST significantly reduced controller workload and demonstrated a potential for an increase in landing rate.

  6. The Effects of Moderate- and High-Fidelity Patient Simulator Use on Critical Thinking in Associate Degree Nursing Students

    ERIC Educational Resources Information Center

    Vieck, Jana

    2013-01-01

    The purpose of this study was to examine the impact of moderate- and high-fidelity patient simulator use on the critical thinking skills of associate degree nursing students. This quantitative study used a quasi-experimental design and the Health Sciences Reasoning Test (HSRT) to evaluate the critical thinking skills of third semester nursing…

  7. Human Simulators and Standardized Patients to Teach Difficult Conversations to Interprofessional Health Care Teams

    PubMed Central

    Zimmerman, Christine; Kennedy, Christopher; Schremmer, Robert; Smith, Katharine V.

    2010-01-01

    Objective To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients. PMID:21088725

  8. The Effectiveness of Standardized Patient Simulation in Training Hospital Ethics Committees.

    PubMed

    Harari, David Y; Macauley, Robert C

    2016-01-01

    Clinical simulation using standardized patients has become standard in medical education--and is now being incorporated into some graduate programs in bioethics--for both formative and summative evaluation. In most hospitals, though, clinical ethics consultation is done by the ethics committee (or a subset of it). This study is the first, to our knowledge, to examine the effectiveness of standardized patient simulation in training hospital ethics committees to deal with ethically complex and emotionally fraught clinical situations. Following a substantial revision of the institution's nonbeneficial treatment policy, ethics committee members underwent a simulation to determine whether a specific requested treatment should be withheld on the basis of futility. Pre- and post-intervention surveys showed improvement in all domains, although the small sample size limited the power of the study, with only one measure showing a statistically significant difference. An interesting incidental finding was that one-quarter of committee members voted against a determination of futility, even though the case clearly met the definition set forth in the policy. This highlights the emotional challenges in implementing an ethically rigorous, unanimously accepted policy that ultimately determines the timing and manner of a patient's death. PMID:27045300

  9. Fetus absorbed dose evaluation in head and neck radiotherapy procedures of pregnant patients.

    PubMed

    da Costa, Etieli C; da Rosa, Luiz Antonio R; Batista, Delano Valdivino S

    2015-06-01

    In this work the head and neck cancer treatment of a pregnant patient was experimentally simulated. A female anthropomorphic Alderson phantom was used and the absorbed dose to the fetus was evaluated protecting the patient's abdomen with a 7cm lead layer and using no abdomen shielding. The target volume dose was 50Gy. The fetus doses evaluated with and without the lead shielding were, respectively, 0.52±0.039 and 0.88±0.052cGy. PMID:25620113

  10. An electric scooter simulation program for training the driving skills of stroke patients with mobility problems: a pilot study.

    PubMed

    Jannink, Michiel J A; Erren-Wolters, C Victorien; de Kort, Alexander C; van der Kooij, Herman

    2008-12-01

    This paper describes an electric scooter simulation program and a first evaluation study in which we explored if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training. Within this explorative study,10 stroke survivors were randomly assigned to either the control (n=5) or the electric scooter simulation intervention group (n=5). Participants were assessed twice on the functional evaluating rating scale. During the followup measurement, subjective experiences regarding both forms of electric scooter training were elicited by a questionnaire. After a training period of 5 weeks, both groups improved on the Functional Evaluation Rating Scale. It can be concluded that the patients with stroke were satisfied with the electric scooter simulation training. PMID:18954289

  11. MCNP simulation of radiation doses distributions in a water phantoms simulating interventional radiology patients

    NASA Astrophysics Data System (ADS)

    He, Wenjun; Mah, Eugene; Huda, Walter; Selby, Bayne; Yao, Hai

    2011-03-01

    Purpose: To investigate the dose distributions in water cylinders simulating patients undergoing Interventional Radiological examinations. Method: The irradiation geometry consisted of an x-ray source, dose-area-product chamber, and image intensifier as currently used in Interventional Radiology. Water cylinders of diameters ranging between 17 and 30 cm were used to simulate patients weighing between 20 and 90 kg. X-ray spectra data with peak x-ray tube voltages ranging from 60 to 120 kV were generated using XCOMP3R. Radiation dose distributions inside the water cylinder (Dw) were obtained using MCNP5. The depth dose distribution along the x-ray beam central axis was normalized to free-in-air air kerma (AK) that is incident on the phantom. Scattered radiation within the water cylinders but outside the directly irradiated region was normalized to the dose at the edge of the radiation field. The total absorbed energy to the directly irradiated volume (Ep) and indirectly irradiated volume (Es) were also determined and investigated as a function of x-ray tube voltage and phantom size. Results: At 80 kV, the average Dw/AK near the x-ray entrance point was 1.3. The ratio of Dw near the entrance point to Dw near the exit point increased from ~ 26 for the 17 cm water cylinder to ~ 290 for the 30 cm water cylinder. At 80 kV, the relative dose for a 17 cm water cylinder fell to 0.1% at 49 cm away from the central ray of the x-ray beam. For a 30 cm water cylinder, the relative dose fell to 0.1% at 53 cm away from the central ray of the x-ray beam. At a fixed x-ray tube voltage of 80 kV, increasing the water cylinder diameter from 17 to 30 cm increased the Es/(Ep+Es) ratio by about 50%. At a fixed water cylinder diameter of 24 cm, increasing the tube voltage from 60 kV to 120 kV increased the Es/(Ep+Es) ratio by about 12%. The absorbed energy from scattered radiation was between 20-30% of the total energy absorbed by the water cylinder, and was affected more by patient size

  12. Multiscale Hydrologic Evaluation of Radar Rainfall for Flow Simulations

    NASA Astrophysics Data System (ADS)

    Quintero, Felipe; Krajewski, Witold; Seo, Bong-Chul; Mantilla, Ricardo

    2016-04-01

    We made an evaluation of the performance of a hydrologic model to produce real-time flow forecasts. The model has been developed by the Iowa Flood Center (IFC), and it is implemented operationally to produce streamflow forecast for the communities of the State of Iowa in the United States. The model parameters are calibration-free. It has a parsimonious structure, that reproduces the more significant processes involved in the transformation from rainfall to runoff. The operational model uses a rainfall forcing produced by IFC, derived from the combination of rainfall fields of seven NEXRAD radars. However, this rainfall forcing does not include bias adjustment from rain gauges, due to the non-existence of a raingage network that enable the correction in real-time. In consideration, the model is also run offline using bias-adjusted rainfall products as Stage IV, and more recently MRMS. We used an extensive record of five years of IFC rainfall product and Stage IV, to evaluate the performance of the hydrologic model and the sensitivity of the flow simulations to model input. The model is not calibrated to any particular rainfall product. The distributed structure of the model allows to obtain results at any channel of the drainage network. We obtained simulated hydrographs at about 150 locations with different sub-basin spatial scales, where there are available USGS gages with streamflow observations. We obtained error metrics as Nash Sutcliffe efficiency and root mean square error, by comparing flow simulations to observations. We evaluated also the number of occurrences of hits and false alarms of discharge forecasts exceeding flood stage.

  13. Evaluation of Cryofreezer Technology through Simulation and Testing (DRAFT)

    NASA Technical Reports Server (NTRS)

    Anderson, Molly; Curley, Su

    2005-01-01

    A cryofreezer system is being evaluated as a new method of compressing and storing carbon dioxide (CO2) in an Advanced Life Support (ALS) Environmental Control and Life Support System (ECLSS). A cryocooler is used to provide cold temperatures and heat removal while CO2 freezes and accumulates around a coldtip. The CO2 can then be stored as a liquid or high-pressure gas after it has been accumulated. This system was originally conceived as an In-Situ Resource Utilization (ISRU) application for collecting CO2 from the Mars atmosphere to be converted to methane fuel with a Sabatier reaction. In the ALS application, this system could collect CO2 from the International Space Station (ISS) Carbon Dioxide Removal Assembly (CDRA) for delivery to the Sabatier reactor. The Sabatier reaction is an important part of proposed Air Revitalization System (ARS) for ALS, and technology sharing is often possible between ISRU and ARS applications in CO2 processing systems. A prototype system developed and initially tested by Lockheed Martin Astronautics is now being evaluated in the Air Revitalization Technology Evaluation Facility (ARTEF) at NASA Johnson Space Center (JSC). This paper will discuss testing conducted through December 2004 to examine the performance and capacity of the system under a variety of input conditions. A simulation of the system was developed simultaneously using the Aspen Custom Modeler (ACM) software package. Several approaches using varying levels of detail could be used when modeling the system, and this paper will discuss the assumptions and choices made in this simulation, as well as the validity of the simulation for predicting performance of the prototype unit.

  14. Using simulation to evaluate warhead monitoring system effectiveness

    SciTech Connect

    Perkins, Casey J.; Brigantic, Robert T.; Keating, Douglas H.; Liles, Karina R.; Meyer, Nicholas J.; Oster, Matthew R.; Waterworth, Angela M.

    2015-07-12

    There is a need to develop and demonstrate technical approaches for verifying potential future agreements to limit and reduce total warhead stockpiles. To facilitate this aim, warhead monitoring systems employ both concepts of operations (CONOPS) and technologies. A systems evaluation approach can be used to assess the relative performance of CONOPS and technologies in their ability to achieve monitoring system objectives which include: 1) confidence that a treaty accountable item (TAI) initialized by the monitoring system is as declared; 2) confidence that there is no undetected diversion from the monitoring system; and 3) confidence that a TAI is dismantled as declared. Although there are many quantitative methods that can be used to assess system performance for the above objectives, this paper focuses on a simulation perspective primarily for the ability to support analysis of the probabilities that are used to define operating characteristics of CONOPS and technologies. This paper describes a discrete event simulation (DES) model, comprised of three major sub-models: including TAI lifecycle flow, monitoring activities, and declaration behavior. The DES model seeks to capture all processes and decision points associated with the progressions of virtual TAIs, with notional characteristics, through the monitoring system from initialization through dismantlement. The simulation updates TAI progression (i.e., whether the generated test objects are accepted and rejected at the appropriate points) all the way through dismantlement. Evaluation of TAI lifecycles primarily serves to assess how the order, frequency, and combination of functions in the CONOPS affect system performance as a whole. It is important, however, to note that discrete event simulation is also capable (at a basic level) of addressing vulnerabilities in the CONOPS and interdependencies between individual functions as well. This approach is beneficial because it does not rely on complex mathematical

  15. Evaluating the Dominant Components of Warming in Pliocene Climate Simulations

    NASA Technical Reports Server (NTRS)

    Hill, D. J.; Haywood, A. M.; Lunt, D. J.; Hunter, S. J.; Bragg, F. J.; Contoux, C.; Stepanek, C.; Sohl, L.; Rosenbloom, N. A.; Chan, W.-L.; Kamae, Y.; Zhang, Z.; Abe-Ouchi, A.; Chandler, M. A.; Jost, A.; Lohmann, G.; Otto-Bliesner, B. L.; Ramstein, G.; Ueda, H.

    2014-01-01

    The Pliocene Model Intercomparison Project (PlioMIP) is the first coordinated climate model comparison for a warmer palaeoclimate with atmospheric CO2 significantly higher than pre-industrial concentrations. The simulations of the mid-Pliocene warm period show global warming of between 1.8 and 3.6 C above pre-industrial surface air temperatures, with significant polar amplification. Here we perform energy balance calculations on all eight of the coupled ocean-atmosphere simulations within PlioMIP Experiment 2 to evaluate the causes of the increased temperatures and differences between the models. In the tropics simulated warming is dominated by greenhouse gas increases, with the cloud component of planetary albedo enhancing the warming in most of the models, but by widely varying amounts. The responses to mid-Pliocene climate forcing in the Northern Hemisphere midlatitudes are substantially different between the climate models, with the only consistent response being a warming due to increased greenhouse gases. In the high latitudes all the energy balance components become important, but the dominant warming influence comes from the clear sky albedo, only partially offset by the increases in the cooling impact of cloud albedo. This demonstrates the importance of specified ice sheet and high latitude vegetation boundary conditions and simulated sea ice and snow albedo feedbacks. The largest components in the overall uncertainty are associated with clouds in the tropics and polar clear sky albedo, particularly in sea ice regions. These simulations show that albedo feedbacks, particularly those of sea ice and ice sheets, provide the most significant enhancements to high latitude warming in the Pliocene.

  16. Evaluation of Differentiation Strategy in Shipping Enterprises with Simulation Model

    NASA Astrophysics Data System (ADS)

    Vaxevanou, Anthi Z.; Ferfeli, Maria V.; Damianos, Sakas P.

    2009-08-01

    The present inquiring study aims at investigating the circumstances that prevail in the European Shipping Enterprises with special reference to the Greek ones. This investigation is held in order to explore the potential implementation of strategies so as to create a unique competitive advantage [1]. The Shipping sector is composed of enterprises that are mainly activated in the following three areas: the passenger, the commercial and the naval. The main target is to create a dynamic simulation model which, with reference to the STAIR strategic model, will evaluate the strategic differential choice that some of the shipping enterprises have.

  17. An evaluation of information retrieval accuracy with simulated OCR output

    SciTech Connect

    Croft, W.B.; Harding, S.M.; Taghva, K.; Borsack, J.

    1994-12-31

    Optical Character Recognition (OCR) is a critical part of many text-based applications. Although some commercial systems use the output from OCR devices to index documents without editing, there is very little quantitative data on the impact of OCR errors on the accuracy of a text retrieval system. Because of the difficulty of constructing test collections to obtain this data, we have carried out evaluation using simulated OCR output on a variety of databases. The results show that high quality OCR devices have little effect on the accuracy of retrieval, but low quality devices used with databases of short documents can result in significant degradation.

  18. Integrated Clinical Training for Space Flight Using a High-Fidelity Patient Simulator in a Simulated Microgravity Environment

    NASA Technical Reports Server (NTRS)

    Hurst, Victor; Doerr, Harold K.; Polk, J. D.; Schmid, Josef; Parazynksi, Scott; Kelly, Scott

    2007-01-01

    This viewgraph presentation reviews the use of telemedicine in a simulated microgravity environment using a patient simulator. For decades, telemedicine techniques have been used in terrestrial environments by many cohorts with varied clinical experience. The success of these techniques has been recently expanded to include microgravity environments aboard the International Space Station (ISS). In order to investigate how an astronaut crew medical officer will execute medical tasks in a microgravity environment, while being remotely guided by a flight surgeon, the Medical Operation Support Team (MOST) used the simulated microgravity environment provided aboard DC-9 aircraft teams of crew medical officers, and remote flight surgeons performed several tasks on a patient simulator.

  19. [Evaluation of joint inflammation by MRI in patients with RA].

    PubMed

    Sumida, Takayuki; Sugihara, Makoto; Hirota, Tomoya; Horikoshi, Masanobu; Suzuki, Takeshi

    2012-02-01

    We compared the characteristics of MRI imaging and US imaging on joint inflammation in patients with rheumatoid arthritis (RA) . MRI imaging is worth for diagnosis of RA at the early stage, evaluation of drug treatment effects, and a new measure for true remission. US imaging is also useful for estimation of therapy and a criteria for complete remission, and cheep machine. We hope that both imaging technologies will be a standard for diagnosis and therapy evaluation in RA patients. PMID:22298072

  20. Evaluation of the patient with hip pain.

    PubMed

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. PMID:24444505

  1. Air Force Electronic Warfare Evaluation Simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Jackson, Hank D., II; Shepherd, Seth D.

    2004-08-01

    The Air Force Electronic Warfare Evaluation Simulator (AFEWES) Infrared Countermeasures (IRCM) test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, point-source flares and lamp- and LASER-based jammer systems. The simulations of IR missiles in flight include missile seeker hardware mounted on a six degree-of-freedom flight simulation table. This paper will focus on recent developments and upgrades to the AFEWES IR capability. In particular, current developments in IR scene generation/projection and efforts to optically combining the IR image produced by a resistive array with existing foreground lamp sources.

  2. Air Force electronic warfare evaluation simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Jackson, Hank D., II; Blair, Tommy L.; Ensor, Bruce A.; Deyo, Charles R.; Longbottom, Jeff A.; White, Jason C.

    2005-05-01

    The Air Force Electronic Warfare Evaluation Simulator (AFEWES) Infrared Countermeasures (IRCM) test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, point-source flares, and lamp- and LASER-based jammer systems. The simulations of IR missiles in flight include missile seeker hardware mounted on a six degree-of-freedom flight simulation table. This paper will focus on recent developments and upgrades to the AFEWES IR capability. In particular, current developments in IR scene generation/projection and efforts to optically combining the IR image produced by a resistive array with existing foreground lamp sources.

  3. Air Force electronic warfare evaluation simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Jackson, Hank D., II; Grauvogel, Nathanael L.; Blair, Tommy L.; Ensor, Bruce A.

    2006-05-01

    The Air Force Electronic Warfare Evaluation Simulator (AFEWES) infrared countermeasures (IRCM) test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, point-source flares, and lamp- and LASER-based jammer systems. The simulations of IR missiles in flight include missile seeker hardware mounted on a six degree-of-freedom flight simulation table. This paper will focus on recent developments and upgrades to the AFEWES IR capability. In particular, current developments in IR scene generation/projection and efforts to optically combine the IR image produced by a resistive array with existing foreground lamp sources.

  4. Air Force Electronic Warfare Evaluation Simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Jackson, Hank D., II; Blair, Tommy L.; Ensor, Bruce A.

    2007-04-01

    The Air Force Electronic Warfare Evaluation Simulator (AFEWES) Infrared Countermeasures (IRCM) test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, point-source flares and lamp- and LASER-based jammer systems. The simulations of IR missiles in flight include missile seeker hardware mounted on a six degree-of-freedom flight simulation table. This paper will focus on recent developments and upgrades to the AFEWES IR capability. In particular, current developments in IR scene generation/projection and efforts to optically combining the IR image produced by a resistive array with existing foreground lamp sources.

  5. Using the Simulated Patient Methodology to Assess Paracetamol-Related Counselling for Headache

    PubMed Central

    Horvat, Nejc; Koder, Marko; Kos, Mitja

    2012-01-01

    Objectives Firstly, to assess paracetamol-related counselling. Secondly, to evaluate the patient’s approach as a determinant of counselling and to test the acceptability of the simulated patient method in Slovenian pharmacies. Methods The simulated patient methodology was used in 17 community pharmacies. Three scenarios related to self-medication for headaches were developed and used in all participating pharmacies. Two scenarios were direct product requests: scenario 1: a patient with an uncomplicated short-term headache; scenario 2: a patient with a severe, long-duration headache who takes paracetamol for too long and concurrently drinks alcohol. Scenario 3 was a symptom-based request: a patient asking for medicine for a headache. Pharmacy visits were audio recorded and scored according to predetermined criteria arranged in two categories: counselling content and manner of counselling. The acceptability of the methodology used was evaluated by surveying the participating pharmacists. Results The symptom-based request was scored significantly better (a mean 2.17 out of a possible 4 points) than the direct product requests (means of 1.64 and 0.67 out of a possible 4 points for scenario 1 and 2, respectively). The most common information provided was dosage and adverse effects. Only the symptom-based request stimulated spontaneous counselling. No statistically significant differences in the duration of the consultation between the scenarios were found. There were also no significant differences in the quality of counselling between the Masters of Pharmacy and Pharmacy Technicians. The acceptability of the SP method was not as high as in other countries. Conclusion The assessment of paracetamol-related counselling demonstrates room for practice improvement. PMID:23300691

  6. Evaluation of irradiated fuel during RIA simulation tests. Final report

    SciTech Connect

    Montgomery, R.O.; Rashid, Y.R.

    1996-08-01

    A critical assessment of the RIA-simulation experiments performed to date on previously irradiated test rods is presented. Included in this assessment are the SPERT-CDC, the NSRR, and the CABRI REP Na experimental programs. Information was collected describing the base irradiation, test rod characterization, and test procedures and conditions. The representativeness of the test rods and test conditions to anticipated LWR RIA accident conditions was evaluated using analysis results from fuel behavior and three-dimensional spatial kinetics simulations. It was shown that the pulse characteristics and coolant conditions are significantly different from those anticipated in an LWR-Furthermore, the unrepresentative test conditions were found to exaggerate the mechanisms that caused cladding failure. The data review identified several test rods which contained unusual cladding damage incurred prior to the RIA-simulation test that produced the observed failures. The mechanisms responsible for the observed test rod failures have been shown to result from processes that have a second order effect of burnup. A correlation with burnup could not be appropriately established for the fuel enthalpy at failure. However, the successful test rods can be used to construct a conservative region of success for fuel rod behavior during an RIA event.

  7. Bioenergy Crop Model Simulation and Evaluation of Miscanthus

    NASA Astrophysics Data System (ADS)

    di Vittorio, A.; Miller, N. L.

    2008-12-01

    With rising demand for biofuels there is a need to convert some abandoned grasslands to biofuel crop cultivation. Miscanthus as a feedstock is a highly productive grass under well-watered and fertilized conditions, and has the potential to efficiently provide biomass and lignin-cellulosic ethanol. Few studies have addressed Miscanthus under ambient conditions, and those that have focused on mixed grasslands within the endemic range of miscanthus sp. Here a series of benchmark simulations were performed to evaluate the productivity of Miscanthus Giganteus in a converted Mediterranean C3 grassland site under ambient conditions. To assess the potential of miscanthus as a biofuel crop, we use an ecosystem biogoechemistry model, Biome-BGC, to simulate crop productivity at the Mediterranean site in California. The site is a C3 grassland in the Sierra Nevada foothills, and has an annual average precipitation of 61.6 cm. Initial soil and vegetation conditions were determined using historical climate data and current vegetation distributions. The current vegetation was replaced with miscanthus sp., and BIOME-BGC simulations were made for the planting season, growing season, and harvest under ambient climatic conditions. Modeled biofuel crop productivity is compared with published productivities from field studies.

  8. An enriched simulation environment for evaluation of closed-loop anesthesia.

    PubMed

    Fang, Mengqi; Tao, Yuan; Wang, Youqing

    2014-02-01

    To simulate and evaluate the administration of anesthetic agents in the clinical setting, many pharmacology models have been proposed and validated, which play important roles for in silico testing of closed-loop control methods. However, to the authors' best knowledge, there is no anesthesia simulator incorporating closed-loop feedback control of anesthetic agent administration freely available and accessible to the public. Consequently, many necessary but time consuming procedures, such as selecting models from the available literatures and establishing new simulator algorithms, will be repeated by different researchers who intend to explore a novel control algorithm for closed-loop anesthesia. To address this issue, an enriched anesthesia simulator was devised in our laboratory and made freely available to the anesthesia community. This simulator was built by using MATLAB(®) (The MathWorks, Natick, MA). The GUI technology embedded in MATLAB was chosen as the tool to develop a human-machine interface. This simulator includes four types of anesthetic models, and all have been wildly used in closed-loop anesthesia studies. For each type of model, 24 virtual patients were created with significant diversity. In addition, the platform also provides a model identification module and a control method library. For the model identification module, the least square method and particle swarm optimization were presented. In the control method library, a proportional-integral-derivative control and a model predictive control were provided. Both the model identification module and the control method library are extensive and readily accessible for users to add user-defined functions. This simulator could be a benchmark-testing platform for closed-loop control of anesthesia, which is of great value and has significant development potential. For convenience, this simulator is termed as Wang's Simulator, which can be downloaded from http://www.AutomMed.org . PMID:23748601

  9. Evaluating techniques for metagenome annotation using simulated sequence data

    PubMed Central

    Randle-Boggis, Richard J.; Helgason, Thorunn; Sapp, Melanie; Ashton, Peter D.

    2016-01-01

    The advent of next-generation sequencing has allowed huge amounts of DNA sequence data to be produced, advancing the capabilities of microbial ecosystem studies. The current challenge is to identify from which microorganisms and genes the DNA originated. Several tools and databases are available for annotating DNA sequences. The tools, databases and parameters used can have a significant impact on the results: naïve choice of these factors can result in a false representation of community composition and function. We use a simulated metagenome to show how different parameters affect annotation accuracy by evaluating the sequence annotation performances of MEGAN, MG-RAST, One Codex and Megablast. This simulated metagenome allowed the recovery of known organism and function abundances to be quantitatively evaluated, which is not possible for environmental metagenomes. The performance of each program and database varied, e.g. One Codex correctly annotated many sequences at the genus level, whereas MG-RAST RefSeq produced many false positive annotations. This effect decreased as the taxonomic level investigated increased. Selecting more stringent parameters decreases the annotation sensitivity, but increases precision. Ultimately, there is a trade-off between taxonomic resolution and annotation accuracy. These results should be considered when annotating metagenomes and interpreting results from previous studies. PMID:27162180

  10. Evaluating techniques for metagenome annotation using simulated sequence data.

    PubMed

    Randle-Boggis, Richard J; Helgason, Thorunn; Sapp, Melanie; Ashton, Peter D

    2016-07-01

    The advent of next-generation sequencing has allowed huge amounts of DNA sequence data to be produced, advancing the capabilities of microbial ecosystem studies. The current challenge is to identify from which microorganisms and genes the DNA originated. Several tools and databases are available for annotating DNA sequences. The tools, databases and parameters used can have a significant impact on the results: naïve choice of these factors can result in a false representation of community composition and function. We use a simulated metagenome to show how different parameters affect annotation accuracy by evaluating the sequence annotation performances of MEGAN, MG-RAST, One Codex and Megablast. This simulated metagenome allowed the recovery of known organism and function abundances to be quantitatively evaluated, which is not possible for environmental metagenomes. The performance of each program and database varied, e.g. One Codex correctly annotated many sequences at the genus level, whereas MG-RAST RefSeq produced many false positive annotations. This effect decreased as the taxonomic level investigated increased. Selecting more stringent parameters decreases the annotation sensitivity, but increases precision. Ultimately, there is a trade-off between taxonomic resolution and annotation accuracy. These results should be considered when annotating metagenomes and interpreting results from previous studies. PMID:27162180

  11. Simulated patients in general practice: a different look at the consultation.

    PubMed Central

    Rethans, J J; van Boven, C P

    1987-01-01

    To develop a better empirical basis for developing quality assessment in general practice three simulated patients made appointments with 48 general practitioners during actual surgery hours and collected facts about their performance. The simulated patients were indistinguishable from real patients and presented a standardised story of a symptomatic urinary tract infection. Two months later the same general practitioners received a written simulation about a patient who had the same urinary tract infection and were asked how they would handle this in real practice. Both results were scored against an existing consensus standard. The overall score for both methods did not show any substantial differences. A more differentiated analysis, however, showed that general practitioners performed significantly better with simulated patients. It also showed that general practitioners answering the written simulation performed significantly more unnecessary and superfluous actions. The results of this study show that the use of simulated patients seems to show the efficient performance of general practitioners in practice. PMID:3105753

  12. Preoperative evaluation of the cardiac patient for noncardiac surgery.

    PubMed Central

    Fleisher, L. A.; Barash, P. G.

    1993-01-01

    Perioperative cardiac events continue to represent a significant cause of morbidity in patients undergoing noncardiac surgery. The evaluation of the high risk patient should begin with an assessment of the probability of coronary artery disease and exercise tolerance. Decisions to undergo further evaluation, including noninvasive testing, should be based upon the perioperative morbidity and mortality rate for the planned surgical procedure. In patients with significant coronary artery stenoses and a high probability of perioperative cardiac morbidity, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and preoperative optimization of hemodynamics in an intensive care unit have all been advocated as means of reducing risk. PMID:7825340

  13. Evaluation of simSchool: An Instructional Simulation for Pre-Service Teachers

    ERIC Educational Resources Information Center

    Deale, Deb; Pastore, Ray

    2014-01-01

    This study uses theory-based design principles to evaluate the effectiveness of an instructional simulation, simSchool. It begins by examining the simulation and evaluation literature, followed by an evaluation of the simSchool software. It is a Web-based simulation designed to emulate various students (reactions) in order to provide practice for…

  14. On the practice of ignoring center-patient interactions in evaluating hospital performance.

    PubMed

    Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

    2016-01-30

    We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. PMID:26303843

  15. Evaluation of the orofacial lesions in treated leprosy patients

    PubMed Central

    Pooja, VK; Vanishree, M; Ravikumar, Shamala; Koneru, Anila; Hunasgi, Santhosh; Surekha, R

    2014-01-01

    Background: Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. Aim: To evaluate the incidence of orofacial lesions in treated leprosy patients. Materials and Methods: Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated. Results: On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%). Conclusion: Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae. PMID:25948993

  16. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    PubMed Central

    Dunda, Sebastian E.; Bozkurt, Ahmet; Pallua, Norbert; Krapohl, Björn Dirk

    2015-01-01

    Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures. Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma. Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment. Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases. PMID:26734539

  17. Evaluation of an antipsychotic information sheet for patients.

    PubMed

    Whiskey, Eromona; Taylor, David

    2005-01-01

    Introduction. The objective of this study was to develop a decision aid that patients and clinicians might use to help the patient in the process of selecting an antipsychotic medication. In addition, we aimed to determine the antipsychotic that patients would choose given the information contained in the leaflet. Method. We designed a questionnaire for patients to appraise the contents of the leaflet, their understanding of the leaflet and the potential impact of the leaflet on compliance and therapeutic relationship between patient and doctor. Results. We recruited 30 stable patients with a diagnosis of a psychotic illness to evaluate the leaflet and to determine patient choice. Over 90% of patients felt that the leaflet improved their knowledge of antipsychotic medication. Seventy-six percent of patients agreed that the leaflet contained the right type and amount of information. Seventy percent of respondents believed the leaflet would improve the trust between them and their doctors, and almost half (47%) stated they were more likely to take their medicine after reading the leaflet. Forty percent of patients would prefer to switch antipsychotic medication, with quetiapine being the most frequently preferred option. Conclusion. The results indicate that, for patients in the stable phase of their illness, the leaflet is a useful tool in selecting an antipsychotic medication and may represent a way forward in improving outcomes in patients with psychotic disorders. A larger study examining outcomes using this tool would establish its clinical utility. PMID:24930924

  18. Development of an automatic evaluation method for patient positioning error.

    PubMed

    Kubota, Yoshiki; Tashiro, Mutsumi; Shinohara, Ayaka; Abe, Satoshi; Souda, Saki; Okada, Ryosuke; Ishii, Takayoshi; Kanai, Tatsuaki; Ohno, Tatsuya; Nakano, Takashi

    2015-01-01

    Highly accurate radiotherapy needs highly accurate patient positioning. At our facility, patient positioning is manually performed by radiology technicians. After the positioning, positioning error is measured by manually comparing some positions on a digital radiography image (DR) to the corresponding positions on a digitally reconstructed radiography image (DRR). This method is prone to error and can be time-consuming because of its manual nature. Therefore, we propose an automated measuring method for positioning error to improve patient throughput and achieve higher reliability. The error between a position on the DR and a position on the DRR was calculated to determine the best matched position using the block-matching method. The zero-mean normalized cross correlation was used as our evaluation function, and the Gaussian weight function was used to increase importance as the pixel position approached the isocenter. The accuracy of the calculation method was evaluated using pelvic phantom images, and the method's effectiveness was evaluated on images of prostate cancer patients before the positioning, comparing them with the results of radiology technicians' measurements. The root mean square error (RMSE) of the calculation method for the pelvic phantom was 0.23 ± 0.05 mm. The coefficients between the calculation method and the measurement results of the technicians were 0.989 for the phantom images and 0.980 for the patient images. The RMSE of the total evaluation results of positioning for prostate cancer patients using the calculation method was 0.32 ± 0.18 mm. Using the proposed method, we successfully measured residual positioning errors. The accuracy and effectiveness of the method was evaluated for pelvic phantom images and images of prostate cancer patients. In the future, positioning for cancer patients at other sites will be evaluated using the calculation method. Consequently, we expect an improvement in treatment throughput for these other sites

  19. Acquisition of Competencies by Medical Students in Neurological Emergency Simulation Environments Using High Fidelity Patient Simulators.

    PubMed

    Sánchez-Ledesma, M J; Juanes, J A; Sáncho, C; Alonso-Sardón, M; Gonçalves, J

    2016-06-01

    The training of medical students demands practice of skills in scenarios as close as possible to real ones that on one hand ensure acquisition of competencies, and on the other, avoid putting patients at risk. This study shows the practicality of using high definition mannequins (SimMan 3G) in scenarios of first attention in neurological emergencies so that medical students at the Faculty of Medicine of the University of Salamanca could acquire specific and transversal competencies. The repetition of activities in simulation environments significantly facilitates the acquisition of competencies by groups of students (p < 00.5). The greatest achievements refer to skills whereas the competencies that demand greater integration of knowledge seem to need more time or new sessions. This is what happens with the competencies related to the initial diagnosis, the requesting of tests and therapeutic approaches, which demand greater theoretical knowledge. PMID:27106583

  20. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    ERIC Educational Resources Information Center

    Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

    2009-01-01

    Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

  1. Design, modeling, simulation and evaluation of a distributed energy system

    NASA Astrophysics Data System (ADS)

    Cultura, Ambrosio B., II

    This dissertation presents the design, modeling, simulation and evaluation of distributed energy resources (DER) consisting of photovoltaics (PV), wind turbines, batteries, a PEM fuel cell and supercapacitors. The distributed energy resources installed at UMass Lowell consist of the following: 2.5kW PV, 44kWhr lead acid batteries and 1500W, 500W & 300W wind turbines, which were installed before year 2000. Recently added to that are the following: 10.56 kW PV array, 2.4 kW wind turbine, 29 kWhr Lead acid batteries, a 1.2 kW PEM fuel cell and 4-140F supercapacitors. Each newly added energy resource has been designed, modeled, simulated and evaluated before its integration into the existing PV/Wind grid-connected system. The Mathematical and Simulink model of each system was derived and validated by comparing the simulated and experimental results. The Simulated results of energy generated from a 10.56kW PV system are in good agreement with the experimental results. A detailed electrical model of a 2.4kW wind turbine system equipped with a permanent magnet generator, diode rectifier, boost converter and inverter is presented. The analysis of the results demonstrates the effectiveness of the constructed simulink model, and can be used to predict the performance of the wind turbine. It was observed that a PEM fuel cell has a very fast response to load changes. Moreover, the model has validated the actual operation of the PEM fuel cell, showing that the simulated results in Matlab Simulink are consistent with the experimental results. The equivalent mathematical equation, derived from an electrical model of the supercapacitor, is used to simulate its voltage response. The model is completely capable of simulating its voltage behavior, and can predict the charge time and discharge time of voltages on the supercapacitor. The bi-directional dc-dc converter was designed in order to connect the 48V battery bank storage to the 24V battery bank storage. This connection was

  2. Economic evaluation in patient safety: a literature review of methods.

    PubMed

    de Rezende, Bruna Alves; Or, Zeynep; Com-Ruelle, Laure; Michel, Philippe

    2012-06-01

    Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost-benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety. PMID:22396602

  3. Air Force electronic warfare evaluation simulator (AFEWES) infrared test and evaluation capabilities

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2002-07-01

    The Air Force Electronic Warfare Evaluation Simulator IR Countermeasures test facility currently has the ability to simulate a complete IRCM test environment, including IR missiles in flight, aircraft in flight, and various IR countermeasures including maneuvers, LASERs, flares and lamp-based jammer systems. The simulations of IR missiles in flight include real missile seeker hardware mounted in a six degree-of-freedom flight simulation table. The simulations of aircraft signatures and IR countermeasures are accomplished by using up to eight xenon arc lamps, located in 9 inch X 3 inch cylindrical housings, in the presentation foreground. A mirror system keeps the high intensity IR sources in the missile field of view. Range closure is simulated in the background by zooming in on the scene and int eh foreground by separating and controlling the irises of the arc lamp sources for property spatial and intensity characteristics. Al relative motion and range closure is controlled by missile flyout software and aircraft flight-profile software models.

  4. The moral aesthetics of simulated suffering in standardized patient performances.

    PubMed

    Taylor, Janelle S

    2011-06-01

    Standardized patient (SP) performances are staged clinical encounters between health-professional students and people who specialize in role-playing the part of patients. Such performances have in recent years become increasingly central to the teaching and assessment of clinical skills in U.S. medical schools. SP performances are valued for being both "real" (in that they involve interaction with a real person, unlike written examinations) and "not real" (in that the SP does not actually suffer from the condition portrayed, unlike an actual patient). This article considers how people involved in creating SP performances reconcile a moral commitment to avoid suffering (to keep it "not real"), with an aesthetic commitment to realistically portray it (to keep it "real"). The term "moral aesthetic" is proposed, to indicate a sensibility that combines ideas about what is morally right with ideas about what is aesthetically compelling. Drawing on ethnographic research among SPs and SP program staff and medical faculty who work closely with them, this article argues that their work of creating "realism" in simulated clinical encounters encompasses multiple different (and sometimes conflicting) understandings and practices of realism, informed by three different moral aesthetics: (1) a moral aesthetic of induction, in which an accurate portrayal with a well-documented provenance serves to introduce experientially distant forms of suffering; (2) a moral aesthetic of inoculation, in which the authenticity and emotional impact of a performance are meant to inoculate students against the impact of future encounters with suffering; (3) a moral aesthetic of presence, generating forms of voice and care that are born out of the embodied presence of suffering individuals in a clinical space. All are premised on the assumption that risk and suffering can be banished from SP performances. This article suggests, however, that SP performances necessarily raise the same difficult

  5. Generator System for Written Examinations of Patient Management Simulations

    PubMed Central

    Orthner, Helmuth F.; Acord, Arlis L.

    1982-01-01

    A system of programs is described that supports the design, review, and construction of written patient management problem simulations. The Exam Generator System may be viewed as an on-line editing system that combines word processing, database retrieval, specialized text formatting, and printing functions. The system supports electronic “Cut and Paste” functions at several levels of detail: entire exam, section level, and item level. Some of these functions are: insert, delete, move, transfer (from other exams), split or merge entire sections. Items may be inserted from the keyboard or from an on-line Item Data Bank. The system automatically formats all text and permits to print “proof copies” in which both the problem side (left side) and the answer side (right side) are printed side by side. Other printing functions support the production of master sheets and wax stencils. The latter are used for mimeographing the text of the answer fields on to the examination sheets with a special invisible ink (latent image).

  6. Quantifying ITV instabilities arising from 4DCT: a simulation study using patient data

    NASA Astrophysics Data System (ADS)

    St. James, Sara; Mishra, Pankaj; Hacker, Fred; Berbeco, Ross I.; Lewis, John H.

    2012-03-01

    Treatment planning for patients undergoing radiation therapy is often performed based on four-dimensional computed tomography (4DCT) when respiratory motion is present, as in lung cancer patients. 4DCT is used to define the internal target volume (ITV) that, ideally, incorporates all potential locations of the tumour. In this work, we use the locations of gold fiducial markers implanted in lung tumours of eight patients to represent tumour motion. These fiducial locations are used in a simulation of a four-slice CT scanner to generate the ITV for 10, 20 and 30 mm diameter model tumours. To demonstrate instabilities in the ITV definition based on 4DCT, the ITV calculation was repeated for the same patients for consecutive scan start times, staggered by 1 s. The volumetric difference in the ITV and the per cent of time that the ITV contains in the tumour are both evaluated. The ITV from a single patient was found to vary by 46%-127% for a tumour diameter of 10 mm. The ITV did not cover the entirety of the tumour 11%-74% of the time for a 10 mm tumour diameter.

  7. Pharmacists’ response to anaphylaxis in the community (PRAC): a randomised, simulated patient study of pharmacist practice

    PubMed Central

    Salter, Sandra M; Delfante, Brock; de Klerk, Sarah; Sanfilippo, Frank M; Clifford, Rhonda M

    2014-01-01

    Objective To evaluate how community pharmacists manage patients with anaphylaxis. Design A randomised, cross-sectional, simulated patient study of community pharmacist practice. Setting 300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen. Participants 300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen). Outcome measures Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis). Methods Simulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement). Results The mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, p<0.001, respectively). Overall, 17.3% of pharmacists correctly demonstrated the epinephrine autoinjector. The mean anaphylaxis engagement score was 3.11 points (SD 1.73). Scores for new-look EpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001). Conclusions Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis

  8. Evaluating North America Paleoclimate Simulations using Simulated and Observed Paleovegetation Data for 6 ka and 21 ka

    NASA Astrophysics Data System (ADS)

    Shafer, S. L.; Bartlein, P. J.; Thompson, R. S.; Anderson, K.; Izumi, K.; Strickland, L. E.; Pelltier, R.

    2013-12-01

    An important use of paleoclimate data is to evaluate climate models that simulate future climate. We used paleoclimate simulations from the Paleoclimate Modelling Intercomparison Project phase 3 (PMIP3) and Coupled Model Intercomparison Project phase 5 (CMIP5) database to evaluate simulated and observed vegetation agreement for 6 ka and 21 ka. The paleoclimate simulations were downscaled to a 10-km grid of North America following the PMIP3 vegetation simulation protocol. The downscaled climate data were used with BIOME4, an equilibrium vegetation model, to simulate paleovegetation for each time period. The simulated paleovegetation was compared with observed paleovegetation data from the BIOME 6000 (ver. 4.2) dataset and the U.S. Geological Survey/NOAA North American Packrat Midden Database (ver. 3). We evaluated the magnitude and spatial patterns of agreement and disagreement of the observed and simulated paleovegetation. The results were analyzed for individual climate model simulations and paleovegetation types. Some simulated paleovegetation types (e.g., needleleaf evergreen forest) showed good agreement with observed paleovegetation data while other simulated paleovegetation types (e.g., open conifer woodland) showed relatively poor agreement. The analyses provide insights into climate and vegetation model performance and suggest opportunities for improving both model simulations and interpretations of observed paleovegetation data.

  9. EVALUATION OF THE CERVICAL SPINE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS

    PubMed Central

    Passos Cardoso, André Luiz; Da Silva, Nilzio Antonio; Daher, Sérgio; De Moraes, Frederico Barra; Do Carmo, Humberto Franco

    2015-01-01

    Objective: To evaluate the prevalence of cervical spine abnormalities among patients with rheumatoid arthritis and correlate the imaging findings with the clinical state. Methods: A cross-sectional study on 35 patients was carried out at the School of Medicine of the Federal University of Goiás (UFG) in 2004. The following were evaluated: age, use of medications and the clinical picture of pain and neurological characteristics. The erythrocyte sedimentation rate (ESR) and rheumatoid factor were tested, and radiographs of the cervical spine were produced in anteroposterior, lateral and dynamic views. To evaluate the influence of the variables on the emergence of instabilities, univariate and multivariate logistic regression tests were used (p < 0.05). Results: Among the 35 patients evaluated, 13 (37.1%) presented a stable cervical spine. Out of the 22 patients with instability, six presented more than one type. Atlantoaxial instability was found in 15 patients, with a mean anterior atlantodental distance of 3.40 mm in the neutral lateral radiographic view and 6.54 mm in the lateral view with flexion. Basilar invagination was found in five patients and subaxial subluxation in seven patients. Two thirds of the asymptomatic patients had instabilities. Bicipital hyperreflexia presented statistically significant correlations with atlantoaxial instability (p = 0.024) and subaxial instability (p = 0.01). Age at diagnosis correlated with subaxial instability (p = 0.02). Conclusions: The prevalence of cervical instability was 62.9 % (22/35). The most frequent instabilities were: atlantoaxial subluxation (42.9 %), subaxial subluxation (20%) and basilar invagination (14.3%). The correlation between instabilities and clinical signs and symptoms was poor. The patients with subaxial subluxation presented disease onset at a younger age. Dynamic radiography was important for diagnosing atlantoaxial subluxation. PMID:27022536

  10. Process simulation and economical evaluation of enzymatic biodiesel production plant.

    PubMed

    Sotoft, Lene Fjerbaek; Rong, Ben-Guang; Christensen, Knud V; Norddahl, Birgir

    2010-07-01

    Process simulation and economical evaluation of an enzymatic biodiesel production plant has been carried out. Enzymatic biodiesel production from high quality rapeseed oil and methanol has been investigated for solvent free and cosolvent production processes. Several scenarios have been investigated with different production scales (8 and 200 mio. kg biodiesel/year) and enzyme price. The cosolvent production process is found to be most expensive and is not a viable choice, while the solvent free process is viable for the larger scale production of 200 mio. kg biodiesel/year with the current enzyme price. With the suggested enzyme price of the future, both the small and large scale solvent free production proved viable. The product price was estimated to be 0.73-1.49 euro/kg biodiesel with the current enzyme price and 0.05-0.75 euro/kg with the enzyme price of the future for solvent free process. PMID:20171880

  11. Dynamic simulation of tibial tuberosity realignment: model evaluation.

    PubMed

    Purevsuren, Tserenchimed; Elias, John J; Kim, Kyungsoo; Kim, Yoon Hyuk

    2015-01-01

    This study was performed to evaluate a dynamic multibody model developed to characterize the influence of tibial tuberosity realignment procedures on patellofemoral motion and loading. Computational models were created to represent four knees previously tested at 40°, 60°, and 80° of flexion with the tibial tuberosity in a lateral, medial and anteromedial positions. The experimentally loaded muscles, major ligaments of the knee, and patellar tendon were represented. A repeated measures ANOVA with post-hoc testing was performed at each flexion angle to compare data between the three positions of the tibial tuberosity. Significant experimental trends for decreased patella flexion due to tuberosity anteriorization and a decrease in the lateral contact force due to tuberosity medialization were reproduced computationally. The dynamic multibody modeling technique will allow simulation of function for symptomatic knees to identify optimal surgical treatment methods based on parameters related to knee pathology and pre-operative kinematics. PMID:25025488

  12. Lunar Regolith Characterization for Simulant Design and Evaluation

    NASA Technical Reports Server (NTRS)

    Schrader, Christian M.; Stoeser, Douglas; Rickman, Douglas; Wentworth, Susan J.; Mclemore, Carole; Fikes, John; McKay, David S.

    2009-01-01

    NASA's Marshall Space Flight Center (MSFC), in conjunction with the United States Geological Survey (USGS), is implementing a new data acquisition strategy to support the development and evaluation of lunar regolith simulants. The objective is to characterize the variance in particle composition, size, shape, and bulk density of the lunar regolith. Apollo drive and drill cores are the preferred samples as they allow for investigation of variation with depth, and many proposed operations on the moon will involve excavation of lunar regolith to depths of at least tens of centimeters. Multiple Apollo cores will be sampled multiple times along their vertical axes and analyzed. This will permit statistical statements about variation both within a core, between closely spaced cores, and between distant areas.

  13. [Evaluation of +Gz tolerance following simulation of 8-hr flight].

    PubMed

    Khomenko, M N; Bukhtiiarov, I V; Malashchuk, L S

    2005-01-01

    Tolerance of +Gz (head-pelvis) centrifugation of pilots was evaluated following simulation of a long flight on single-seat fighter. The experiment involved 5 test-subjects who were exposed to +Gz before and after simulated 8-hr flight with a growth gradient of 0.1 u/s without anti-g suits and muscles relaxed; in addition, limiting tolerance of intricate profile +Gz loads of 2.0 to 9.0 units with a growth gradient of 1.0 u/s of test-subjects in anti-g suits (AGS) with a change-over pressure valve in the peak mode using muscle straining and breathing maneuvers. To counteract the negative effects of extended flight, various seat configurations: with a back inclination at 30 degrees to the +Gz vector and changeable geometry with a back inclination at 55 degrees to the vector. The other counter-measures applied were cool air shower, suit ventilation, physical exercises, lower body massage with AGS, electrostimulation of the back and lumber region, profiling of the supporting and soft parts of the seat, and 30-s exposure to +5 Gz. Hemodynamic and respiration parameters as well as body temperature were measured in the course of 8 hrs of flight and during and shortly after centrifugation. According to the results of the investigation, seat inclination at 55 degrees to the +Gz vector and tested system of countermeasures prevent degradation of tolerance of large (9 u.) loads following 8-hr flight simulation with the use of the modern anti-g gear, PMID:16353624

  14. Simulation Modeling and Performance Evaluation of Space Networks

    NASA Technical Reports Server (NTRS)

    Jennings, Esther H.; Segui, John

    2006-01-01

    In space exploration missions, the coordinated use of spacecraft as communication relays increases the efficiency of the endeavors. To conduct trade-off studies of the performance and resource usage of different communication protocols and network designs, JPL designed a comprehensive extendable tool, the Multi-mission Advanced Communications Hybrid Environment for Test and Evaluation (MACHETE). The design and development of MACHETE began in 2000 and is constantly evolving. Currently, MACHETE contains Consultative Committee for Space Data Systems (CCSDS) protocol standards such as Proximity-1, Advanced Orbiting Systems (AOS), Packet Telemetry/Telecommand, Space Communications Protocol Specification (SCPS), and the CCSDS File Delivery Protocol (CFDP). MACHETE uses the Aerospace Corporation s Satellite Orbital Analysis Program (SOAP) to generate the orbital geometry information and contact opportunities. Matlab scripts provide the link characteristics. At the core of MACHETE is a discrete event simulator, QualNet. Delay Tolerant Networking (DTN) is an end-to-end architecture providing communication in and/or through highly stressed networking environments. Stressed networking environments include those with intermittent connectivity, large and/or variable delays, and high bit error rates. To provide its services, the DTN protocols reside at the application layer of the constituent internets, forming a store-and-forward overlay network. The key capabilities of the bundling protocols include custody-based reliability, ability to cope with intermittent connectivity, ability to take advantage of scheduled and opportunistic connectivity, and late binding of names to addresses. In this presentation, we report on the addition of MACHETE models needed to support DTN, namely: the Bundle Protocol (BP) model. To illustrate the use of MACHETE with the additional DTN model, we provide an example simulation to benchmark its performance. We demonstrate the use of the DTN protocol

  15. Development and Evaluation of Patient Education Materials for Elderly Lung Cancer Patients.

    PubMed

    Jewitt, Natalie; Hope, Andrew J; Milne, Robin; Le, Lisa W; Papadakos, Janet; Abdelmutti, Nazek; Catton, Pamela; Giuliani, Meredith E

    2016-03-01

    Patients treated for lung cancer are often elderly presenting a unique challenge for developing patient education materials. This study developed and evaluated a patient education pamphlet on lung stereotactic body radiotherapy (SBRT) designed specifically for an elderly population. The SBRT pamphlet was developed using a participatory design involving a convenience sample of patients. This prospective study assessed patient's opinions of pamphlet effectiveness through self-report questionnaires. The pamphlet was deemed "effective" if patients rated 16/18 evaluation statements as "strongly agree" or "agree." Demographic data and health literacy (Rapid Estimate of Adult Literacy in Medicine short-form (REALM-SF)) were also assessed. Patient opinion of pamphlet "effectiveness" was compared between patients with REALM-SF scores of 7 versus <7 using Fisher's exact test. The overall EQ-5D-5L score was compared for patients who did and did not find the pamphlet effective using the Wilcoxon-Mann-Whitney test. Thirty-seven patients participated. The median age was 76 years (range 56-93) and 22 patients (59 %) had ≤high school education. Most patients preferred to have verbal (65 %) or written (78 %) educational materials as opposed to online information or educational classes. Thirty-two patients (86 %) rated the pamphlet as effective. The proportion of patients who found the pamphlet effective was 85.7 versus 86.7 % (p = 1.00) in those with REALM 7 versus <7. The mean EQ-5D score was 67.5 (SD 19.1) versus 71.8 (SD 8.7) (p = 0.84) in those who found the pamphlet effective versus not. Participatory design is an effective method for developing education materials for challenging patient groups such as elderly patients. Despite advanced age and comorbidity, this patient group had adequate health literacy. PMID:25572462

  16. Simulator Evaluation of Airborne Information for Lateral Spacing (AILS) Concept

    NASA Technical Reports Server (NTRS)

    Abbott, Terence S.; Elliott, Dawn M.

    2001-01-01

    The Airborne Information for Lateral Spacing (AILS) concept is designed to support independent parallel approach operations to runways spaced as close as 2500 ft. This report describes the AILS operational concept and the results of a ground-based flight simulation experiment of one implementation of this concept. The focus of this simulation experiment was to evaluate pilot performance, pilot acceptability, and minimum miss-distances for the rare situation in which all aircraft oil one approach intrudes into the path of an aircraft oil the other approach. Results from this study showed that the design-goal mean miss-distance of 1200 ft to potential collision situations was surpassed with an actual mean miss-distance of 2236 ft. Pilot reaction times to the alerting system, which was an operational concern, averaged 1.11 sec, well below the design-goal reaction time 2.0 sec.These quantitative results and pilot subjective data showed that the AILS concept is reasonable from an operational standpoint.

  17. Evaluation of a simulation-based surrogate safety metric.

    PubMed

    Wang, Chen; Stamatiadis, Nikiforos

    2014-10-01

    The development of surrogate safety measures is essential due to the problems of availability and quality of historical crash data. The Aggregate Conflict Propensity Metric (ACPM) is a surrogate metric recently proposed and it is based on conflict studies and traffic simulations. ACPM is expected to be capable of assessing the relative safety levels of traffic facilities and/or treatments in order to help traffic engineers to select appropriate treatments based on traffic safety estimates. This paper presents three experimental tests conducted to evaluate the reliability of ACPM. In each test, ACPM is compared to a traditional conflict indicator in terms of identifying and ranking safety of traffic conditions under various traffic volumes based on traffic simulations. ACPM shows its strength and reliability in all three tests, as it provides results highly consistent with the Highway Safety Manual. The experimental tests indicate that ACPM is a promising surrogate safety measure that can appropriately identify relative safety among traffic treatments and/or facilities and provide traffic engineers with useful information on potential safety impact. PMID:24892875

  18. Using standardized patients to evaluate hospital-based intervention outcomes

    PubMed Central

    Li, Li; Lin, Chunqing; Guan, Jihui

    2014-01-01

    Background The standardized patient approach has proved to be an effective training tool for medical educators. This article explains the process of employing standardized patients in an HIV stigma reduction intervention in healthcare settings in China. Methods The study was conducted in 40 hospitals in two provinces of China. One year after the stigma reduction intervention, standardized patients made unannounced visits to participating hospitals, randomly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results. After each visit, the standardized patients evaluated their providers’ attitudes and behaviours using a structured checklist. Standardized patients also took open-ended observation notes about their experience and the evaluation process. Results Seven standardized patients conducted a total of 217 assessments (108 from 20 hospitals in the intervention condition; 109 from 20 hospitals in the control condition). Based on a comparative analysis, the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal precaution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the standardized patients. Conclusion Standardized patients are a useful supplement to traditional self-report assessments, particularly for measuring intervention outcomes that are sensitive or prone to social desirability. PMID:24369433

  19. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  20. Diagnostic evaluation of urinary incontinence in geriatric patients.

    PubMed

    Weiss, B D

    1998-06-01

    In most cases, the evaluation of urinary incontinence requires only a history, a physical examination, urinalysis and measurement of postvoid residual urine volume. The initial purposes of the evaluation are to identify conditions requiring referral or specialized work-up and to detect and treat reversible causes that may be present. If the patient does not appear to require referral and a reversible cause is not identified, the next step is to categorize the patient's symptoms as typical of either urge or stress incontinence and treat the patient accordingly. If treatment fails or a presumptive diagnosis of urge or stress incontinence cannot be reached, the final step would be to perform more sophisticated tests or refer the patient for testing to define the cause and determine the best treatment. PMID:9636332

  1. Low earth orbital atomic oxygen simulation for materials durability evaluation

    NASA Technical Reports Server (NTRS)

    Banks, Bruce A.; Rutledge, Sharon K.

    1989-01-01

    The erosion yields of numerous materials have been evaluated in low earth orbital space tests. There appears to be three classes of materials: materials of high erosion yield which include most of the hydrocarbon organic materials; materials which either do not react with atomic oxygen or form self-protecting oxides which allow the underlying material to appear durable to atomic oxygen, and materials with low but nonnegligeable erosion yields, such as fluoropolymers. A NASA atomic oxygen effects test program has been established to utilize collective data from a multitude of simulation facilities to promote an understanding of mechanism and erosion yield dependencies. Atomic oxygen protective coatings for Kapton polymide solar array blankets, fiberglass-epoxy composite mast structures, and solar dynamic power system concentrator surfaces have been identified and evaluated under atomic oxygen exposure in RF plasma asher laboratory tests. The control of defect density in protective coatings appears to be the key to the assurance of long-term protection of oxidizable materials in low earth orbit.

  2. Solar power plant performance evaluation: simulation and experimental validation

    NASA Astrophysics Data System (ADS)

    Natsheh, E. M.; Albarbar, A.

    2012-05-01

    In this work the performance of solar power plant is evaluated based on a developed model comprise photovoltaic array, battery storage, controller and converters. The model is implemented using MATLAB/SIMULINK software package. Perturb and observe (P&O) algorithm is used for maximizing the generated power based on maximum power point tracker (MPPT) implementation. The outcome of the developed model are validated and supported by a case study carried out using operational 28.8kW grid-connected solar power plant located in central Manchester. Measurements were taken over 21 month's period; using hourly average irradiance and cell temperature. It was found that system degradation could be clearly monitored by determining the residual (the difference) between the output power predicted by the model and the actual measured power parameters. It was found that the residual exceeded the healthy threshold, 1.7kW, due to heavy snow in Manchester last winter. More important, the developed performance evaluation technique could be adopted to detect any other reasons that may degrade the performance of the P V panels such as shading and dirt. Repeatability and reliability of the developed system performance were validated during this period. Good agreement was achieved between the theoretical simulation and the real time measurement taken the online grid connected solar power plant.

  3. A simulator tool set for evaluating HEVC/SHVC streaming

    NASA Astrophysics Data System (ADS)

    Al Hadhrami, Tawfik; Nightingale, James; Wang, Qi; Grecos, Christos; Kehtarnavaz, Nasser

    2015-02-01

    Video streaming and other multimedia applications account for an ever increasing proportion of all network traffic. The recent adoption of High Efficiency Video Coding (HEVC) as the H.265 standard provides many opportunities for new and improved services multimedia services and applications in the consumer domain. Since the delivery of version one of H.265, the Joint Collaborative Team on Video Coding have been working towards standardisation of a scalable extension (SHVC) to the H.265 standard and a series of range extensions and new profiles. As these enhancements are added to the standard the range of potential applications and research opportunities will expend. For example the use of video is also growing rapidly in other sectors such as safety, security, defence and health with real-time high quality video transmission playing an important role in areas like critical infrastructure monitoring and disaster management. Each of which may benefit from the application of enhanced HEVC/H.265 and SHVC capabilities. The majority of existing research into HEVC/H.265 transmission has focussed on the consumer domain addressing issues such as broadcast transmission and delivery to mobile devices with the lack of freely available tools widely cited as an obstacle to conducting this type of research. In this paper we present a toolset which facilitates the transmission and evaluation of HEVC/H.265 and SHVC encoded video on the popular open source NCTUns simulator. Our toolset provides researchers with a modular, easy to use platform for evaluating video transmission and adaptation proposals on large scale wired, wireless and hybrid architectures. The toolset consists of pre-processing, transmission, SHVC adaptation and post-processing tools to gather and analyse statistics. It has been implemented using HM15 and SHM5, the latest versions of the HEVC and SHVC reference software implementations to ensure that currently adopted proposals for scalable and range extensions to

  4. Study of Physiological Responses to Acute Carbon Monoxide Exposure with a Human Patient Simulator

    ERIC Educational Resources Information Center

    Cesari, Whitney A.; Caruso, Dominique M.; Zyka, Enela L.; Schroff, Stuart T.; Evans, Charles H., Jr.; Hyatt, Jon-Philippe K.

    2006-01-01

    Human patient simulators are widely used to train health professionals and students in a clinical setting, but they also can be used to enhance physiology education in a laboratory setting. Our course incorporates the human patient simulator for experiential learning in which undergraduate university juniors and seniors are instructed to design,…

  5. The evaluation and treatment of the sexually assaulted patient.

    PubMed

    Hochbaum, S R

    1987-08-01

    There are several significant problems encountered in treating the assault victim in the Emergency Department setting. In a busy Emergency Department, the patient who has been assaulted may be prioritized behind other patients with more significant life-threatening illnesses or injuries. The delay in treatment that ensues may aggravate the emotional trauma already experienced. Additionally, the legal and technical aspects involved in the evaluation and subsequent testimony may erect a psychological barrier on the part of the physician or nurse. This article provides guidelines and handling all of the above problems with regard to the sexually assaulted patient. PMID:3308430

  6. Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

    PubMed Central

    Mannava, Sandeep; Howse, Elizabeth A.; Stone, Austin V.; Stubbs, Allston J.

    2015-01-01

    Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases. PMID:26759783

  7. Evaluating health interest profiles extracted from patient-generated data.

    PubMed

    Hartzler, Andrea L; McDonald, David W; Park, Albert; Huh, Jina; Weaver, Charles; Pratt, Wanda

    2014-01-01

    Patient-generated health data (PGHD) offers a promising resource for shaping patient care, self-management, population health, and health policy. Although emerging technologies bolster opportunities to extract PGHD and profile the needs and experiences of patients, few efforts examine the validity and use of such profiles from the patient's perspective. To address this gap, we explore health interest profiles built automatically from online community posts. Through a user evaluation with community members, we found that extracted profiles not only align with members' stated health interests, but also expand upon those manually entered interests with little user effort. Community members express positive attitudes toward the use and expansion of profiles to connect with peers for support. Despite this promising approach, findings also point to improvements required of biomedical text processing tools to effectively process PGHD. Findings demonstrate opportunities to leverage the wealth of unstructured PGHD available in emerging technologies that patients regularly use. PMID:25954368

  8. Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

    PubMed Central

    Onyeonoro, Ugochukwu U; Chukwu, Joseph N; Nwafor, Charles C; Meka, Anthony O; Omotowo, Babatunde I; Madichie, Nelson O; Ogbudebe, Chidubem; Ikebudu, Joy N; Oshi, Daniel C; Ekeke, Ngozi; Paul, Nsirimobu I; Duru, Chukwuma B

    2015-01-01

    OBJECTIVE Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. MATERIALS AND METHODS A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. RESULTS Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. CONCLUSION Patient- and health system–related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing. PMID:26508872

  9. Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

    PubMed Central

    JOHNSON, TERESA R.; LYONS, REBECCA; CHUAH, JOON HAO; KOPPER, REGIS; LOK, BENJAMIN C.; CENDAN, JUAN C.

    2013-01-01

    Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students. PMID:22938679

  10. Acquisition history simulation for evaluation of Landsat-based crop inventory systems

    NASA Technical Reports Server (NTRS)

    Smith, J. H.; Malin, J. T.; Lin, C. C.; Dvorin, M.

    1982-01-01

    This paper describes the development and evaluation of a simulation procedure which produces patterns of Landsat data loss attributable to cloud patterns that are characteristic of a crop region. This simulation procedure is part of a simulation system under development which evaluates the performance of crop inventory system components over a number of years and under a variety of conditions.

  11. Clinical trial simulation to evaluate population pharmacokinetics and food effect: capturing abiraterone and nilotinib exposures.

    PubMed

    Li, Claire H; Sherer, Eric A; Lewis, Lionel D; Bies, Robert R

    2015-05-01

    The objectives of this study were to determine (1) the accuracy with which individual patient level exposure can be determined and (2) whether a known food effect can be identified in a trial simulation of a typical population pharmacokinetic trial. Clinical trial simulations were undertaken using NONMEM VII to assess a typical oncology pharmacokinetic trial design. Nine virtual trials for each compound were performed for combinations of different levels of between-occasion variability, number of patients in the trial, and magnitude of a food covariate on oral clearance. Less than 5% and 20% bias and precision were obtained in individual clearance estimated for both abiraterone and nilotinib using this design. This design resulted in biased and imprecise population clearance estimates for abiraterone. The between-occasion variability in most trials was captured with less than 30% of percent bias and precision. The food effect was detectable as a statistically significant covariate on oral clearance for abiraterone and nilotinib with percent bias and precision of the food covariate less than 20%. These results demonstrate that clinical trial simulation can be used to explore the ability of specific trial designs to evaluate the power to identify individual and population level exposures, covariate, and variability effects. PMID:25511575

  12. Clinical Trial Simulation to Evaluate Population Pharmacokinetics and Food Effect: Capturing Abiraterone and Nilotinib Exposures

    PubMed Central

    Sherer, Eric A.; Lewis, Lionel D.; Bies, Robert R.

    2015-01-01

    The objectives of this study were to determine (1) the accuracy with which individual patient level exposure can be determined and (2) whether a known food effect can be identified in a trial simulation of a typical population pharmacokinetic trial. Clinical trial simulations were undertaken using NONMEM VII to assess a typical oncology pharmacokinetic trial design. Nine virtual trials for each compound were performed for combinations of different level of between-occasion variability, number of patients in the trial and magnitude of a food covariate on oral clearance. Less than 5% and 20% bias and precision were obtained in individual clearance estimated for both abiraterone and nilotinib using this design. This design resulted biased and imprecise population clearance estimates for abiraterone. The between-occasion variability in most trials was captured with less than 30% of percent bias and precision. The food effect was detectable as a statistically significant covariate on oral clearance for abiraterone and nilotinib with percent bias and precision of the food covariate less than 20%. These results demonstrate that clinical trial simulation can be used to explore the ability of specific trial designs to evaluate the power to identify individual and population level exposures,covariate and variability effects. PMID:25511575

  13. Audio Taping Simulated Patient Encounters in Community Pharmacy to Enhance the Reliability of Assessments

    PubMed Central

    Werner, Joel Benjamin

    2008-01-01

    Objectives To assess whether audio taping simulated patient interactions can improve the reliability of manually documented data and result in more accurate assessments. Methods Over a 3-month period, 1340 simulated patient visits were made to community pharmacies. Following the encounters, data gathered by the simulated patient were relayed to a coordinator who completed a rating form. Data recorded on the forms were later compared to an audiotape of the interaction. Corrections were tallied and reasons for making them were coded. Results Approximately 10% of cases required corrections, resulting in a 10%-20% modification in the pharmacy's total score. The difference between postcorrection and precorrection scores was significant. Conclusions Audio taping simulated patient visits enhances data integrity. Most corrections were required because of the simulated patients' poor recall abilities. PMID:19325956

  14. Interactive Simulated Patient: Experiences with Collaborative E-Learning in Medicine

    ERIC Educational Resources Information Center

    Bergin, Rolf; Youngblood, Patricia; Ayers, Mary K.; Boberg, Jonas; Bolander, Klara; Courteille, Olivier; Dev, Parvati; Hindbeck, Hans; Edward, Leonard E., II; Stringer, Jennifer R.; Thalme, Anders; Fors, Uno G. H.

    2003-01-01

    Interactive Simulated Patient (ISP) is a computer-based simulation tool designed to provide medical students with the opportunity to practice their clinical problem solving skills. The ISP system allows students to perform most clinical decision-making procedures in a simulated environment, including history taking in natural language, many…

  15. Finite element simulation of the insertion of guidewires during an EVAR procedure: example of a complex patient case, a first step toward patient-specific parameterized models.

    PubMed

    Gindre, Juliette; Bel-Brunon, Aline; Kaladji, Adrien; Duménil, Aurélien; Rochette, Michel; Lucas, Antoine; Haigron, Pascal; Combescure, Alain

    2015-07-01

    Deformations of the vascular structure due to the insertion of tools during endovascular treatment of aneurysms of the abdominal aorta, unless properly anticipated during the preoperative planning phase, may be the source of intraoperative or postoperative complications. We propose here an explicit finite element simulation method which enables one to predict such deformations. This method is based on a mechanical model of the vascular structure which takes into account the nonlinear behavior of the arterial wall, the prestressing effect induced by the blood pressure and the mechanical support of the surrounding organs and structures. An analysis of the model sensitivity to the parameters used to represent this environment is done. This allows determining the parameters that have the largest influence on the quality of the prediction and also provides realistic values for each of them as no experimental data are available in the literature. Moreover, for the first time, the results are compared with 3D intraoperative data. This is done for a patient-specific case with a complex anatomy in order to assess the feasibility of the method. Finally, the predictive capability of the simulation is evaluated on a group of nine patients. The error between the final simulated and intraoperatively measured tool positions was 2.1 mm after the calibration phase on one patient. It results in a 4.6 ± 2.5 mm in average error for the blind evaluation on nine patients. PMID:25820933

  16. Virtual patient simulation in psychiatric care - A pilot study of digital support for collaborate learning.

    PubMed

    Sunnqvist, Charlotta; Karlsson, Karin; Lindell, Lisbeth; Fors, Uno

    2016-03-01

    Psychiatric and mental health nursing is built on a trusted nurse and patient relationship. Therefore communication and clinical reasoning are two important issues. Our experiences as teachers in psychiatric educational programmes are that the students feel anxiety and fear before they start their clinical practices in psychiatry. Therefore there is a need for bridging over the fear. Technology enhanced learning might support such activities so we used Virtual patients (VPs), an interactive computer simulations of real-life clinical scenarios. The aim of this study was to investigate 4th term nursing students' opinions on the use of Virtual Patients for assessment in a Mental Health and Ill-health course module. We asked 24 volunteering students to practise with five different VP cases during almost 10 weeks before the exam. The participants were gathered together for participating in a written and an oral evaluation. The students were positive to the use of VPs in psychiatry and were very positive to use VPs in their continued nursing education. It seems that Virtual Patients can be an activity producing pedagogic model promoting students' independent knowledge development, critical thinking, reflection and problem solving ability for nurse students in psychiatric care. PMID:27038085

  17. Interactive Graphics Simulator: Design, Development, and Effectiveness/Cost Evaluation. Final Report.

    ERIC Educational Resources Information Center

    Pieper, William J.; And Others

    This study was initiated to design, develop, implement, and evaluate a videodisc-based simulator system, the Interactive Graphics Simulator (IGS) for 6883 Converter Flight Control Test Station training at Lowry Air Force Base, Colorado. The simulator provided a means for performing task analysis online, developing simulations from the task…

  18. Evaluation of parathyroid autograft growth and function in hemodialysis patients

    SciTech Connect

    Karsenty, G.; Petraglia, A.; Bourdeau, A.; Gambini, D.J.; Moreau, J.F.; Lecharpentier, Y.; Zingraff, J.; Bournerias, F.; Buisson, C.; Dubost, C.

    1986-07-01

    The aim of our study was to evaluate the function and growth of parathyroid tissue autografted into the forearm of hemodialysis patients using several presently available methods. In a dynamic study, the secretory function of autografted tissue was evaluated in seven patients using either zero calcium dialysate or calcium infusion. In an additional prospective study, seven patients had repeated determinations of plasma immunoreactive parathyroid hormone (iPTH) concentration on samples from both forearms, a radionuclide evaluation of autograft function using thallium-201 chloride, and real time ultrasonography. Light microscopy analysis was performed in two patients. The dynamic study demonstrated that induction of hypocalcemia was followed by an increase, and induction of hypercalcemia by a decrease in circulating iPTH in both forearms using three different radioimmunoassays similar to what has been reported for normal parathyroid tissue. A significant gradient (ie, greater than 2.0) of plasma iPTH concentration in samples from both forearms was observed in only three out of the seven patients of the prospective study. Two of these patients disclosed an increased uptake of /sup 201/TI chloride at the site of autografted tissue and had an echographically detectable mass. In both, hyperplastic parathyroid tissue was removed. At present, the remaining third patient does not have other features of recurrent hyperparathyroidism. In conclusion, autotransplanted parathyroid tissue of hemodialysis patients shows an adequate response to physiologic stimuli such as hypo- and hypercalcemia. Dynamic tests, therefore, appear to be a useful tool in the assessment of its function. In addition, radionuclide and echographic studies may be reliable adjuncts in the detection of marked parathyroid autograft hyperplasia.

  19. Evaluating risk factor assumptions: a simulation-based approach

    PubMed Central

    2011-01-01

    Background Microsimulation models are an important tool for estimating the comparative effectiveness of interventions through prediction of individual-level disease outcomes for a hypothetical population. To estimate the effectiveness of interventions targeted toward high risk groups, the mechanism by which risk factors influence the natural history of disease must be specified. We propose a method for evaluating these risk factor assumptions as part of model-building. Methods We used simulation studies to examine the impact of risk factor assumptions on the relative rate (RR) of colorectal cancer (CRC) incidence and mortality for a cohort with a risk factor compared to a cohort without the risk factor using an extension of the CRC-SPIN model for colorectal cancer. We also compared the impact of changing age at initiation of screening colonoscopy for different risk mechanisms. Results Across CRC-specific risk factor mechanisms, the RR of CRC incidence and mortality decreased (towards one) with increasing age. The rate of change in RRs across age groups depended on both the risk factor mechanism and the strength of the risk factor effect. Increased non-CRC mortality attenuated the effect of CRC-specific risk factors on the RR of CRC when both were present. For each risk factor mechanism, earlier initiation of screening resulted in more life years gained, though the magnitude of life years gained varied across risk mechanisms. Conclusions Simulation studies can provide insight into both the effect of risk factor assumptions on model predictions and the type of data needed to calibrate risk factor models. PMID:21899767

  20. USING COMPUTATIONAL PATIENTS TO EVALUATE ILLNESS MECHANISMS IN SCHIZOPHRENIA

    PubMed Central

    Hoffman, Ralph E.; Grasemann, Uli; Gueorguieva, Ralitza; Quinlan, Donald; Lane, Douglas; Miikkulainen, Risto

    2011-01-01

    Background Various malfunctions involving working memory, semantics, prediction error, and dopamine neuromodulation have been hypothesized to cause disorganized speech and delusions in schizophrenia. Computational models may provide insights into why some mechanisms are unlikely, suggest alternative mechanisms, and tie together explanations of seemingly disparate symptoms and experimental findings. Methods Eight corresponding illness mechanisms were simulated in DISCERN, an artificial neural network model of narrative understanding and recall. For this study, DISCERN learned sets of “autobiographical” and “impersonal” crime stories with associated emotion-coding. In addition, 20 healthy controls and 37 patients with schizophrenia or schizoaffective disorder matched for age, gender and parental education were studied using a delayed story-recall task. A goodness-of-fit analysis was performed to determine the mechanism best reproducing narrative breakdown profiles generated by healthy controls and patients with schizophrenia. Evidence of delusion-like narratives was sought in simulations best matching the narrative breakdown profile of patients. Results All mechanisms were equivalent in matching the narrative breakdown profile of healthy controls. However, exaggerated prediction-error signaling during consolidation of episodic memories, termed hyperlearning, was statistically superior to other mechanisms in matching the narrative breakdown profile of patients. These simulations also systematically confused “autobiographical” agents with “impersonal” crime story agents to model fixed, self-referential delusions. Conclusions Findings suggest that exaggerated prediction-error signaling in schizophrenia intermingles and corrupts narrative memories when incorporated into long-term storage, thereby disrupting narrative language and producing fixed delusional narratives. If further validated by clinical studies, these computational patients could provide a

  1. Statistical evaluation of the simulated convective activity over Central Greece

    NASA Astrophysics Data System (ADS)

    Kartsios, Stergios; Kotsopoulos, Stylianos; Karacostas, Theodore S.; Tegoulias, Ioannis; Pytharoulis, Ioannis; Bampzelis, Dimitrios

    2015-04-01

    In the framework of the project DAPHNE (www.daphne-meteo.gr), the non-hydrostatic Weather Research and Forecasting model with the Advanced Research dynamic solver (WRF-ARW, version 3.5.1) is used to produce very high spatiotemporal resolution simulations of the convective activity over Thessaly plain and hence, enhancing our knowledge on the impact of high resolution elevation and land use data in the moist convection. The expecting results act as a precursor for the potential applicability of a planned precipitation enhancement program. The three model domains, covering Europe, the Mediterranean Sea and northern Africa (d01), the wider area of Greece (d02) and Thessaly region-central Greece (d03), are used at horizontal grid-spacings of 15km, 5km and 1km respectively. ECMWF operational analyses at 6-hourly intervals (0.25ox0.25o lat.-long.) are imported as initial and boundary conditions of the coarse domain, while in the vertical, 39 sigma levels (up to 50 hPa) are used, with increased resolution in the boundary layer. Microphysical processes are represented by WSM6 scheme, sub-grid scale convection by Kain-Fritsch scheme, longwave and shortwave radiation by RRTMG scheme, surface layer by Monin-Obukhov (MM5), boundary layer by Yonsei University and soil physics by NOAH Unified model. Six representative days with different upper-air synoptic circulation types are selected, while high resolution (3'') elevation data from the Shuttle Radar Topography Mission (SRTM - version 4) are inserted in the innermost domain (d03), along with the Corine Land Cover 2000 raster data (3''x3''). The aforementioned data sets are used in different configurations, in order to evaluate the impact of each one on the simulated convective activity in the vicinity of Thessaly region, using a grid of available meteorological stations in the area. For each selected day, four (4) sensitivity simulations are performed, setting a total number of 24 runs. Finally, the best configuration provides

  2. Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

    PubMed

    Yip, Kenneth; Pang, Suk-King; Chan, Kui-Tim; Chan, Chi-Kuen; Lee, Tsz-Leung

    2016-08-01

    Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service. PMID:27477930

  3. Simulation evaluation of equivalent vision technologies for aerospace operations

    NASA Astrophysics Data System (ADS)

    Kramer, Lynda J.; Williams, Steven P.; Wilz, Susan J.; Arthur, Jarvis (Trey) J., III

    2009-05-01

    A fixed-based simulation experiment was conducted in NASA Langley Research Center's Integration Flight Deck simulator to investigate enabling technologies for equivalent visual operations (EVO) in the emerging Next Generation Air Transportation System operating environment. EVO implies the capability to achieve or even improve on the safety of current-day Visual Flight Rules (VFR) operations, maintain the operational tempos of VFR, and perhaps even retain VFR procedures-all independent of the actual weather and visibility conditions. Twenty-four air transport-rated pilots evaluated the use of Synthetic/Enhanced Vision Systems (S/EVS) and eXternal Vision Systems (XVS) technologies as enabling technologies for future all-weather operations. The experimental objectives were to determine the feasibility of XVS/SVS/EVS to provide for all weather (visibility) landing capability without the need (or ability) for a visual approach segment and to determine the interaction of XVS/EVS and peripheral vision cues for terminal area and surface operations. Another key element of the testing investigated the pilot's awareness and reaction to non-normal events (i.e., failure conditions) that were unexpectedly introduced into the experiment. These non-normal runs served as critical determinants in the underlying safety of all-weather operations. Experimental data from this test are cast into performance-based approach and landing standards which might establish a basis for future all-weather landing operations. Glideslope tracking performance appears to have improved with the elimination of the approach visual segment. This improvement can most likely be attributed to the fact that the pilots didn't have to simultaneously perform glideslope corrections and find required visual landing references in order to continue a landing. Lateral tracking performance was excellent regardless of the display concept being evaluated or whether or not there were peripheral cues in the side window

  4. Simulation Evaluation of Equivalent Vision Technologies for Aerospace Operations

    NASA Technical Reports Server (NTRS)

    Kramer, Lynda J.; Williams, Steven P.; Wilz, Susan J.; Arthur, Jarvis J.

    2009-01-01

    A fixed-based simulation experiment was conducted in NASA Langley Research Center s Integration Flight Deck simulator to investigate enabling technologies for equivalent visual operations (EVO) in the emerging Next Generation Air Transportation System operating environment. EVO implies the capability to achieve or even improve on the safety of current-day Visual Flight Rules (VFR) operations, maintain the operational tempos of VFR, and perhaps even retain VFR procedures - all independent of the actual weather and visibility conditions. Twenty-four air transport-rated pilots evaluated the use of Synthetic/Enhanced Vision Systems (S/EVS) and eXternal Vision Systems (XVS) technologies as enabling technologies for future all-weather operations. The experimental objectives were to determine the feasibility of XVS/SVS/EVS to provide for all weather (visibility) landing capability without the need (or ability) for a visual approach segment and to determine the interaction of XVS/EVS and peripheral vision cues for terminal area and surface operations. Another key element of the testing investigated the pilot's awareness and reaction to non-normal events (i.e., failure conditions) that were unexpectedly introduced into the experiment. These non-normal runs served as critical determinants in the underlying safety of all-weather operations. Experimental data from this test are cast into performance-based approach and landing standards which might establish a basis for future all-weather landing operations. Glideslope tracking performance appears to have improved with the elimination of the approach visual segment. This improvement can most likely be attributed to the fact that the pilots didn't have to simultaneously perform glideslope corrections and find required visual landing references in order to continue a landing. Lateral tracking performance was excellent regardless of the display concept being evaluated or whether or not there were peripheral cues in the side window

  5. Initial Evaluation of the Patient with Suspected Epilepsy.

    PubMed

    Jetté, Nathalie; Wiebe, Samuel

    2016-05-01

    The initial evaluation of the patient with suspected epilepsy is multifaceted and includes a careful history, diagnostic evaluation (EEG and brain imaging) and prompt referral to an epilepsy specialist to clarify seizure types and epilepsy syndrome. Screening for mental health conditions also should be considered, along with neurocognitive testing when deficits of language, memory, learning, attention, or executive function are present or when MRI shows involvement of brain regions implicated in cognitive function. In this review, we examine the approach to the initial evaluation of those with new-onset unprovoked seizures and possible epilepsy. PMID:27086982

  6. Evaluation of Ocular Movements in Patients with Dyslexia

    ERIC Educational Resources Information Center

    Vagge, Aldo; Cavanna, Margherita; Traverso, Carlo Enrico; Iester, Michele

    2015-01-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological…

  7. Preoperative evaluation of a patient for abdominal aortic aneurysm repair.

    PubMed Central

    Chonchubhair, A. N.; Cunningham, A. J.

    1998-01-01

    Coexistent cardiovascular disease is common in patients presenting for repair of aortic aneurysms. However, preoperative cardiac evaluation prior to abdominal aortic aneurysm (AAA) surgery remains contentious with significant variations in practice between countries, institutions and individual anesthetists. The following case report raises some everyday issues confronting clinical anesthetists. PMID:10604782

  8. Cephalometric skeletal evaluation of patients with Incontinentia Pigmenti

    PubMed Central

    Maahs, Marcia Angelica Peter; Kiszewski, Ana Elisa; Rosa, Rafael Fabiano Machado; Maria, Fernanda Diffini Santa; Prates, Frederico Ballvé; Zen, Paulo Ricardo Gazzola

    2014-01-01

    Purpose The aim of this study was to evaluate the skeletal characteristics of patients with the rare genetic disease of Incontinentia Pigmenti, by lateral cephalometric analysis on the antero-posterior plane and by frontal cephalometric analysis on the horizontal plane. Methods Lateral skeletal cephalometric analyses were performed according to Steiner for evaluation of antero-posterior direction, and frontal skeletal cephalometric analyses according to Ricketts for evaluation of horizontal direction in 9 patients with IP. Left and right facial widths at the level of the zygomatic arch were also evaluated. The Student t-test was used for paired to a 5% level of significance data. Results The lateral skeletal cephalometric findings were not statistically significant, but the Class II was the most frequent finding (44.4%), followed by Class III (33.3%) and Class I (22.2%). The right maxillo-mandibular width was significantly lower than normal values, and the right facial width was significantly higher than the left, at the level of the zygomatic arch. Conclusions Patients with IP showed more skeletal discrepancies of Class II and III than Class I malocclusion, and had significant horizontal facial skeletal asymmetries. This should alert health professionals to route these patients for orthodontic assessment and possible therapeutic interventions. However, larger samples are needed to better elucidate if these cephalometric findings can be specifically related to IP. PMID:25737924

  9. Evaluating Functional Decline in Patients with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Rosenblum, Sara; Weiss, Patrice L.

    2010-01-01

    Multiple Sclerosis (MS) is a disease with a wide-ranging impact on functional status. The aim of the study was to examine the added value of simultaneously evaluating fatigue, personal ADL and handwriting performance as indicators for functional decline among patients with MS. Participants were 50 outpatients with MS and 26 matched healthy…

  10. Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

    PubMed

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

    This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given