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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. 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.

  6. 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.

  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. 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

  11. 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

  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. 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

  15. 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

  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. 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…

  9. 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…

  10. 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

  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. 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

  20. 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.

  1. 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

  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. 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.

  4. 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

  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. 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

  8. 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

  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. 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.

  12. 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

  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. 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

  18. 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

  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. 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.

  12. 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.

  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. 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

  3. 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.

  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. 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.

  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. 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

  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. 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.

  17. 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

  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. 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.

  3. 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

  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. 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

  8. 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

  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. 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.

  12. 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.

  13. 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

  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. 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.

  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. 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

  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

    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

  10. 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

  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. 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

  1. 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…

  2. 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.

  3. 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

  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. 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.

  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. 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.

  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. 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

  11. 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

  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. 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.

  16. 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

  17. 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

  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. 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

  6. 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

  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. 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.

  9. 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

  10. 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

  11. 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

  12. 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

  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. 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

  16. 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

  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. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  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. 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

  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. 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…

  7. 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…

  8. 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

  9. 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

  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

  11. Evaluating denture cleanliness of patients in a regional dental hospital.

    PubMed

    Mylonas, P; Attrill, D C; Walmsley, A D

    2016-08-12

    Aims To evaluate the quality of clinical record keeping and determine quality of denture cleanliness; record baseline denture cleanliness for 60 patients; introduce denture hygiene instruction (DHI); and then re-assess the patients for improvement and enhanced record keeping.Methods Analysis of patients' denture hygiene instruction record keeping (n = 60) was undertaken retrospectively. The Denture Cleanliness Index (DCI) was utilised to assess denture cleanliness (best score 0, worst score 4). Baseline DCI scores were taken and individual DHI was delivered. After one month, patients were reviewed and scored, with record keeping quality analysed.Results At baseline, 11.7% (n = 7) of patients had DCI scores of ≤2, improving to 93.8% (n = 45) after one month, demonstrating short-term improvement in denture cleanliness. Only 63% (n = 38) of patients had evidence of a record of DHI within their notes at baseline, improving to 100% at recall.Conclusions New patient information leaflet and clinical guidelines on denture hygiene have been written and implemented. The results of this study suggest that this may be a relatively straightforward method to achieve a short-term improvement in denture cleanliness. The implementation of a DCI score is helpful in allowing patients to improve denture hygiene and its wider use is supported. PMID:27514347

  12. Evaluation of dry eye findings in patients with vitiligo

    PubMed Central

    Dogan, Aysun Sanal; Atacan, Damla; Durmazlar, Selda Pelin Kartal; Acar, Mutlu; Gurdal, Canan

    2015-01-01

    Objective: To evaluate the association of dry eye and vitiligo diseases with objective parameters and a questionnaire. Methods: The study was conducted in 30 vitiligo patients and 31 patients with non-complicated refractory complaints. All the patients underwent complete ophthalmologic examinations including fluorescein break-up time (FBU), corneal fluorescein staining (CFS) and Schirmer test-I. The dry eye status was evaluated by means of Ocular Surface Disease Index (OSDI). Results: The groups were similar regarding the age and gender distribution. The vitiligo group had higher OSDI scores (26.1±15.9 vs 14.7±5.4, t-test, p<0.001), shorter FBU (7.8±2.9 vs 9.8±2.2, Mann Whitney U test, p=0.005) and higher CFS positivity (18/30 vs 3/31, chi-square test, p<0.001) than control group. The groups were similar regarding the Meibomian Gland Dysfunction (MGD) and Schirmer test results. Fourteen (46.7%) of vitiligo patients had periocular involvement. The analysis within vitiligo patients revealed that FBU and Schirmer test were shorter in patients with periocular involvement, the OSDI scores and MGD status were similar. Conclusion: Our study suggest a possible association of dry eye and vitiligo diseases. The diagnostic tools for dry eye disease are in good correlation with each other. The OSDI questionnaire seems practical for both diagnostic purposes and follow-up. PMID:26150849

  13. Extreme events evaluation over African cities with regional climate simulations

    NASA Astrophysics Data System (ADS)

    Bucchignani, Edoardo; Mercogliano, Paola; Simonis, Ingo; Engelbrecht, Francois

    2013-04-01

    The warming of the climate system in recent decades is evident from observations and is mainly related to the increase of anthropogenic greenhouse gas concentrations (IPCC, 2012). Given the expected climate change conditions on the African continent, as underlined in different publications, and their associated socio-economic impacts, an evaluation of the specific effects on some strategic African cities on the medium and long-term is of crucial importance with regard to the development of adaptation strategies. Assessments usually focus on averages climate properties rather than on variability or extremes, but often these last ones have more impacts on the society than averages values. Global Coupled Models (GCM) are generally used to simulate future climate scenarios as they guarantee physical consistency between variables; however, due to the coarse spatial resolution, their output cannot be used for impact studies on local scales, which makes necessary the generation of higher resolution climate change data. Regional Climate Models (RCM) describe better the phenomena forced by orography or by coastal lines, or that are related to convection. Therefore they can provide more detailed information on climate extremes that are hard to study and even harder to predict because they are, by definition, rare and obey different statistical laws. The normal bias of the RCM to represent the local climatology is reduced using adequate statistical techniques based on the comparison of the simulated results with long observational time series. In the framework of the EU-FP7 CLUVA (Climate Change and Urban Vulnerability in Africa) project, regional projections of climate change at high resolution (about 8 km), have been performed for selected areas surrounding five African cities. At CMCC, the regional climate model COSMO-CLM has been employed: it is a non-hydrostatic model. For each domain, two simulations have been performed, considering the RCP4.5 and RCP8.5 emission

  14. Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

    PubMed

    Hosgood, Jessica Richards; Kimbrel, Jason M; McCrate Protus, Bridget; Grauer, Phyllis A

    2016-04-01

    Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management. However, according to the American Hospital Formulary Service, subcutaneous administration of commercially available injectable phenobarbital is cautioned due to possible skin reactions. This study evaluates the tolerability of phenobarbital administered subcutaneously. Of 69 patients and 774 distinct subcutaneous phenobarbital injections, 2 site reactions were recorded (2.9% of patients; 0.3% of injections). Both were mild, grade 1 reactions. Each patient continued to receive subcutaneous phenobarbital via newly placed ports with no additional reactions. Based on these findings, phenobarbital appears to be well tolerated when administered subcutaneously. PMID:25473092

  15. A system for automatic evaluation of simulation software

    NASA Technical Reports Server (NTRS)

    Ryan, J. P.; Hodges, B. C.

    1976-01-01

    Within the field of computer software, simulation and verification are complementary processes. Simulation methods can be used to verify software by performing variable range analysis. More general verification procedures, such as those described in this paper, can be implicitly, viewed as attempts at modeling the end-product software. From software requirement methodology, each component of the verification system has some element of simulation to it. Conversely, general verification procedures can be used to analyze simulation software. A dynamic analyzer is described which can be used to obtain properly scaled variables for an analog simulation, which is first digitally simulated. In a similar way, it is thought that the other system components and indeed the whole system itself have the potential of being effectively used in a simulation environment.

  16. The centricity of presence in scenario-based high fidelity human patient simulation: a model.

    PubMed

    Dunnington, Renee M

    2015-01-01

    Enhancing immersive presence has been shown to have influence on learning outcomes in virtual types of simulation. Scenario-based human patient simulation, a mixed reality form, may pose unique challenges for inducing the centricity of presence among participants in simulation. A model for enhancing the centricity of presence in scenario-based human patient simulation is presented here. The model represents a theoretical linkage among the interaction of pedagogical, individual, and group factors that influence the centricity of presence among participants in simulation. Presence may have an important influence on the learning experiences and learning outcomes in scenario-based high fidelity human patient simulation. This report is a follow-up to an article published in 2014 by the author where connections were made to the theoretical basis of presence as articulated by nurse scholars. PMID:25520467

  17. Patient-Specific Geometry Modeling and Mesh Generation for Simulating Obstructive Sleep Apnea Syndrome Cases by Maxillomandibular Advancement

    PubMed Central

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

    2011-01-01

    The objective of this paper is the reconstruction of upper airway geometric models as hybrid meshes from clinically used Computed Tomography (CT) data sets in order to understand the dynamics and behaviors of the pre- and postoperative upper airway systems of Obstructive Sleep Apnea Syndrome (OSAS) patients by viscous Computational Fluid Dynamics (CFD) simulations. The selection criteria for OSAS cases studied are discussed because two reasonable pre- and postoperative upper airway models for CFD simulations may not be created for every case without a special protocol for CT scanning. The geometry extraction and manipulation methods are presented with technical barriers that must be overcome so that they can be used along with computational simulation software as a daily clinical evaluation tool. Eight cases are presented in this paper, and each case consists of pre- and postoperative configurations. The results of computational simulations of two cases are included in this paper as demonstration. PMID:21625395

  18. Who's Driving? The role and training of the human patient simulation operator.

    PubMed

    Gantt, Laura

    2012-11-01

    Within the airline industry, where much of simulation-based education originated, cockpit simulators are operated by current or former pilots whose expertise ensures the authenticity of the training experience. As yet, identifying the most appropriate person to run a patient simulator has not been translated into healthcare. Furthermore, few training resources exist for those who must learn the intricacies of the relationship between patient simulators, simulation scenarios, and educational objectives. This article reviews literature related to the role, educational preparation, and training of the patient simulator operator and explores solutions to the uncertainty about the difference between simulator operators and technicians. Because simulators are operationally intensive and because scarce faculty may be best used to facilitate student learning within the laboratory, the tendency has been to use a variety of personnel to manage patient simulators. Recommendations for standardizing the role of the operator that are consistent with the pedagogical purposes of simulation are offered. Potential questions are posed, and methods for future work are discussed. PMID:22948404

  19. Evaluation of Low-Level Laser Therapy in TMD Patients

    PubMed Central

    Ayyildiz, Simel; Emir, Faruk; Sahin, Cem

    2015-01-01

    Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient's main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm2, three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm2) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods. PMID:26587294

  20. Evaluation of different projectiles in matched experimental eye impact simulations.

    PubMed

    Weaver, Ashley A; Kennedy, Eric A; Duma, Stefan M; Stitzel, Joel D

    2011-03-01

    Eye trauma results in 30,000 cases of blindness each year in the United States and is the second leading cause of monocular visual impairment. Eye injury is caused by a wide variety of projectile impacts and loading scenarios with common sources of trauma being motor vehicle crashes, military operations, and sporting impacts. For the current study, 79 experimental eye impact tests in literature were computationally modeled to analyze global and localized responses of the eye to a variety of blunt projectile impacts. Simulations were run with eight different projectiles (airsoft pellets, baseball, air gun pellets commonly known as BBs, blunt impactor, paintball, aluminum, foam, and plastic rods) to characterize effects of the projectile size, mass, geometry, material properties, and velocity on eye response. This study presents a matched comparison of experimental test results and computational model outputs including stress, energy, and pressure used to evaluate risk of eye injury. In general, the computational results agreed with the experimental results. A receiver operating characteristic curve analysis was used to establish the stress and pressure thresholds that best discriminated for globe rupture in the matched experimental tests. Globe rupture is predicted by the computational simulations when the corneoscleral stress exceeds 17.21 MPa or the vitreous pressure exceeds 1.01 MPa. Peak stresses were located at the apex of the cornea, the limbus, or the equator depending on the type of projectile impacting the eye. A multivariate correlation analysis revealed that area-normalized kinetic energy was the best single predictor of peak stress and pressure. Additional incorporation of a relative size parameter that relates the projectile area to the area of the eye reduced stress response variability and may be of importance in eye injury prediction. The modeling efforts shed light on the injury response of the eye when subjected to a variety of blunt projectile

  1. 3D Immersive Patient Simulators and Their Impact on Learning Success: A Thematic Review

    PubMed Central

    Wahba, Roger; Chang, De-Hua; Plum, Patrick; Hölscher, Arnulf H; Stippel, Dirk L

    2015-01-01

    Background Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity. Objective It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies. Methods A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point. Results There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity). Conclusions IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous

  2. Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis

    PubMed Central

    Eftekharsadat, Bina; Habibzadeh, Afshin; Kolahi, Babak

    2015-01-01

    Objective: Knee osteoarthritis (OA) is the main cause of pain, physical impairment and chronic disability in older people. Electrotherapeutic modalities such as interferential therapy (IFT) and action potential simulation (APS) are used for the treatment of knee OA. In this study, we aim to evaluate the therapeutic effects of APS and IFT on knee OA. Methods: In this randomized clinical trial, 67 patients (94% female and 6% male with mean age of 52.80 ± 8.16 years) with mild and moderate knee OA were randomly assigned to be treated with APS (n = 34) or IFT (n = 33) for 10 sessions in 4 weeks. Baseline and post-treatment Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscales, visual analogue scale (VAS) and timed up and go (TUG) test were measured in all patients. Results: VAS and WOMAC subscales were significantly improved after treatment in APS and IFT groups (p < 0.001 for all). TUG was also significantly improved after treatment in APS group (p < 0.001), but TUG changes in IFT was not significant (p = 0.09). There was no significant difference in VAS, TUG and WOMAC subscales values before and after treatment as well as the mean improvement in VAS, TUG and WOMAC subscales during study between groups. Conclusion: Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA. PMID:26029268

  3. The Evaluation of Undergraduate Nursing Students' Knowledge of Post-op Pain Management after Participation in Simulation.

    PubMed

    Evans, Cecile B; Mixon, Diana K

    2015-12-01

    The purpose of this paper was to assess undergraduate nursing students' pain knowledge after participation in a simulation scenario. The Knowledge and Attitudes of Survey Regarding Pain (KASRP) was used to assess pain knowledge. In addition, reflective questions related to the simulation were examined. Student preferences for education method and reactions to the simulation (SIM) were described. Undergraduate nursing students' knowledge of pain management is reported as inadequate. An emerging pedagogy used to educate undergraduate nurses in a safe, controlled environment is simulation. Literature reports of simulation to educate students' about pain management are limited. As part of the undergraduate nursing student clinical coursework, a post-operative pain management simulation, the SIM was developed. Students were required to assess pain levels and then manage the pain for a late adolescent male whose mother's fear of addiction was a barrier to pain management. The students completed an anonymous written survey that included selected questions from the KASRP and an evaluation of the SIM experience. The students' mean KASRP percent correct was 70.4% ± 8.6%. Students scored the best on items specific to pain assessment and worst on items specific to opiate equivalents and decisions on PRN orders. The students' overall KASRP score post simulation was slightly better than previous studies of nursing students. These results suggest that educators should consider simulations to educate about pain assessment and patient/family education. Future pain simulations should include more opportunities for students to choose appropriate pain medications when provided PRN orders. PMID:26697818

  4. Musculoskeletal evaluation in severe haemophilia A patients from Latin America

    PubMed Central

    Ozelo, M C; Villaça, P R; Pérez-Bianco, R; Candela, M; Garcia-Chavez, J; Moreno-Rodriguez, B; Rodrigues, M B; Rodriguez-Grecco, I; Solano, M H; Chumpitaz, G; Morales-Gana, M M; Ruiz-Sáez, A

    2013-01-01

    Summary There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL−1) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5–66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5–10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated. PMID:24354487

  5. Auditorium acoustics evaluation based on simulated impulse response

    NASA Astrophysics Data System (ADS)

    Wu, Shuoxian; Wang, Hongwei; Zhao, Yuezhe

    2001-05-01

    The impulse responses and other acoustical parameters of Huangpu Teenager Palace in Guangzhou were measured. Meanwhile, the acoustical simulation and auralization based on software ODEON were also made. The comparison between the parameters based on computer simulation and measuring is given. This case study shows that auralization technique based on computer simulation can be used for predicting the acoustical quality of a hall at its design stage.

  6. SU-E-J-90: MRI-Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

    SciTech Connect

    Yang, Y; Cao, M; Han, F; Santhanam, A; Neylon, J; Gomez, C; Kaprealian, T; Sheng, K; Agazaryan, N; Low, D; Hu, P

    2014-06-01

    Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR-based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra-short T2 and T1, which presents difficulty for both dose calculation and patient setup in terms of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in-house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on-board images were used to evaluate 2D patient setup with MRI-DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI-DRR is comparable to CT-based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post-processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.

  7. Using patient management as a surrogate for patient health outcomes in diagnostic test evaluation

    PubMed Central

    2012-01-01

    Background Before a new test is introduced in clinical practice, evidence is needed to demonstrate that its use will lead to improvements in patient health outcomes. Studies reporting test accuracy may not be sufficient, and clinical trials of tests that measure patient health outcomes are rarely feasible. Therefore, the consequences of testing on patient management are often investigated as an intermediate step in the pathway. There is a lack of guidance on the interpretation of this evidence, and patient management studies often neglect a discussion of the limitations of measuring patient management as a surrogate for health outcomes. Methods We discuss the rationale for measuring patient management, describe the common study designs and provide guidance about how this evidence should be reported. Results Interpretation of patient management studies relies on the condition that patient management is a valid surrogate for downstream patient benefits. This condition presupposes two critical assumptions: the test improves diagnostic accuracy; and the measured changes in patient management improve patient health outcomes. The validity of this evidence depends on the certainty around these critical assumptions and the ability of the study design to minimise bias. Three common designs are test RCTs that measure patient management as a primary endpoint, diagnostic before-after studies that compare planned patient management before and after testing, and accuracy studies that are extended to report on the actual treatment or further tests received following a positive and negative test result. Conclusions Patient management can be measured as a surrogate outcome for test evaluation if its limitations are recognised. The potential consequences of a positive and negative test result on patient management should be pre-specified and the potential patient benefits of these management changes clearly stated. Randomised comparisons will provide higher quality evidence about

  8. Evaluation of the medical and occupational shielding in cerebral angiography using Monte Carlo simulations and virtual anthropomorphic phantoms

    NASA Astrophysics Data System (ADS)

    Santos, William S.; Neves, Lucio P.; Perini, Ana P.; Caldas, Linda V. E.; Maia, Ana F.

    2015-12-01

    Cerebral angiography exams may provide valuable diagnostic information for the patients with suspect of cerebral diseases, but it may also deliver high doses of radiation to the patients and medical staff. In order to evaluate the medical and occupational expositions from different irradiation conditions, Monte Carlo (MC) simulations were employed. Virtual anthropomorphic phantoms (MASH) were used to represent the patient and the physician inside a typical fluoroscopy room, also simulated in details, incorporated in the MCNPX 2.7.0 MC code. The evaluation was carried out by means of dose conversion coefficients (CCs) for equivalent (H) and effective (E) doses normalized by the air kerma-area product (KAP). The CCs for the surface entrance dose of the patient (ESD) and equivalent dose for the eyes of the medical staff were determined, because CA exams present higher risks for those organs. The tube voltage was 80 kVp, and Al filters with thicknesses of 2.5 mm, 3.5 mm and 4.0 mm were positioned in the beams. Two projections were simulated: posterior-anterior (PA) and right-lateral (RLAT). In all situations there was an increase of the CC values with the increase of the Al filtration. The highest dose was obtained for a RLAT projection with a 4.0 mm Al filter. In this projection, the ESD/KAP and E/KAP values to patient were 11 (14%) mGy/Gy cm2 and 0.12 (0.1%) mSv/Gy cm2, respectively. For the physician, the use of shield lead glass suspended and lead curtain attached to the surgical table resulted in a significant reduction of the CCs. The use of MC simulations proved to be a very important tool in radiation protection dosimetry, and specifically in this study several parameters could be evaluated, which would not be possible experimentally.

  9. Evaluating palliative care: bereaved family members' evaluations of patients' pain, anxiety and depression.

    PubMed

    McPherson, Christine J; Addington-Hall, Julia M

    2004-08-01

    Palliative care surveys often rely on bereaved family members to act as proxies to provide information on patient care at the end of life, after the patient's death. However, when comparing bereaved family members' assessments with those of the patients, agreement is found to be better for symptoms that are more concrete and observable than subjective aspects such as psychological symptoms and pain. To date, little is known about how proxies actually evaluate these types of symptoms. The present study used retrospective verbal protocol analysis to elucidate the thought processes of 30 bereaved relatives during their evaluations of patients' pain, anxiety and depression. The qualitative analysis raised awareness of the difficulties experienced by proxies when discerning the presence of symptoms. It also provided insights into the cues and strategies used when making decisions, contributing to a fuller understanding of how proxies distinguish symptoms. Recommendations are made to improve the design of retrospective palliative care surveys. PMID:15276191

  10. Chronic toxicity evaluation of simulated DWPF effluent to Ceriodaphnia dubia

    SciTech Connect

    Not Available

    1990-04-01

    A 7-Day Full Series Chronic Toxicity test was conducted April 13--20, 1990, for the Savannah River Site to assess the chronic toxicity of Simulated defense waste processing facility (DWPF) effluent to Ceriodaphnia dubia. The simulated effluented consisted of Sodium Nitrate, Sodium Oxalate, Sodium Formate, and Corros. Inib.

  11. Computerized Simulation in the Social Sciences: A Survey and Evaluation

    ERIC Educational Resources Information Center

    Garson, G. David

    2009-01-01

    After years at the periphery of the social sciences, simulation is now emerging as an important and widely used tool for understanding social phenomena. Through simulation, researchers can identify causal effects, specify critical parameter estimates, and clarify the state of the art with respect to what is understood about how processes evolve…

  12. Onychomycosis: Evaluation, Treatment Options, Managing Recurrence, and Patient Outcomes.

    PubMed

    Vlahovic, Tracey C

    2016-07-01

    Onychomycosis is the most common nail disease seen in podiatric practice. Effective long-term management remains problematic. We need to treat onychomycosis effectively to prevent its progression into a severe, debilitating, and painful condition, and to manage recurrence. With new agents now available and greater discussion on management strategies, this article reviews the appropriate evaluation of the disease, treatment options, and optimal patient outcomes. PMID:27215153

  13. Evaluation of simulation learning materials use to fill the gap in Japanese dental English education.

    PubMed

    Seki, Naoko; Moross, Janelle; Sunaga, Masayo; Hobo, Koki; Miyoshi, Tomoe; Nitta, Hiroshi; Kinoshita, Atsuhiro; Morio, Ikuko

    2016-01-01

    Even though English is most frequently the common language when the patient's native language differs from that of a dentist, the opportunities for Japanese undergraduate dental students to learn dental English are now quite limited. The purposes of our study were to investigate: the effectiveness and feasibility of the computer-assisted simulation materials as one solution strategy for dental English education in Japan, and the needs and demands for dental English from the learners' side. Interactive simulation materials for medical interviews in English and clinical cases which were translated to English, were delivered via Learning Management System (LMS) to nineteen trainee residents of dentistry (residents). Evaluation for the materials, learners' knowledge and interests in the contents, and ease of operation were obtained by post-questionnaire (response rates were 100% and 95%, respectively). Both questionnaire-surveys received positive feedback toward the materials, yet 47% answered that they lacked the level of knowledge about contents of the medical interview in English. Results were sufficient to suggest that the residents would like to have the opportunity to study or practice medical interview in English, or English related to dentistry, and that the simulation materials could be one of the solution strategies for opportunity provision. PMID:27181485

  14. Evaluation of hearing functions in patients with euthyroid Hashimoto's thyroiditis.

    PubMed

    Arduc, Ayse; Isık, Serhat; Allusoglu, Serpil; Iriz, Ayse; Dogan, Bercem Aycicek; Gocer, Celil; Tuna, Mazhar Muslim; Berker, Dilek; Guler, Serdar

    2015-12-01

    Sensorineural hearing loss has been reported in various autoimmune diseases. The relationship between Hashimoto's thyroiditis (HT) and the auditory system has not been previously evaluated. In this study, we investigated the effect of euthyroid HT on the hearing ability of adult patients. The study included 30 patients with newly diagnosed euthyroid HT and 30 age- and gender-matched healthy controls. All subjects had a normal otoscopic examination and tympanometry, and they were negative for rheumatoid factor, antinuclear, anti-smooth muscle, antimitochondrial, antineutrophilcytoplasmic, and antigliadin antibodies. Pure tone audiometry exams at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hertz (Hz) were performed in both groups. Thyroid peroxidase antibody and thyroglobulin antibody (anti-Tg) levels were higher in HT group while TSH, free T4, free T3, plasma electrolytes, glucose, lipid profile, vitamin B12, and blood pressure measurements were similar between the two groups. Higher audiometric thresholds and a higher prevalence of hearing loss at 250, 500, and 6000 Hz were detected in the HT patients than in the healthy controls (P < 0.05). Hearing levels at 250 and 500 Hz correlated positively with anti-Tg levels (ρ = 0.650, P = 0.002; ρ = 0.719, P < 0.001, respectively), and this association remained significant in linear regression analysis. Anti-Tg-positive HT patients had higher hearing thresholds at 250 and 500 Hz than anti-Tg-negative HT patients. Hearing thresholds were similar between anti-Tg-negative HT patients and the control subjects. This study demonstrated that hearing functions are impaired in HT patients. Thyroid autoimmunity seems to have an important impact on a decreased hearing ability, particularly at lower frequencies, in this population of patients. PMID:25963023

  15. Evaluation of ventricular function in patients with coronary artery disease

    SciTech Connect

    Rocco, T.P.; Dilsizian, V.; Fischman, A.J.; Strauss, H.W.

    1989-07-01

    The recent expansion of interventional cardiovascular technologies has stimulated a concomitant expansion of noninvasive cardiac studies, both to assist in diagnosis and to evaluate treatment outcomes. Radionuclide ventricular function studies provide a reliable, reproducible means to quantify global left ventricular systolic performance, a critical determinant of prognosis in patients with cardiovascular disease. In addition, the ability to evaluate regional left ventricular wall motion and to assess ventricular performance during exercise have secured a fundamental role for such studies in the screening and treatment of patients with coronary artery disease. Radionuclide techniques have been extended to the evaluation of left ventricular relaxation/filling events, left ventricular systolic/diastolic function in the ambulatory setting, and with appropriate technical modifications, to the assessment of right ventricular performance at rest and with exercise. As a complement to radionuclide perfusion studies, cardiac blood-pool imaging allows for thorough noninvasive description of cardiac physiology and function in both normal subjects and in patients with a broad range of cardiovascular diseases. 122 references.

  16. Using Patient-Simulators to Teach Telephone Communication Skills to Health Professionals.

    ERIC Educational Resources Information Center

    Evens, Susan; Curtis, Peter

    1983-01-01

    A cost-effective audiotaped patient-simulation program to teach residents at a university family practice center is described. Similar programs have been implemented in other areas such as pediatrics, psychiatry, nursing, and a family medicine clerkship. (MSE)

  17. Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies

    SciTech Connect

    Silva-Rodríguez, Jesús Aguiar, Pablo; Sánchez, Manuel; Mosquera, Javier; Luna-Vega, Víctor; Cortés, Julia; Garrido, Miguel; Pombar, Miguel; Ruibal, Álvaro

    2014-05-15

    Purpose: Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. Methods: One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. Results: Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. Conclusions: The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.

  18. Developing simulations to reproduce in vivo fluoroscopy kinematics in total knee replacement patients.

    PubMed

    Fitzpatrick, Clare K; Komistek, Richard D; Rullkoetter, Paul J

    2014-07-18

    For clinically predictive testing and design-phase evaluation of prospective total knee replacement (TKR) implants, devices should ideally be evaluated under physiological loading conditions which incorporate population-level variability. A challenge exists for experimental and computational researchers in determining appropriate loading conditions for wear and kinematic knee simulators which reflect in vivo joint loading conditions. There is a great deal of kinematic data available from fluoroscopy studies. The purpose of this work was to develop computational methods to derive anterior-posterior (A-P) and internal-external (I-E) tibiofemoral (TF) joint loading conditions from in vivo kinematic data. Two computational models were developed, a simple TF model, and a more complex lower limb model. These models were driven through external loads applied to the tibia and femur in the TF model, and applied to the hip, ankle and muscles in the lower limb model. A custom feedback controller was integrated with the finite element environment and used to determine the external loads required to reproduce target kinematics at the TF joint. The computational platform was evaluated using in vivo kinematic data from four fluoroscopy patients, and reproduced in vivo A-P and I-E motions and compressive force with a root-mean-square (RMS) accuracy of less than 1mm, 0.1°, and 40 N in the TF model and in vivo A-P and I-E motions, TF flexion, and compressive loads with a RMS accuracy of less than 1mm, 0.1°, 1.4°, and 48 N in the lower limb model. The external loading conditions derived from these models can ultimately be used to establish population variability in loading conditions, for eventual use in computational as well as experimental activity simulations. PMID:24845696

  19. Evaluation of the GEM-AQ simulations for the Air Quality Model Evaluation International Initiative (AQMEII)

    NASA Astrophysics Data System (ADS)

    Lobocki, Lech; Gawuc, Lech; Jefimow, Maciej; Kaminski, Jacek; Porebska, Magdalena; Struzewska, Joanna; Zdunek, Malgorzata

    2013-04-01

    A multiscale, on-line meteorological and air quality model GEM-AQ was used to simulate ozone and particulate matter over the European continent in 2006, as a part of the Air Quality Model Evaluation International Initiative (AQMEII). In contrast to the majority of models participating in the Phase I of AQMEII, the GEM-AQ configuration employed here utilized neither external meteorological fields nor lateral boundary conditions, owing to the global-extent and variable grid resolution of the model setup. We will present evaluation results for global model performance statistics calculated for the entire year and more detailed performance analysis of pollution episodes. Evaluation of meteorological parameters includes comparisons of model-predicted wind, temperature and cloudiness with hourly observations at surface weather stations, daily maxima, and comparison with upper-air soundings at selected sites. Frequency distribution of principal boundary layer parameters and its spatial structure will be presented. Air quality predictions are assessed in terms of ground-level daily mean ozone concentrations and its daily peak values, vertical structure as inferred from ozone soundings, and particulate matter daily mean concentrations at the surface.

  20. Description and Preliminary Training Evaluation of an Arc Welding Simulator. Research Report SRR 73-23.

    ERIC Educational Resources Information Center

    Abrams, Macy L.; And Others

    A prototype arc welding training simulator was designed to provide immediate, discriminative feedback and the capacity for concentrated practice. Two randomly selected groups of welding trainees were compared to evaluate the simulator, one group being trained using the simulator and the other using conventional practice. Preliminary data indicated…

  1. Human patient simulators: a new face in baccalaureate nursing education at Brigham Young University.

    PubMed

    Bearnson, Carolyn S; Wiker, Kathleen M

    2005-09-01

    Simulation has been used to augment learning in the health care professions. The human patient simulator (HPS) has been used primarily by medical students but is now being used by nursing students, as well. This study explored the benefits and limitations of using an HPS as a patient substitute for one day of actual clinical experience for junior nursing students. Learning outcomes included increased student knowledge, ability, and confidence in medication administration. PMID:16220650

  2. Generation and Evaluation of a Simultaneous Cardiac and Respiratory Gated Rb-82 PET Simulation

    PubMed Central

    Park, Min Jae; Chen, Si; Lee, Taek-Soo; Fung, George S. K.; Lodge, Martin; Tsui, Benjamin M. W.

    2012-01-01

    The goal is to generate and evaluate a simulated 4D Rb-82 PET dataset that realistically models simultaneous respiratory and cardiac motions for use to study the effects of the motions and their compensation using various gating schemes. Normal cardiac and respiratory (C&R) motions were simulated separately using the realistic 4D XCAT phantoms. The C&R motion cycles were divided into 24 and 48 equally-spaced time points, respectively. The simultaneous dual motions were modeled by 24 × 48 phantoms with different combinations of C&R motion phases. Almost noise-free projections of the heart, blood pool, lungs, liver, stomach, spleen, and the remaining body were simulated separately using the combined SimSET and GATE Monte Carlo simulation program which is 12 times faster than GATE alone. The projections were scaled and combined to simulate a typical Rb-82 myocardial perfusion (MP) PET patient study. The no gating, 6-frame respiratory gating only, 8-frame cardiac gating only, and simultaneous 6-frame respiratory and 8-frame cardiac gating schemes were applied. Each gated projection dataset was reconstructed using a 2D OS-EM without and with attenuation correction (AC) using an averaged and gated attenuation maps. The reconstructed images were evaluated in terms of artifactual non-uniformity in the MP polar map. Significant artifactual non-uniformity was found in the MP polar map over all gating scheme without AC. With AC, the artifactual decreases in both the anterior and inferior regions were reduced with respiratory gating. Cardiac motion alone did not cause significant artifactual non-uniformity. In addition, the combination of dual gating and AC using the gated attenuation map provided the most uniform MP polar map. We demonstrated the flexibility and utility of the 4D XCAT phantom set with simultaneous C&R motions. It is a powerful tool to study motion effects on MP PET studies and to evaluate C&R gating schemes, AC and quantitative 4D PET image reconstruction

  3. The Discrepancy Evaluation Model: A Strategy for Improving a Simulation and Determining Effectiveness.

    ERIC Educational Resources Information Center

    Morra, Linda G.

    This paper presents the Discrepancy Evaluation Model (DEM) as an overall strategy or framework for both the improvement and assessment of effectiveness of simulation/games. While application of the evaluation model to simulation/games rather than educational programs requires modification of the model, its critical features remain. These include:…

  4. Performance evaluation using SYSTID time domain simulation. [computer-aid design and analysis for communication systems

    NASA Technical Reports Server (NTRS)

    Tranter, W. H.; Ziemer, R. E.; Fashano, M. J.

    1975-01-01

    This paper reviews the SYSTID technique for performance evaluation of communication systems using time-domain computer simulation. An example program illustrates the language. The inclusion of both Gaussian and impulse noise models make accurate simulation possible in a wide variety of environments. A very flexible postprocessor makes possible accurate and efficient performance evaluation.

  5. Research on the evaluation method for modelling and simulation of infrared imaging sensor

    NASA Astrophysics Data System (ADS)

    Lou, Shuli; Ren, Jiancun; Liu, Liang; Li, Zhaolong

    2015-10-01

    The validity of infrared image guidance simulation is determined by the fidelity and the accuracy of modelling and simulation of infrared imaging sensor system, and the research on assessment of modelling and simulation of infrared imaging sensor is important to design and assess the IR system. A method is proposed to evaluate simulation of infrared sensor effect based on full reference quality assessment method, the evaluation index system is established to evaluate simulation fidelity of infrared imaging sensor. The accuracy of irradiance and contrast of infrared simulation image can be assessed with one-dimension histogram analysis, and the spatial correlation of image is assessed with two-dimension histogram analysis, and geometrical and gray distribution characteristics are assessed with fidelity function. With the method, modelling and simulation of infrared imaging sensor can be effectively assessed.

  6. Primary Aspergillus sellar abscess simulating pituitary tumor in immunocompetent patient.

    PubMed

    Ouyang, Taohui; Zhang, Na; Wang, Long; Jiao, Jiantong; Zhao, Yiqing; Li, Zheng; Chen, Jian

    2015-03-01

    A 55-year-old woman presented with headache, dizziness, and decreased visual acuity. Magnetic resonance imaging revealed a sellar mass with sphenoid sinus extension. The result of hormone showed an obviously high prolactin (815 ng/mL). The mass was resected and diagnosed with aspergillosis pathologically. Postoperatively, the level of prolactin dramatically decreased, and the patient received medical treatment with voriconazole and caspofungin. During a 6-month follow-up, the patient's headache and dizziness disappeared, and visual acuity improved. Therefore, aspergillus sellar abscess could result in hyperprolactinemia and should be considered in the differential diagnosis of a sellar mass, even in immunocompetent patients. A combination of surgery and antifungal therapy could reduce the hyperprolactinemia and improve symptoms. PMID:25675014

  7. Application of software simulation to DBS transmission design and evaluation

    NASA Astrophysics Data System (ADS)

    White, Lawrence W.; Palmer, Larry C.; Chang, Peter Y.; Shenoy, Ajit

    The paper describes software simulation results in the following three areas related to DBS planning: multipath and overdeviation of the video signal, digital audio transmission, and phase-locked loop demodulation. The results obtained for multipath and overdeviation involved simulation to examine a dual-path phenomenon that can be encountered in DBS applications. Results are also presented on the insertion of high rate digital data directly into the horizontal blanking interval of the video scan line. The results of simulations with a phase-locked demodular determined the degree of threshold extension achieved for various test patterns, as compared to a conventional limiter/discriminator.

  8. Evaluation of internet websites about retinopathy of prematurity patient education

    PubMed Central

    Martins, E N; Morse, L S

    2005-01-01

    Background/aims: The success of the treatment in patients with retinopathy of prematurity (ROP) is mainly associated with timely diagnosis and appropriate management. Information dissemination is crucial for the outcome of ROP. This study aimed to evaluate the quality of the information about ROP available for patients on the internet. Methods: Cross sectional study. In March 2004 the ROP information available on the internet was evaluated using two search engines (MetaCrawler and MSN) and four key terms (“retinopathy of prematurity,” “premature eye,” “premature retina,” and “ROP”). The quality of each website was evaluated using a score system. The sites were classified as academic, organisational, or commercial. Readability, general quality of the website (based on ownership, purpose, authorship, author qualification, attribution, interactivity, and currency), and quality of the content specific to ROP (definition, causes, epidemiology, risk factors, diagnosis, classification, treatment, and prognosis) were analysed. Results: Of 114 websites evaluated, 40 were included. 10 sites (25.0%) were academic, eight (20.0%) organisational, and 22 (55.0%) commercial. In the majority of the sites (62.5%) the ROP information was fair or poor. Conclusions: A large amount of information about ROP is available on the internet. However, most websites were considered incomplete. PMID:15834086

  9. Definition and evaluation of testing scenarios for knee wear simulation under conditions of highly demanding daily activities.

    PubMed

    Schwiesau, Jens; Schilling, Carolin; Kaddick, Christian; Utzschneider, Sandra; Jansson, Volkmar; Fritz, Bernhard; Blömer, Wilhelm; Grupp, Thomas M

    2013-05-01

    The objective of our study was the definition of testing scenarios for knee wear simulation under various highly demanding daily activities of patients after total knee arthroplasty. This was mainly based on a review of published data on knee kinematics and kinetics followed by the evaluation of the accuracy and precision of a new experimental setup. We combined tibio-femoral load and kinematic data reported in the literature to develop deep squatting loading profiles for simulator input. A servo-hydraulic knee wear simulator was customised with a capability of a maximum flexion of 120°, a tibio-femoral load of 5000N, an anterior-posterior (AP) shear force of ±1000N and an internal-external (IE) rotational torque of ±50Nm to simulate highly demanding patient activities. During the evaluation of the newly configurated simulator the ability of the test machine to apply the required load and torque profiles and the flexion kinematics in a precise manner was examined by nominal-actual profile comparisons monitored periodically during subsequent knee wear simulation. For the flexion kinematics under displacement control a delayed actuator response of approximately 0.05s was inevitable due to the inertia of masses in movement of the coupled knee wear stations 1-3 during all applied activities. The axial load and IE torque is applied in an effective manner without substantial deviations between nominal and actual load and torque profiles. During the first third of the motion cycle a marked deviation between nominal and actual AP shear load profiles has to be noticed but without any expected measurable effect on the latter wear simulation due to the fact that the load values are well within the peak magnitude of the nominal load amplitude. In conclusion the described testing method will be an important tool to have more realistic knee wear simulations based on load conditions of the knee joint during activities of daily living. PMID:22922096

  10. Simulated-patient-based programs for teaching communication with adolescents: the link between guidelines and practice.

    PubMed

    Hardoff, D; Benita, S; Ziv, A

    2008-03-01

    Adolescents frequently tend not to share personal issues with their health care providers, thus communication with the adolescent patient and frequently also with his or her parents requires unique skills on behalf of the physician. Guidelines for obtaining information regarding adolescents' risk behaviors and other psychosocial issues that have been developed, do not provide the necessary tools for optimal communication with adolescents. Communication skills are best obtained in role-play models where either colleagues or actors simulate the patients' roles. Simulation-based medical education offers a safe and "mistake forgiving" environment that enables consideration of the trainees' needs, without the use of real patients that is associated with traditional bedside teaching. Training programs to improve physicians' communication skills with adolescents have been developed at the Israel Center for Medical Simulation (MSR). Between 2003 and 2007, 470 physicians were trained at MSR in 40 one-day courses. These courses dealt with common adolescent health issues that require unique communication skills on behalf of the clinician, utilizing the simulated-patient-based programs. At each training day up to 12 physicians were exposed to 8 typical adolescent health related scenarios simulated by professional actors in rooms equipped with video facilities and one-way mirrors. Following the encounters with the simulated patients, the different scenarios were discussed in debriefing group sessions with experienced facilitators utilizing the encounters' video recording. Feedbacks from participants in the programs were excellent, emphasizing the need to include simulation-based programs in physicians' training curricula. PMID:18403816

  11. Evaluation of aminotransferase abnormality in dengue patients: A meta analysis.

    PubMed

    Wang, Xiao-Jun; Wei, Hai-Xia; Jiang, Shi-Chen; He, Cheng; Xu, Xiu-Juan; Peng, Hong-Juan

    2016-04-01

    Dengue virus is a type of flavivirus transmitted by Aedes mosquitoes. The symptoms of infection by this virus range from asymptomatic or mild symptomatic dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Significant abnormality in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) has been shown in a large number of dengue infection cases and to be indicator for liver injury provided that there are no other combined infections or liver injury. This study aims to assess the abnormal levels of liver aminotransferase in dengue patients. The related literature was searched in multiple databases, including PubMed, Embase, Google Scholar and Cochrane Library. The literature was selected through strict inclusion and exclusion criteria, and the quantitative synthesis of the liver aminotransferase abnormality was performed with R software. The fixed or random effects model was employed based on the results of the statistical test for homogeneity. In total, 15 studies were included. The proportion of AST abnormality with 95% confidence interval (95% CI) was 0.80 (95% CI: 0.56-0.92) in DHF patients and 0.75 (95% CI: 0.63-0.84) in DF patients; the proportion of ALT abnormality was 0.54 (95% CI: 0.34-0.73) in DHF patients and 0.52 (95% CI: 0.41-0.63) in DF patients. Serum ALT and AST levels may be indicators for evaluating liver injury in dengue infection and for diagnosis and treatment effect. PMID:26739659

  12. Patient Entry of Information: Evaluation of User Interfaces

    PubMed Central

    Johnson, Kevin B

    2004-01-01

    Background Personal health records are web-based applications that allow patients to directly enter their own data into secure repositories in order to generate accessible profiles of medical information. Objective The authors evaluated a variety of user interfaces to determine whether different types of data entry methods employed by Personal health records may have an impact on the accuracy of patient-entered medical information. Methods Patients with disorders requiring treatment with thyroid hormone preparations were recruited to enter data into a web-based study application. The study application presented sequences of exercises that prompted free text entry, pick list selection, or radio button selection of information related to diagnoses, prescriptions, and laboratory test results. Entered data elements were compared to information abstracted from patients' clinic notes, prescription records, and laboratory test reports. Results Accuracy rates associated with the different data entry methods tested varied in relation to the complexity of requested information. Most of the data entry methods tested allowed for accurate entry of thyroid hormone preparation names, laboratory test names, and familiar diagnoses. Data entry methods that prompted guided abstraction of data elements from primary source documents were associated with more accurate entry of qualitative and quantitative information. Conclusions Different types of data entry methods employed by Personal health records may have an impact on the accuracy of patient-entered medical information. Approaches that rely on guided entry of data elements abstracted from primary source documents may promote more accurate entry of information. PMID:15249262

  13. Evaluation of aspirin hypersensitivity in patients with chronic rhinosinusitis.

    PubMed

    Kwun, Chul; Kim, Su Il; Lee, Kun Hee; Kim, Sung Wan

    2016-06-01

    Conclusion The recurrence rates of chronic rhinosinusitis (CRS) were higher in the aspirin nasal provocation test (ANPT)-positive group, regardless of the presence of nasal polyps. Thus, a careful endoscopic examination is required during follow-up in ANPT-positive patients with CRS. Objectives The aim of this study was to evaluate the clinical features and prognosis after surgical treatment in patients with CRS and aspirin hypersensitivity. Methods In a prospective study, 100 patients were analyzed with CRS who underwent endoscopic sinus surgery at the hospital from October 2012 to March 2013. This study measured changes in nasal volume and symptoms before and after the ANPT and examined patient's asthma history, allergy, Lund-Mackay score (LMS), total immunoglobulin E, percentage of peripheral eosinophils, and objectively measured relapse at 6 months. Results Patients wwith CRS and nasal polyps (CRSwNP) were more likely to have a positive ANPT test result compared to those without nasal polyps (CRSsNP) (21.4% vs 5.5%). The ANPT-positive group had a higher LMS and required more revision endoscopic sinus surgery than those in the ANPT-negative group. The results were that similar results were observed in CRSwNP and CRSsNP. PMID:26924187

  14. Exploring Interprofessional Education through a High-Fidelity Human Patient Simulation Scenario: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Rossler, Kelly Lynn

    2013-01-01

    High-fidelity human patient simulation has emerged as a valuable medium to reinforce educational content within programs of nursing. As simulation learning experiences have been identified as augmenting both didactic lecture content and clinical learning, these experiences have expanded to incorporate interprofessional education. Review of…

  15. Using Simulation to Train Junior Psychiatry Residents to Work with Agitated Patients: A Pilot Study

    ERIC Educational Resources Information Center

    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

    Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…

  16. Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy

    SciTech Connect

    Li Hua; Noel, Camille; Chen, Haijian; Harold Li, H.; Low, Daniel; Moore, Kevin; Klahr, Paul; Michalski, Jeff; Gay, Hiram A.; Thorstad, Wade; Mutic, Sasa

    2012-12-15

    Purpose: Severe artifacts in kilovoltage-CT simulation images caused by large metallic implants can significantly degrade the conspicuity and apparent CT Hounsfield number of targets and anatomic structures, jeopardize the confidence of anatomical segmentation, and introduce inaccuracies into the radiation therapy treatment planning process. This study evaluated the performance of the first commercial orthopedic metal artifact reduction function (O-MAR) for radiation therapy, and investigated its clinical applications in treatment planning. Methods: Both phantom and clinical data were used for the evaluation. The CIRS electron density phantom with known physical (and electron) density plugs and removable titanium implants was scanned on a Philips Brilliance Big Bore 16-slice CT simulator. The CT Hounsfield numbers of density plugs on both uncorrected and O-MAR corrected images were compared. Treatment planning accuracy was evaluated by comparing simulated dose distributions computed using the true density images, uncorrected images, and O-MAR corrected images. Ten CT image sets of patients with large hip implants were processed with the O-MAR function and evaluated by two radiation oncologists using a five-point score for overall image quality, anatomical conspicuity, and CT Hounsfield number accuracy. By utilizing the same structure contours delineated from the O-MAR corrected images, clinical IMRT treatment plans for five patients were computed on the uncorrected and O-MAR corrected images, respectively, and compared. Results: Results of the phantom study indicated that CT Hounsfield number accuracy and noise were improved on the O-MAR corrected images, especially for images with bilateral metal implants. The {gamma} pass rates of the simulated dose distributions computed on the uncorrected and O-MAR corrected images referenced to those of the true densities were higher than 99.9% (even when using 1% and 3 mm distance-to-agreement criterion), suggesting that dose

  17. Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy

    PubMed Central

    Li, Hua; Noel, Camille; Chen, Haijian; Harold Li, H.; Low, Daniel; Moore, Kevin; Klahr, Paul; Michalski, Jeff; Gay, Hiram A.; Thorstad, Wade; Mutic, Sasa

    2012-01-01

    Purpose: Severe artifacts in kilovoltage-CT simulation images caused by large metallic implants can significantly degrade the conspicuity and apparent CT Hounsfield number of targets and anatomic structures, jeopardize the confidence of anatomical segmentation, and introduce inaccuracies into the radiation therapy treatment planning process. This study evaluated the performance of the first commercial orthopedic metal artifact reduction function (O-MAR) for radiation therapy, and investigated its clinical applications in treatment planning. Methods: Both phantom and clinical data were used for the evaluation. The CIRS electron density phantom with known physical (and electron) density plugs and removable titanium implants was scanned on a Philips Brilliance Big Bore 16-slice CT simulator. The CT Hounsfield numbers of density plugs on both uncorrected and O-MAR corrected images were compared. Treatment planning accuracy was evaluated by comparing simulated dose distributions computed using the true density images, uncorrected images, and O-MAR corrected images. Ten CT image sets of patients with large hip implants were processed with the O-MAR function and evaluated by two radiation oncologists using a five-point score for overall image quality, anatomical conspicuity, and CT Hounsfield number accuracy. By utilizing the same structure contours delineated from the O-MAR corrected images, clinical IMRT treatment plans for five patients were computed on the uncorrected and O-MAR corrected images, respectively, and compared. Results: Results of the phantom study indicated that CT Hounsfield number accuracy and noise were improved on the O-MAR corrected images, especially for images with bilateral metal implants. The γ pass rates of the simulated dose distributions computed on the uncorrected and O-MAR corrected images referenced to those of the true densities were higher than 99.9% (even when using 1% and 3 mm distance-to-agreement criterion), suggesting that dose

  18. Evaluation of Vancomycin Dosing in Pediatric Cystic Fibrosis Patients

    PubMed Central

    Hewlett, Jennifer L.; Moonnumakal, Siby P.; Baker, Carol J.

    2016-01-01

    OBJECTIVES: The presence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients' sputa is associated with a decline in pulmonary function and increased mortality. Vancomycin is the preferred treatment for MRSA pneumonia in children. No published studies have evaluated the vancomycin dose needed to achieve goal vancomycin trough concentrations (VTCs; 15–20 mg/L) in pediatric patients with CF. The primary objective is to determine whether a vancomycin dosage of 60 mg/kg/day achieves a goal VTC in pediatric CF patients. Secondary objectives include determining the average dosage required to reach a goal VTC and the impact of achieving a goal VTC on estimated glomerular filtration rate (eGFR) and pulmonary function. METHODS: A retrospective review of pediatric patients with CF who received vancomycin was conducted. RESULTS: A total of 90 vancomycin treatment courses were analyzed. Standard vancomycin dosing (60 mg/kg/day) achieved goal VTC in 11 courses (12.2%). The mean dosage required to achieve a goal VTC for all courses was 70.6 ± 16.7 mg/kg/day. Patients who achieved goal VTCs were more often older, weighed more, and had higher serum creatinine concentrations at therapy initiation. On average, a dosage of 70.6 mg/kg/day was required to achieve a goal VTC. Despite dosages up to 120 mg/kg/day, no significant changes in renal function occurred. Achieving a goal VTC had no significant impact on eGFR or pulmonary function during therapy. CONCLUSIONS: Vancomycin dosing of 60 mg/kg/day does not reliably achieve a VTC of 15 to 20 mg/L in pediatric CF patients. Younger CF patients may require higher vancomycin doses. PMID:27199623

  19. Improvement of the performance evaluation for solar simulators

    NASA Astrophysics Data System (ADS)

    Li, Tiecheng; Shi, Leibing; Xia, Ming; Yin, Dejin; Lin, Fangsheng; Huang, Biyong

    2015-10-01

    A solar simulator is a device that provides illumination approximating natural sunlight. Solar simulators are classified as A, B or C for each of the three categories based on criteria of spectral distribution, irradiance non-uniformity on the test plane and temporal instability of irradiance. In this paper, we find that spectral match may change during the pulse of a pulsed solar simulator. In our experiments, a second PV device, which is placed at a fixed position outside the test area, has been used for monitoring the irradiance during the pulse and correcting the measurement results. We focus on the temporal instability measurements of pulsed solar simulators, especially for those whose irradiance changes rapidly during the time of data acquisition, and make a conclusion.

  20. Evaluation of a 4D cone-beam CT reconstruction approach using a simulation framework.

    PubMed

    Hartl, Alexander; Yaniv, Ziv

    2009-01-01

    Current image-guided navigation systems for thoracic abdominal interventions utilize three dimensional (3D) images acquired at breath-hold. As a result they can only provide guidance at a specific point in the respiratory cycle. The intervention is thus performed in a gated manner, with the physician advancing only when the patient is at the same respiratory cycle in which the 3D image was acquired. To enable a more continuous workflow we propose to use 4D image data. We describe an approach to constructing a set of 4D images from a diagnostic CT acquired at breath-hold and a set of intraoperative cone-beam CT (CBCT) projection images acquired while the patient is freely breathing. Our approach is based on an initial reconstruction of a gated 4D CBCT data set. The 3D CBCT images for each respiratory phase are then non-rigidly registered to the diagnostic CT data. Finally the diagnostic CT is deformed based on the registration results, providing a 4D data set with sufficient quality for navigation purposes. In this work we evaluate the proposed reconstruction approach using a simulation framework. A 3D CBCT dataset of an anthropomorphic phantom is deformed using internal motion data acquired from an animal model to create a ground truth 4D CBCT image. Simulated projection images are then created from the 4D image and the known CBCT scan parameters. Finally, the original 3D CBCT and the simulated X-ray images are used as input to our reconstruction method. The resulting 4D data set is then compared to the known ground truth by normalized cross correlation(NCC). We show that the deformed diagnostic CTs are of better quality than the gated reconstructions with a mean NCC value of 0.94 versus a mean 0.81 for the reconstructions. PMID:19964143

  1. Evaluation of the effectiveness of simulation for preceptor preparation.

    PubMed

    Wilson, Rebecca; Acuna, Michelle; Ast, Marianne; Bodas, Elizabeth

    2013-01-01

    This quality improvement project focused on addressing perceived gaps in preceptor preparation. In addition to realigning course goals with organizational priorities, the authors explored the effectiveness of incorporating simulation-based education into an initial preceptor workshop through measures of participant satisfaction, knowledge gain, and follow-up surveys of preceptor behaviors. The results obtained from this project support the use of simulation-based education in preceptor preparation. PMID:23877289

  2. Motor Simulation during Action Word Processing in Neurosurgical Patients

    ERIC Educational Resources Information Center

    Tomasino, Barbara; Ceschia, Martina; Fabbro, Franco; Skrap, Miran

    2012-01-01

    The role that human motor areas play in linguistic processing is the subject of a stimulating debate. Data from nine neurosurgical patients with selective lesions of the precentral and postcentral sulcus could provide a direct answer as to whether motor area activation is necessary for action word processing. Action-related verbs (face-, hand-,…

  3. Use of the Marshall Space Flight Center solar simulator in collector performance evaluation

    NASA Technical Reports Server (NTRS)

    Humphries, W. R.

    1978-01-01

    Actual measured values from simulator checkout tests are detailed. Problems encountered during initial startup are discussed and solutions described. Techniques utilized to evaluate collector performance from simulator test data are given. Performance data generated in the simulator are compared to equivalent data generated during natural outdoor testing. Finally, a summary of collector performance parameters generated to date as a result of simulator testing are given.

  4. Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation

    NASA Technical Reports Server (NTRS)

    Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelly, J. H.; Depkovich, T. M.

    1984-01-01

    A generic computer simulation for manipulator systems (ROBSIM) was implemented and the specific technologies necessary to increase the role of automation in various missions were developed. The specific items developed are: (1) capability for definition of a manipulator system consisting of multiple arms, load objects, and an environment; (2) capability for kinematic analysis, requirements analysis, and response simulation of manipulator motion; (3) postprocessing options such as graphic replay of simulated motion and manipulator parameter plotting; (4) investigation and simulation of various control methods including manual force/torque and active compliances control; (5) evaluation and implementation of three obstacle avoidance methods; (6) video simulation and edge detection; and (7) software simulation validation.

  5. Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database

    SciTech Connect

    Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C.; Loudos, George; Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris

    2013-11-15

    heterogeneous activity distribution for visual assessment.Results: The accuracy of the simulated database was assessed against the original clinical images. The PVC simulated images matched the clinical ones best. Local, regional, and global features extracted from the PVC simulated images were closest to the clinical measurements, with the exception of the size zone variability and the mean intensity values, where heterogeneous tumors showed better reproducibility. The profiles on PVC simulated tumors after postfiltering seemed to represent the more realistic heterogeneous regions with respect to the clinical reference.Conclusions: In this study, the authors investigated the input activity map heterogeneity in the GATE simulations of tumors with heterogeneous activity distribution. The most realistic heterogeneous tumors were obtained by inserting PVC activity distributions from the clinical image into the activity map of the simulation. Partial volume effect (PVE) can play a crucial role in the quantification of heterogeneity within tumors and have an important impact on applications such as patient follow-up during treatment and assessment of tumor response to therapy. The development of such a database incorporating patient anatomical and functional variability can be used to evaluate new image processing or analysis algorithms, while providing control of the ground truth, which is not available when dealing with clinical datasets. The database includes all images used and generated in this study, as well as the sinograms and the attenuation phantoms for further investigation. It is freely available to the interested reader of the journal at http://www.med.upatras.gr/oncobase/.

  6. Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills.

    PubMed

    Schittek Janda, M; Mattheos, N; Nattestad, A; Wagner, A; Nebel, D; Färbom, C; Lê, D-H; Attström, R

    2004-08-01

    Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking, clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history. PMID:15233775

  7. Fluconazole dosing predictions in critically-ill patients receiving prolonged intermittent renal replacement therapy: a Monte Carlo simulation approach.

    PubMed

    Gharibian, Katherine N; Mueller, Bruce A

    2016-07-01

    Fluconazole is a renally-eliminated antifungal commonly used to treat Candida species infections. In critically-ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic (PK) data are available to guide fluconazole dosing. We used previously-published fluconazole clearance data and PK data of critically-ill patients with acute kidney injury to develop a PK model with the goal of determining a therapeutic dosing regimen for critically-ill patients receiving PIRRT. Monte Carlo simulations were performed to create a virtual cohort of patients receiving different fluconazole dosing regimens. Plasma drug concentration-time profiles were evaluated on the probability of attaining a mean 24-hour area under the drug concentration-time curve to minimum inhibitory concentration ratio (AUC24h : MIC) of 100 during the initial 48 hours of antifungal therapy. At the susceptibility breakpoint of Candida albicans (2 mg/L), 93 - 96% of simulated subjects receiving PIRRT attained the pharmacodynamic target with a fluconazole 800-mg loading dose plus 400 mg twice daily (q12h or pre and post PIRRT) regimen. Monte Carlo simulations of a PK model of PIRRT provided a basis for the development of an informed fluconazole dosing recommendation when PK data was limited. This finding should be validated in the clinical setting. PMID:27251341

  8. Cultural Competence Clinic: An Online, Interactive, Simulation for Working Effectively with Arab American Muslim Patients

    ERIC Educational Resources Information Center

    Smith, Brian Daniel; Silk, Kami

    2011-01-01

    Objective: This pilot study investigates the impact of an online, interactive simulation involving an Arab American Muslim patient on the knowledge, skills, and attitudes of 2nd-year medical students regarding culturally competent healthcare, both in general and specific to Arab American Muslim patients. Method: Participants (N = 199), were…

  9. Patient Simulation and Team-Teaching in a Medical Interviewing Course.

    ERIC Educational Resources Information Center

    Coulehan, John L.; Nardini, Donna

    1982-01-01

    A physical diagnosis course is described that introduced an interviewing segment with patient simulation at a medical school where medical interviewing or communications skills were not in the required curriculum. Physicians' responsibility for the quality of the physician-patient relationships was stressed. (MSE)

  10. Teaching Clinical Reasoning and Problem-solving Skills Using Human Patient Simulation

    PubMed Central

    Vyas, Deepti; Ottis, Erica J.; Caligiuri, Frank J.

    2011-01-01

    This paper discusses using human patient simulation (HPS) to expose students to complex dynamic patient cases that require clinical judgment, problem-solving skills, and teamwork skills for success. An example of an HPS exercise used to teach multifaceted clinical concepts in a therapeutics course also is provided. PMID:22171117

  11. Student and Teacher Reflections on Indirectness as a Pragmatic Feature of Pharmacist-Patient Simulations

    ERIC Educational Resources Information Center

    Hussin, Virginia

    2013-01-01

    This article reports on a research process where focussed reflection on pharmacist-patient simulations led to meta-pragmatic awareness and directions for pedagogical practice. The research participants were third-year EAL pharmacy students, who were practising being pharmacists, and pharmacy staff members, who played the part of patients. Analysis…

  12. Feasibility of real-time echocardiographic evaluation during patient transport.

    PubMed

    Garrett, Paul D; Boyd, Sheri Y N; Bauch, Terry D; Rubal, Bernard J; Bulgrin, James R; Kinkler, E Sterling

    2003-03-01

    Echocardiography is a key diagnostic tool in evaluating patients with cardiac emergencies and chest trauma. The lack of qualified real-time interpretation limits its use by emergency first responders. Early diagnosis of cardiac emergencies has the potential to facilitate triage and medical intervention to improve outcomes. We investigated the feasibility of remote, real-time interpretation of echocardiograms during patient transport. Echocardiograms using a hand-carried ultrasound device were transmitted from an ambulance in transit to a tertiary care facility using a distributed mobile local area network. Transmitted studies were reviewed by a cardiologist for ability to interpret predefined features. Transmission quality and reliability were assessed. Echocardiographic images were successfully transmitted greater than 88% of transport time. The evaluation of left-ventricular size and function, and presence of pericardial effusion were greater than 90% concordant, but only 66% of all echocardiographic features were concordant. Most transmission losses were brief (patient transport of adequate quality for accurate interpretation. PMID:12618725

  13. Evaluation and management of patients with refractory ascites

    PubMed Central

    Senousy, Bahaa Eldeen; Draganov, Peter V

    2009-01-01

    Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician. PMID:19115470

  14. Usefulness of Submental Ultrasonographic Evaluation for Dysphagia Patients

    PubMed Central

    Lee, Yoon Soo; Kang, Yeon; Yi, Tae Im; Kim, Joo Sup

    2016-01-01

    Objective To investigate the usefulness of ultrasonographic measurement of hyoid bone movement during swallowing. Methods Fifty-two patients who had swallowing dysfunction were enrolled in this study. When a patient swallowed 5 mL of water while maintaining an upright sitting position, hyoid bone movement during swallowing was measured with ultrasonography. Recorded images were analyzed to measure the maximum change in hyoid bone displacement. Mandible was used as reference point to calculate hyoid bone displacement. The farthest distance from resting position and the nearest distance during swallowing were measured and their differences were recorded. Participants also underwent videofluoroscopic swallowing study (VFSS). Based on penetration-aspiration scale (PAS), they were grouped to non-aspirators (PAS 1), penetrators (PAS 2–5), or aspirators (PAS 6–8). Measured hyoid bone displacements by submental ultrasonography were compared among groups. Results The mean hyoid bone displacement in non-aspirators group (n=21, 15.9±2.7 mm) was significantly (p<0.05) greater than that in penetrators group (n=20, 11.5±2.8 mm) or aspirators group (n=11, 8.0±1.0 mm). Hyoid bone displacement below 13.5 mm as a cutoff point for detecting penetration or aspiration had a sensitivity and specificity of 83.9% and 81.0%, respectively. Conclusion Submental ultrasonographic evaluation was well correlated with PAS measured by VFSS. Therefore, submental ultrasonographic evaluation could be a useful screening tool for dysphagic patients. PMID:27152268

  15. Sociological evaluation of patients with lung cancer--revision study in hospital patients.

    PubMed

    Rodrigues, Graça; Costa, David; Rocha, Lúcia; Monteiro, Ada; Mendes, Elisabete

    2005-01-01

    Lung cancer was a rare disease until the middle of the XX century, a time when it became one of the most important causes of morbidity and mortality in the actual world. Nowadays, it is esteemed that one million people all over the world die every year due to lung cancer, which means that a life is lost each 30 seconds. The quality of life of this patients decreases inevitably, being frequent hospital readmission due to the lack of conditions to lead a normal and painless life. The aim of this study was to evaluate physical and cognitive incapacity and the social needs of patients with lung cancer in the outpatient department of Hospital de S. João--Porto. Our study includes 68 patients, predominantly married male, with average age of 63, retired, ex-smokers. Moreover, they had high physical dependence degrees and the most frequent social need was the attribution of the "complemento por dependência". In this type of patients, the family has a very important role on which the treatment is concerned, as well as to the level of the personal adjustment of the patient to his disease. Its social workers job to play a mediating role between the patients and their relatives and the several institutions which can give better responses to the needs of this sort of patients. PMID:16027947

  16. Observer study to evaluate the simulation of mammographic calcification clusters

    NASA Astrophysics Data System (ADS)

    Sousa, Maria A. Z.; Marcomini, Karem D.; Bakic, Predrag R.; Maidment, Andrew D. A.; Schiabel, Homero

    2016-03-01

    Numerous breast phantoms have been developed to be as realistic as possible to ensure the accuracy of image quality analysis, covering a greater range of applications. In this study, we simulated three different densities of the breast parenchyma using paraffin gel, acrylic plates and PVC films. Hydroxyapatite was used to simulate calcification clusters. From the images acquired with a GE Senographe DR 2000D mammography system, we selected 68 regions of interest (ROIs) with and 68 without a simulated calcification cluster. To validate the phantom simulation, we selected 136 ROIs from the University of South Florida's Digital Database for Screening Mammography (DDSM). Seven trained observers performed two observer experiments by using a high-resolution monitor Barco mod. E-3620. In the first experiment, the observers had to distinguish between real or phantom ROIs (with and without calcification). In the second one, the observers had to indicate the ROI with calcifications between a pair of ROIs. Results from our study show that the hydroxyapatite calcifications had poor contrast in the simulated breast parenchyma, thus observers had more difficulty in identifying the presence of calcification clusters in phantom images. Preliminary analysis of the power spectrum was conducted to investigate the radiographic density and the contrast thresholds for calcification detection. The values obtained for the power spectrum exponent (β) were comparable with those found in the literature.

  17. Evaluation of surgical training in the era of simulation

    PubMed Central

    Shaharan, Shazrinizam; Neary, Paul

    2014-01-01

    AIM: To assess where we currently stand in relation to simulator-based training within modern surgical training curricula. METHODS: A systematic literature search was performed in PubMed database using keywords “simulation”, “skills assessment” and “surgery”. The studies retrieved were examined according to the inclusion and exclusion criteria. Time period reviewed was 2000 to 2013. The methodology of skills assessment was examined. RESULTS: Five hundred and fifteen articles focussed upon simulator based skills assessment. Fifty-two articles were identified that dealt with technical skills assessment in general surgery. Five articles assessed open skills, 37 assessed laparoscopic skills, 4 articles assessed both open and laparoscopic skills and 6 assessed endoscopic skills. Only 12 articles were found to be integrating simulators in the surgical training curricula. Observational assessment tools, in the form of Objective Structured Assessment of Technical Skills (OSATS) dominated the literature. CONCLUSION: Observational tools such as OSATS remain the top assessment instrument in surgical training especially in open technical skills. Unlike the aviation industry, simulation based assessment has only now begun to cross the threshold of incorporation into mainstream skills training. Over the next decade we expect the promise of simulator-based training to finally take flight and begin an exciting voyage of discovery for surgical trainees. PMID:25228946

  18. Evaluation of ongoing oxycodone abuse among methadone-maintained patients.

    PubMed

    Dunn, Kelly E; Sigmon, Stacey C; McGee, Mark R; Heil, Sarah H; Higgins, Stephen T

    2008-12-01

    Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. This study presents results from an internal quality assurance project conducted by an outpatient methadone maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis-testing methods. One hundred five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic's usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, whereas the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration, and provide significantly more opioid- and cocaine-positive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. Although future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication-dosing decisions, and determining patient eligibility for methadone take-home privileges. PMID:18295434

  19. Evaluation of Ongoing Oxycodone Abuse among Methadone-Maintained Patients

    PubMed Central

    Dunn, Kelly E.; Sigmon, Stacey C.; McGee, Mark R.; Heil, Sarah H; Higgins, Stephen T.

    2008-01-01

    Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. The current study presents results from an internal quality-assurance project conducted by an outpatient methadone-maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis testing methods. One-hundred and five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic’s usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, while the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration and provide significantly more opioid- and cocaine-positive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. While future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication dosing decisions, and determining patient eligibility for methadone take-home privileges. PMID:18295434

  20. Evaluation of patient exposure in computerised tomogram in Poland.

    PubMed

    Staniszewska, M A

    2002-01-01

    The increasing number of computerised tomography (CT) procedures performed in Poland in recent years has resulted in a growing contribution of these examinations to the whole exposure of the population to ionising radiation from medical sources. (The number of CT examinations in Poland was 170,000 in 1995 and 460,000 in 1999.) An evaluation is presented of doses to patients in CT examinations performed with different types of CT unit. To evaluate the exposure to patients dose linear product (DLP) was measured using a NOMEX dosemeter with a pencil chamber (PTW, Frieburg) and the cylindrical PMMA phantoms 'head' and 'body'. CTDI values were evaluated according to current methodology as described in European Guidelines (EUR 16262). The measurements were performed for seven types of CT unit made by different companies. The CTDI values were also compared to reference levels recommended by IAEA. In conclusion it was found that the value of collective effective dose (2200 man.Sv), has increased in Poland nearly 4 times in comparison to 1995, whereas the number of CT examinations increased nearly 3 times in this period. For most of the 'controlled' CT scanners the values of CTDI in head procedures are near to or higher than the IAEA Reference Level (50 mGy); this can result from the protocols, which are chosen without a dose analysis. PMID:12120672

  1. Working as simulated patient has effects on real patient life – Preliminary insights from a qualitative study

    PubMed Central

    Simmenroth-Nayda, Anne; Marx, Gabriella; Lorkowski, Thorsten; Himmel, Wolfgang

    2016-01-01

    Background: Persons who simulate patients during medical education understand the routines and the underlying script of medical consultations better. We aimed to explore how simulated patients (SPs) integrated this new understanding into their daily life, how this work affected their private life as patients, and what we can learn from these changes for concepts of empowerment. Design, setting, and participants: A qualitative interview study. All SPs of Göttingen medical school who had been working longer than three semesters (n=14) were invited and agreed to take part in an open interview about their daily experience with real doctors. Documentary method was used to identify the main issues. Several cases were chosen according to maximum contrast and analysed by in-depth analysis to provide vivid examples of how simulations may affect the real life of the SPs as patients. Results: Our analysis revealed three main changes in the behaviour of SPs as real patients. They were more attentive, had a better understanding of the circumstances under which doctors work, and acted more self-confidently. From the selected cases it became apparent that working as a SP may lead to a constant and significant decrease of fear of hospitals and medical procedures or, in other cases, may enable the SPs to develop new abilities for giving feedback, questioning procedures, and explanations for real doctors. Conclusion: working as a simulated patient seems to be well-suited to understand own progression of diseases, to increase self-responsibility and to a confident attitude as patient. PMID:27275507

  2. Toward patient-specific simulations of cardiac valves: state-of-the-art and future directions

    PubMed Central

    Votta, Emiliano; Le, Trung Bao; Stevanella, Marco; Fusini, Laura; Caiani, Enrico G; Redaelli, Alberto; Sotiropoulos, Fotis

    2012-01-01

    Recent computational methods enabling patient-specific simulations of native and prosthetic heart valves are reviewed. Emphasis is placed on two critical components of such methods: 1) anatomically realistic finite element models for simulating the structural dynamics of heart valves; and 2) fluid structure interaction methods for simulating the performance of heart valves in a patient specific beating left ventricle. It is shown that the significant progress achieved in both fronts paves the way toward clinically relevant computational models that can simulate the performance of a range of heart valves, native and prosthetic, in a patient-specific left heart environment. The significant algorithmic and model validation challenges that need to be tackled in the future to realize this goal are also discussed. PMID:23174421

  3. Evaluation of Network-Based Minimally Invasive VR Surgery Simulator.

    PubMed

    Tagawa, Kazuyoshi; Tanaka, Hiromi T; Kurumi, Yoshimasa; Komori, Masaru; Morikawa, Shigehiro

    2016-01-01

    In this paper, we report a result of an experiment of a field trial of our network-based minimally invasive surgery simulator. In our previous paper, we proposed a network-based visuohaptic surgery training system for laparoscopic surgery. In addition, we proposed a volume-based haptic communication approach, which allows participants at remote sites on the network to simultaneously interact with the same target object in virtual environments presented by multi-level computer performance systems, by only exchanging a small set of manipulation parameters for the target object and additional packet for synchronization of status of binary tree and deformation of shared volume model. We implemented the approach into our network-based surgery simulator, and field trial of the simulator at three locations was performed. PMID:27046613

  4. Characterization and Evaluation of Lunar Regolith and Simulants

    NASA Technical Reports Server (NTRS)

    Cross, William M.; Murphy, Gloria A.

    2010-01-01

    A NASA-ESMD (National Aeronautics and Space Administration-Exploration Systems Mission Directorate) funded senior design project "Mineral Separation Technology for Lunar Regolith Simulant Production" is directed toward designing processes to produce Simulant materials as close to lunar regolith as possible. The eight undergraduate (junior and senior) students involved are taking a systems engineering design approach to identifying the most pressing concerns in simulant needs, then designing subsystems and processing strategies to meet these needs using terrestrial materials. This allows the students to, not only learn the systems engineering design process, but also, to make a significant contribution to an important NASA ESMD project. This paper will primarily be focused on the implementation aspect, particularly related to the systems engineering process, of this NASA EMSD senior design project. In addition comparison of the NASA ESMD group experience to the implementation of systems engineering practices into a group of existing design projects is given.

  5. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    PubMed Central

    Miranda, Matheus; Hossne, Nelson Américo; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; da Fonseca, José Honório de Almeida Palma; Pestana, José Osmar Medina de Abreu; Juliano, Yara; Buffolo, Enio

    2014-01-01

    Background Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Objective Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Methods Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. Results High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Conclusion Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions. PMID:24270865

  6. Evaluation of medication adherence in Lebanese hypertensive patients.

    PubMed

    Yassine, Mohammad; Al-Hajje, Amal; Awada, Sanaa; Rachidi, Samar; Zein, Salam; Bawab, Wafa; Bou Zeid, Mayssam; El Hajj, Maya; Salameh, Pascale

    2016-09-01

    Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59±2.0. In bivariate analyses, having controlled blood pressure (p=0.003) and taking a combination drug (p=0.023) were predictors of high adherence. Forgetfulness (p<0.01), complicated drug regimen (p=0.001), and side effects (p=0.006) were predictors of low adherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p=0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence. PMID:26232704

  7. Vertical mammaplasty: Postoperative changes, complications and patient evaluation

    PubMed Central

    Keck, M; Kaye, K; Thieme, I; Ueberreiter, K

    2007-01-01

    The aim of the present study was to investigate postoperative changes after vertical mammaplasty. Between 2002 and 2005, 72 consecutive patients aged 15 to 69 years with an average weight of 72 kg underwent bilateral vertical mammaplasty. Forty-two patients attended the regular follow-up one week, four weeks, three months, six months and one year after the operation. Nipple diameter, notch-to-nipple distance, scar length and the number of skin folds along the vertical scar were evaluated. Complications were recorded during the entire follow-up period. A questionnaire was used to document patient satisfaction 12 months after the operation. The main changes took place during the first three months after surgery. Nipple diameter showed an average increase of 28% after surgery, and the notch-to-nipple distance increased by an average of 17% over the intraoperative value. The average increase of the scar length after one year was 22%. The rate of complications was low, and patient satisfaction was high. PMID:19554130

  8. Initial evaluation and management of the critical burn patient.

    PubMed

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. PMID:26724246

  9. Simulation of transcatheter aortic valve implantation: a patient-specific finite element approach.

    PubMed

    Auricchio, F; Conti, M; Morganti, S; Reali, A

    2014-01-01

    Until recently, heart valve failure has been treated adopting open-heart surgical techniques and cardiopulmonary bypass. However, over the last decade, minimally invasive procedures have been developed to avoid high risks associated with conventional open-chest valve replacement techniques. Such a recent and innovative procedure represents an optimal field for conducting investigations through virtual computer-based simulations: in fact, nowadays, computational engineering is widely used to unravel many problems in the biomedical field of cardiovascular mechanics and specifically, minimally invasive procedures. In this study, we investigate a balloon-expandable valve and we propose a novel simulation strategy to reproduce its implantation using computational tools. Focusing on the Edwards SAPIEN valve in particular, we simulate both stent crimping and deployment through balloon inflation. The developed procedure enabled us to obtain the entire prosthetic device virtually implanted in a patient-specific aortic root created by processing medical images; hence, it allows evaluation of postoperative prosthesis performance depending on different factors (e.g. device size and prosthesis placement site). Notably, prosthesis positioning in two different cases (distal and proximal) has been examined in terms of coaptation area, average stress on valve leaflets as well as impact on the aortic root wall. The coaptation area is significantly affected by the positioning strategy (- 24%, moving from the proximal to distal) as well as the stress distribution on both the leaflets (+13.5%, from proximal to distal) and the aortic wall (- 22%, from proximal to distal). No remarkable variations of the stress state on the stent struts have been obtained in the two investigated cases. PMID:23402555

  10. Evaluation of macrophage antiviral activity in patients affected by neoplasia.

    PubMed

    Merendino, R A; Iannello, D; Arena, A; Bonina, L; Greco, V; Mesiti, M; Chillemi, S; Mastroeni, P

    1988-01-01

    The intrinsic antiviral activity of macrophages has been studied in healthy donors and in patients affected by breast cancer and melanoma. In vitro differentiated macrophages from blood-derived monocytes were infected with measles virus, herpes simplex virus type 2 and adenovirus 17. The challenge was carried out with different multiplicities of infection and the synthesis of virus was tested by evaluating the single cycle growth curve in 24 h. The results obtained show that the restriction of virus infectivity by macrophages is strongly influenced by the multiplicity of infection. This was particularly evident with the adenovirus 17. Moreover, macrophages from patients with melanoma and breast cancer showed an impairment of the intrinsic antiviral activity in comparison with normal subjects. PMID:2842553

  11. Little shop of errors: an innovative simulation patient safety workshop for community health care professionals.

    PubMed

    Tupper, Judith B; Pearson, Karen B; Meinersmann, Krista M; Dvorak, Jean

    2013-06-01

    Continuing education for health care workers is an important mechanism for maintaining patient safety and high-quality health care. Interdisciplinary continuing education that incorporates simulation can be an effective teaching strategy for improving patient safety. Health care professionals who attended a recent Patient Safety Academy had the opportunity to experience firsthand a simulated situation that included many potential patient safety errors. This high-fidelity activity combined the best practice components of a simulation and a collaborative experience that promoted interdisciplinary communication and learning. Participants were challenged to see, learn, and experience "ah-ha" moments of insight as a basis for error reduction and quality improvement. This innovative interdisciplinary educational training method can be offered in place of traditional lecture or online instruction in any facility, hospital, nursing home, or community care setting. PMID:23654294

  12. Process evaluation of podiatric treatment of patients with forefoot pain

    PubMed Central

    2013-01-01

    Background Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel. Method We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist. Results Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n =13) and a non-functional approach (n =12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all. Conclusion In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence. PMID:23919765

  13. Transatlantic medical education: preliminary data on distance-based high-fidelity human patient simulation training.

    PubMed

    von Lubitz, Dag K J E; Carrasco, Benjamin; Gabbrielli, Francesco; Ludwig, Timm; Levine, Howard; Patricelli, Frederic; Poirier, Caleb; Richir, Simon

    2003-01-01

    Advanced training using Human Patient Simulators (HPS) is, for the large part, unavailable for the majority of healthcare providers in rural, remote, and less developed regions of the world--either due to their separation from the major medical education centers or significant fiscal austerity. Remote access to HPS based on the Applications Software Provider principles may provide the solution to this problem. The medical ASP (MED-ASP) concept proposed and developed by MedSMART has been subjected to an extensive qualitative and quantitative international test conducted among France, Italy, and USA. Two SimMan HPSs (Laerdal, Norway) were used, with one unit based in Ann Arbor, MI, USA, and one in Laval, France. While the French site had both remote and hands-on access to the simulator, the Italian site could access the HPS only remotely. Simulator visualization was provided by 4 remotely operated cameras (Sony, zoom, pan, tilt) at each HPS site. HPS-generated vital signs were transmitted to each site together with the interactive simulator control panel using a communications hub at the MedSMART facility in Ann Arbor. All remote interactions were performed via the Internet (TCP/IP) using ISDN and/or ADSL connections at minimum 128 Kbps. During the course of training, the trainees were exposed to 3 emergency scenarios with the remote expert providing instruction. Interventions were performed either remotely (Italy) or remotely and hands-on (France). Quantitative measurement of the efficiency of training was performed at the Italian site based on the evaluation of video recordings of each session and the assessment of several performance measures. At the end of the training program, a Likert scale-based assessment test was also given. The trainees showed statistically significant (p<0.03 - 0.05) improvement in all testing measures. The Likert scale questionnaire revealed overwhelming satisfaction with the simulation-based distance training even when the access to the

  14. Using clinical simulation to teach patient safety in an acute/critical care nursing course.

    PubMed

    Henneman, Elizabeth A; Cunningham, Helene

    2005-01-01

    High-fidelity simulation using lifelike mannequins has been used to teach medical and aviation students, but little is known about using this method to educate nurses. The process and methods authors used to develop, implement, and evaluate high-fidelity simulation experiences in an acute/critical care elective for senior nursing students are described. Authors share their insight, experiences, and lessons learned, along with practical information and a framework, in developing simulations and debriefing. PMID:16030454

  15. Simulated Distribution Nitrification: Nitrification Index Evaluation and Viable AOB

    EPA Science Inventory

    Lab-scale reactors evaluated the impact of increasing temporal influent monochloramine (NH2Cl) concentrations (0.0 to 3.2 mg Cl2 L-1) and chlorine to nitrogen mass ratios (0:1 to 3.2:1) on nitrification, allowing evaluation of the recently proposed nitrification index (NI) for ch...

  16. Evaluating the Patient with Right Upper Quadrant Abdominal Pain.

    PubMed

    Avegno, Jennifer; Carlisle, Matthew

    2016-05-01

    Right upper quadrant (RUQ) pain is among the most common complaints in the emergency department. The differential diagnosis is broad and includes gastrointestinal (GI) and non-GI causes for pain. Evaluation of patients requires a combination of history, physical examination, laboratory testing, and diagnostic imaging. This article details the anatomy and physiology of the right upper abdomen and approach to the history and physical examination of the most common diseases encountered in the emergency department. "Can't miss," non-GI diagnoses are discussed. Best practices of laboratory and imaging, and treatment of most common diagnoses of RUQ pain are reviewed. PMID:27133241

  17. Evaluating and improving patient-specific QA for IMRT delivery

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

    Modern radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and newly-emerging volumetric modulated arc therapy (VMAT) aim to deliver highly conformal radiation dose to the target volume while sparing nearby critical organs as much as possible with the complex motion of multi-leaf collimator (MLC) leaves. Pre-treatment patient specific quality assurance (QA) has become an essential part of IMRT in making sure the delivered dose distributions agree with the planned ones. This dissertation evaluates the performance of current patient-specific QA process and proposes solutions to improve its sensitivity, accuracy and efficiency. In step and shoot IMRT, the study on the sensitivity of patient-specific QA to minor MLC errors reveals tighter criterion such as 2%/2mm must be employed to detect systematic MLC positioning errors of 2 mm. However, such criterion results in low average passing rate which leads to excessive false alarms, mainly due to inadequate treatment planning system (TPS) beam modeling on beam penumbra. An analytical deconvolution approach is proposed to recover true photon beam profiles to obtain a true beam model which significantly improves agreement between calculated and measured dose distributions. Thus a tighter criterion could be employed to enhance the sensitivity of patient-specific QA to minor errors in the delivery system. Measurement based patient-specific IMRT QA is a time-consuming process. A fast and accurate independent planar dose calculation algorithm is proposed to replace measurement based QA. The algorithm analytically models photons coming out from the accelerator and computes dose distribution from first principles. Accuracy of the algorithm is validated against 2D diode array measurements. The algorithm is found to be fast and accurate enough to replace time consuming measurement based QA. Patient-specific QA for VMAT differs significantly from step and shoot IMRT due to the increased use of dynamic

  18. Simulation in Inner City Teaching - A Demonstration and Evaluation.

    ERIC Educational Resources Information Center

    Gleason, Gerald T.

    This study provided an assessment of the effectiveness of simulation in developing attitudes, values and cognitive understanding in a teacher education program. The experimental participants were 24 undergraduates enrolled in a course on learning and development. The course consisted of demonstrations of problems faced by the teacher in the inner…

  19. Simulation-Based Evaluation of Learning Sequences for Instructional Technologies

    ERIC Educational Resources Information Center

    McEneaney, John E.

    2016-01-01

    Instructional technologies critically depend on systematic design, and learning hierarchies are a commonly advocated tool for designing instructional sequences. But hierarchies routinely allow numerous sequences and choosing an optimal sequence remains an unsolved problem. This study explores a simulation-based approach to modeling learning…

  20. An evaluation of ozone dry deposition simulations in East Asia

    SciTech Connect

    Park, R.; Hong, Seungkyu K.; Kwon, Hyoung-Ahn; Kim, Saewung; Guenther, Alex B.; Woo, Jung-Hun; Loughner, C. P.

    2014-08-11

    We used a 3-D regional atmospheric chemistry transport model (WRF-Chem) to examine processes that determine O3 in East Asia; in particular, we focused on O3 dry deposition, which is an uncertain research area due to insufficient observation and numerical studies in East Asia. Here, we compare two widely used dry deposition parameterization schemes, Wesely and M3DRY, which are used in the WRF-Chem and CMAQ models, respectively. The O3 dry deposition velocities simulated using the two aforementioned schemes under identical meteorological conditions show considerable differences (a factor of 2) due to surface resistance parameterization discrepancies. The O3 concentration differed by up to 10 ppbv for the monthly mean. The simulated and observed dry deposition velocities were compared, which showed that the Wesely scheme model is consistent with the observations and successfully reproduces the observed diurnal variation. We conduct several sensitivity simulations by changing the land use data, the surface resistance of the water and the model’s spatial resolution to examine the factors that affect O3 concentrations in East Asia. As shown, the model was considerably sensitive to the input parameters, which indicates a high uncertainty for such O3 dry deposition simulations. Observations are necessary to constrain the dry deposition parameterization and input data to improve the East Asia air quality models.

  1. An Experimental Evaluation of a Shadowgraph Simulator for Driver Training.

    ERIC Educational Resources Information Center

    Henry, J. P.

    An experiment to assess the value of a shadowgraph simulator for driver training is described. Two groups of 36 pupils with no previous driving experience, and matched for age and sex, were taught to drive up to the standard of the DOE driving test. The pupils in one of the groups received their first three hours instruction on a shadowgraph…

  2. Novel virtual Lap-Band simulator could promote patient safety.

    PubMed

    De, Suvranu; Ahn, Woojin; Lee, Doo Yong; Jones, Daniel B

    2008-01-01

    This paper presents, for the first time, a physics-based modeling technique for the Lap-Band (Inamed Health) used in laparoscopic gastric banding (LAGB) operations for treating the morbidly obese. A virtual LAGB simulator can help train medical students as well as surgeons who embark at learning this relatively new operation. The Lap-Band has different thickness and curvature along the centerline, and therefore leads to different deformation behaviors. A hybrid modeling strategy is therefore adopted to successfully replicate its dynamics. A mass-spring model, used to model the less stiff part, is coupled to a quasi-static articulated link model for the more stiff and inextensible part. The virtual Lap-Band model has been implemented into a complete graphics-haptics-physics-based system with two PHANToM Omni devices (from Sensible Technologies) being used for real-time bimanual interaction with force feedback. PMID:18391265

  3. Using CONFIG for Simulation of Operation of Water Recovery Subsystems for Advanced Control Software Evaluation

    NASA Technical Reports Server (NTRS)

    Malin, Jane T.; Flores, Luis; Fleming, Land; Throop, Daiv

    2002-01-01

    A hybrid discrete/continuous simulation tool, CONFIG, has been developed to support evaluation of the operability life support systems. CON FIG simulates operations scenarios in which flows and pressures change continuously while system reconfigurations occur as discrete events. In simulations, intelligent control software can interact dynamically with hardware system models. CONFIG simulations have been used to evaluate control software and intelligent agents for automating life support systems operations. A CON FIG model of an advanced biological water recovery system has been developed to interact with intelligent control software that is being used in a water system test at NASA Johnson Space Center

  4. Flavor perception test: evaluation in patients with Kallmann syndrome.

    PubMed

    Maione, Luigi; Cantone, Elena; Nettore, Immacolata Cristina; Cerbone, Gaetana; De Brasi, Davide; Maione, Nunzia; Young, Jacques; Di Somma, Carolina; Sinisi, Antonio Agostino; Iengo, Maurizio; Macchia, Paolo Emidio; Pivonello, Rosario; Colao, Annamaria

    2016-05-01

    In Kallmann syndrome (KS), congenital hypogonadism is associated with olfactory impairment. To evaluate flavor perception-related disability in KS patients, 30 patients with KS, 12 with normosmic hypogonadism (nIHH), 24 with acquired anosmia (AA), and 58 healthy controls entered the study. All participants completed questionnaires concerning dietary habits, olfaction-related quality of life (QoL), and self-determined olfactory, flavor, and taste abilities prior to undergoing standardized olfactometry and gustometry. Each subject underwent flavor testing, using orally administered aqueous aromatic solutions, identifying 21 different compounds by choosing each out of 5 alternative items. Flavor score (FS) was calculated as the sum of correct answers (range 0-21). Flavor perception by self-assessment was similar between KS, nIHH, and controls, and was mostly reduced only in AA. FS was similar between KS (5.4 ± 1.4) and AA (6.4 ± 1.9), and lower than in nIHH (16.2 ± 2.4, p < 0.001) and controls (16.8 ± 1.7, p < 0.0001). FS showed strong reproducibility, and correlated with olfactory scores in the overall population. KS and AA patients identified aromatics eliciting trigeminal stimulation better than pure odorants. Olfaction-related QoL was more impaired in AA than in KS. We report significant flavor impairment in KS. This contrasts with routine clinic evidence; KS patients, in contrast with AA, do not complain of flavor perception impairment, perhaps owing to the congenital nature of the dysfunction. Flavor perception impairment should be considered a specific KS disability, because of important detrimental effects on physical and mental health and on QoL. KS patients should also be advised of this impairment in order to prevent accidental and life-threatening events. PMID:26209039

  5. Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

    PubMed

    Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

    2012-06-01

    The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) =5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10

  6. Validation of an Integrated Airframe and Turbofan Engine Simulation for Evaluation of Propulsion Control Modes

    NASA Technical Reports Server (NTRS)

    Litt, Jonathan S.; Sowers, T Shane; Liu, Yuan; Owen, A. Karl; Guo, Ten-Huei

    2015-01-01

    The National Aeronautics and Space Administration (NASA) has developed independent airframe and engine models that have been integrated into a single real-time aircraft simulation for piloted evaluation of propulsion control algorithms. In order to have confidence in the results of these evaluations, the integrated simulation must be validated to demonstrate that its behavior is realistic and that it meets the appropriate Federal Aviation Administration (FAA) certification requirements for aircraft. The paper describes the test procedures and results, demonstrating that the integrated simulation generally meets the FAA requirements and is thus a valid testbed for evaluation of propulsion control modes.

  7. Path selection system simulation and evaluation for a Martian roving vehicle

    NASA Technical Reports Server (NTRS)

    Boheim, S. L.; Prudon, W. C.

    1972-01-01

    The simulation and evaluation of proposed path selection systems for an autonomous Martian roving vehicle was developed. The package incorporates a number of realistic features, such as the simulation of random effects due to vehicle bounce and sensor-reading uncertainty, to increase the reliability of the results. Qualitative and quantitative evaluation criteria were established. The performance of three different path selection systems was evaluated to determine the effectiveness of the simulation package, and to form some preliminary conclusions regarding the tradeoffs involved in a path selection system design.

  8. Evaluation of virtual cockpit concepts during simulated missions

    NASA Astrophysics Data System (ADS)

    Kaye, M. G.; Ineson, Judith; Jarett, D. N.; Wickham, G.

    1990-04-01

    The Virtual Environment Integration Laboratory (VEIL) of the Royal Aerospace Establishement (RAE) is described. The VEIL program is intended to provoke appropriate technological developments by exploring the human requirements of operating within a virtual cockpit whilst conducting demanding missions. Under construction is a lightweight binocular, color helmet mounted display with a wide field of view, driven by a versatile parallel architecture computer graphic system which accommodates simulated sensor images from a camera and terrain model. Prototypes of suitable display formats will be developed using a bench mounted stereoscopic viewing rig which will also facilitate investigation of critical psychophysical issues. The complete VEIL hardware will integrate eye and head position sensors, three dimensional sound, direct voice input, and tactile sensors with the binocular display system. When allied to the ground attack, helicopter and air combat simulator facilities of Mission Management Department, it will enable the practicality of operating virtual cockpit systems in a wide variety of missions and tasks to be addressed.

  9. Evaluating System Parameters on a Dragonfly using Simulation and Visualization

    SciTech Connect

    Bhatele, Abhinav; Jain, Nikhil; Livnat, Yarden; Pascucci, Valerio; Bremer, Peer-Timo

    2015-04-24

    The dragon y topology is becoming a popular choice for build- ing high-radix, low-diameter networks with high-bandwidth links. Even with a powerful network, preliminary experi- ments on Edison at NERSC have shown that for communica- tion heavy applications, job interference and thus presumably job placement remains an important factor. In this paper, we explore the e ects of job placement, job sizes, parallel workloads and network con gurations on network through- put to better understand inter-job interference. We use a simulation tool called Damsel y to model the network be- havior of Edison and study the impact of various system parameters on network throughput. Parallel workloads based on ve representative communication patters are used and the simulation studies on up to 131,072 cores are aided by a new visualization of the dragon y network.

  10. Visual cues in flight simulation - An evaluation of stereo effectiveness

    NASA Technical Reports Server (NTRS)

    Johnson, Walter W.; Andre, Anthony D.; Kruk, Ronald V.

    1992-01-01

    The purpose of the present study was to quantify the effects of visual scene information on precision hovering tasks under biocular and stereo viewing conditions in a rotorcraft helmet-mounted display simulator. Four NASA test pilots performed a series of precision hover maneuvers in the context of three different scene contents, two ground textures, and three levels of control configuration difficulty. The results revealed that vertical position variability was greatest when vertical cues were absent, and that patterned ground texture aided hover stability only when other position-reference cues were absent from the scene. The stereo viewing condition showed no uniform advantages over the biocular condition. The results are discussed in terms of their implications for simulator design and qualification.

  11. Steroid Dermatitis Resembling Rosacea: A Clinical Evaluation of 75 Patients

    PubMed Central

    Hameed, Ammar F.

    2013-01-01

    Background. The use of topical steroids on the skin of the face should be carefully evaluated by the dermatologist; however, its misuse still occurs producing dermatological problem resembling rosacea. Objectives. To report the different clinical manifestations of steroid dermatitis resembling rosacea and to discover causes behind abusing topical steroids on the face. Methods. In this prospective observational study, 75 patients with steroid dermatitis resembling rosacea who had history of topical steroid use on their faces for at least 1–3 months were evaluated at the Department of Dermatology, Baghdad Teaching Hospital, between August 2010 and December 2012. Results. The majority of patients were young women who used a combinations of potent and very potent topical steroid for average period of 0.25–10 years. Facial redness and hotness, telangiectasia, and rebound phenomenon with papulopustular eruption were the main clinical presentations. The most common causes of using topical steroid on the face were pigmentary problems and acne through recommendations from nonmedical personnel. Conclusion. Topical steroid should not be used on the face unless it is under strict dermatological supervision. PMID:23691345

  12. Lessons from evaluating an automated patient severity index.

    PubMed Central

    Gibson, R F; Haug, P J; Horn, S D

    1996-01-01

    OBJECTIVE: To report lessons learned from evaluation of an automated interface between a hospital clinical information system and a severity of illness index. DESIGN: A system was developed to convert coded electronic patient findings from the HELP System at LDS Hospital into the attributes used by the Computerized Severity Index (CSI) to calculate a severity of illness score. Performance was assessed by comparing the automated CSI score with the manual CSI score (from paper chart review) and by evaluating changes introduced by augmenting the manual CSI score with verified patient data discovered by the automated CSI method. MEASUREMENTS: The strengths and weaknesses of each method are presented. RESULTS: The automated CSI score matched the manual CSI score in 61% of the cases. Sources of errors were analyzed. When the automated score was in error, two-thirds of the time it was due to the lack of codes in the HELP system representing CSI concepts; one-third of the time it was due to nurses not using established HELP system codes. Surprisingly, significant problems were also discovered in the manual system, making it difficult to define a "gold standard". CONCLUSIONS: Automated computerized severity indices have great potential for future applicability once their performance exceeds that of the time-consuming manual chart review method. Neither automated nor manual methods are adequate at the present time. This area remains a fertile ground for future research. PMID:8880682

  13. An Evaluation of the High Level Architecture (HLA) as a Framework for NASA Modeling and Simulation

    NASA Technical Reports Server (NTRS)

    Reid, Michael R.; Powers, Edward I. (Technical Monitor)

    2000-01-01

    The High Level Architecture (HLA) is a current US Department of Defense and an industry (IEEE-1516) standard architecture for modeling and simulations. It provides a framework and set of functional rules and common interfaces for integrating separate and disparate simulators into a larger simulation. The goal of the HLA is to reduce software costs by facilitating the reuse of simulation components and by providing a runtime infrastructure to manage the simulations. In order to evaluate the applicability of the HLA as a technology for NASA space mission simulations, a Simulations Group at Goddard Space Flight Center (GSFC) conducted a study of the HLA and developed a simple prototype HLA-compliant space mission simulator. This paper summarizes the prototyping effort and discusses the potential usefulness of the HLA in the design and planning of future NASA space missions with a focus on risk mitigation and cost reduction.

  14. Wireless Communication for Controlling Microgrids: Co-simulation and Performance Evaluation

    SciTech Connect

    Mao, Rukun; Xu, Yan; Li, Huijuan; Li, Husheng

    2013-01-01

    A microgrid with wireless communication links for microgrid control has been designed and developed. The complete simulation model has been developed in MatLab SimuLink with seamless integration of the power subsystem and the communication subsystem. Unlike the conventional co-simulators that usually glue two existing simulators together by creating an interface, which has a steep learning curve, the proposed simulator is a compact single-unit model. Detailed modeling of the power subsystem and communication system is presented as well as the microgrid control architecture and strategies. The impact of different communication system performances on microgrid control has been studied and evaluated in the proposed simulator.

  15. Evaluating the Accuracy of Hessian Approximations for Direct Dynamics Simulations.

    PubMed

    Zhuang, Yu; Siebert, Matthew R; Hase, William L; Kay, Kenneth G; Ceotto, Michele

    2013-01-01

    Direct dynamics simulations are a very useful and general approach for studying the atomistic properties of complex chemical systems, since an electronic structure theory representation of a system's potential energy surface is possible without the need for fitting an analytic potential energy function. In this paper, recently introduced compact finite difference (CFD) schemes for approximating the Hessian [J. Chem. Phys.2010, 133, 074101] are tested by employing the monodromy matrix equations of motion. Several systems, including carbon dioxide and benzene, are simulated, using both analytic potential energy surfaces and on-the-fly direct dynamics. The results show, depending on the molecular system, that electronic structure theory Hessian direct dynamics can be accelerated up to 2 orders of magnitude. The CFD approximation is found to be robust enough to deal with chaotic motion, concomitant with floppy and stiff mode dynamics, Fermi resonances, and other kinds of molecular couplings. Finally, the CFD approximations allow parametrical tuning of different CFD parameters to attain the best possible accuracy for different molecular systems. Thus, a direct dynamics simulation requiring the Hessian at every integration step may be replaced with an approximate Hessian updating by tuning the appropriate accuracy. PMID:26589009

  16. Evaluation of external cardiac massage performance during hypogravity simulation.

    PubMed

    Dalmarco, Gustavo; Calder, Alyson; Falcão, Felipe; de Azevedo, Dario F G; Sarkar, Subhajit; Evetts, Sarkar; Moniz, Simon; Russomano, Thais

    2006-01-01

    Preservation of astronaut crew health during an exploration mission to the Moon or Mars will be crucial to mission success. The likelyhood of a life threatening medical condition occurring during a mission to Mars has been estimated by NASA to be 1% per year. Since basic life support is a vital skill in critical care medicine, plans must be in place for cardiopulmonary resuscitation in both microgravity and hypogravity (i.e. on the surface of the Moon or Mars). Following the design of a body suspension device to simulate a hypogravity environment, subjects performed external chest compressions in 1G, 0.17G (Lunar), 0.38G (Mars) and 0.7G ('Planet X'). Chest compression adequacy was assessed by means of rate and depth. Heart rate immediately before and after 3 minutes of chest compression gave a measure of rescuer fatigue. Elbow flexion was measured using an electrogoniometer in order to assess the use of arm muscles to achieve chest compressions. This study found that depth (Lunar and Mars) and rate (Mars) of chest compression was below American Heart Association recommendations during hypogravity simulation in the female group. Furthermore, elbow flexion proved to be significantly greater during Lunar and Mars hypogravity simulation than that of the 1G control condition, suggesting that upper arm force may be used to counter the loss of body weight in an attempt to maintain adequate chest compression under these conditions. PMID:17946990

  17. Evaluation of Plasma Isoprostane in Patients with Oral Lichen Planus

    PubMed Central

    Amirchaghmaghi, Maryam; Hashemy, Seyed Isaac; Alirezaei, Banafsheh; Jahed Keyhani, Fereshteh; Kargozar, Sanaz; Vasigh, Samaneh; Gharaei, Shideh; Pakfetrat, Atessa

    2016-01-01

    Statement of the Problems Lichen planus is a chronic inflammatory disease. Free radicals and reactive oxygen species play important roles in pathogenesis of oral lichen planus (OLP). Isoprostanes show oxidative stress and are formed by free-radical mediated lipid peroxidation of arachidonic acid and cell membrane phospholipids. Purpose This study was conducted to evaluate the plasma level of 8-isoprostane in patients suffering from erosive and non-erosive forms of OLP. Materials and Method In this case-control study, 31 patients with OLP and 30 control subjects were enrolled. Plasma samples were obtained and the level of 8-isoprostane was measured with Sandwich enzyme-linked immunosorbent assay (ELISA) in both groups. The data were analyzed by using two-sample t-test, chi-square and ANOVA tests. Results The results showed significant increase in the plasma level of 8-isoprostane in OLP group compared with the control group. The results of independent t-test revealed no significant correlation between the plasma level of isoprostane and sex, smoking, or previous treatment. Conclusion Based on the findings of this study, oxidative stress was increased in patients with OLP, reflected by higher concentrations of 8-isoprostane in plasma. PMID:26966704

  18. The evaluation of haemodynamics in cirrhotic patients with spectral CT

    PubMed Central

    Zhao, L-q; Yan, B; Wang, H-y; Wang, J

    2013-01-01

    Objective: To evaluate haemodynamics in cirrhotic patients with portal hypertension using spectral CT imaging. Methods: 118 cirrhotic patients with portal hypertension were included in the study group (further divided into Child–Pugh A, B and C subgroups). The control group consisted of 21 subjects with normal liver functionality. All subjects underwent three-phase spectral CT scans. Material decomposition images with water and iodine as basis material pairs were reconstructed. The iodine concentrations for the hepatic parenchyma in both arterial and portal venous phases were measured. The arterial iodine fraction (AIF) was obtained by dividing the iodine concentration in the hepatic arterial phase by that in the portal venous phase. AIF values from the study and control groups were compared using analysis of variance and between subgroups using a post-hoc test with Bonferroni correction, with a statistical significance of p<0.05. Results: The AIF was 0.25±0.05 in the control group, and 0.29±0.10, 0.37±0.12 and 0.43±0.14 in the study group with Child–Pugh Grades A, B and C, respectively. The difference in AIF between the control and study groups was statistically significant. The differences were statistically significant between the subgroups with multiple comparisons except between the control group and the Child–Pugh A group (p=0.685). Conclusion: AIF measured in spectral CT could be used to evaluate the liver haemodynamics of cirrhotic patients. Advances in knowledge: The AIF, provided by spectral CT, could be used as a new parameter to observe liver haemodynamics. PMID:23881800

  19. Evaluation of Long-Term Cloud-Resolving Model Simulations Using Satellite Radiance Observations and Multi-Frequency Satellite Simulators

    NASA Technical Reports Server (NTRS)

    Matsui, Toshihisa; Zeng, Xiping; Tao, Wei-Kuo; Masunaga, Hirohiko; Olson, William S.; Lang, Stephen

    2008-01-01

    This paper proposes a methodology known as the Tropical Rainfall Measuring Mission (TRMM) Triple-Sensor Three-step Evaluation Framework (T3EF) for the systematic evaluation of precipitating cloud types and microphysics in a cloud-resolving model (CRM). T3EF utilizes multi-frequency satellite simulators and novel statistics of multi-frequency radiance and backscattering signals observed from the TRMM satellite. Specifically, T3EF compares CRM and satellite observations in the form of combined probability distributions of precipitation radar (PR) reflectivity, polarization-corrected microwave brightness temperature (Tb), and infrared Tb to evaluate the candidate CRM. T3EF is used to evaluate the Goddard Cumulus Ensemble (GCE) model for cases involving the South China Sea Monsoon Experiment (SCSMEX) and Kwajalein Experiment (KWAJEX). This evaluation reveals that the GCE properly captures the satellite-measured frequencies of different precipitating cloud types in the SCSMEX case but underestimates the frequencies of deep convective and deep stratiform types in the KWAJEX case. Moreover, the GCE tends to simulate excessively large and abundant frozen condensates in deep convective clouds as inferred from the overestimated GCE-simulated radar reflectivities and microwave Tb depressions. Unveiling the detailed errors in the GCE s performance provides the best direction for model improvements.

  20. Communication and patient safety in simulation for mental health nursing education.

    PubMed

    Fay-Hillier, Theresa M; Regan, Roseann V; Gallagher Gordon, Mary

    2012-11-01

    The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that 65% of medical sentinel events or medical errors are associated with communication breakdowns. In addition to the JCAHO, The Institute of Medicine, in their Core Competencies for health care professional education, recommend improvement in professional communication, collaboration, and a patient-centered approach to provide safety. Consistency of opportunities for students to practice their communication and collaboration skills is limited based on the variety of clinical experiences that are available. Simulation would provide consistency in students' experiences. Students can practice giving a structured report, providing and receiving peer feedback, and obtaining patient feedback in a safe setting through a simulation experience. A structured hand-off shift report using a technique such as SBAR communication has been found to improve patient safety in health care environments. This paper examines the implementation of a simulation experience for students taking a Mental Health course in a Bachelor of Science in Nursing (BSN) Program to support their practice of patient and professional communication, as well as, collaboration skills with a patient-centered approach using a standardized patient simulation. PMID:23146005

  1. A mathematical model approach quantifying patients' response to changes in mechanical ventilation: evaluation in volume support.

    PubMed

    Larraza, S; Dey, N; Karbing, D S; Jensen, J B; Nygaard, M; Winding, R; Rees, S E

    2015-04-01

    This paper presents a mathematical model-approach to describe and quantify patient-response to changes in ventilator support. The approach accounts for changes in metabolism (V̇O2, V̇CO2) and serial dead space (VD), and integrates six physiological models of: pulmonary gas-exchange; acid-base chemistry of blood, and cerebrospinal fluid; chemoreflex respiratory-drive; ventilation; and degree of patients' respiratory muscle-response. The approach was evaluated with data from 12 patients on volume support ventilation mode. The models were tuned to baseline measurements of respiratory gases, ventilation, arterial acid-base status, and metabolism. Clinical measurements and model simulated values were compared at five ventilator support levels. The models were shown to adequately describe data in all patients (χ(2), p > 0.2) accounting for changes in V̇CO2, VD and inadequate respiratory muscle-response. F-ratio tests showed that this approach provides a significantly better (p < 0.001) description of measured data than: (a) a similar model omitting the degree of respiratory muscle-response; and (b) a model of constant alveolar ventilation. The approach may help predict patients' response to changes in ventilator support at the bedside. PMID:25686673

  2. In-vitro evaluation of physiological controller response of rotary blood pumps to changes in patient state.

    PubMed

    Pauls, Jo P; Gregory, Shaun D; Stevens, Michael; Tansley, Geoff

    2014-01-01

    Rotary blood pumps (RBPs) have a low sensitivity to preload changes when run at constant speed, which can lead to harmful ventricular suction events. Therefore a control mechanism is needed to adjust RBP speed in response to patient demand, but an appropriate response time for physiological control strategies to these changes in patient demand has not been determined. This paper aims to evaluate the response of a simulated healthy heart with those of different RBP control techniques during exercise simulations and a Valsalva manoeuver. A mock circulation loop was used to simulate the response of a healthy heart to these changes in patient state. The generated data was compared with a simulated RBP (VentrAssist) supported left heart failure condition. A range of control techniques including constant speed, proportional integral (PI) (active control) and a compliant inflow cannula (passive control) were used to achieve restored haemodynamics and evaluate controller response time. Controllers that responded faster (active control) or slower (active control and constant speed mode) than the native heart's response led to ventricular suction. Active control systems can respond both faster or slower than the heart depending on the controller gains. A control system that responded similar to the native heart was able to prevent ventricular suction. This study concluded that a physiological control system should mimic the response of the native heart to changes in patient state in order to prevent ventricular suction. PMID:25569955

  3. Signaling pathway models as biomarkers: Patient-specific simulations of JNK activity predict the survival of neuroblastoma patients.

    PubMed

    Fey, Dirk; Halasz, Melinda; Dreidax, Daniel; Kennedy, Sean P; Hastings, Jordan F; Rauch, Nora; Munoz, Amaya Garcia; Pilkington, Ruth; Fischer, Matthias; Westermann, Frank; Kolch, Walter; Kholodenko, Boris N; Croucher, David R

    2015-12-22

    Signaling pathways control cell fate decisions that ultimately determine the behavior of cancer cells. Therefore, the dynamics of pathway activity may contain prognostically relevant information different from that contained in the static nature of other types of biomarkers. To investigate this hypothesis, we characterized the network that regulated stress signaling by the c-Jun N-terminal kinase (JNK) pathway in neuroblastoma cells. We generated an experimentally calibrated and validated computational model of this network and used the model to extract prognostic information from neuroblastoma patient-specific simulations of JNK activation. Switch-like JNK activation mediates cell death by apoptosis. An inability to initiate switch-like JNK activation in the simulations was significantly associated with poor overall survival for patients with neuroblastoma with or without MYCN amplification, indicating that patient-specific simulations of JNK activation could stratify patients. Furthermore, our analysis demonstrated that extracting information about a signaling pathway to develop a prognostically useful model requires understanding of not only components and disease-associated changes in the abundance or activity of the components but also how those changes affect pathway dynamics. PMID:26696630

  4. Effectiveness of a Web-Based Simulation in Improving Nurses’ Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

    PubMed Central

    Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim

    2016-01-01

    Background Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting. Objective The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. Methods A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. Results The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The

  5. Comparison of simulator fidelity model predictions with in-simulator evaluation data

    NASA Technical Reports Server (NTRS)

    Parrish, R. V.; Mckissick, B. T.; Ashworth, B. R.

    1983-01-01

    A full factorial in simulator experiment of a single axis, multiloop, compensatory pitch tracking task is described. The experiment was conducted to provide data to validate extensions to an analytic, closed loop model of a real time digital simulation facility. The results of the experiment encompassing various simulation fidelity factors, such as visual delay, digital integration algorithms, computer iteration rates, control loading bandwidths and proprioceptive cues, and g-seat kinesthetic cues, are compared with predictions obtained from the analytic model incorporating an optimal control model of the human pilot. The in-simulator results demonstrate more sensitivity to the g-seat and to the control loader conditions than were predicted by the model. However, the model predictions are generally upheld, although the predicted magnitudes of the states and of the error terms are sometimes off considerably. Of particular concern is the large sensitivity difference for one control loader condition, as well as the model/in-simulator mismatch in the magnitude of the plant states when the other states match.

  6. Nuclear power plant human computer interface design incorporating console simulation, operations personnel, and formal evaluation techniques

    SciTech Connect

    Chavez, C.; Edwards, R.M.; Goldberg, J.H.

    1993-12-31

    New CRT-based information displays which enhance the human machine interface are playing a very important role and are being increasingly used in control rooms since they present a higher degree of flexibility compared to conventional hardwired instrumentation. To prototype a new console configuration and information display system at the Experimental Breeder Reactor II (EBR-II), an iterative process of console simulation and evaluation involving operations personnel is being pursued. Entire panels including selector switches and information displays are simulated and driven by plant dynamical simulations with realistic responses that reproduce the actual cognitive and physical environment. Careful analysis and formal evaluation of operator interaction while using the simulated console will be conducted to determine underlying principles for effective control console design for this particular group of operation personnel. Additional iterations of design, simulation, and evaluation will then be conducted as necessary.

  7. Monte Carlo fluence simulation for prospective evaluation of interstitial photodynamic therapy treatment plans

    NASA Astrophysics Data System (ADS)

    Cassidy, Jeffrey; Betz, Vaughn; Lilge, Lothar

    2015-03-01

    Photodynamic therapy (PDT) delivers a localized cytotoxic dose that is a function of tissue oxygen availability, photosensitive drug concentration, and light fluence. Providing safe and effective PDT requires an understanding of all three elements and the physiological response to the radicals generated. Interstitial PDT (IPDT) for solid tumours poses particular challenges due to complex organ geometries and the associated limitations for diffusion theory based fluence rate prediction, in addition to restricted access for light delivery and dose monitoring. As a first step towards enabling a complete prospective IPDT treatment-planning platform, we demonstrate use of our previously developed FullMonte tetrahedral Monte Carlo simulation engine for modeling of the interstitial fluence field due to intravesicular insertion of brief light sources. The goal is to enable a complete treatment planning and monitoring work flow analogous to that used in ionizing radiation therapy, including plan evaluation through dose-volume histograms and algorithmic treatment plan optimization. FullMonte is to our knowledge the fastest open-source tetrahedral MC light propagation software. Using custom hardware acceleration, we achieve 4x faster computing with 67x better power efficiency for limited-size meshes compared to the software. Ongoing work will improve the performance advantage to 16x with unlimited mesh size, enabling algorithmic plan optimization in reasonable time. Using FullMonte, we demonstrate significant new plan-evaluation capabilities including fluence field visualization, generation of organ dose-volume histograms, and rendering of isofluence surfaces for a representative bladder cancer mesh from a real patient. We also discuss the advantages of MC simulations for dose-volume histogram generation and the need for online personalized fluence-rate monitoring.

  8. Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

    PubMed Central

    Paro, J. A. M.; Rodriguez, R. M.; Reddy, S. T.; Horwitz, L. I.; Johnson, J. K.; Arora, V. M.

    2009-01-01

    Aim The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students’ sign-out skills using a real-time assessment tool, the Hand-off CEX. Setting Thirty-two 4th year medical students participated as part of an elective course. Program description One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video. Program evaluation Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the “Mini-CEX,” which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre- and post-student self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4–9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post- vs. 27% pre-reporting ‘well-prepared,’ p < 0.009). Discussion This brief, standardized hand-off training exercise improved students’ confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument. Electronic supplementary material The online version of this article (doi:10.1007/s11606-009-1170-y) contains supplementary material, which is available to authorized users. PMID:19924489

  9. Multicriteria evaluation of discharge simulation in Dynamic Global Vegetation Models

    NASA Astrophysics Data System (ADS)

    Yang, Hui; Piao, Shilong; Zeng, Zhenzhong; Ciais, Philippe; Yin, Yi; Friedlingstein, Pierre; Sitch, Stephen; Ahlström, Anders; Guimberteau, Matthieu; Huntingford, Chris; Levis, Sam; Levy, Peter E.; Huang, Mengtian; Li, Yue; Li, Xiran; Lomas, Mark R.; Peylin, Philippe; Poulter, Ben; Viovy, Nicolas; Zaehle, Soenke; Zeng, Ning; Zhao, Fang; Wang, Lei

    2015-08-01

    In this study, we assessed the performance of discharge simulations by coupling the runoff from seven Dynamic Global Vegetation Models (DGVMs; LPJ, ORCHIDEE, Sheffield-DGVM, TRIFFID, LPJ-GUESS, CLM4CN, and OCN) to one river routing model for 16 large river basins. The results show that the seasonal cycle of river discharge is generally modeled well in the low and middle latitudes but not in the high latitudes, where the peak discharge (due to snow and ice melting) is underestimated. For the annual mean discharge, the DGVMs chained with the routing model show an underestimation. Furthermore, the 30 year trend of discharge is also underestimated. For the interannual variability of discharge, a skill score based on overlapping of probability density functions (PDFs) suggests that most models correctly reproduce the observed variability (correlation coefficient higher than 0.5; i.e., models account for 50% of observed interannual variability) except for the Lena, Yenisei, Yukon, and the Congo river basins. In addition, we compared the simulated runoff from different simulations where models were forced with either fixed or varying land use. This suggests that both seasonal and annual mean runoff has been little affected by land use change but that the trend itself of runoff is sensitive to land use change. None of the models when considered individually show significantly better performances than any other and in all basins. This suggests that based on current modeling capability, a regional-weighted average of multimodel ensemble projections might be appropriate to reduce the bias in future projection of global river discharge.

  10. Using a Radiofrequency Identification System for Improving the Patient Discharge Process: A Simulation Study.

    PubMed

    Shim, Sung J; Kumar, Arun; Jiao, Roger

    2016-01-01

    A hospital is considering deploying a radiofrequency identification (RFID) system and setting up a new "discharge lounge" to improve the patient discharge process. This study uses computer simulation to model and compare the current process and the new process, and it assesses the impact of the RFID system and the discharge lounge on the process in terms of resource utilization and time taken in the process. The simulation results regarding resource utilization suggest that the RFID system can slightly relieve the burden on all resources, whereas the RFID system and the discharge lounge together can significantly mitigate the nurses' tasks. The simulation results in terms of the time taken demonstrate that the RFID system can shorten patient wait times, staff busy times, and bed occupation times. The results of the study could prove helpful to others who are considering the use of an RFID system in the patient discharge process in hospitals or similar processes. PMID:27443064

  11. Psychometric Evaluation of the Fear of Positive Evaluation Scale in Patients With Social Anxiety Disorder

    PubMed Central

    Weeks, Justin W.; Heimberg, Richard G.; Rodebaugh, Thomas L.; Goldin, Philippe R.; Gross, James J.

    2014-01-01

    The Fear of Positive Evaluation Scale (FPES; Weeks, Heimberg, & Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only one previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (Fergus et al., 2009). The primary purpose of the present study was to conduct a large multi-site examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype: 97.8%). Responses of non-anxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples. PMID:21966932

  12. Evaluation of temperature profiles in packed beds by simulation

    SciTech Connect

    Serrano, M.T.C.; Hernandez Suarez, R.

    1996-12-31

    The packed bed reactors with cocurrent upflow or downflow of gas and liquid are widely used in chemical and petrochemical industries for solid-catalysed heterogeneous reactions. It`s well known that a preferential-flow exists, thus the estimation of heat transfer parameters such as thermal conductivity of the bed and wall transfer resistance are important in order to predict the temperature profiles inside the reactor. This paper let us simulate the influence of these preferential zones of flow on the heat transfer parameters on this type of reactor. 6 refs., 1 fig., 2 tabs.

  13. Simulation and evaluation of latent heat thermal energy storage

    NASA Technical Reports Server (NTRS)

    Sigmon, T. W.

    1980-01-01

    The relative value of thermal energy storage (TES) for heat pump storage (heating and cooling) as a function of storage temperature, mode of storage (hotside or coldside), geographic locations, and utility time of use rate structures were derived. Computer models used to simulate the performance of a number of TES/heat pump configurations are described. The models are based on existing performance data of heat pump components, available building thermal load computational procedures, and generalized TES subsystem design. Life cycle costs computed for each site, configuration, and rate structure are discussed.

  14. Validation of Ultrafilter Performance Model Based on Systematic Simulant Evaluation

    SciTech Connect

    Russell, Renee L.; Billing, Justin M.; Smith, Harry D.; Peterson, Reid A.

    2009-11-18

    Because of limited availability of test data with actual Hanford tank waste samples, a method was developed to estimate expected filtration performance based on physical characterization data for the Hanford Tank Waste Treatment and Immobilization Plant. A test with simulated waste was analyzed to demonstrate that filtration of this class of waste is consistent with a concentration polarization model. Subsequently, filtration data from actual waste samples were analyzed to demonstrate that centrifuged solids concentrations provide a reasonable estimate of the limiting concentration for filtration.

  15. A Numerical Simulation Approach for Reliability Evaluation of CFRP Composite

    NASA Astrophysics Data System (ADS)

    Liu, D. S.-C.; Jenab, K.

    2013-02-01

    Due to the superior mechanical properties of carbon fiber reinforced plastic (CFRP) materials, they are vastly used in industries such as aircraft manufacturers. The aircraft manufacturers are switching metal to composite structures while studying reliability (R-value) of CFRP. In this study, a numerical simulation method to determine the reliability of Multiaxial Warp Knitted (MWK) textiles used to make CFRP composites is proposed. This method analyzes the distribution of carbon fiber angle misalignments, from a chosen 0° direction, caused by the sewing process of the textile, and finds the R-value, a value between 0 and 1. The application of this method is demonstrated by an illustrative example.

  16. A three-axis flight simulator. [for testing and evaluating inertial measuring units, and flight platforms

    NASA Technical Reports Server (NTRS)

    Mason, M. G.

    1975-01-01

    A simulator is described, which was designed for testing and evaluating inertial measuring units, and flight platforms. Mechanical and electrical specifications for the outer, middle, and inner axis are presented. Test results are included.

  17. Social simulation theory: a framework to explain nurses' understanding of patients' experiences of ill-health.

    PubMed

    Nordby, Halvor

    2016-09-01

    A fundamental aim in caring practice is to understand patients' experiences of ill-health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that we do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness. PMID:27198752

  18. Efficient evaluation of collisional energy transfer terms for plasma particle simulations

    NASA Astrophysics Data System (ADS)

    Turrell, A. E.; Sherlock, M.; Rose, S. J.

    2016-01-01

    Particle-based simulations, such as in particle-in-cell (PIC) codes, are widely used in plasma physics research. The analysis of particle energy transfers, as described by the second moment of the Boltzmann equation, is often necessary within these simulations. We present computationally efficient, analytically derived equations for evaluating collisional energy transfer terms from simulations using discrete particles. The equations are expressed as a sum over the properties of the discrete particles.

  19. Using Microanalytical Simulation Methods in Educational Evaluation: An Exploratory Study

    ERIC Educational Resources Information Center

    Sondergeld, Toni A.; Beltyukova, Svetlana A.; Fox, Christine M.; Stone, Gregory E.

    2012-01-01

    Scientifically based research used to inform evidence based school reform efforts has been required by the federal government in order to receive grant funding since the reenactment of No Child Left Behind (2002). Educational evaluators are thus faced with the challenge to use rigorous research designs to establish causal relationships. However,…

  20. Evaluation of virtual cockpit concepts during simulated missions

    NASA Astrophysics Data System (ADS)

    Kaye, Martin G.; Ineson, Judith; Jarrett, Donald N.; Wickham, G.

    1990-10-01

    This paper describes the Virtual Environment Integration Laboratory (VEIL) of the Royal Aerospace Establishment (RAE). The VEIL programme is intended to provoke appropriate technological developments by exploring the human requirements of operating within a virtual cockpit whilst conducting demanding missions. Under construction is a light-weight binocular, colour helmet-mounted display with a wide field of view, driven by a versatile parallelarchitecture computer graphic system which accommodates simulated sensor images from a camera and terrain model. Prototypes of suitable display formats will be developed using a bench-mounted stereoscopic viewing rig which will also facilitate investigation of critical psychophysical issues. The complete VEIL hardware will integrate eye and head position sensors, three dimensional sound, direct voice input, and tactile sensors with the binocular display system. When allied to the ground-attack, helicopter and air-combat simulator facilities of Mission Management Department, it will enable the practicality of operating virtual cockpit systems in a wide variety of missions and tasks to be addressed.

  1. Evaluation of rodded BWR assembly pin powers with simulate

    SciTech Connect

    Bahadir, T.; Lindahl, S. Oe.

    2012-07-01

    In the development of Studsvik's nodal code SIMULATE5, special attention has been given to the accurate description of pin powers. The code solves the multi-group diffusion or simplified P3 equations with high spatial resolution. A short description is given of the handling of material heterogeneities in the axial and radial directions - the axial re-homogenization and the radial sub-mesh model, respectively. Furthermore, two models which are of special importance in the presence of control rods, and hence on the pellet clad interaction (PCI) phenomenon, are described; the quarter-assembly thermal-hydraulic treatment and the depletion of absorber material. A numerical example for a real core shows that while the impact of the fine grained description is negligible on global parameters such as k{sub eff}, the effect on pin powers may be substantial. For a deeply inserted and highly depleted control rod, the difference in pin powers caused by neglecting the advanced models of SIMULATE5, may be as high as 15 %. (authors)

  2. Cognitively automated assembly processes: a simulation based evaluation of performance.

    PubMed

    Mayer, Marcel Ph; Odenthal, Barbara; Faber, Marco; Schlick, Christopher M

    2012-01-01

    The numerical control of an experimental assembly cell with two robots--termed a cognitive control unit (CCU)--is able to simulate human information processing at a rule-based level of cognitive control. To enable the CCU to work on a large range of assembly tasks expected of a human operator, the cognitive architecture SOAR is used. The CCU can plan assembly processes autonomously and react to ad-hoc changes in assembly sequences effectively. Extensive simulation studies have shown that cognitive automation based on SOAR is especially suitable for random parts supply, which reduces planning effort in logistics. Conversely, a disproportional increase in processing time was observed for deterministic parts supply, especially for assemblies containing large numbers of identical parts. In this contribution, the effect of phase-shifts in deterministic part supply is investigated for assemblies containing maximal different parts. It can be shown that the concept of cognitive automation is as well suitable for these planning problems. PMID:22317246

  3. Evaluation of Arctic Sea Ice Thickness Simulated by AOMIP Models

    NASA Technical Reports Server (NTRS)

    Johnson, Mark; Proshutinsky, Andrey; Aksenov, Yevgeny; Nguyen, An T.; Lindsay, Ron; Haas, Christian; Zhang, Jinlun; Diansky, Nimolay; Kwok, Ron; Maslowski, Wieslaw; Hakkinen, Sirpa; Ashik, Igor; de Cuevas, Beverly

    2011-01-01

    We compare results from six AOMIP model simulations with estimates of sea ice thickness obtained from ICESat, moored and submarine-based upward looking sensors, airborne electromagnetic measurements and drill holes. Our goal is to find patterns of model performance to guide model improvement. The satellite data is pan-arctic from 2004-2008, ice-draft data is from moored instruments in Fram Strait, the Greenland Sea and the Beaufort Sea from 1992-2008 and from submarines from 1975-2000. The drill hole data are from the Laptev and East Siberian marginal seas from 1982-1986 and from coastal stations from 1998-2009. While there are important caveats when comparing modeled results with measurements from different platforms and time periods such as these, the models agree well with moored ULS data. In general, the AOMIP models underestimate the thickness of measured ice thicker than about 2 m and overestimate thickness of ice thinner than 2 m. The simulated results are poor over the fast ice and marginal seas of the Siberian shelves. Averaging over all observational data sets, the better correlations and smaller differences from observed thickness are from the ECCO2 and UW models.

  4. Evaluation method of motorcycle fatigue strength using road simulator

    SciTech Connect

    Harashima, Shokichi

    1995-12-31

    Studies using a road simulator in an endurance testing have been developed in the field of automobiles and widely utilized in recent years. In the endurance testing of motorcycles, on the other hand, the mainstream technique has been to repeat riding over cams on rotating drums. As it is impossible for this technique to accurately reproduce the loads encountered during driving on a rough road, it had to be made up in other tests so that improvement has been desired in both accuracy and efficiency. A study was done on a technique to accelerate endurance testing while retaining correlation with loading caused by the irregularities of public road surfaces. The technique has enabled us to realize bench endurance testing having a high degree of correlation with the loading of riding public roads by the use of a road simulator for motorcycles, which activates a front axle in two directions, longitudinal and vertical. The technique can be applied to all on-road motorcycles, thereby enhancing development efficiency.

  5. How Can Exploratory Learning with Games and Simulations within the Curriculum Be Most Effectively Evaluated?

    ERIC Educational Resources Information Center

    de Freitas, Sara; Oliver, Martin

    2006-01-01

    There have been few attempts to introduce frameworks that can help support tutors evaluate educational games and simulations that can be most effective in their particular learning context and subject area. The lack of a dedicated framework has produced a significant impediment for the uptake of games and simulations particularly in formal…

  6. An Evaluation of Student Perceptions of Screen Presentations in Computer-based Laboratory Simulations.

    ERIC Educational Resources Information Center

    Edward, Norrie S.

    1997-01-01

    Evaluates the importance of realism in the screen presentation of the plant in computer-based laboratory simulations for part-time engineering students. Concludes that simulations are less effective than actual laboratories but that realism minimizes the disadvantages. The schematic approach was preferred for ease of use. (AIM)

  7. Study of physiological responses to acute carbon monoxide exposure with a human patient simulator.

    PubMed

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

    2006-12-01

    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, conduct, and present (orally and in written form) their project testing physiological adaptation to an extreme environment. This article is a student report on the physiological response to acute carbon monoxide exposure in a simulated healthy adult male and a coal miner and represents how 1) human patient simulators can be used in a nonclinical way for experiential hypothesis testing; 2) students can transition from traditional textbook learning to practical application of their knowledge; and 3) student-initiated group investigation drives critical thought. While the course instructors remain available for consultation throughout the project, the relatively unstructured framework of the assignment drives the students to create an experiment independently, troubleshoot problems, and interpret the results. The only stipulation of the project is that the students must generate an experiment that is physiologically realistic and that requires them to search out and incorporate appropriate data from primary scientific literature. In this context, the human patient simulator is a viable educational tool for teaching integrative physiology in a laboratory environment by bridging textual information with experiential investigation. PMID:17108253

  8. Use of the human patient simulator to teach clinical judgment skills in a baccalaureate nursing program.

    PubMed

    Rhodes, Mattie L; Curran, Cynthia

    2005-01-01

    Nurse educators are finding it increasingly more challenging to prepare undergraduate students for the ever-changing and more acute clinical environment. As an answer to this dilemma, the human patient simulator can provide students with the opportunity to enhance knowledge, to facilitate skill acquisition, to decrease anxiety, and to promote clinical judgment in a safe environment. These experiences assist the novice nursing student to progress to the advanced beginner stage of practice. This article describes how faculty used the human patient simulator in creating a case scenario that enhanced critical thinking in senior nursing students. PMID:16166827

  9. Developing patient-centered care competencies among prelicensure nursing students using simulation.

    PubMed

    McKeon, Leslie M; Norris, Tommie; Cardell, Brittany; Britt, Teresa

    2009-12-01

    Health care improvement requires collaboration between academia and practice to bridge gaps in nurse education and achievement of quality outcomes. Quality and Safety Education for Nurses identified six domains, including patient-centered care, that should be addressed during prelicensure education. Simulation is a recommended strategy to teach safe clinical practice; however, cost, space, and faculty resources are barriers to its use. Computer-based social simulation is less resource intensive and effective in improving critical-thinking skills. A pilot study was conducted to compare required resources and student learning outcomes for traditional versus computer-based simulation. Fifty-three baccalaureate nursing students participated in the study; 34 completed the computer-based simulation and 31 completed the traditional simulation. Group patient-centered care competency scores improved similarly (p < 0.001), although fewer faculty hours were required to administer the computer-based intervention. Findings suggest computer-based simulation is an efficient and effective learning strategy to develop patient-centered care competencies. PMID:20000255

  10. Obstacle Avoidance, Visual Detection Performance, and Eye-Scanning Behavior of Glaucoma Patients in a Driving Simulator: A Preliminary Study

    PubMed Central

    Prado Vega, Rocío; van Leeuwen, Peter M.; Rendón Vélez, Elizabeth; Lemij, Hans G.; de Winter, Joost C. F.

    2013-01-01

    The objective of this study was to evaluate differences in driving performance, visual detection performance, and eye-scanning behavior between glaucoma patients and control participants without glaucoma. Glaucoma patients (n = 23) and control participants (n = 12) completed four 5-min driving sessions in a simulator. The participants were instructed to maintain the car in the right lane of a two-lane highway while their speed was automatically maintained at 100 km/h. Additional tasks per session were: Session 1: none, Session 2: verbalization of projected letters, Session 3: avoidance of static obstacles, and Session 4: combined letter verbalization and avoidance of static obstacles. Eye-scanning behavior was recorded with an eye-tracker. Results showed no statistically significant differences between patients and control participants for lane keeping, obstacle avoidance, and eye-scanning behavior. Steering activity, number of missed letters, and letter reaction time were significantly higher for glaucoma patients than for control participants. In conclusion, glaucoma patients were able to avoid objects and maintain a nominal lane keeping performance, but applied more steering input than control participants, and were more likely than control participants to miss peripherally projected stimuli. The eye-tracking results suggest that glaucoma patients did not use extra visual search to compensate for their visual field loss. Limitations of the study, such as small sample size, are discussed. PMID:24146975

  11. A real time Pegasus propulsion system model for VSTOL piloted simulation evaluation

    NASA Technical Reports Server (NTRS)

    Mihaloew, J. R.; Roth, S. P.; Creekmore, R.

    1981-01-01

    A real time propulsion system modeling technique suitable for use in man-in-the-loop simulator studies was developd. This technique provides the system accuracy, stability, and transient response required for integrated aircraft and propulsion control system studies. A Pegasus-Harrier propulsion system was selected as a baseline for developing mathematical modeling and simulation techniques for VSTOL. Initially, static and dynamic propulsion system characteristics were modeled in detail to form a nonlinear aerothermodynamic digital computer simulation of a Pegasus engine. From this high fidelity simulation, a real time propulsion model was formulated by applying a piece-wise linear state variable methodology. A hydromechanical and water injection control system was also simulated. The real time dynamic model includes the detail and flexibility required for the evaluation of critical control parameters and propulsion component limits over a limited flight envelope. The model was programmed for interfacing with a Harrier aircraft simulation. Typical propulsion system simulation results are presented.

  12. Incorporating Standardized Colleague Simulations in a Clinical Assessment Course and Evaluating the Impact on Interprofessional Communication

    PubMed Central

    Dunn, Brianne; Blake, Elizabeth; Phillips, Cynthia

    2015-01-01

    Objective. To determine the impact of incorporating standardized colleague simulations on pharmacy students’ confidence and interprofessional communication skills. Design. Four simulations using standardized colleagues portraying attending physicians in inpatient and outpatient settings were integrated into a required course. Pharmacy students interacted with the standardized colleagues using the Situation, Background, Assessment, Request/Recommendation (SBAR) communication technique and were evaluated on providing recommendations while on simulated inpatient rounds and in an outpatient clinic. Additionally, changes in student attitudes and confidence toward interprofessional communication were assessed with a survey before and after the standardized colleague simulations. Assessment. One hundred seventy-one pharmacy students participated in the simulations. Student interprofessional communication skills improved after each simulation. Student confidence with interprofessional communication in both inpatient and outpatient settings significantly improved. Conclusion. Incorporation of simulations using standardized colleagues improves interprofessional communication skills and self-confidence of pharmacy students. PMID:26089566

  13. Rapid Evaluation of Particle Properties using Inverse SEM Simulations

    SciTech Connect

    Bekar, Kursat B.; Miller, Thomas Martin; Patton, Bruce W.; Weber, Charles F.

    2016-01-01

    This report is the final deliverable of a 3 year project whose purpose was to investigate the possibility of using simulations of X-ray spectra generated inside a scanning electron microscope (SEM) as a means to perform quantitative analysis of the sample imaged in the SEM via an inverse analysis methodology. Using the nine point Technology Readiness Levels (TRL) typically used by the US Department of Defense (DOD) and the National Aeronautics and Space Administration (NASA), this concept is now at a TRL of 3. In other words, this work has proven the feasibility of this concept and is ready to be further investigated to address some of the issues highlighted by this initial proof of concept.

  14. A simulator evaluation of an automatic terminal approach system

    NASA Technical Reports Server (NTRS)

    Hinton, D. A.

    1983-01-01

    The automatic terminal approach system (ATAS) is a concept for improving the pilot/machine interface with cockpit automation. The ATAS can automatically fly a published instrument approach by using stored instrument approach data to automatically tune airplane avionics, control the airplane's autopilot, and display status information to the pilot. A piloted simulation study was conducted to determine the feasibility of an ATAS, determine pilot acceptance, and examine pilot/ATAS interaction. Seven instrument-rated pilots each flew four instrument approaches with a base-line heading select autopilot mode. The ATAS runs resulted in lower flight technical error, lower pilot workload, and fewer blunders than with the baseline autopilot. The ATAS status display enabled the pilots to maintain situational awareness during the automatic approaches. The system was well accepted by the pilots.

  15. Evaluation of clinical IMRT treatment planning using the GATE Monte Carlo simulation platform for absolute and relative dose calculations

    SciTech Connect

    Benhalouche, S.; Le Maitre, A.; Visvikis, D.; Pradier, O.; Boussion, N.

    2013-02-15

    Purpose: The objective of this study was to evaluate and validate the use of the Geant4 application for emission tomography (GATE) Monte Carlo simulation platform for clinical intensity modulated radiotherapy (IMRT) dosimetry studies. Methods: The first step consisted of modeling a 6 MV photon beam linear accelerator (LINAC), with its corresponding validation carried out using percent depth dose evaluation, transverse profiles, tissue phantom ratio, and output factor on water phantom. The IMRT evaluation was performed by comparing simulation and measurements in terms of absolute and relative doses using IMRT dedicated quality assurance phantoms considering seven different patient datasets. Results: Concerning the LINAC simulated model validation tissue phantom ratios at 20 and 10 cm in water TPR{sub 10}{sup 20} obtained from GATE and measurements were 0.672 {+-} 0.063 and 0.675, respectively. In terms of percent depth dose and transverse profiles, error ranges were, respectively: 1.472%{+-} 0.285% and 4.827%{+-} 1.323% for field size of 4 Multiplication-Sign 4, 5 Multiplication-Sign 5, 10 Multiplication-Sign 10, 15 Multiplication-Sign 15, 20 Multiplication-Sign 20, 25 Multiplication-Sign 25, 30 Multiplication-Sign 30, and 40 Multiplication-Sign 40 cm{sup 2}. Most errors were observed at the edge of radiation fields because of higher dose gradient in these areas. Output factors showed good agreement between simulation and measurements with a maximum error of 1.22%. Finally, for IMRT simulations considering seven patient datasets, GATE provided good results with a relative error of 0.43%{+-} 0.25% on absolute dose between simulated and measured beams (measurements at the isocenter, volume 0.125 cm{sup 3}). Planar dose comparisons were also performed using gamma-index analysis. For the whole set of beams considered the mean gamma-index value was 0.497 {+-} 0.152 and 90.8%{+-} 3.6% of the evaluated dose points satisfied the 5%/ 4 mm criterion. Conclusions: These

  16. Considerations in the Radiologic Evaluation of the Pregnant Orthopaedic Patient.

    PubMed

    Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K

    2015-08-01

    Radiographic imaging of the pregnant patient represents a diagnostic and management dilemma for the orthopaedic surgeon. Imaging is often necessary in the setting of trauma; however, in utero radiation exposure can result in deleterious developmental effects in the embryo and fetus. The likelihood of a negative effect is proportional to the radiation dose and the gestational age of the embryo or fetus at the time of exposure. Ionizing radiation doses >100 mGy in the first trimester of pregnancy may lead to spontaneous abortion, malformation, and mental retardation. Whereas plain radiographs of the extremities and cervical spine expose the fetus to minimal doses of radiation of <10 mGy, other commonly performed orthopaedic diagnostic studies, such as CT of the pelvis, emit significantly higher exposure doses of approximately 35 mGy. Non-emitting modalities, such as ultrasonography and MRI, are alternatives for evaluation in the clinical setting. PMID:26116850

  17. Axillary lymph nodes in breast cancer patients: sonographic evaluation*

    PubMed Central

    Pinheiro, Denise Joffily Pereira da Costa; Elias, Simone; Nazário, Afonso Celso Pinto

    2014-01-01

    Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes. PMID:25741091

  18. The correct renal function evaluation in patients with thyroid dysfunction.

    PubMed

    Simeoni, Mariadelina; Cerantonio, Annamaria; Pastore, Ida; Liguori, Rossella; Greco, Marta; Foti, Daniela; Gulletta, Elio; Brunetti, Antonio; Fuiano, Giorgio

    2016-05-01

    Thyroid dysfunction induces several renal derangements involving all nephron portions. Furthermore, dysthyroidism is a recognized risk factor associated with the development of chronic kidney disease. Current data, in fact, demonstrate that either subclinical or overt thyroid disease is associated with significant changes in creatinine, estimated glomerular filtration rate, measured glomerular filtration rate and Cystatin C. Herein, we systematically reviewed several relevant studies aiming at the identification of the most sensitive and specific parameter for the correct renal function evaluation in patients with thyroid dysfunction, that are usually treated as outpatients. Our systematic review indicates that estimated glomerular filtration rate, preferably with CKD-EPI equation, appears to be the most reliable and wieldy renal function parameter. Instead, Cystatin C should be better used in the grading of thyroid dysfunction severity. PMID:26511999

  19. Evaluating Patient Motivation and the Use of Online Health Information: Keeping Patients and Families in the Loop

    ERIC Educational Resources Information Center

    Lewis, Carol Ann

    2013-01-01

    Purpose: To evaluate the adult patient's understanding of the emergency department (ED) discharge instructions and motivation to use an online health education website. A survey of the ED staff was incorporated into the study to evaluate the ED staff members' motivation to include patient education on an online health education website prior to…

  20. Mathematical and statistical aids to evaluate data from renal patients.

    PubMed

    Knapp, M S; Smith, A F; Trimble, I M; Pownall, R; Gordon, K

    1983-10-01

    The monitoring of renal patients and the making of many decisions during their management involves consideration of sequences of numerical data. Renal function results after renal transplantation were used as an example of how graphical presentations, simple mathematical transforms, statistical evaluation and adjustments to the data, to take into account other biological and technical sources of error, can all contribute to better understanding. Experience with a statistical technique, the 4-state Kalman filter not often used in the biological sciences, was summarized and its use suggested as a method to quantitate some traditionally subjective decisions about individual patients, for example, the onset of allograft rejection. The method has identified in retrospect and in prospect events after transplantation earlier than did experienced clinicians. Other statistical techniques to set the sensitivity and specificity of monitoring methods, to detect change points and to quantitate rhythmic sequences of clinical data were discussed, with examples, and with increasing access to computers, these can be used more easily by nephrologists, transplant surgeons, and others. PMID:6358637

  1. Evaluation of Nutritional Status of Patients with Depression

    PubMed Central

    Kaner, Gülşah; Soylu, Meltem; Yüksel, Nimet; Inanç, Neriman; Ongan, Dilek; Başmısırlı, Eda

    2015-01-01

    Aims and Objectives. Our goal was to determine nutritional status, body composition, and biochemical parameters of patients diagnosed with depression based on DSM-IV-TR criteria. Methods. A total of 59 individuals, aged 18–60 years admitted to Mental Health Centre of Kayseri Education and Research Hospital, were included in the study. The participants were randomly assigned to two groups; depression group (n = 29) and control group (n = 30). Anthropometric measurements, some biochemical parameters, demographic data, and 24-hour dietary recall were evaluated. Results. 65.5% of depression and 60.0% of control group were female. Intake of vitamins A, thiamine, riboflavin, B6, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and fibre (p < 0.05) were lower in depression group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio (p < 0.05) were significantly higher in depression group. Fasting blood glucose levels, serum vitamins B12, and folic acid (p < 0.05) in depression group were lower than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion. Some vitamin B consumption and serum vitamin B12 and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future research exploring nutritional status of individuals with depression is warranted. PMID:26413529

  2. Evaluating bone quality in patients with chronic kidney disease

    PubMed Central

    Malluche, Hartmut H.; Porter, Daniel S.; Pienkowski, David

    2013-01-01

    Bone of normal quality and quantity can successfully endure physiologically imposed mechanical loads. Chronic kidney disease–mineral and bone disorder (CKD–MBD) adversely affects bone quality through alterations in bone turnover and mineralization, whereas bone quantity is affected through changes in bone volume. Changes in bone quality can be associated with altered bone material, structure, or microdamage, which can result in an elevated rate of fracture in patients with CKD–MBD. Fractures cannot always be explained by reduced bone quantity and, therefore, bone quality should be assessed with a variety of techniques from the macro-organ level to the nanoscale level. In this Review, we demonstrate the importance of evaluating bone from multiple perspectives and hierarchical levels to understand CKD–MBD-related abnormalities in bone quality. Understanding the relationships between variations in material, structure, microdamage, and mechanical properties of bone in patients with CKD–MBD should aid in the development of new modalities to prevent, or treat, these abnormalities. PMID:24100399

  3. Evaluation of a patient with both aquagenic and cholinergic urticaria.

    PubMed

    Davis, R S; Remigio, L K; Schocket, A L; Bock, S A

    1981-12-01

    An 11-yr-old girl presented with a history of urticaria induced by warm or cool showers, exercise, and emotional stimuli. During evaluation she repeatedly developed generalized punctate urticaria, pruritus, palpitations, and headaches after warm baths or exercise, and she had a positive methacholine skin test. She developed similar lesions and pruritus after local application of sterile water, tap water, ethanol, normal saline, or 3% saline. The diagnosis of combined aquagenic and cholinergic urticaria was made and presented a unique opportunity to study and compare mediator release and clinical symptoms in both conditions. The patient was submerged in bath water at either 37 degree or 41 degree C to induce either aquagenic or cholinergic urticaria, respectively. Histamine was released into the systemic circulation in both conditions in a similar time course; however, systemic symptoms occurred only after the 41 degree C bath. After failure to induce tolerance to the 41 degree C bath water, hydroxyzine therapy was instituted. One week later she was rechallenged; few symptoms appeared, and a rise in serum histamine was not detected as had been shown in previous challenges. The data suggest that in our patient, hydroxyzine may have contributed to the inhibition of both histamine release and the appearance of symptoms during hot bath challenging. PMID:7310013

  4. A Clinical Evaluation Denture Adhesives Used by Patients With Xerostomia

    PubMed Central

    Bogucki, Zdzislaw A.; Napadlek, Piotr; Dabrowa, Tomasz

    2015-01-01

    Abstract The purpose of study was to analyze the participants’ opinions concerning the effectiveness of 6 denture adhesives (DA). The study group included 60 participants. Criteria for selecting the patients were as follows: reduced retention and stabilization of maxillary complete dentures and xerostomia. These features were evaluated on basis of clinical examination and standard sialometry tests (u-SFR). Retention of maxillary dentures was scored by modified Kapur index before application of DA. All participants were divided randomly into 6 groups regarding the use of the 6 DA during a 6-month period. After this time, participants completed an HRQL questionnaire. DA noticeably improved retention and stabilization of maxillary complete dentures. DA in the glue form had the best retention effectiveness in participants with xerostomia. These materials are difficult to clean from the denture base. The data are presented in tables and figures. The results of the study collected positive influence of adhesives on retention of dentures in xerostomia patients. The cleaning dentures and denture bearing tissues was difficult. DA help in the use of prostheses, but it is also necessary for the treatment of the causes and symptoms of xerostomia. PMID:25700320

  5. Evaluation and Management of Patients with Isolated Neutropenia

    PubMed Central

    Newburger, Peter E.; Dale, David C.

    2013-01-01

    Neutropenia, defined as an absolute neutrophil count below 1.5 × 109/L, encompasses a wide range of diagnoses, from normal variants to life-threatening acquired and congenital disorders. This review addresses the diagnosis and management of isolated neutropenia, not multiple cytopenias due to splenomegaly, bone marrow replacement, or myelosuppression by chemotherapy or radiation. Laboratory evaluation generally includes repeat complete blood counts with differentials and bone marrow examination with cytogenetics. Neutrophil antibody testing may be useful, but only in the context of clinical and bone marrow findings. The discovery of genes responsible for congenital neutropenias now permits genetic diagnosis in many cases. Management of severe chronic neutropenia includes common-sense precautions to avoid infection; aggressive treatment of bacterial or fungal infections; and administration of granulocyte colony-stimulating factor (G-CSF). Patients with severe congenital neutropenia, particularly those who respond poorly to G-CSF, have a risk of eventually developing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) and require monitoring for this complication, which can also occur without G-CSF therapy. Patients with cyclic, idiopathic and autoimmune neutropenia have virtually no risk of evolving to MDS or AML. Hematopoietic stem cell transplantation is a curative therapy for congenital neutropenia with MDS/AML or with cytogenetic abnormalities indicating impending conversion. PMID:23953336

  6. Patient-specific coronary artery blood flow simulation using myocardial volume partitioning

    NASA Astrophysics Data System (ADS)

    Kim, Kyung Hwan; Kang, Dongwoo; Kang, Nahyup; Kim, Ji-Yeon; Lee, Hyong-Euk; Kim, James D. K.

    2013-03-01

    Using computational simulation, we can analyze cardiovascular disease in non-invasive and quantitative manners. More specifically, computational modeling and simulation technology has enabled us to analyze functional aspect such as blood flow, as well as anatomical aspect such as stenosis, from medical images without invasive measurements. Note that the simplest ways to perform blood flow simulation is to apply patient-specific coronary anatomy with other average-valued properties; in this case, however, such conditions cannot fully reflect accurate physiological properties of patients. To resolve this limitation, we present a new patient-specific coronary blood flow simulation method by myocardial volume partitioning considering artery/myocardium structural correspondence. We focus on that blood supply is closely related to the mass of each myocardial segment corresponding to the artery. Therefore, we applied this concept for setting-up simulation conditions in the way to consider many patient-specific features as possible from medical image: First, we segmented coronary arteries and myocardium separately from cardiac CT; then the myocardium is partitioned into multiple regions based on coronary vasculature. The myocardial mass and required blood mass for each artery are estimated by converting myocardial volume fraction. Finally, the required blood mass is used as boundary conditions for each artery outlet, with given average aortic blood flow rate and pressure. To show effectiveness of the proposed method, fractional flow reserve (FFR) by simulation using CT image has been compared with invasive FFR measurement of real patient data, and as a result, 77% of accuracy has been obtained.

  7. The impact of simulation-based teaching on home hemodialysis patient training

    PubMed Central

    Chan, Doris T.; Faratro, Rose; Chan, Christopher T.

    2015-01-01

    Background Simulation has been associated with positive educational benefits in the training of healthcare professionals. It is unknown whether the use of simulation to supplement patient training for home hemodialysis (HHD) will assist in improving a patient's transition to home. We aim to assess the impact of simulation training on home visits, retraining and technique failure. Methods Since February 2013, patients training for HHD are required to dialyze independently in a dedicated training room (innovation room) which simulates a patient's home prior to graduation from the program. We performed a single-center retrospective, observational, cohort study comparing patients who completed training using the innovation room (n = 28) versus historical control (n = 21). The outcome measures were number of home visits, retraining visits and technique failure. Results Groups were matched for age, gender, race, body mass index and comorbidities. Compared with controls, significantly more cases had a permanent vascular access at the commencement of training (57.1 versus 28.6%, χ2 P = 0.04). Cases spent a median of 2 days [IQR (1.75)] in the innovation room. Training duration was not statistically different between groups {cases: median 10.0 weeks [IQR (6.0)] versus controls: 11.0 [IQR (4.0)]}. Compared with controls, cases showed a trend towards needing less home visits with no difference in the number of re-training session or technique failure. Conclusions Simulation-based teaching in NHHD training is associated with a trend to a reduction in the number of home visits but had no effect on the number of re-training sessions or proportion of patients with technique failure. PMID:26413287

  8. Clinical evaluation of patients with complaints related to formaldehyde exposure

    SciTech Connect

    Imbus, H.R.

    1985-12-01

    Formaldehyde is a very widely used chemical in our present society and one with which every physician has had a first-hand experience in his early days of training in the anatomy laboratory. The National Institute of Occupational Safety and Health lists 52 occupations that expose people to formaldehyde. In recent years, however, the increasing use of formaldehyde resins in the production of building materials such as particleboard and urea-formaldehyde foam insulation has resulted in exposures of large numbers of people in nonoccupational settings. Consumer products such as cosmetics, cigarettes, textiles, furniture, draperies, and preservatives release formaldehyde. It is present in the outdoor atmosphere from products of combustion and automobile exhaust and likewise in the home from such things as gas cooking. These more widespread and increased exposures have resulted in concern regarding potential health effects. Therefore, it is likely that physicians have or will encounter patients who wish evaluations of a present or potential health effect from formaldehyde. This article is for the purpose of providing assistance in such evaluation.110 references.

  9. Equivalence evaluation of moisturizers in atopic dermatitis patients.

    PubMed

    Tamura, Mai; Kawasaki, Hiroshi; Masunaga, Takuji; Ebihara, Tamotsu

    2015-01-01

    Skin care with moisturizers to compensate for dry skin and decreased barrier function, and to prevent recurrence of inflammation is thought to be very important for management of atopic dermatitis. However, many patients cannot continue the use of moisturizing medications because of unpleasantness. Cosmetics may be able to compensate for such deficiencies. To evaluate the usefulness of cosmetics in maintenance of the skin in remission, we conducted a clinical trial using moisturizing cosmetics of a phospholipid preparation that showed good moisture-retaining effect in dry skin. The utility of moisturizing cosmetics was evaluated by skin findings, subjective symptoms, adverse events, moisture content of the stratum corneum, transepidermal water loss (TEWL), and a questionnaire on feel of use in comparison with a heparinoid preparation as a control product. Degree of improvement in skin findings, dryness and desquamation score, pruritus score, TEWL, and moisture content were nearly the same as with the control product. The result indicated that the moisturizing cosmetic was of equivalent effect compared with the heparinoid control preparation. PMID:26753433

  10. A real time Pegasus propulsion system model for VSTOL piloted simulation evaluation

    NASA Technical Reports Server (NTRS)

    Mihaloew, J. R.; Roth, S. P.; Creekmore, R.

    1981-01-01

    A Pegasus-Harrier propulsion system is selected as a baseline for developing mathematical modeling and simulation techniques for VSTOL. Initially, static and dynamic propulsion system characteristics are modeled in detail to form a nonlinear aerothermodynamic digital computer simulation of a Pegasus engine. From this high fidelity simulation, a real-time propulsion model is formulated by applying a piecewise linear state variable methodology. A hydromechanical and water injection control system is also simulated. It is noted that the real-time dynamic model includes the detail and flexibility required for evaluating critical control parameters and propulsion component limits over a limited flight envelope.

  11. Simulation, manufacturing, and evaluation of a sonar for a miniaturized submersible explorer.

    PubMed

    Jonsson, Jonas; Edqvist, Erik; Kratz, Henrik; Almqvist, Monica; Thornell, Greger

    2010-01-01

    Single-beam side-scan sonar elements, to be fitted on a miniaturized submersible, are here simulated, manufactured, and evaluated. Finite element analysis simulations are compared with measurements, and an overall observation is that the agreement between simulations and measurements deviates from the measured values of 1.5 to 2 degrees, for the narrow lobe angle, by less than 10% for most models. An overall finding is that the lobe width along the track direction can be accurately simulated and, hence, the resolution of the sonars can be predicted. This paper presents, to the authors' knowledge, the world's smallest side-scan sonars. PMID:20178915

  12. Evaluation of cast creep occurring during simulated clubfoot correction.

    PubMed

    Cohen, Tamara L; Altiok, Haluk; Wang, Mei; McGrady, Linda M; Krzak, Joseph; Graf, Adam; Tarima, Sergey; Smith, Peter A; Harris, Gerald F

    2013-08-01

    The Ponseti method is a widely accepted and highly successful conservative treatment of pediatric clubfoot involving weekly manipulations and cast applications. Qualitative assessments have indicated the potential success of the technique with cast materials other than standard plaster of Paris. However, guidelines for clubfoot correction based on the mechanical response of these materials have yet to be investigated. The current study sought to characterize and compare the ability of three standard cast materials to maintain the Ponseti-corrected foot position by evaluating cast creep response. A dynamic cast testing device, built to model clubfoot correction, was wrapped in plaster of Paris, semi-rigid fiberglass, and rigid fiberglass. Three-dimensional motion responses to two joint stiffnesses were recorded. Rotational creep displacement and linearity of the limb-cast composite were analyzed. Minimal change in position over time was found for all materials. Among cast materials, the rotational creep displacement was significantly different (p < 0.0001). The most creep displacement occurred in the plaster of Paris (2.0°), then the semi-rigid fiberglass (1.0°), and then the rigid fiberglass (0.4°). Torque magnitude did not affect creep displacement response. Analysis of normalized rotation showed quasi-linear viscoelastic behavior. This study provided a mechanical evaluation of cast material performance as used for clubfoot correction. Creep displacement dependence on cast material and insensitivity to torque were discovered. This information may provide a quantitative and mechanical basis for future innovations for clubfoot care. PMID:23636764

  13. Synthetic tracked aperture ultrasound imaging: design, simulation, and experimental evaluation.

    PubMed

    Zhang, Haichong K; Cheng, Alexis; Bottenus, Nick; Guo, Xiaoyu; Trahey, Gregg E; Boctor, Emad M

    2016-04-01

    Ultrasonography is a widely used imaging modality to visualize anatomical structures due to its low cost and ease of use; however, it is challenging to acquire acceptable image quality in deep tissue. Synthetic aperture (SA) is a technique used to increase image resolution by synthesizing information from multiple subapertures, but the resolution improvement is limited by the physical size of the array transducer. With a large F-number, it is difficult to achieve high resolution in deep regions without extending the effective aperture size. We propose a method to extend the available aperture size for SA-called synthetic tracked aperture ultrasound (STRATUS) imaging-by sweeping an ultrasound transducer while tracking its orientation and location. Tracking information of the ultrasound probe is used to synthesize the signals received at different positions. Considering the practical implementation, we estimated the effect of tracking and ultrasound calibration error to the quality of the final beamformed image through simulation. In addition, to experimentally validate this approach, a 6 degree-of-freedom robot arm was used as a mechanical tracker to hold an ultrasound transducer and to apply in-plane lateral translational motion. Results indicate that STRATUS imaging with robotic tracking has the potential to improve ultrasound image quality. PMID:27088108

  14. Simulations reveal adverse hemodynamics in patients with multiple systemic to pulmonary shunts.

    PubMed

    Esmaily-Moghadam, Mahdi; Murtuza, Bari; Hsia, Tain-Yen; Marsden, Alison

    2015-03-01

    For newborns diagnosed with pulmonary atresia or severe pulmonary stenosis leading to insufficient pulmonary blood flow, cyanosis can be mitigated with placement of a modified Blalock-Taussig shunt (MBTS) between the innominate and pulmonary arteries. In some clinical scenarios, patients receive two systemic-to-pulmonary connections, either by leaving the patent ductus arteriosus (PDA) open or by adding an additional central shunt (CS) in conjunction with the MBTS. This practice has been motivated by the thinking that an additional source of pulmonary blood flow could beneficially increase pulmonary flow and provide the security of an alternate pathway in case of thrombosis. However, there have been clinical reports of premature shunt occlusion when more than one shunt is employed, leading to speculation that multiple shunts may in fact lead to unfavorable hemodynamics and increased mortality. In this study, we hypothesize that multiple shunts may lead to undesirable flow competition, resulting in increased residence time (RT) and elevated risk of thrombosis, as well as pulmonary overcirculation. Computational fluid dynamics-based multiscale simulations were performed to compare a range of shunt configurations and systematically quantify flow competition, pulmonary circulation, and other clinically relevant parameters. In total, 23 cases were evaluated by systematically changing the PDA/CS diameter, pulmonary vascular resistance (PVR), and MBTS position and compared by quantifying oxygen delivery (OD) to the systemic and coronary beds, wall shear stress (WSS), oscillatory shear index (OSI), WSS gradient (WSSG), and RT in the pulmonary artery (PA), and MBTS. Results showed that smaller PDA/CS diameters can lead to flow conditions consistent with increased thrombus formation due to flow competition in the PA, and larger PDA/CS diameters can lead to insufficient OD due to pulmonary hyperfusion. In the worst case scenario, it was found that multiple shunts can lead to

  15. [Medical simulation as a professional tool which affect the safety of the patient used in the learning process].

    PubMed

    Czekajlo, Michael; Dąbrowski, Marek; Dąbrowska, Agata; Torres, Kamil; Torres, Anna; Witt, Magdalena; Gąsiorowski, Łukasz; Szukała, Magdalena

    2015-06-01

    Simulation is the methodology of teaching, learning process using educational equipment from simple simulators, designed to study individual tasks, through advanced mannequins called human patient stimulators faithfully mimic the human and its parameters. The medical simulation's main task is education and improvement patients' safety. Advanced human simulators can realistically cough, vomit with artificial chyme and bleed with artificial blood causing a real stress of medical personnel and the need for immediate action. Medical simulation gives the opportunity to prepare medical personnel to the profession more effectively, in less time than traditional education and also clearly affects the patients' safety. PMID:26098659

  16. Dynamic Evaluation of Long-Term Air Quality Model Simulations Over the Northeastern U.S.

    EPA Science Inventory

    Dynamic model evaluation assesses a modeling system's ability to reproduce changes in air quality induced by changes in meteorology and/or emissions. In this paper, we illustrate various approaches to dynamic mode evaluation utilizing 18 years of air quality simulations perform...

  17. The Place Setting Simulator. Courseware Evaluation for Vocational and Technical Education.

    ERIC Educational Resources Information Center

    Sarle, Ruth; And Others

    This courseware evaluation rates "The Place Setting Simulator" program developed by Orange Juice Software Systems. The courseware was rated by a team of home economists participating in a network designed to identify and evaluate courseware and disseminate reviews for vocational and technical teachers, media staff, and administrators. Part A…

  18. FEHR-PRACTICUM: A Computerized Game to Simulate Experience in Educational Research and Evaluation. Final Report.

    ERIC Educational Resources Information Center

    Collet, LeVerne S.; And Others

    This project represents the first year of a proposed two-year program to develop FEHR-PRACTICUM (Formative Evaluation and Heuristic Research), a computerized game which simulates experience in a research evaluation assistantship or practicum. In the game teams of from two to five players are given the task of finding the "best" among several…

  19. An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

    SciTech Connect

    Pascau, Javier; Santos Miranda, Juan Antonio; Calvo, Felipe A.; Bouche, Ana; Morillo, Virgina; Gonzalez-San Segundo, Carmen; Ferrer, Carlos; Lopez Tarjuelo, Juan; and others

    2012-06-01

    Purpose: Intraoperative electron beam radiation therapy (IOERT) involves a modified strategy of conventional radiation therapy and surgery. The lack of specific planning tools limits the spread of this technique. The purpose of the present study is to describe a new simulation and planning tool and its initial evaluation by clinical users. Methods and Materials: The tool works on a preoperative computed tomography scan. A physician contours regions to be treated and protected and simulates applicator positioning, calculating isodoses and the corresponding dose-volume histograms depending on the selected electron energy. Three radiation oncologists evaluated data from 15 IOERT patients, including different tumor locations. Segmentation masks, applicator positions, and treatment parameters were compared. Results: High parameter agreement was found in the following cases: three breast and three rectal cancer, retroperitoneal sarcoma, and rectal and ovary monotopic recurrences. All radiation oncologists performed similar segmentations of tumors and high-risk areas. The average applicator position difference was 1.2 {+-} 0.95 cm. The remaining cancer sites showed higher deviations because of differences in the criteria for segmenting high-risk areas (one rectal, one pancreas) and different surgical access simulated (two rectal, one Ewing sarcoma). Conclusions: The results show that this new tool can be used to simulate IOERT cases involving different anatomic locations, and that preplanning has to be carried out with specialized surgical input.

  20. Exploring the use of standardized patients for simulation-based learning in preparing advanced practice nurses.

    PubMed

    Kowitlawakul, Yanika; Chow, Yeow Leng; Salam, Zakir Hussian Abdul; Ignacio, Jeanette

    2015-07-01

    The use of standardized patients for simulation-based learning was integrated into the Master of Nursing curriculum in the 2012-2013 academic year. The study aimed to explore the Master of Nursing students' experiences with and perceptions of using standardized patients in simulations, and to identify the students' learning needs in preparing to become advanced practice nurses. The study adopted an exploratory descriptive qualitative design, using a focus group interview. The study was conducted at a university in Singapore. Seven Master of Nursing students who were enrolled in the Acute Care Track of Master of Nursing program in the 2012-2013 academic year participated in the study. The data were gathered at the end of the first semester. Content analysis was used to analyze the data. Three main categories - usefulness, clinical limitations, and realism - were identified in the study. The results revealed that the students felt using standardized patients was useful and realistic for developing skills in history taking, communication, and responding to an emergency situation. On the other hand, they found that the standardized patients were limited in providing critical signs and symptoms of case scenarios. To meet the learning objectives, future development and integration of standardized patients in the Master of Nursing curriculum might need to be considered along with the use of a high-fidelity simulator. This can be an alternative strategy to fill the gaps in each method. Obviously, using standardized patients for simulation-based learning has added value to the students' learning experiences. It is highly recommended that future studies explore the impact of using standardized patients on students' performance in clinical settings. PMID:25819268

  1. The Role of Causal Knowledge in Knowledge-Based Patient Simulation

    PubMed Central

    Chin, Homer L.; Cooper, Gregory F.

    1987-01-01

    We have investigated the ability to simulate a patient from a knowledge base. Specifically, we have examined the use of knowledge bases that associate findings with diseases through the use of probability measures, and their ability to generate realistic patient cases that can be used for teaching purposes. Many of these knowledge bases encode neither the interdependence among findings, nor intermediate disease states. Because of this, the use of these knowledge bases results in the generation of inconsistent or nonsensical patients. This paper describes an approach for the addition of causal structure to these knowledge bases which can overcome many of these limitations and improve the explanatory capability of such systems.

  2. FERN – a Java framework for stochastic simulation and evaluation of reaction networks

    PubMed Central

    Erhard, Florian; Friedel, Caroline C; Zimmer, Ralf

    2008-01-01

    Background Stochastic simulation can be used to illustrate the development of biological systems over time and the stochastic nature of these processes. Currently available programs for stochastic simulation, however, are limited in that they either a) do not provide the most efficient simulation algorithms and are difficult to extend, b) cannot be easily integrated into other applications or c) do not allow to monitor and intervene during the simulation process in an easy and intuitive way. Thus, in order to use stochastic simulation in innovative high-level modeling and analysis approaches more flexible tools are necessary. Results In this article, we present FERN (Framework for Evaluation of Reaction Networks), a Java framework for the efficient simulation of chemical reaction networks. FERN is subdivided into three layers for network representation, simulation and visualization of the simulation results each of which can be easily extended. It provides efficient and accurate state-of-the-art stochastic simulation algorithms for well-mixed chemical systems and a powerful observer system, which makes it possible to track and control the simulation progress on every level. To illustrate how FERN can be easily integrated into other systems biology applications, plugins to Cytoscape and CellDesigner are included. These plugins make it possible to run simulations and to observe the simulation progress in a reaction network in real-time from within the Cytoscape or CellDesigner environment. Conclusion FERN addresses shortcomings of currently available stochastic simulation programs in several ways. First, it provides a broad range of efficient and accurate algorithms both for exact and approximate stochastic simulation and a simple interface for extending to new algorithms. FERN's implementations are considerably faster than the C implementations of gillespie2 or the Java implementations of ISBJava. Second, it can be used in a straightforward way both as a stand

  3. Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study.

    PubMed

    Alonso, Fabiola; Latorre, Malcolm A; Göransson, Nathanael; Zsigmond, Peter; Wårdell, Karin

    2016-01-01

    New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a "virtual" ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode. PMID:27618109

  4. External Support for Collaborative Problem Solving in a Simulated Provider/Patient Medication Scheduling Task

    ERIC Educational Resources Information Center

    Morrow, Daniel; Raquel, Liza; Schriver, Angela; Redenbo, Seth; Rozovski, David; Weiss, Gillian

    2008-01-01

    Taking medication requires developing plans to accomplish the activity. This planning challenges older adults because of age-related cognitive limits and inadequate collaboration with health providers. The authors investigated whether an external aid ("medtable") supports collaborative planning in the context of a simulated patient/provider task…

  5. Effect of Horseback Riding Simulation Machine Training on Trunk Balance and Gait of Chronic Stroke Patients

    PubMed Central

    Kim, Hyungguen; Her, Jin Gang; Ko, Jooyeon

    2014-01-01

    [Purpose] The purpose of this study was to assess the effect of horseback riding simulation machine training on trunk balance and gait of patients with chronic stroke. [Subjects and Methods] The subjects were 20 patients hospitalized for treatment after being diagnosed with stroke. Horseback riding simulation training was provided for 30 minutes, 5 times a week, for 6 weeks. Trunk balance was assessed using the Trunk Impairment Scale (TIS) and a balance measuring device (Biorescue, RM ingenierie, France), and gait ability was measured using the Functional Gait Assessment (FGA) and a gait analyzer (GAITRite, CIR system Inc., USA). [Results] There were significant changes in movement area, distance and velocity of body sway as measured by the TIS and the balance measuring device, and in gait velocity, cadence, stride length and double limb support as measured by the FGA and gait analyzer. [Conclusion] Horseback riding simulation training improved the trunk balance and gait of chronic stroke patients. This present study provides preliminary objective data for future research, and useful clinical information for physical therapists using horseback riding simulation machines as a treatment modality for patients with chronic stroke. PMID:24567670

  6. High-Fidelity Patient Simulators to Expose Undergraduate Students to the Clinical Relevance of Physiology Concepts

    ERIC Educational Resources Information Center

    Harris, David M.; Bellew, Christine; Cheng, Zixi J.; Cendán, Juan C.; Kibble, Jonathan D.

    2014-01-01

    The use of high-fidelity patient simulators (HFPSs) has expanded throughout medical, nursing, and allied health professions education in the last decades. These manikins can be programmed to represent pathological states and are used to teach clinical skills as well as clinical reasoning. First, the students are typically oriented either to the…

  7. Stimulation through Simulation? Motor Imagery and Functional Reorganization in Hemiplegic Stroke Patients

    ERIC Educational Resources Information Center

    Johnson-Frey, Scott H.

    2004-01-01

    A key factor influencing reorganization of function in damaged neural networks of the adult brain is stimulation. How to stimulate motor areas of patients with paralyses is a formidable challenge. One possibility is to use internal movement simulations, or motor imagery, as an alternative to conventional therapeutic interventions that require…

  8. Evaluation of a model for glycemic prediction in critically ill surgical patients.

    PubMed

    Pappada, Scott M; Cameron, Brent D; Tulman, David B; Bourey, Raymond E; Borst, Marilyn J; Olorunto, William; Bergese, Sergio D; Evans, David C; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-01-01

    We evaluated a neural network model for prediction of glucose in critically ill trauma and post-operative cardiothoracic surgical patients. A prospective, feasibility trial evaluating a continuous glucose-monitoring device was performed. After institutional review board approval, clinical data from all consenting surgical intensive care unit patients were converted to an electronic format using novel software. This data was utilized to develop and train a neural network model for real-time prediction of serum glucose concentration implementing a prediction horizon of 75 minutes. Glycemic data from 19 patients were used to "train" the neural network model. Subsequent real-time simulated testing was performed in 5 patients to whom the neural network model was naive. Performance of the model was evaluated by calculating the mean absolute difference percent (MAD%), Clarke Error Grid Analysis, and calculation of the percent of hypoglycemic (≤70 mg/dL), normoglycemic (>70 and <150 mg/dL), and hyperglycemic (≥150 mg/dL) values accurately predicted by the model; 9,405 data points were analyzed. The models successfully predicted trends in glucose in the 5 test patients. Clark Error Grid Analysis indicated that 100.0% of predictions were clinically acceptable with 87.3% and 12.7% of predicted values falling within regions A and B of the error grid respectively. Overall model error (MAD%) was 9.0% with respect to actual continuous glucose modeling data. Our model successfully predicted 96.7% and 53.6% of the normo- and hyperglycemic values respectively. No hypoglycemic events occurred in these patients. Use of neural network models for real-time prediction of glucose in the surgical intensive care unit setting offers healthcare providers potentially useful information which could facilitate optimization of glycemic control, patient safety, and improved care. Similar models can be implemented across a wider scale of biomedical variables to offer real-time optimization

  9. Undergraduate Nursing Students' Evaluation of the Debriefing Phase in Mental Health Nursing Simulation.

    PubMed

    Kirkbakk-Fjær, Kari; Hedelin, Birgitta; Moen, Øyfrid Larsen

    2016-05-01

    The debriefing phase in mental health nursing simulation promotes a reflexive learning process with the opportunity to develop metacognitive and nontechnical skills. The aim of this quantitative study was to describe undergraduate nursing students' evaluation of their experience during the debriefing phase following high fidelity human simulation (HFHS). Data was collected using the "Debriefing Experience Scale" and analysed with descriptive and comparative tests. The debriefing phase was evaluated as very good. Background data and group size revealed few significant differences. Students with little clinical praxis evaluated having time to acknowledge feelings as important. Differences between groups revealed that groups should consist of up to eighteen students. PMID:27050663

  10. Evaluation of the meteorological forcing used for the Air Quality Model Evaluation International Initiative (AQMEII) air quality simulations

    NASA Astrophysics Data System (ADS)

    Vautard, Robert; Moran, Michael D.; Solazzo, Efisio; Gilliam, Robert C.; Matthias, Volker; Bianconi, Roberto; Chemel, Charles; Ferreira, Joana; Geyer, Beate; Hansen, Ayoe B.; Jericevic, Amela; Prank, Marje; Segers, Arjo; Silver, Jeremy D.; Werhahn, Johannes; Wolke, Ralf; Rao, S. T.; Galmarini, Stefano

    2012-06-01

    Accurate regional air pollution simulation relies strongly on the accuracy of the mesoscale meteorological simulation used to drive the air quality model. The framework of the Air Quality Model Evaluation International Initiative (AQMEII), which involved a large international community of modeling groups in Europe and North America, offered a unique opportunity to evaluate the skill of mesoscale meteorological models for two continents for the same period. More than 20 groups worldwide participated in AQMEII, using several meteorological and chemical transport models with different configurations. The evaluation has been performed over a full year (2006) for both continents. The focus for this particular evaluation was meteorological parameters relevant to air quality processes such as transport and mixing, chemistry, and surface fluxes. The unprecedented scale of the exercise (one year, two continents) allowed us to examine the general characteristics of meteorological models' skill and uncertainty. In particular, we found that there was a large variability between models or even model versions in predicting key parameters such as surface shortwave radiation. We also found several systematic model biases such as wind speed overestimations, particularly during stable conditions. We conclude that major challenges still remain in the simulation of meteorology, such as nighttime meteorology and cloud/radiation processes, for air quality simulation.

  11. Assessment and management of serotonin syndrome in a simulated patient study of Australian community pharmacies

    PubMed Central

    2015-01-01

    Background: The incidence of serotonin syndrome is increasing due to the widening use of serotonergic drugs. Identification of serotonin syndrome is challenging as the manifestations are diverse. Misdiagnosis can lead to delay in care and inappropriate treatment. Objectives: The objectives of this study were to determine if staff of community pharmacies in Australia could identify the symptoms of serotonin syndrome in simulated patients and recommend an appropriate course of action. Methods: Agents acting on behalf of a simulated patient were trained on a patient scenario that reflected possible serotonin syndrome due to an interaction between duloxetine and recently prescribed tramadol. They entered 148 community pharmacies in Australia to ask for advice about a 60 year old male simulated patient who was ‘not feeling well’. The interaction was audio recorded and analysed for degree of access to the pharmacist, information gathered by pharmacy staff, management advice given and pharmacotherapy recommended. Results: The simulated patient’s agent was consulted by a pharmacist in 94.0% (139/148) of cases. The potential for serotonin syndrome was identified by 35.1% (52/148) of pharmacies. Other suggested causes of the simulated patient’s symptoms were viral (16.9%; 25/148) and cardiac (15.5%; 23/148). A total of 33.8% (50/148) of pharmacies recommended that the simulated patient should cease taking tramadol. This advice always came from the pharmacist. Immediate cessation of tramadol was advised by 94.2% (49/52) of pharmacists correctly identifying serotonin syndrome. The simulated patient was advised to seek urgent medical care in 14.2% (21/148) of cases and follow up with a doctor when possible in 68.2% (101/148) of cases. The majority of pharmacies (87.8%; 130/148) did not recommend non-prescription medicines. Conclusion: While not identifying the cause of the simulated patient’s symptoms in the majority of cases, community pharmacies recommended

  12. Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation, appendix A

    NASA Technical Reports Server (NTRS)

    Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelly, J. H.; Depkovich, T. M.

    1984-01-01

    A generic computer simulation for manipulator systems (ROBSIM) was implemented and the specific technologies necessary to increase the role of automation in various missions were developed. The specific items developed were: (1) Capability for definition of a manipulator system consisting of multiple arms, load objects, and an environment; (2) Capability for kinematic analysis, requirements analysis, and response simulation of manipulator motion; (3) Postprocessing options such as graphic replay of simulated motion and manipulator parameter plotting; (4) Investigation and simulation of various control methods including manual force/torque and active compliance control; (5) Evaluation and implementation of three obstacle avoidance methods; (6) Video simulation and edge detection; and (7) Software simulation validation. This appendix is the user's guide and includes examples of program runs and outputs as well as instructions for program use.

  13. Instructor and student pilots' subjective evaluation of a general aviation simulator with a terrain visual system

    NASA Technical Reports Server (NTRS)

    Kiteley, G. W.; Harris, R. L., Sr.

    1978-01-01

    Ten student pilots were given a 1 hour training session in the NASA Langley Research Center's General Aviation Simulator by a certified flight instructor and a follow-up flight evaluation was performed by the student's own flight instructor, who has also flown the simulator. The students and instructors generally felt that the simulator session had a positive effect on the students. They recommended that a simulator with a visual scene and a motion base would be useful in performing such maneuvers as: landing approaches, level flight, climbs, dives, turns, instrument work, and radio navigation, recommending that the simulator would be an efficient means of introducing the student to new maneuvers before doing them in flight. The students and instructors estimated that about 8 hours of simulator time could be profitably devoted to the private pilot training.

  14. Using screen-based simulation of inhaled anaesthetic delivery to improve patient care.

    PubMed

    Philip, J H

    2015-12-01

    Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation program that depicts pictorially and graphically the anaesthetic gas and vapour tension from the vaporizer to the site of action, namely the brain and spinal cord. The gases and vapours depicted are desflurane, enflurane, ether, halothane, isoflurane, nitrogen, nitrous oxide, sevoflurane, and xenon. Multiple agents can be administered simultaneously or individually and the results shown on an overlay graph. Practice exercises provide in-depth knowledge of the subject matter. Experienced clinicians can simulate anaesthesia occurrences and practices for application to their clinical practice, and publish the results to benefit others to improve patient care. Published studies using this screen-based simulation have led to a number of findings, as follows: changing from isoflurane to desflurane toward the end of anaesthesia does not accelerate recovery in humans; vital capacity induction can produce loss of consciousness in 45 s; simulated context-sensitive decrement times explain recovery profiles; hyperventilation does not dramatically speed emergence; high fresh gas flow is wasteful; fresh gas flow and not the vaporizer setting should be reduced during intubation; re-anaesthetization can occur with severe hypoventilation after extubation; and in re-anaesthetization, the anaesthetic redistributes from skeletal muscle. Researchers using screen-based simulations can study fewer subjects to reach valid conclusions that impact clinical care. PMID:26658205

  15. Fluid Structure Interaction simulation of heart prosthesis in patient-specific left-ventricle/aorta anatomies

    NASA Astrophysics Data System (ADS)

    Le, Trung; Borazjani, Iman; Sotiropoulos, Fotis

    2009-11-01

    In order to test and optimize heart valve prosthesis and enable virtual implantation of other biomedical devices it is essential to develop and validate high-resolution FSI-CFD codes for carrying out simulations in patient-specific geometries. We have developed a powerful numerical methodology for carrying out FSI simulations of cardiovascular flows based on the CURVIB approach (Borazjani, L. Ge, and F. Sotiropoulos, Journal of Computational physics, vol. 227, pp. 7587-7620 2008). We have extended our FSI method to overset grids to handle efficiently more complicated geometries e.g. simulating an MHV implanted in an anatomically realistic aorta and left-ventricle. A compliant, anatomic left-ventricle is modeled using prescribed motion in one domain. The mechanical heart valve is placed inside the second domain i.e. the body-fitted curvilinear mesh of the anatomic aorta. The simulations of an MHV with a left-ventricle model underscore the importance of inflow conditions and ventricular compliance for such simulations and demonstrate the potential of our method as a powerful tool for patient-specific simulations.

  16. Population Pharmacodynamic Modeling and Simulation of the Respiratory Effect of Acetazolamide in Decompensated COPD Patients

    PubMed Central

    Heming, Nicholas; Urien, Saïk; Fulda, Virginie; Meziani, Ferhat; Gacouin, Arnaud; Clavel, Marc; Planquette, Benjamin; Faisy, Christophe

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis. Methods 619 time-respiratory (minute ventilation, tidal volume and respiratory rate) and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug. Results The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily) was required to significantly increase minute ventilation (P<.001 vs pre-acetazolamide administration). Based on our model, 1000 mg per day of acetazolamide would increase minute ventilation by >0.75 L min−1 in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day. Conclusions Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide. PMID:24466018

  17. Relationship between Patients' In-Process Evaluations of Therapy and Psychotherapy Outcome.

    ERIC Educational Resources Information Center

    Bernard, Harold S.; Schwartz, Allan J.

    1980-01-01

    Investigated relationship between patients' session-by-session evaluations of brief psychotherapy and outcome. Results indicated that patients' in-process evaluations were correlated significantly and positively with some positive treatment outcome measures, especially achievement of patients' specified treatment goals, but only during initial and…

  18. Computer simulation and capacity evaluation of Panama Canal alternatives

    SciTech Connect

    Rosselli, A.T.; Bronzini, M.S.; Weekly, D.A.

    1994-12-31

    The Operating Characteristics and Capacity Evaluation (OCCE) Study was one of the components of a group of studies of future alternatives to the Panama Canal, sponsored by a study commission formed by the governments of Panama, the US and Japan. The basic tool in the conduct of the study was the Waterway Analysis Model (WAM), developed originally by the US Army Corps of Engineers for use on the US inland waterway system and adapted under OCCE for study of Panama Canal alternatives. The study synthesized the many alternative plans for the Canal proposed historically into four basic groups: High-Rise Lock Canal, Low-Rise Lock Canal, Sea-Level Canal and Status Quo Canal. For economy, the sea-level cases were based on, essentially, a single-lane canal, in conjunction with the status quo canal. Hydraulic and navigation studies indicted that to achieve safe navigation, tide gates or locks would be required to control currents that would otherwise be generated by the differences in tides between the two oceans. The alternatives studied in detail are illustrated in the body of the paper.

  19. Image-based estimation of ventricular fiber orientations for patient-specific simulations.

    PubMed

    Vadakkumpadan, Fijoy; Arevalo, Hermenegild; Ceritoglu, Can; Miller, Michael; Trayanova, Natalia

    2011-01-01

    Patient-specific simulation of heart (dys)function aimed at personalizing cardiac therapy are hampered by the absence of in vivo imaging technology for clinically acquiring myocardial fiber orientations. In this research, we develop a methodology to predict ventricular fiber orientations of a patient heart, given the geometry of the heart and an atlas. We test the methodology by comparing the estimated fiber orientations with measured ones, and by quantifying the effect of the estimation error on outcomes of electrophysiological simulations, in normal and failing canine hearts. The new insights obtained from the project will pave the way for the development of patient-specific models of the heart that can aid physicians in personalized diagnosis and decisions regarding electrophysiological interventions. PMID:22254646

  20. Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts.

    PubMed

    Perrin, David; Badel, Pierre; Orgeas, Laurent; Geindreau, Christian; du Roscoat, Sabine Rolland; Albertini, Jean-Noël; Avril, Stéphane

    2016-10-01

    The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to

  1. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients

    PubMed Central

    Chopra, Pooja; Dixit, Madhu Bala; Dang, Aashish; Gupta, Vibhuti

    2016-01-01

    Background and Aims: We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients. Material and Methods: In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX. After locally anesthetizing the airway and applying a cervical collar, patients either received DEX 1 μg/kg over 10 min followed by 0.7 μg/kg/h maintenance infusion or normal saline in the same dose and rate during AFOI. Targeted sedation (Ramsay sedation score [RSS] ≥2) during AFOI was maintained with midazolam [MDZ] in both groups. Statistical Analysis was performed using unpaired Student's t-test, Chi-square test, Mann-Whitney test and Wilcoxon-w test. Results: The total number of patients requiring MDZ and the mean dose of MDZ required to achieve targeted sedation (RSS ≥2) was significantly less in DEX group compared to the placebo group (P < 0.001). Similarly, patient satisfaction score, heart rate, systolic, diastolic and mean arterial pressure and respiratory parameters were significantly better in DEX group (P < 0.001). Postintubation arousability in the two groups was comparable (P = 0.29). Conclusions: Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment. PMID:27006542

  2. Enhancing the management of deteriorating patients with Australian on line e-simulation software: Acceptability, transferability, and impact in Hong Kong.

    PubMed

    Sparkes, Louise; Chan, Maggie Mee Kie; Cooper, Simon; Pang, Michelle Tsz Ha; Tiwari, Agnes

    2016-09-01

    International concerns relating to healthcare professionals' failure to rescue deteriorating patients exist. Web-based training programs have been developed and evaluated in Western settings but further testing is required before application in non-Western countries, as traditional modalities of learning may differ between cultures. We trialed an Australian English language online simulation program for the management of deteriorating patients, Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACTWeb), to test cultural acceptability, transferability, and educational impact. The study was designed as a quasi-experimental evaluation of the FIRST(2) ACTWeb program with final year nursing students from a Bachelor of Nursing program at the University of Hong Kong. Participants completed pre-course and post-course tests, three interactive scenarios, and program evaluations. The program was positively evaluated, with significant improvements in knowledge, skills, self-rating of performance, confidence, and competence. Outcomes were comparable to earlier evaluations with Australian students, demonstrating that an interactive simulation-based program of patient deterioration management has cultural and language acceptability and transferability across communities with significant educational impact. PMID:27103595

  3. Evaluation of cloud resolving model simulations of midlatitude cirrus with ARM and A-Train observations

    NASA Astrophysics Data System (ADS)

    Muehlbauer, A. D.; Ackerman, T. P.; Lawson, P.; Xie, S.; Zhang, Y.

    2015-12-01

    This paper evaluates cloud resolving model (CRM) and cloud system-resolving model (CSRM) simulations of a midlatitude cirrus case with comprehensive observations collected under the auspices of the Atmospheric Radiation Measurements (ARM) program and with spaceborne observations from the National Aeronautics and Space Administration (NASA) A-train satellites. Vertical profiles of temperature, relative humidity and wind speeds are reasonably well simulated by the CSRM and CRM but there are remaining biases in the temperature, wind speeds and relative humidity, which can be mitigated through nudging the model simulations toward the observed radiosonde profiles. Simulated vertical velocities are underestimated in all simulations except in the CRM simulations with grid spacings of 500m or finer, which suggests that turbulent vertical air motions in cirrus clouds need to be parameterized in GCMs and in CSRM simulations with horizontal grid spacings on the order of 1km. The simulated ice water content and ice number concentrations agree with the observations in the CSRM but are underestimated in the CRM simulations. The underestimation of ice number concentrations is consistent with the overestimation of radar reflectivity in the CRM simulations and suggests that the model produces too many large ice particles especially toward cloud base. Simulated cloud profiles are rather insensitive to perturbations in the initial conditions or the dimensionality of the model domain but the treatment of the forcing data has a considerable effect on the outcome of the model simulations. Despite considerable progress in observations and microphysical parameterizations, simulating the microphysical, macrophysical and radiative properties of cirrus remains challenging. Comparing model simulations with observations from multiple instruments and observational platforms is important for revealing model deficiencies and for providing rigorous benchmarks. However, there still is considerable

  4. Is radiography justified for the evaluation of patients presenting with cervical spine trauma?

    SciTech Connect

    Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John

    2009-10-15

    Conventional radiography has been for decades the standard method of evaluation for cervical spine trauma patients. However, currently available helical multidetector CT scanners allow multiplanar reconstruction of images, leading to increased diagnostic accuracy. The purpose of this study was to determine the relative benefit/risk ratio between cervical spine CT and cervical spine radiography and between cervical spine CT and cervical spine radiography, followed by CT as an adjunct for positive findings. A decision analysis model for the determination of the optimum imaging technique was developed. The sensitivity and specificity of CT and radiography were obtained by dedicated meta-analysis. Lifetime attributable risk of mortal cancer from CT and radiography was calculated using updated organ-specific risk coefficients and organ-absorbed doses. Patient organ doses from radiography were calculated using Monte Carlo techniques, simulated exposures performed on an anthropomorphic phantom, and thermoluminescence dosimetry. A prospective patient study was performed regarding helical CT scans of the cervical spine. Patient doses were calculated based on the dose-length-product values and Monte Carlo-based CT dosimetry software program. Three groups of patient risk for cervical spine fracture were incorporated in the decision model on the basis of hypothetical trauma mechanism and clinical findings. Radiation effects were assessed separately for males and females for four age groups (20, 40, 60, and 80 yr old). Effective dose from radiography amounts to 0.050 mSv and from a typical CT scan to 3.8 mSv. The use of CT in a hypothetical cohort of 10{sup 6} patients prevents approximately 130 incidents of paralysis in the low risk group (a priori fracture probability of 0.5%), 500 in the moderate risk group (a priori fracture probability of 2%), and 5100 in the high risk group (a priori fracture probability of 20%). The expense of this CT-based prevention is 15-32 additional

  5. Evaluation of an integrated simulation courseware in a pediatric nursing practicum.

    PubMed

    Shin, Hyunsook; Kim, Mi Ja

    2014-10-01

    This study examined the effect of integrated pediatric nursing simulation courseware on students' critical thinking and clinical judgment. Ninety-five senior nursing students participated in this study. Every student followed the established courseware schedule, as well as the regular pediatric nursing practicum. The courseware schedule included two simple simulation scenarios and one comprehensive scenario on the first day of the first, second, and third weeks of the practicum. Students' critical thinking scores showed significant improvement after the use of simulation courseware using high-fidelity simulators and standardized patients. No significant predictors were found for improvement in critical thinking, but bivariate transformation of upper and lower groups in critical thinking achievement revealed a significant difference in the clinical judgment ability between the two groups. Simulation courseware supplementation is an innovative learning strategy for improving nursing students' critical thinking and clinical judgment during clinical practicum. Clinical judgment may play a role in facilitating nursing student improvement in critical thinking ability. PMID:25275992

  6. The use of vestibular models for design and evaluation of flight simulator motion

    NASA Technical Reports Server (NTRS)

    Bussolari, Steven R.; Young, Laurence R.; Lee, Alfred T.

    1989-01-01

    Quantitative models for the dynamics of the human vestibular system are applied to the design and evaluation of flight simulator platform motion. An optimal simulator motion control algorithm is generated to minimize the vector difference between perceived spatial orientation estimated in flight and in simulation. The motion controller has been implemented on the Vertical Motion Simulator at NASA Ames Research Center and evaluated experimentally through measurement of pilot performance and subjective rating during VTOL aircraft simulation. In general, pilot performance in a longitudinal tracking task (formation flight) did not appear to be sensitive to variations in platform motion condition as long as motion was present. However, pilot assessment of motion fidelity by means of a rating scale designed for this purpose, were sensitive to motion controller design. Platform motion generated with the optimal motion controller was found to be generally equivalent to that generated by conventional linear crossfeed washout. The vestibular models are used to evaluate the motion fidelity of transport category aircraft (Boeing 727) simulation in a pilot performance and simulator acceptability study at the Man-Vehicle Systems Research Facility at NASA Ames Research Center. Eighteen airline pilots, currently flying B-727, were given a series of flight scenarios in the simulator under various conditions of simulator motion. The scenarios were chosen to reflect the flight maneuvers that these pilots might expect to be given during a routine pilot proficiency check. Pilot performance and subjective rating of simulator fidelity was relatively insensitive to the motion condition, despite large differences in the amplitude of motion provided. This lack of sensitivity may be explained by means of the vestibular models, which predict little difference in the modeled motion sensations of the pilots when different motion conditions are imposed.

  7. Objective Fidelity Evaluation in Multisensory Virtual Environments: Auditory Cue Fidelity in Flight Simulation

    PubMed Central

    Meyer, Georg F.; Wong, Li Ting; Timson, Emma; Perfect, Philip; White, Mark D.

    2012-01-01

    We argue that objective fidelity evaluation of virtual environments, such as flight simulation, should be human-performance-centred and task-specific rather than measure the match between simulation and physical reality. We show how principled experimental paradigms and behavioural models to quantify human performance in simulated environments that have emerged from research in multisensory perception provide a framework for the objective evaluation of the contribution of individual cues to human performance measures of fidelity. We present three examples in a flight simulation environment as a case study: Experiment 1: Detection and categorisation of auditory and kinematic motion cues; Experiment 2: Performance evaluation in a target-tracking task; Experiment 3: Transferrable learning of auditory motion cues. We show how the contribution of individual cues to human performance can be robustly evaluated for each task and that the contribution is highly task dependent. The same auditory cues that can be discriminated and are optimally integrated in experiment 1, do not contribute to target-tracking performance in an in-flight refuelling simulation without training, experiment 2. In experiment 3, however, we demonstrate that the auditory cue leads to significant, transferrable, performance improvements with training. We conclude that objective fidelity evaluation requires a task-specific analysis of the contribution of individual cues. PMID:22957068

  8. Preanesthetic evaluation of a patient with a deep brain stimulator: a practical guide and checklist for patient safety.

    PubMed

    Weinstein, Adam S; Aglio, Linda S

    2016-06-01

    As the patient population with deep brain stimulators grows, medical personnel need to be comfortable managing these patients because they will likely encounter them in practice. Caring for a patient with a deep brain stimulator during surgery or a procedure requires technical knowledge of the device and its possible interactions in order to take the correct precautionary measures. Here we discuss the key issues and questions that should be covered in every preanesthetic evaluation visit of a patient with a deep brain stimulator along with an evaluation checklist. PMID:27185727

  9. Simulated evaluation of an intraoperative surface modeling method for catheter ablation by a real phantom simulation experiment

    NASA Astrophysics Data System (ADS)

    Sun, Deyu; Rettmann, Maryam E.; Packer, Douglas; Robb, Richard A.; Holmes, David R.

    2015-03-01

    In this work, we propose a phantom experiment method to quantitatively evaluate an intraoperative left-atrial modeling update method. In prior work, we proposed an update procedure which updates the preoperative surface model with information from real-time tracked 2D ultrasound. Prior studies did not evaluate the reconstruction using an anthropomorphic phantom. In this approach, a silicone heart phantom (based on a high resolution human atrial surface model reconstructed from CT images) was made as simulated atriums. A surface model of the left atrium of the phantom was deformed by a morphological operation - simulating the shape difference caused by organ deformation between pre-operative scanning and intra-operative guidance. During the simulated procedure, a tracked ultrasound catheter was inserted into right atrial phantom - scanning the left atrial phantom in a manner mimicking the cardiac ablation procedure. By merging the preoperative model and the intraoperative ultrasound images, an intraoperative left atrial model was reconstructed. According to results, the reconstruction error of the modeling method is smaller than the initial geometric difference caused by organ deformation. As the area of the left atrial phantom scanned by ultrasound increases, the reconstruction error of the intraoperative surface model decreases. The study validated the efficacy of the modeling method.

  10. Simulated evaluation of an intraoperative surface modeling method for catheter ablation by a real phantom simulation experiment

    PubMed Central

    Sun, Deyu; Rettmann, Maryam E.; Packer, Douglas; Robb, Richard A.; Holmes, David R.

    2015-01-01

    In this work, we propose a phantom experiment method to quantitatively evaluate an intraoperative left-atrial modeling update method. In prior work, we proposed an update procedure which updates the preoperative surface model with information from real-time tracked 2D ultrasound. Prior studies did not evaluate the reconstruction using an anthropomorphic phantom. In this approach, a silicone heart phantom (based on a high resolution human atrial surface model reconstructed from CT images) was made as simulated atriums. A surface model of the left atrium of the phantom was deformed by a morphological operation – simulating the shape difference caused by organ deformation between pre-operative scanning and intra-operative guidance. During the simulated procedure, a tracked ultrasound catheter was inserted into right atrial phantom – scanning the left atrial phantom in a manner mimicking the cardiac ablation procedure. By merging the preoperative model and the intraoperative ultrasound images, an intraoperative left atrial model was reconstructed. According to results, the reconstruction error of the modeling method is smaller than the initial geometric difference caused by organ deformation. As the area of the left atrial phantom scanned by ultrasound increases, the reconstruction error of the intraoperative surface model decreases. The study validated the efficacy of the modeling method. PMID:26405371

  11. Effects of Armodafinil on Simulated Driving and Self-Report Measures in Obstructive Sleep Apnea Patients prior to Treatment with Continuous Positive Airway Pressure

    PubMed Central

    Kay, Gary G.; Feldman, Neil

    2013-01-01

    Study Objectives: Obstructive sleep apnea (OSA) has been associated with an increased risk of motor vehicle crashes. This driving risk can be reduced (≥ 50%) by treatment with continuous positive airway pressure (CPAP). However residual excessive daytime sleepiness (EDS) can persist for some patients who regularly use CPAP. The current study was designed to assess the effect of armodafinil on simulated driving performance and subsequent CPAP treatment compliance in newly diagnosed OSA patients with EDS during a 2-week “waiting period” prior to initiation of CPAP. Methods: Sixty-nine newly diagnosed OSA patients, awaiting CPAP therapy, were randomized (1:1) to placebo or armodafinil (150 mg/day) treatment. Simulated driving tests and self-report measures were completed at baseline, after 2 weeks of drug treatment, and following 6 weeks of CPAP treatment. CPAP compliance was evaluated at the end of 6 weeks of CPAP. Results: Compared to placebo, armodafinil improved simulated driving safety performance in OSA patients awaiting CPAP therapy (p = 0.03). Improvement was seen in lane position deviation (p = 0.002) and number of lane excursions (p = 0.02). Improvement was also observed on measures of sleepiness using the Epworth Sleepiness Scale (ESS) and sleep related quality of life. Following 6 weeks of CPAP, there was also significant improvement observed on multiple measures of simulated driving performance. CPAP compliance did not differ between armodafinil-treated and placebo-treated patients (p = 0.80). Conclusions: Armodafinil was found to improve simulated driving performance in OSA patients with EDS prior to initiation of CPAP. Treatment with armodafinil showed no effect on subsequent CPAP compliance. Citation: Kay GG; Feldman N. Effects of armodafinil on simulated driving and self-report measures in obstructive sleep apnea patients prior to treatment with continuous positive airway pressure. J Clin Sleep Med 2013;9(5):445-454. PMID:23674935

  12. Evaluation of ocular movements in patients with dyslexia.

    PubMed

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

    2015-04-01

    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 examinations, and eye movement analysis, specifically, stability analysis on fixating a still target, tracking saccades, analysis of fixation pauses, speed reading, saccades, and regressions through the reading of a text. Stability analysis on fixating a still target showed a significant (p < 0.001) difference between the two groups showing an increased amount of loss of fixation among dyslexic subjects (5.36 ± 2.5 s and 0.82 ± 2.1, respectively). Tracking saccades (left and right horizontal axis) did not show a significant difference. When reading parameters were looked into (number of saccades, number of regressions, reading time through the reading of a text), a significant (p < 0.001) difference was found between the groups. This study supports the belief that the alteration of eye movement does not depend on oculo-motor dysfunction but is secondary to a defect in the visual processing of linguistic material. Inclusion of assessment of this defect might prove beneficial in determining the presence of dyslexia in young children at a younger age, and an earlier intervention could be initiated. PMID:25804764

  13. Physical methods for evaluating the nutrition status of hemodialysis patients.

    PubMed

    Marcelli, Daniele; Wabel, Peter; Wieskotten, Sebastian; Ciotola, Annalisa; Grassmann, Aileen; Di Benedetto, Attilio; Canaud, Bernard

    2015-10-01

    This article aims to provide an overview of the different nutritional markers and the available methodologies for the physical assessment of nutrition status in hemodialysis patients, with special emphasis on early detection of protein energy wasting (PEW). Nutrition status assessment is made on the basis of anamnesis, physical examination, evaluation of nutrient intake, and on a selection of various screening/diagnostic methodologies. These methodologies can be subjective, e.g. the Subjective Global Assessment score (SGA), or objective in nature (e.g. bioimpedance analysis). In addition, certain biochemical tests may be employed (e.g. albumin, pre-albumin). The various subjective-based and objective methodologies provide different insights for the assessment of PEW, particularly regarding their propensity to differentiate between the important body composition compartments-fluid overload, fat mass and muscle mass. This review of currently available methods showed that no single approach and no single marker is able to detect alterations in nutrition status in a timely fashion and to follow such changes over time. The most clinically relevant approach presently appears to be the combination of the SGA method with the bioimpedance spectroscopy technique with physiological model and, additionally, laboratory tests for the detection of micro-nutrient deficiency. PMID:25791209

  14. Medical simulation is needed in anesthesia training to achieve patient's safety

    PubMed Central

    2013-01-01

    Many medical schools and hospitals throughout the world are equipped with a simulation center for the purpose of training anesthesiologists to perform both technical and non-technical skills. Because induction, maintenance, and emergence of general anesthesia are critical to patient welfare, various simulation mannequins and tools are utilized for the purpose of training anesthesiologists for safer patient care. Traditionally, anesthesia residency training mostly consisted of didactic lectures and observations. After completion of "traditional" training, anesthesia residents were allowed to perform procedures on patients under supervision. However, simulation would be a more effective training tool for which to teach anesthesiologists the skills necessary to perform invasive procedures, such as endotracheal intubation, central venous catheter insertion, and epidural catheter insertion. Recently, non-technical skills, such as the Anesthesia Non-Technical Skills developed by anesthesiologists from Aberdeen University, have been emphasized as an important training resource. Technical skills and non-technical skills can be learned by anesthesiology residents through a standardized and organized simulation program. Such programs would be beneficial in training anesthesia residents to work efficiently as a team in the operation room. PMID:23560184

  15. Evaluating North America Paleoclimate Simulations for 6 ka and 21 ka Using a Combination of Observed Paleovegetation Data and Process-Based Vegetation Model Simulations

    NASA Astrophysics Data System (ADS)

    Shafer, S. L.; Bartlein, P. J.

    2015-12-01

    Paleoclimate model simulations are often evaluated using observed paleovegetation data (e.g., pollen and plant macrofossils) that record vegetation responses to past climate changes. These observed vegetation data can be combined with mechanistic vegetation model simulations to develop process-based evaluations of paleoclimate model simulations. The use of mechanistic vegetation model simulations allows us to identify the particular spatial and temporal features of individual paleoclimate simulations that may be producing agreement or disagreement between the observed and simulated vegetation data. We used this approach to evaluate a set of eight PMIP3 (Paleoclimate Modelling Intercomparison Project phase 3) paleoclimate simulations for 6 ka and 21 ka from the CMIP5 (Coupled Model Intercomparison Project phase 5) database. Climate data were regridded onto a 10-km grid of North America using the PMIP3 vegetation simulation protocol. The regridded climate data were used as input to BIOME4, an equilibrium vegetation model, to simulate 6 ka and 21 ka biomes across the study area. The simulated biome data were compared with observed paleovegetation data from the BIOME 6000 (version 4.2) dataset. In general, agreement between simulated and observed biomes was greater for forest biomes than for non-forest biomes. We evaluated specific instances of disagreement between the simulated and observed biomes to determine whether the biome disagreement was produced by the climate model simulation (e.g., temperature bias), the vegetation model simulation (e.g., inability to simulate important disturbance regimes), the observed paleovegetation data (e.g., limits in the biomization method), or a combination of these factors. The results are summarized and we describe some of the strengths and limitations of this data-model comparison approach for evaluating paleoclimate simulations.

  16. Wind Evaluation Breadboard: mechanical design and analysis, control architecture, dynamic model, and performance simulation

    NASA Astrophysics Data System (ADS)

    Reyes García-Talavera, Marcos; Viera, Teodora; Núñez, Miguel; Zuluaga, Pablo; Ronquillo, Bernardo; Ronquillo, Mariano; Brunetto, Enzo; Quattri, Marco; Castro, Javier; Hernández, Elvio

    2008-07-01

    The Wind Evaluation Breadboard (WEB) for the European Extremely Large Telescope (ELT) is a primary mirror and telescope simulator formed by seven segments simulators, including position sensors, electromechanical support systems and support structures. The purpose of the WEB is to evaluate the performance of the control of wind buffeting disturbance on ELT segmented mirrors using an electro-mechanical set-up which simulates the real operational constrains applied to large segmented mirrors. The instrument has been designed and developed by IAC, ALTRAN, JUPASA and ESO, with FOGALE responsible of the Edge Sensors, and TNO of the Position Actuators. This paper describes the mechanical design and analysis, the control architecture, the dynamic model generated based on the Finite Element Model and the close loop performance achieved in simulations. A comparison in control performance between segments modal control and actuators local control is also presented.

  17. Application of artificial neural network in simulating subjective evaluation of tumor segmentation

    NASA Astrophysics Data System (ADS)

    Lv, Dongjiao; Deng, Xiang

    2011-03-01

    Systematic validation of tumor segmentation technique is very important in ensuring the accuracy and reproducibility of tumor segmentation algorithm in clinical applications. In this paper, we present a new method for evaluating 3D tumor segmentation using Artificial Neural Network (ANN) and combined objective metrics. In our evaluation method, a three-layer feed-forwarding backpropagation ANN is first trained to simulate radiologist's subjective rating using a set of objective metrics. The trained neural network is then used to evaluate the tumor segmentation on a five-point scale in a way similar to expert's evaluation. The accuracy of segmentation evaluation is quantified using average correct rank and frequency of the reference rating in the top ranks of simulated score list. Experimental results from 93 lesions showed that our evaluation method performs better than individual metrics. The optimal combination of metrics from normalized volume difference, volume overlap, Root Mean Square symmetric surface distance and maximum symmetric surface distance showed the smallest average correct rank (1.43) and highest frequency of the reference rating in the top two places of simulated rating list (93.55%). Our results also demonstrate that the ANN based non-linear combination method showed better evaluation accuracy than linear combination method in all performance measures. Our evaluation technique has the potential to facilitate large scale segmentation validation study by predicting radiologists rating, and to assist development of new tumor segmentation algorithms. It can also be extended to validation of segmentation algorithms for other applications.

  18. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers

    PubMed Central

    Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-01-01

    Objective To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. Design An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. Results The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. Conclusions The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols. PMID:21486883

  19. Path selection system simulation and evaluation for a Martian roving vehicle

    NASA Technical Reports Server (NTRS)

    Frederick, D. K.

    1975-01-01

    A comprehensive digital computer simulation program has been developed for evaluating the path-selection system performance of an autonomous roving vehicle being designed for the exploration of Mars. Vehicle performance over realistic three-dimensional terrains in the presence of random motion disturbances and sensor measurement noise is simulated and plotted on a terrain contour map. In addition, a numerical figure-of-merit is computed automatically for each run.

  20. In vivo evaluating skin doses for lung cancer patients undergoing volumetric modulated arc therapy treatment.

    PubMed

    Tseng, Hsien-Chun; Pan, Lung-Kang; Chen, Hsin-Yu; Liu, Wen-Shan; Hsu, Chang-Chieh; Chen, Chien-Yi

    2015-01-01

    This study is the first to use 10- to 90-kg tissue-equivalent phantoms as patient surrogates to measure peripheral skin doses (Dskin) in lung cancer treatment through Volumetric Modulated Arc Therapy of the Axesse linac. Five tissue-equivalent and Rando phantoms were used to simulate lung cancer patients using the thermoluminescent dosimetry (TLD-100H) approach. TLD-100H was calibrated using 6 MV photons coming from the Axesse linac. Then it was inserted into phantom positions that closely corresponded with the position of the represented organs and tissues. TLDs were measured using the Harshaw 3500 TLD reader. The ICRP 60 evaluated the mean Dskin to the lung cancer for 1 fraction (7 Gy) undergoing VMAT. The Dskin of these phantoms ranged from 0.51±0.08 (10-kg) to 0.22±0.03 (90-kg) mSv/Gy. Each experiment examined the relationship between the Dskin and the distance from the treatment field. These revealed strong variations in positions close to the tumor center. The correlation between Dskin and body weight was Dskin (mSv) = -0.0034x + 0.5296, where x was phantom's weight in kg. R2 is equal to 0.9788. This equation can be used to derive an equation for lung cancer in males. Finally, the results are compared to other published research. These findings are pertinent to patients, physicians, radiologists, and the public. PMID:26405934

  1. Assessing the Reliability of Simulation Evaluation Instruments Used in Nursing Education: A Test of Concept Study

    ERIC Educational Resources Information Center

    Adamson, Katie Anne

    2011-01-01

    Human patient simulation (HPS) provides experiential learning opportunities for student nurses and may be used as a supplement or alternative to traditional clinical education. The body of evidence supporting HPS as a teaching strategy is growing. However, challenges associated with measuring student learning and performance in HPS activities…

  2. Development and evaluation of a general aviation real world noise simulator

    NASA Technical Reports Server (NTRS)

    Galanter, E.; Popper, R.

    1980-01-01

    An acoustic playback system is described which realistically simulates the sounds experienced by the pilot of a general aviation aircraft during engine idle, take-off, climb, cruise, descent, and landing. The physical parameters of the signal as they appear in the simulator environment are compared to analogous parameters derived from signals recorded during actual flight operations. The acoustic parameters of the simulated and real signals during cruise conditions are within plus or minus two dB in third octave bands from 0.04 to 4 kHz. The overall A-weighted levels of the signals are within one dB of signals generated in the actual aircraft during equivalent maneuvers. Psychoacoustic evaluations of the simulator signal are compared with similar measurements based on transcriptions of actual aircraft signals. The subjective judgments made by human observers support the conclusion that the simulated sound closely approximates transcribed sounds of real aircraft.

  3. Development and evaluation of a general aviation real world noise simulator

    NASA Astrophysics Data System (ADS)

    Galanter, E.; Popper, R.

    1980-03-01

    An acoustic playback system is described which realistically simulates the sounds experienced by the pilot of a general aviation aircraft during engine idle, take-off, climb, cruise, descent, and landing. The physical parameters of the signal as they appear in the simulator environment are compared to analogous parameters derived from signals recorded during actual flight operations. The acoustic parameters of the simulated and real signals during cruise conditions are within plus or minus two dB in third octave bands from 0.04 to 4 kHz. The overall A-weighted levels of the signals are within one dB of signals generated in the actual aircraft during equivalent maneuvers. Psychoacoustic evaluations of the simulator signal are compared with similar measurements based on transcriptions of actual aircraft signals. The subjective judgments made by human observers support the conclusion that the simulated sound closely approximates transcribed sounds of real aircraft.

  4. Evaluating the impact of distance measures on deforestation simulations in the fluvial landscapes of amazonia.

    PubMed

    Salonen, Maria; Maeda, Eduardo Eiji; Toivonen, Tuuli

    2014-10-01

    Land use and land cover change (LUCC) models frequently employ different accessibility measures as a proxy for human influence on land change processes. Here, we simulate deforestation in Peruvian Amazonia and evaluate different accessibility measures as LUCC model inputs. We demonstrate how the selection, and different combinations, of accessibility measures impact simulation results. Out of the individual measures, time distance to market center catches the essential aspects of accessibility in our study area. The most accurate simulation is achieved when time distance to market center is used in association with distance to transport network and additional landscape variables. Although traditional Euclidean measures result in clearly lower simulation accuracy when used separately, the combination of two complementary Euclidean measures enhances simulation accuracy significantly. Our results highlight the need for site and context sensitive selection of accessibility variables. More sophisticated accessibility measures can potentially improve LUCC models' spatial accuracy, which often remains low. PMID:24165869

  5. Collaborative learning in nursing simulation: near-peer teaching using standardized patients.

    PubMed

    Owen, Amy M; Ward-Smith, Peggy

    2014-03-01

    Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment. PMID:24530131

  6. Integration and evaluation of a simulator designed to be used within a dynamic prototyping environment

    NASA Technical Reports Server (NTRS)

    Moore, Loretta A.

    1993-01-01

    The human computer interface (HCI) prototyping environment is designed to allow developers to rapidly prototype systems so that the interface and functionality of a system can be evaluated and iteratively refined early in the development process. This keeps development costs down by modifying the interface during the requirements definition phase, thus minimizing changes that need to be made during and after flight code development. Problems occur within a system when the user interface is not adequately developed and when designers and developers have an incomplete understanding of the system requirements. A process has been developed for prototyping on-board payload displays for Space Station Freedom. This prototyping process consists of five phases: identification of known requirements, analysis of the requirements, development of a formal design representation and specification, development of the prototype, and evaluation of the prototype. The actual development of the prototype involves prototyping the displays, developing a low fidelity simulator, building of an interface (or communication) between the displays and the simulator, integration of these components, and testing to ensure that the interface does what the developer expects. This research integrates and evaluates a software tool which has been developed to serve as a simulator within the prototyping environment. The tool is being evaluated to determine whether or not it meets the basic requirements which are needed for a low fidelity simulator within this environment. In order to evaluate the architecture and its components, a human computer interface for and a simulator of an automobile have been developed as a prototype. The individual components (i.e., the interface and simulator) have been developed, and the current research was designed to integrate and test the complete working system within the prototyping environment. The following sections will describe the architecture and components of

  7. Computer simulation of microgravity long-term effects and risk evaluation

    NASA Astrophysics Data System (ADS)

    Perez-Poch, Antoni

    The objective of this work is to analyse and simulate possible long-term effects of microgravity on the human pulmonary function. It is also studied the efficacy of long-term regular exercise on relevant cardiovascular parameters when the human body is also exposed to microgravity. Little is known today about what long-term effects microgravity may cause on pulmonary function. It does not exist a complete explanation of the possible risks involved, although some experiments are under way on the ISS in order to evaluate them. Computer simulations are an important tool which may be used to predict and analyse these possible effects, and compare them with in-flight experiments. We based our study on a previous computer model (NELME: Numerical Evaluation of Long-term Microgravity Effects) which was developed in our laboratory and validated with the available data, focusing on the cardiovascular parameters affected by changes in gravity exposure. In this previous work we simulated part of the cardiovascular systems and we applied it to evaluate risks of blood-forming organs malfunction. NELME is based on an electrical-like control system model of the physiological changes, that may occur when gravity changes are applied. The computer implementation has a modular architecture. Hence, different output parameters, potential effects, organs and countermeasures can be easily implemented and evaluated. In this work we added a module to the system to analyse the pulmonary function with a gravity input parameter, as well as exposure time. We then conducted a battery of simulations when different values of g are applied for long-term exposures. We found no significant evidence of changes and no risks were foreseen. We also carried out an EVA simulation as a perturbation in the system (intense exercise, changes in breathed air) and studied the acute response. This is of great importance as current mission requirements do not allow data collection immediately following real EVAs

  8. Evaluation of the effects of solar radiation on glass. [space environment simulation

    NASA Technical Reports Server (NTRS)

    Firestone, R. F.; Harada, Y.

    1979-01-01

    The degradation of glass used on space structures due to electromagnetic and particulate radiation in a space environment was evaluated. The space environment was defined and a simulated space exposure apparatus was constructed. Four optical materials were exposed to simulated solar and particulate radiation in a space environment. Sapphire and fused silica experienced little change in transmittance, while optical crown glass and ultra low expansion glass darkened appreciably. Specimen selection and preparation, exposure conditions, and the effect of simulated exposure are discussed. A selective bibliography of the effect of radiation on glass is included.

  9. Coupling Photon Monte Carlo Simulation and CAD Software. Application to X-ray Nondestructive Evaluation

    NASA Astrophysics Data System (ADS)

    Tabary, J.; Glière, A.

    A Monte Carlo radiation transport simulation program, EGS Nova, and a Computer Aided Design software, BRL-CAD, have been coupled within the framework of Sindbad, a Nondestructive Evaluation (NDE) simulation system. In its current status, the program is very valuable in a NDE laboratory context, as it helps simulate the images due to the uncollided and scattered photon fluxes in a single NDE software environment, without having to switch to a Monte Carlo code parameters set. Numerical validations show a good agreement with EGS4 computed and published data. As the program's major drawback is the execution time, computational efficiency improvements are foreseen.

  10. A graphical workstation based part-task flight simulator for preliminary rapid evaluation of advanced displays

    NASA Technical Reports Server (NTRS)

    Wanke, Craig; Kuchar, James; Hahn, Edward; Pritchett, Amy; Hansman, R. J.

    1992-01-01

    Advances in avionics and display technology are significantly changing the cockpit environment in current transport aircraft. The MIT Aeronautical Systems Lab (ASL) has developed a part-task flight simulator specifically to study the effects of these new technologies on flight crew situational awareness and performance. The simulator is based on a commercially-available graphics workstation, and can be rapidly reconfigured to meet the varying demands of experimental studies. The simulator has been successfully used to evaluate graphical microburst alerting displays, electronic instrument approach plates, terrain awareness and alerting displays, and ATC routing amendment delivery through digital datalinks.

  11. A graphical workstation based part-task flight simulator for preliminary rapid evaluation of advanced displays

    NASA Technical Reports Server (NTRS)

    Wanke, Craig; Kuchar, James; Hahn, Edward; Pritchett, A.; Hansman, R. John

    1994-01-01

    Advances in avionics and display technology are significantly changing the cockpit environment in current transport aircraft. The MIT Aeronautical Systems Lab (ASL) developed a part-task flight simulator specifically to study the effects of these new technologies on flight crew situational awareness and performance. The simulator is based on a commercially-available graphics workstation, and can be rapidly reconfigured to meet the varying demands of experimental studies. The simulator was successfully used to evaluate graphical microbursts alerting displays, electronic instrument approach plates, terrain awareness and alerting displays, and ATC routing amendment delivery through digital datalinks.

  12. Evaluation and operationalization of a novel forest detrainment modeling approach for computational snow avalanche simulation

    NASA Astrophysics Data System (ADS)

    Teich, M.; Feistl, T.; Fischer, J.; Bartelt, P.; Bebi, P.; Christen, M.; Grêt-Regamey, A.

    2013-12-01

    Two-dimensional avalanche simulation software operating in three-dimensional terrain are widely used for hazard zoning and engineering to predict runout distances and impact pressures of snow avalanche events. Mountain forests are an effective biological protection measure; however, the protective capacity of forests to decelerate or even to stop avalanches that start within forested areas or directly above the treeline is seldom considered in this context. In particular, runout distances of small- to medium-scale avalanches are strongly influenced by the structural conditions of forests in the avalanche path. This varying decelerating effect has rarely been addressed or implemented in avalanche simulation. We present an evaluation and operationalization of a novel forest detrainment modeling approach implemented in the avalanche simulation software RAMMS. The new approach accounts for the effect of forests in the avalanche path by detraining mass, which leads to a deceleration and runout shortening of avalanches. The extracted avalanche mass caught behind trees stops immediately and, therefore, is instantly subtracted from the flow and the momentum of the stopped mass is removed from the total momentum of the avalanche flow. This relationship is parameterized by the empirical detrainment coefficient K [Pa] which accounts for the braking power of different forest types per unit area. To define K dependent on specific forest characteristics, we simulated 40 well-documented small- to medium-scale avalanches which released in and ran through forests with varying K-values. Comparing two-dimensional simulation results with one-dimensional field observations for a high number of avalanche events and simulations manually is however time consuming and rather subjective. In order to process simulation results in a comprehensive and standardized way, we used a recently developed automatic evaluation and comparison method defining runout distances based on a pressure

  13. Clinical simulation: A method for development and evaluation of clinical information systems.

    PubMed

    Jensen, Sanne; Kushniruk, Andre W; Nøhr, Christian

    2015-04-01

    Use of clinical simulation in the design and evaluation of eHealth systems and applications has increased during the last decade. This paper describes a methodological approach for using clinical simulations in the design and evaluation of clinical information systems. The method is based on experiences from more than 20 clinical simulation studies conducted at the ITX-lab in the Capital Region of Denmark during the last 5 years. A ten-step approach to conducting simulations is presented in this paper. To illustrate the approach, a clinical simulation study concerning implementation of Digital Clinical Practice Guidelines in a prototype planning and coordination module is presented. In the case study potential benefits were assessed in a full-scale simulation test including 18 health care professionals. The results showed that health care professionals can benefit from such a module. Unintended consequences concerning terminology and changes in the division of responsibility amongst healthcare professionals were also identified, and questions were raised concerning future workflow across sector borders. Furthermore unexpected new possible benefits concerning improved communication, content of information in discharge letters and quality management emerged during the testing. In addition new potential groups of users were identified. The case study is used to demonstrate the potential of using the clinical simulation approach described in the paper. PMID:25684129

  14. Evaluating historical simulations of CMIP5 GCMs for key climatic variables in Zhejiang Province, China

    NASA Astrophysics Data System (ADS)

    Xuan, Weidong; Ma, Chong; Kang, Lili; Gu, Haiting; Pan, Suli; Xu, Yue-Ping

    2015-12-01

    Assessing the regional impact of climate change on agriculture, hydrology, and forests is vital for sustainable management. Trustworthy projections of climate change are needed to support these assessments. In this paper, 18 global climate models (GCMs) from the fifth phase of the Coupled Model Intercomparison Project (CMIP5) are evaluated for their ability to simulate regional climate change in Zhejiang Province, Southeast China. Simple graphical approaches and three indices are used to evaluate the performance of six key climatic variables during simulations from 1971 to 2000. These variables include maximum and minimum air temperature, precipitation, wind speed, solar radiation, and relative humidity. These variables are of great importance to researchers and decision makers in climate change impact studies and developing adaptation strategies. This study found that most GCMs failed to reproduce the observed spatial patterns, due to insufficient resolution. However, the seasonal variations of the six variables are simulated well by most GCMs. Maximum and minimum air temperatures are simulated well on monthly, seasonal, and yearly scales. Solar radiation is reasonably simulated on monthly, seasonal, and yearly scales. Compared to air temperature and solar radiation, it was found that precipitation, wind speed, and relative humidity can only be simulated well at seasonal and yearly scales. Wind speed was the variable with the poorest simulation results across all GCMs.

  15. Engaging patients through open notes: an evaluation using mixed methods

    PubMed Central

    Esch, Tobias; Mejilla, Roanne; Anselmo, Melissa; Podtschaske, Beatrice; Delbanco, Tom; Walker, Jan

    2016-01-01

    Objectives (A) To gain insights into the experiences of patients invited to view their doctors’ visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes. Design Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks. Setting Greater Boston, USA. Participants Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23–88 years). In addition, 13 patients (9 female, 4 male; 58–87 years) were interviewed. Results Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits. Conclusions As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient

  16. Implementation and Evaluation of Multiple Adaptive Control Technologies for a Generic Transport Aircraft Simulation

    NASA Technical Reports Server (NTRS)

    Campbell, Stefan F.; Kaneshige, John T.; Nguyen, Nhan T.; Krishakumar, Kalmanje S.

    2010-01-01

    Presented here is the evaluation of multiple adaptive control technologies for a generic transport aircraft simulation. For this study, seven model reference adaptive control (MRAC) based technologies were considered. Each technology was integrated into an identical dynamic-inversion control architecture and tuned using a methodology based on metrics and specific design requirements. Simulation tests were then performed to evaluate each technology s sensitivity to time-delay, flight condition, model uncertainty, and artificially induced cross-coupling. The resulting robustness and performance characteristics were used to identify potential strengths, weaknesses, and integration challenges of the individual adaptive control technologies

  17. Evaluation of Cost Leadership Strategy in Shipping Enterprises with Simulation Model

    NASA Astrophysics Data System (ADS)

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

    2009-08-01

    The present study will attempt the evaluation of cost leadership strategy that prevails in certain shipping enterprises and the creation of simulation models based on strategic model STAIR. The above model is an alternative method of strategic applications evaluation. This is held in order to be realised if the strategy of cost leadership creates competitive advantage [1] and this will be achieved via the technical simulation which appreciates the interactions between the operations of an enterprise and the decision-making strategy in conditions of uncertainty with reduction of undertaken risk.

  18. Monte Carlo simulation of a prototypical patient dosimetry system for fluoroscopic procedures

    NASA Astrophysics Data System (ADS)

    Goertz, Lukas; Tsiamas, Panagiotis; Karellas, Andrew; Sajo, Erno; Zygmanski, Piotr

    2015-08-01

    The purpose of this study is to investigate feasibility of a novel real-time dosimetry method for fluoroscopically guided interventions utilizing thin-film detector arrays in several potential locations with respect to the patient and x-ray equipment. We employed Monte Carlo (MC) simulation to establish the fluoroscopic beam model to determine dosimetric quantities directly from measured doses in thin-film detector arrays at three positions: A—attached to the x-ray source, B—on the couch under the patient and C—attached to the fluoroscopic imager. Next, we developed a calibration method to determine skin dose at the entry of the beam ({{D}\\text{entr}} ) as well as the dose distribution along each ray of the beam in a water-equivalent patient model. We utilized the concept of water-equivalent thickness to determine the dose inside the patient based on doses measured outside of the patient by the thin-film detector array layers: (a) A, (b) B, or (c) B and C. In the process of calibration we determined a correction factor that characterizes the material-specific response of the detector, backscatter factor and attenuation factor for slab water phantoms of various thicknesses. Application of this method to an anthropomorphic phantom showed accuracy of about 1% for {{D}\\text{entr}} and up to about 10% for integral dose along the beam path when compared to a direct simulation of dose by MC.

  19. Dosimetric investigation of proton therapy on CT-based patient data using Monte Carlo simulation

    NASA Astrophysics Data System (ADS)

    Chongsan, T.; Liamsuwan, T.; Tangboonduangjit, P.

    2016-03-01

    The aim of radiotherapy is to deliver high radiation dose to the tumor with low radiation dose to healthy tissues. Protons have Bragg peaks that give high radiation dose to the tumor but low exit dose or dose tail. Therefore, proton therapy is promising for treating deep- seated tumors and tumors locating close to organs at risk. Moreover, the physical characteristic of protons is suitable for treating cancer in pediatric patients. This work developed a computational platform for calculating proton dose distribution using the Monte Carlo (MC) technique and patient's anatomical data. The studied case is a pediatric patient with a primary brain tumor. PHITS will be used for MC simulation. Therefore, patient-specific CT-DICOM files were converted to the PHITS input. A MATLAB optimization program was developed to create a beam delivery control file for this study. The optimization program requires the proton beam data. All these data were calculated in this work using analytical formulas and the calculation accuracy was tested, before the beam delivery control file is used for MC simulation. This study will be useful for researchers aiming to investigate proton dose distribution in patients but do not have access to proton therapy machines.

  20. Monte Carlo simulation of a prototypical patient dosimetry system for fluoroscopic procedures.

    PubMed

    Goertz, Lukas; Tsiamas, Panagiotis; Karellas, Andrew; Sajo, Erno; Zygmanski, Piotr

    2015-08-01

    The purpose of this study is to investigate feasibility of a novel real-time dosimetry method for fluoroscopically guided interventions utilizing thin-film detector arrays in several potential locations with respect to the patient and x-ray equipment. We employed Monte Carlo (MC) simulation to establish the fluoroscopic beam model to determine dosimetric quantities directly from measured doses in thin-film detector arrays at three positions: A-attached to the x-ray source, B-on the couch under the patient and C-attached to the fluoroscopic imager. Next, we developed a calibration method to determine skin dose at the entry of the beam ([Formula: see text]) as well as the dose distribution along each ray of the beam in a water-equivalent patient model. We utilized the concept of water-equivalent thickness to determine the dose inside the patient based on doses measured outside of the patient by the thin-film detector array layers: (a) A, (b) B, or (c) B and C. In the process of calibration we determined a correction factor that characterizes the material-specific response of the detector, backscatter factor and attenuation factor for slab water phantoms of various thicknesses. Application of this method to an anthropomorphic phantom showed accuracy of about 1% for [Formula: see text] and up to about 10% for integral dose along the beam path when compared to a direct simulation of dose by MC. PMID:26184743

  1. Pharmacological Relevance of Endoxifen in a Laboratory Simulation of Breast Cancer in Postmenopausal Patients

    PubMed Central

    Maximov, Philipp Y.; McDaniel, Russell E.; Fernandes, Daphne J.; Bhatta, Puspanjali; Korostyshevskiy, Valeriy R.; Curpan, Ramona F.

    2014-01-01

    Background Tamoxifen is metabolically activated via a CYP2D6 enzyme system to the more potent hydroxylated derivatives 4-hydroxytamoxifen and endoxifen. This study addresses the pharmacological importance of endoxifen by simulating clinical scenarios in vitro. Methods Clinical levels of tamoxifen metabolites in postmenopausal breast cancer patients previously genotyped for CYP2D6 were used in vitro along with clinical estrogen levels (estrone and estradiol) in postmenopausal patients determined in previous studies. The biological effects on cell growth were evaluated in a panel of estrogen receptor–positive breast cancer cell lines via cell proliferation assays and real-time polymerase chain reaction (PCR). Data were analyzed with one- and two-way analysis of variance and Student’s t test. All statistical tests were two-sided. Results Postmenopausal levels of estrogen-induced proliferation of all test breast cancer cell lines (mean fold induction ± SD vs vehicle control: MCF-7 = 11±1.74, P < .001; T47D = 7.52±0.72, P < .001; BT474 = 1.75±0.23, P < .001; ZR-75-1 = 5.5±1.95, P = .001. Tamoxifen and primary metabolites completely inhibited cell growth regardless of the CYP2D6 genotype in all cell lines (mean fold induction ± SD vs vehicle control: MCF-7 = 1.57±0.38, P = .54; T47D = 1.17±0.23, P = .79; BT474 = 0.96±0.2, P = .98; ZR-75-1 = 0.86±0.67, P = .99). Interestingly, tamoxifen and its primary metabolites were not able to fully inhibit the estrogen-stimulated expression of estrogen-responsive genes in MCF-7 cells (P < .05 for all genes), but the addition of endoxifen was able to produce additional antiestrogenic effect on these genes. Conclusions The results indicate that tamoxifen and other metabolites, excluding endoxifen, completely inhibit estrogen-stimulated growth in all cell lines, but additional antiestrogenic action from endoxifen is necessary for complete blockade of estrogen-stimulated genes. Endoxifen is of supportive importance for the

  2. Preliminary evaluation of a virtual reality dental simulation system on drilling operation.

    PubMed

    Wang, Dangxiao; Zhao, Siming; Li, Teng; Zhang, Yuru; Wang, Xiaoyan

    2015-01-01

    To evaluate the fidelity of the iDental system and investigate its utility and performance on simulated drilling operations, user studies consisting of objective and subjective evaluations were performed. A voxel-based drilling simulation sub-system in the iDental system was employed for evaluation. Twenty participants were enrolled to take part in the experiments and were divided into two groups: novice and resident. A combined evaluation method including objective and subjective methods was employed. The objective evaluation included two dental drilling tasks: caries removal operation and pulp chamber opening operation. In the subjective method, participants were required to complete a questionnaire to evaluate the fidelity of the system after the operation task. Based on the structured global assessment scales in the questionnaire, the average subjective evaluation scores of the proposed metrics were greater than 4.5, demonstrating that the system operated above medium fidelity. Dentists expressed great interest and positive attitudes toward the potential of the iDental system. The objective evaluation data including time spent and the volume of removed healthy and carious tissue were obtained. Although no significant differences could be found between the two groups, the volume of removed caries and the depth of pulp chamber insertion manifested small standard deviations. Evaluation results illustrated that dentists were willing to use the virtual reality training system. Several future research topics were identified, including increasing the task difficulty, improving the system fidelity and introducing appropriate finger rest points. PMID:26406071

  3. Method for the evaluation of stretch blow molding simulations with free blow trials

    NASA Astrophysics Data System (ADS)

    Zimmer, Johannes; Stommel, Markus

    2013-12-01

    Finite-Element (FE) simulations are a valuable tool to support the analysis and optimization of production processes. In order to achieve realistic simulation results, a consistent simulation set-up followed by an evaluation through experiments is crucial. Stretch Blow Molding (SBM) is a commonly applied forming method to produce thin walled bottles. Polyethylene terephthalate (PET) preforms are biaxially stretched into a closed cavity to form a bottle. In this process the thermo-mechanical material behavior during forming greatly influences the performance of the end product and consequently plays a key role for a reliable process simulation. To ensure a realistic material representation in the simulation model, an adequate material model is calibrated with stress-strain curves from biaxial tests. Thin PET-sheets are stretched under defined temperatures and strain rates. These representative experiments include process simplifications regarding geometry, heating and deformation parameters. Therefore, an evaluation step subsequent to the simulation set-up is inevitable. This paper presents a method for extracting temperature dependent stress-strain-curves from experiments close to the production process which enables the crucial evaluation of a process simulation. In the SBM process, the wall thickness distribution of the bottle refers to the preform deformation over time but does not fully define the thermo-mechanical material behavior. In the presented method, PET-preforms receive thermal treatment with Infrared (IR)-heaters from an SBM-machine and are subsequently inflated into free air (free-blow-trial). An IR-camera is used to obtain the temperature distribution on the preform immediately before blowing. Two high speed cameras are synchronized with a pressure sensor to consequently calculate reliable stress-strain curves at any point on the preform surface. These data is finally compared to results from FE-simulations of the free blow trials.

  4. Integrating Soft Set Theory and Fuzzy Linguistic Model to Evaluate the Performance of Training Simulation Systems.

    PubMed

    Chang, Kuei-Hu; Chang, Yung-Chia; Chain, Kai; Chung, Hsiang-Yu

    2016-01-01

    The advancement of high technologies and the arrival of the information age have caused changes to the modern warfare. The military forces of many countries have replaced partially real training drills with training simulation systems to achieve combat readiness. However, considerable types of training simulation systems are used in military settings. In addition, differences in system set up time, functions, the environment, and the competency of system operators, as well as incomplete information have made it difficult to evaluate the performance of training simulation systems. To address the aforementioned problems, this study integrated analytic hierarchy process, soft set theory, and the fuzzy linguistic representation model to evaluate the performance of various training simulation systems. Furthermore, importance-performance analysis was adopted to examine the influence of saving costs and training safety of training simulation systems. The findings of this study are expected to facilitate applying military training simulation systems, avoiding wasting of resources (e.g., low utility and idle time), and providing data for subsequent applications and analysis. To verify the method proposed in this study, the numerical examples of the performance evaluation of training simulation systems were adopted and compared with the numerical results of an AHP and a novel AHP-based ranking technique. The results verified that not only could expert-provided questionnaire information be fully considered to lower the repetition rate of performance ranking, but a two-dimensional graph could also be used to help administrators allocate limited resources, thereby enhancing the investment benefits and training effectiveness of a training simulation system. PMID:27598390

  5. Evaluation of two GCMs in simulating rainfall inter-annual variability over Southern Africa

    NASA Astrophysics Data System (ADS)

    Klutse, Nana Ama Browne; Abiodun, Babatunde J.; Hewitson, Bruce C.; Gutowski, William J.; Tadross, Mark A.

    2016-02-01

    We evaluate the performance of two global circulation models (GCMs) over Southern Africa, as part of the efforts to improve the skill of seasonal forecast from a multi-model ensemble system over the region. The two GCMs evaluated in the study are the Community Atmosphere Model version 3 (CAM3) and the Hadley Centre Atmospheric Model version 3 (HadAM3). The study analyzed 30-year climate simulations from the models and compared the results with those from Climate Research Unit (CRU) and National Center for Environmental Prediction (NCEP) reanalysis dataset. The evaluation focused on how well the models simulate circulation features, seasonal variation of temperature and rainfall, and the inter-annual rainfall and circulations during El Niño Southern Oscillation (ENSO) years. The study also investigated the relationship between the regional rainfall from the models and global sea surface temperature (SST) during the El Niño and La Niña years. The results show that both GCMs simulate the circulation features and the seasonal cycles of rainfall and temperature fairly well. The location and magnitude of maxima and minima in surface temperature, sea level pressure (SLP), and rainfall fields are well reproduced. The maximum error in the simulated temperature fields is about 2 °, 4 mb in SLP and 8 mm/day in rainfall. However, CAM3 shows a major bias in simulating the summer rainfall; it simulates the maximum rainfall along the western part of Southern Africa, instead of the eastern part. The phase of the seasonal cycles is well reproduced, but the amplitude is underestimated over the Western Cape. Both CAM3 and HadAM3 give reasonable simulations of significant relationship between the regional rainfall and SST over the Nino 3.4 region and show that ENSO strongly drives the climate of Southern Africa. Hence, the model simulations could contribute to understanding the climate of the region and improve seasonal forecasts over Southern Africa.

  6. Evaluation of finite-element-based simulation model of photoacoustics in biological tissues

    NASA Astrophysics Data System (ADS)

    Wang, Zhaohui; Ha, Seunghan; Kim, Kang

    2012-03-01

    A finite element (FE)-based simulation model for photoacoustic (PA) has been developed incorporating light propagation, PA signal generation, and sound wave propagation in soft tissues using a commercial FE simulation package, COMSOL Multiphysics. The developed simulation model is evaluated by comparing with other known simulation models such as Monte Carlo method and heat-pressure model. In this in silico simulation, FE model is composed of three parts of 1) homogeneous background soft tissues submerged in water, 2) target tissue inclusion (or PA contrast agents), and 3) short pulsed laser source (pulse length of 5-10 ns). The laser point source is placed right above the tissues submerged in water. This laser source light propagation through the multi-layer tissues using the diffusion equation is compared with Monte Carlo solution. Photoacoustic signal generation by the target tissue inclusion is simulated using bioheat equation for temperature change, and resultant stress and strain. With stress-strain model, the process of the PA signal generation can be simulated further in details step by step to understand and analyze the photothermal properties of the target tissues or PA contrast agents. The created wide-band acoustic pressure (band width > 150 MHz) propagates through the background tissues to the ultrasound detector located at the tissue surface, governed by sound wave equation. Acoustic scattering and absorption in soft tissues also have been considered. Accuracy and computational time of the developed FE-based simulation model of photoacoustics have been quantitatively analyzed.

  7. Evaluation of a watershed model to simulate sediment transport in a small agricultural watershed in Indiana

    USGS Publications Warehouse

    Arihood, L.D.

    1989-01-01

    The streamflow and sediment components of the watershed model, ' Hydrologic Simulation Program-Fortran ', were evaluated using 2 years and 9 months of data from a 2.7-sq mi agricultural watershed in Indiana. Hydrographs of simulated sediment concentration generally have smaller peaks and longer recessions than do hydrographs of measured data. The attenuation of simulated peaks was partly caused by difficulties in designing a representative channel system. Simulated surface runoff during low-intensity rainfall was greater than measured surface runoff; this caused an overestimation of sediment concentration and discharge. Rainfalls of low intensity were mostly absorbed by the soil, but the model predicted that the amount of surface runoff from such storms would be large. The overly large volume of simulated surface runoff transported more sediment than actually occurred. The mean absolute error of mean sediment concentrations during storms is 45% of the measured average concentration. The error resulted from a combination of error in recording streamflow and rainfall, in simulating streamflows, and in simulating sedimentation processes. The largest percent errors are associated with simulated maximum streamflows and average sediment discharges. The root-mean-square errors are 93 and 102% of the measured maximum streamflow and average sediment discharges. (USGS)

  8. Evaluation of snowmelt simulation in the Weather Research and Forecasting model

    NASA Astrophysics Data System (ADS)

    Jin, Jiming; Wen, Lijuan

    2012-05-01

    The objective of this study is to better understand and improve snowmelt simulations in the advanced Weather Research and Forecasting (WRF) model by coupling it with the Community Land Model (CLM) Version 3.5. Both WRF and CLM are developed by the National Center for Atmospheric Research. The automated Snow Telemetry (SNOTEL) station data over the Columbia River Basin in the northwestern United States are used to evaluate snowmelt simulations generated with the coupled WRF-CLM model. These SNOTEL data include snow water equivalent (SWE), precipitation, and temperature. The simulations cover the period of March through June 2002 and focus mostly on the snowmelt season. Initial results show that when compared to observations, WRF-CLM significantly improves the simulations of SWE, which is underestimated when the release version of WRF is coupled with the Noah and Rapid Update Cycle (RUC) land surface schemes, in which snow physics is oversimplified. Further analysis shows that more realistic snow surface energy allocation in CLM is an important process that results in improved snowmelt simulations when compared to that in Noah and RUC. Additional simulations with WRF-CLM at different horizontal spatial resolutions indicate that accurate description of topography is also vital to SWE simulations. WRF-CLM at 10 km resolution produces the most realistic SWE simulations when compared to those produced with coarser spatial resolutions in which SWE is remarkably underestimated. The coupled WRF-CLM provides an important tool for research and forecasts in weather, climate, and water resources at regional scales.

  9. Evaluation of Regional Climate Simulations over the Great Lakes Region Driven by Three Global Data Sets

    SciTech Connect

    Zhong, Shiyuan; Li, Xiuping; Bian, Xindi; Heilman, Warren E.; Leung, Lai-Yung R.; Gustafson, William I.

    2012-06-27

    The performance of regional climate simulations is evaluated for the Great Lakes region. Three 10-year (1990–1999) current-climate simulations are performed using the MM5 regional climate model (RCM) with 36-km horizontal resolution. The simulations employed identical configuration and physical parameterizations, but different lateral boundary conditions and sea-surface temperatures derived from the NCEP Global Reanalysis and output from the CCSM3 and GISS general circulation models (GCMs). The simulation results are compared to the North American Regional Reanalysis (NARR). The three RCM simulations appeared to be more accurate in winter and least accurate in summer, and more accurate aloft than near the surface. The reanalysis-constrained simulation adequately captured the spatial distribution and seasonal cycle of the observed surface-air temperature and precipitation, but it produced consistently across all seasons a cold bias that is generally larger over the lakes than over land and a wet bias due to an overestimation of nonconvective precipitation. The simulated seasonal cycle of moisture–flux convergence over the region was in very good agreement with NARR. The two GCM-driven runs adequately simulated the spatial and seasonal variation of temperature, but overestimated cold-season precipitation and underestimated summer precipitation, reversing the observed annual precipitation cycle. The GISS-driven run failed to simulate the prevailing low-level flow and moisture convergence patterns. All three RCM simulations successfully captured the impact of the Great Lakes on the region's climate, especially on winter precipitation, a significant improvement over coarse-resolution GCM simulations over the region.

  10. Using Discrete Event Computer Simulation to Improve Patient Flow in a Ghanaian Acute Care Hospital

    PubMed Central

    Best, Allyson M.; Dixon, Cinnamon A.; Kelton, W. David; Lindsell, Christopher J.

    2014-01-01

    Objectives Crowding and limited resources have increased the strain on acute care facilities and emergency departments (EDs) worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation (DES) is a computer-based tool that can be used to estimate how changes to complex healthcare delivery systems, such as EDs, will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country. Methods We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (e.g. modified staff start times and roles) and resource-additional (e.g. increased staff) operational interventions on patient throughput. Previously captured, de-identified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS). Results The base-case (no change) scenario had a mean LOS of 292 minutes (95% CI 291, 293). In isolation, neither adding staffing, changing staff roles, nor varying shift times affected overall patient LOS. Specifically, adding two registration workers, history takers, and physicians resulted in a 23.8 (95% CI 22.3, 25.3) minute LOS decrease. However, when shift start-times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI 94, 98); and with the simultaneous combination of staff roles (Registration and History-taking) there was an overall mean LOS reduction of 152 minutes (95% CI 150, 154). Conclusions Resource-neutral interventions identified through DES modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. DES offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute

  11. Evaluation of Three Models for Simulating Pesticide Runoff from Irrigated Agricultural Fields.

    PubMed

    Zhang, Xuyang; Goh, Kean S

    2015-11-01

    Three models were evaluated for their accuracy in simulating pesticide runoff at the edge of agricultural fields: Pesticide Root Zone Model (PRZM), Root Zone Water Quality Model (RZWQM), and OpusCZ. Modeling results on runoff volume, sediment erosion, and pesticide loss were compared with measurements taken from field studies. Models were also compared on their theoretical foundations and ease of use. For runoff events generated by sprinkler irrigation and rainfall, all models performed equally well with small errors in simulating water, sediment, and pesticide runoff. The mean absolute percentage errors (MAPEs) were between 3 and 161%. For flood irrigation, OpusCZ simulated runoff and pesticide mass with the highest accuracy, followed by RZWQM and PRZM, likely owning to its unique hydrological algorithm for runoff simulations during flood irrigation. Simulation results from cold model runs by OpusCZ and RZWQM using measured values for model inputs matched closely to the observed values. The MAPE ranged from 28 to 384 and 42 to 168% for OpusCZ and RZWQM, respectively. These satisfactory model outputs showed the models' abilities in mimicking reality. Theoretical evaluations indicated that OpusCZ and RZWQM use mechanistic approaches for hydrology simulation, output data on a subdaily time-step, and were able to simulate management practices and subsurface flow via tile drainage. In contrast, PRZM operates at daily time-step and simulates surface runoff using the USDA Soil Conservation Service's curve number method. Among the three models, OpusCZ and RZWQM were suitable for simulating pesticide runoff in semiarid areas where agriculture is heavily dependent on irrigation. PMID:26641333

  12. Evaluation of simulated photochemical partitioning of oxidized nitrogen in the upper troposphere

    NASA Astrophysics Data System (ADS)

    Henderson, B. H.; Pinder, R. W.; Crooks, J.; Cohen, R. C.; Hutzell, W. T.; Sarwar, G.; Goliff, W. S.; Stockwell, W. R.; Fahr, A.; Mathur, R.; Carlton, A. G.; Vizuete, W.

    2010-08-01

    Regional and global chemical transport models underpredict NOx (NO+NO2) in the upper troposphere where it is a precursor to the greenhouse gas ozone. The NOx bias been shown in model evaluations using aircraft data (Singh et al., 2007) and total column NO2 (molecules cm-2) from satellite observations (Napelenok et al., 2008). The causes of NOx underpredictions have yet to be fully understood due to the interconnected nature of simulated emission, transport, and chemistry processes. Recent observation-based studies suggest that, in the upper troposphere, simulated chemistry overpredicts hydrogen radicals (OH• and HO2•) and would convert NOx to HNO3 too quickly (Olson et al., 2006; Bertram et al., 2007; Ren et al., 2008). Since typical chemistry evaluation techniques are not available for upper tropospheric conditions, this study develops an evaluation platform from in situ observations, stochastic convection, and deterministic chemistry. We derive a stochastic convection model and optimize it using two simulated datasets of time since convection, one based on meteorology and the other on chemistry. The chemistry surrogate for time since convection is calculated using seven different chemical mechanisms, all of which predict shorter time since convection than our meteorological analysis. We evaluate chemical simulations by inter-comparison and by pairing results with observations based on NOx:HNO3, a photochemical aging indicator. Inter-comparison reveals individual chemical mechanism biases and recommended updates. Evaluation against observations shows that all chemical mechanisms overpredict NOx removal relative to long-lived methanol and carbon monoxide. All chemical mechanisms underpredict observed NOx by at least 30%, and further evaluation is necessary to refine simulation sensitivities to initial conditions and chemical rate uncertainties.

  13. The syndrome of fixed dystonia: an evaluation of 103 patients.

    PubMed

    Schrag, Anette; Trimble, Michael; Quinn, Niall; Bhatia, Kailash

    2004-10-01

    We describe the clinical features of 103 patients presenting with fixed dystonia and report the prospective assessment and investigation of 41 of them. Most patients were female (84%) and had a young age of onset [mean 29.7 (SD 13.1) years]. A peripheral injury preceded onset in 63% and spread of dystonia to other body regions occurred in 56%. After an average follow-up of 3.3 years (overall disease duration 8.6 years), partial (19%) or complete (8%) remission had occurred in a minority of patients. The fixed postures affected predominantly the limbs (90%), and rarely the neck/shoulder region (6%) or jaw (4%). In the prospectively studied group, pain was present in most patients and was a major complaint in 41%. Twenty percent of patients fulfilled criteria for Complex Regional Pain Syndrome (CRPS). No consistent investigational abnormalities were found and no patient tested (n = 25) had a mutation in the DYT1 gene. Thirty-seven percent of patients fulfilled classification criteria for documented or clinically established psychogenic dystonia; 29% fulfilled DSM-IV (Diagnostic and statistical manual of mental disorders, 4th edition) criteria for somatization disorder, which was diagnosed only after examination of the primary care records in many cases; and 24% fulfilled both sets of criteria. Ten percent of the prospectively studied and 45% of the retrospectively studied patients did not have any evidence of psychogenic dystonia, and detailed investigation failed to reveal an alternative explanation for their clinical presentation. Detailed, semi-structured neuropsychiatric assessments in a subgroup of 26 patients with fixed dystonia and in a control group of 20 patients with classical dystonia revealed dissociative (42 versus 0%, P = 0.001) and affective disorders (85 versus 50%, P = 0.01) significantly more commonly in the fixed dystonia group. Medical and surgical treatment was largely unsuccessful. However, seven patients who underwent multidisciplinary

  14. Missile airframe simulation testbed: MANPADS (MAST-M) for test and evaluation of aircraft survivability equipment

    NASA Astrophysics Data System (ADS)

    Clements, Jim; Robinson, Richard; Bunt, Leslie; Robinson, Joe

    2011-06-01

    A number of techniques have been utilized to evaluate the performance of Aircraft Survivability Equipment (ASE) against threat Man-Portable Air Defense Systems (MANPADS). These techniques include flying actual threat MANPADS against stationary ASE with simulated aircraft signatures, testing installed ASE systems against simulated threat signatures, and laboratory hardware-in-the-loop (HWIL) testing with simulated aircraft and simulated missile signatures. All of these tests lack the realism of evaluating installed ASE against in-flight MANPADS on a terminal homing intercept path toward the actual ASE equipped aircraft. This limitation is due primarily to the current inability to perform non-destructive MANPADS/Aircraft flight testing. The U.S. Army Aviation and Missile Research and Development and Engineering Center (AMRDEC) is working to overcome this limitation with the development of a recoverable surrogate MANPADS missile system capable of engaging aircraft equipped with ASE while guaranteeing collision avoidance with the test aircraft. Under its Missile Airframe Simulation Testbed - MANPADS (MAST-M) program, the AMRDEC is developing a surrogate missile system which will utilize actual threat MANPADS seeker/guidance sections to control the flight of a surrogate missile which will perform a collision avoidance and recovery maneuver prior to intercept to insure non-destructive test and evaluation of the ASE and reuse of the MANPADS seeker/guidance section. The remainder of this paper provides an overview of this development program and intended use.

  15. Information theoretic evaluation of a noiseband-based cochlear implant simulator.

    PubMed

    Aguiar, Daniel E; Taylor, N Ellen; Li, Jing; Gazanfari, Daniel K; Talavage, Thomas M; Laflen, J Brandon; Neuberger, Heidi; Svirsky, Mario A

    2016-03-01

    Noise-band vocoders are often used to simulate the signal processing algorithms used in cochlear implants (CIs), producing acoustic stimuli that may be presented to normal hearing (NH) subjects. Such evaluations may obviate the heterogeneity of CI user populations, achieving greater experimental control than when testing on CI subjects. However, it remains an open question whether advancements in algorithms developed on NH subjects using a simulator will necessarily improve performance in CI users. This study assessed the similarity in vowel identification of CI subjects and NH subjects using an 8-channel noise-band vocoder simulator configured to match input and output frequencies or to mimic output after a basalward shift of input frequencies. Under each stimulus condition, NH subjects performed the task both with and without feedback/training. Similarity of NH subjects to CI users was evaluated using correct identification rates and information theoretic approaches. Feedback/training produced higher rates of correct identification, as expected, but also resulted in error patterns that were closer to those of the CI users. Further evaluation remains necessary to determine how patterns of confusion at the token level are affected by the various parameters in CI simulators, providing insight into how a true CI simulation may be developed to facilitate more rapid prototyping and testing of novel CI signal processing and electrical stimulation strategies. PMID:26409068

  16. Evaluation of Subgrid-Scale Models for Large Eddy Simulation of Compressible Flows

    NASA Technical Reports Server (NTRS)

    Blaisdell, Gregory A.

    1996-01-01

    The objective of this project was to evaluate and develop subgrid-scale (SGS) turbulence models for large eddy simulations (LES) of compressible flows. During the first phase of the project results from LES using the dynamic SGS model were compared to those of direct numerical simulations (DNS) of compressible homogeneous turbulence. The second phase of the project involved implementing the dynamic SGS model in a NASA code for simulating supersonic flow over a flat-plate. The model has been successfully coded and a series of simulations has been completed. One of the major findings of the work is that numerical errors associated with the finite differencing scheme used in the code can overwhelm the SGS model and adversely affect the LES results. Attached to this overview are three submitted papers: 'Evaluation of the Dynamic Model for Simulations of Compressible Decaying Isotropic Turbulence'; 'The effect of the formulation of nonlinear terms on aliasing errors in spectral methods'; and 'Large-Eddy Simulation of a Spatially Evolving Compressible Boundary Layer Flow'.

  17. Evaluating Clouds in Long-Term Cloud-Resolving Model Simulations with Observational Data

    NASA Technical Reports Server (NTRS)

    Zeng, Xiping; Tao, Wei-Kuo; Zhang, Minghua; Peters-Lidard, Christa; Lang, Stephen; Simpson, Joanne; Kumar, Sujay; Xie, Shaocheng; Eastman, Joseph L.; Shie, Chung-Lin; Geiger, James V.

    2006-01-01

    Two 20-day, continental midlatitude cases are simulated with a three-dimensional (3D) cloud-resolving model (CRM) and compared to Atmospheric Radiation Measurement (ARM) data. This evaluation of long-term cloud-resolving model simulations focuses on the evaluation of clouds and surface fluxes. All numerical experiments, as compared to observations, simulate surface precipitation well but over-predict clouds, especially in the upper troposphere. The sensitivity of cloud properties to dimensionality and other factors is studied to isolate the origins of the over prediction of clouds. Due to the difference in buoyancy damping between 2D and 3D models, surface precipitation fluctuates rapidly with time, and spurious dehumidification occurs near the tropopause in the 2D CRM. Surface fluxes from a land data assimilation system are compared with ARM observations. They are used in place of the ARM surface fluxes to test the sensitivity of simulated clouds to surface fluxes. Summertime simulations show that surface fluxes from the assimilation system bring about a better simulation of diurnal cloud variation in the lower troposphere.

  18. Using simulation to evaluate the performance of resilience strategies and process failures

    SciTech Connect

    Levy, Scott N.; Topp, Bryan Embry; Arnold, Dorian C.; Ferreira, Kurt Brian; Widener, Patrick; Hoefler, Torsten

    2014-01-01

    Fault-tolerance has been identified as a major challenge for future extreme-scale systems. Current predictions suggest that, as systems grow in size, failures will occur more frequently. Because increases in failure frequency reduce the performance and scalability of these systems, significant effort has been devoted to developing and refining resilience mechanisms to mitigate the impact of failures. However, effective evaluation of these mechanisms has been challenging. Current systems are smaller and have significantly different architectural features (e.g., interconnect, persistent storage) than we expect to see in next-generation systems. To overcome these challenges, we propose the use of simulation. Simulation has been shown to be an effective tool for investigating performance characteristics of applications on future systems. In this work, we: identify the set of system characteristics that are necessary for accurate performance prediction of resilience mechanisms for HPC systems and applications; demonstrate how these system characteristics can be incorporated into an existing large-scale simulator; and evaluate the predictive performance of our modified simulator. We also describe how we were able to optimize the simulator for large temporal and spatial scales-allowing the simulator to run 4x faster and use over 100x less memory.

  19. Surface evaluation method and stamping simulation for surface deflection of automotive outer panels

    NASA Astrophysics Data System (ADS)

    Ichijo, Naoki; Iwata, Noritoshi; Iwata, Takamichi; Mita, Taichi; Niihara, Masatomo; Tsutamori, Hideo

    2013-12-01

    In designing dies of automotive outer panels, the most difficult process is to modify surface deflection. To fabricate high-quality outer panels without modifying dies, it is important to develop an evaluation method and a numerical analysis method for surface deflection of outer panels. In this study, we have developed a new evaluation method that uses the maximum value of curvature calculated using reflecting curves in the surface. This new evaluation method made the examiner's evaluation to conform with the digital evaluation. The evaluation results with the new method shows better agreement with the sensory value than those with the conventional methods. We have proposed the new analysis method to predict surface deflection correctly. By the proposed simulation method, plastic deformation is calculated in consideration of stress in thickness direction, and restriking conditions have been examined. We have applied our methods to the fabrication of automotive outer panels, and verified that these are useful and practical.

  20. Practical Considerations in Evaluating Patient/Consumer Health Education Programs.

    ERIC Educational Resources Information Center

    Bryant, Nancy H.

    This report contains brief descriptions of seven evaluative efforts and outcomes of health education programs, some considerations of problems encountered in evaluating the programs, and detailed descriptions of two case studies: (1) a process evaluation of preoperative teaching and (2) a retrospective study of visiting nurse association use by…