Effects of medical training scenarios on heart rate variability and motivation in students and simulated patients.

PubMed

Rieber, Nicole; Betz, Lisa; Enck, Paul; Muth, Eric; Nikendei, Christoph; Schrauth, Markus; Werner, Anne; Kowalski, Axel; Zipfel, Stephan

2009-06-01

Research regarding the experience of stress during medical training scenarios using standardised patients (SPs) has been primarily qualitative and has focused on the SPs. The purpose of this study was to quantitatively evaluate stress and motivation in both students and SPs during these scenarios by measuring heart rate variability (HRV) and administering the German version of the Questionnaire on Current Motivation (QCM). A total of 44 medical students (23 women, 21 men) participated in two medical history-taking training scenarios. In one scenario the SP role-played a patient with a somatic disease; in the other the SP played a patient with a psychosomatic disease, creating easy and difficult scenarios, respectively, for the student. Each student interviewed one of 11 SPs (five women, six men), using the same SP in both scenarios. Heart rate variability was measured during baseline periods and during the training scenarios in both students and SPs. Motivation was assessed before each training scenario. Heart rate variability was lower in both students and SPs during the scenarios compared with baseline values, but did not differ by scenario type. For students, motivation increased when the first scenario involved psychosomatic illness, but decreased when the first condition was somatic. For SPs motivation was consistent over time for scenarios involving psychosomatic disease, but decreased for somatic disease-related scenarios. The training scenarios induced stress in both students and SPs, as indicated by decreased HRV. Student motivation was high, indicating that SP scenarios represent a valid teaching method. Further studies in the natural setting of SP examinations are needed.

Development of a Prototype Automation Simulation Scenario Generator for Air Traffic Management Software Simulations

NASA Technical Reports Server (NTRS)

Khambatta, Cyrus F.

2007-01-01

A technique for automated development of scenarios for use in the Multi-Center Traffic Management Advisor (McTMA) software simulations is described. The resulting software is designed and implemented to automate the generation of simulation scenarios with the intent of reducing the time it currently takes using an observational approach. The software program is effective in achieving this goal. The scenarios created for use in the McTMA simulations are based on data taken from data files from the McTMA system, and were manually edited before incorporation into the simulations to ensure accuracy. Despite the software s overall favorable performance, several key software issues are identified. Proposed solutions to these issues are discussed. Future enhancements to the scenario generator software may address the limitations identified in this paper.

Creating pedestrian crash scenarios in a driving simulator environment.

PubMed

Chrysler, Susan T; Ahmad, Omar; Schwarz, Chris W

2015-01-01

In 2012 in the United States, pedestrian injuries accounted for 3.3% of all traffic injuries but, disproportionately, pedestrian fatalities accounted for roughly 14% of traffic-related deaths (NHTSA 2014 ). In many other countries, pedestrians make up more than 50% of those injured and killed in crashes. This research project examined driver response to crash-imminent situations involving pedestrians in a high-fidelity, full-motion driving simulator. This article presents a scenario development method and discusses experimental design and control issues in conducting pedestrian crash research in a simulation environment. Driving simulators offer a safe environment in which to test driver response and offer the advantage of having virtual pedestrian models that move realistically, unlike test track studies, which by nature must use pedestrian dummies on some moving track. An analysis of pedestrian crash trajectories, speeds, roadside features, and pedestrian behavior was used to create 18 unique crash scenarios representative of the most frequent and most costly crash types. For the study reported here, we only considered scenarios where the car is traveling straight because these represent the majority of fatalities. We manipulated driver expectation of a pedestrian both by presenting intersection and mid-block crossing as well as by using features in the scene to direct the driver's visual attention toward or away from the crossing pedestrian. Three visual environments for the scenarios were used to provide a variety of roadside environments and speed: a 20-30 mph residential area, a 55 mph rural undivided highway, and a 40 mph urban area. Many variables of crash situations were considered in selecting and developing the scenarios, including vehicle and pedestrian movements; roadway and roadside features; environmental conditions; and characteristics of the pedestrian, driver, and vehicle. The driving simulator scenarios were subjected to iterative testing to

Designing Scenarios for Controller-in-the-Loop Air Traffic Simulations

NASA Technical Reports Server (NTRS)

Kupfer, Michael; Mercer, Joey S.; Cabrall, Christopher; Callantine, Todd

2013-01-01

Well prepared traffic scenarios contribute greatly to the success of controller-in-the-loop simulations. This paper describes each stage in the design process of realistic scenarios based on real-world traffic, to be used in the Airspace Operations Laboratory for simulations within the Air Traffic Management Technology Demonstration 1 effort. The steps from the initial analysis of real-world traffic, to the editing of individual aircraft records in the scenario file, until the final testing of the scenarios before the simulation conduct, are all described. The iterative nature of the design process and the various efforts necessary to reach the required fidelity, as well as the applied design strategies, challenges, and tools used during this process are also discussed.

Teaching childbirth with high-fidelity simulation. Is it better observing the scenario during the briefing session?

PubMed

Cuerva, Marcos J; Piñel, Carlos S; Martin, Lourdes; Espinosa, Jose A; Corral, Octavio J; Mendoza, Nicolás

2018-02-12

The design of optimal courses for obstetric undergraduate teaching is a relevant question. This study evaluates two different designs of simulator-based learning activity on childbirth with regard to respect to the patient, obstetric manoeuvres, interpretation of cardiotocography tracings (CTG) and infection prevention. This randomised experimental study which differs in the content of their briefing sessions consisted of two groups of undergraduate students, who performed two simulator-based learning activities on childbirth. The first briefing session included the observations of a properly performed scenario according to Spanish clinical practice guidelines on care in normal childbirth by the teachers whereas the second group did not include the observations of a properly performed scenario, and the students observed it only after the simulation process. The group that observed a properly performed scenario after the simulation obtained worse grades during the simulation, but better grades during the debriefing and evaluation. Simulator use in childbirth may be more fruitful when the medical students observe correct performance at the completion of the scenario compared to that at the start of the scenario. Impact statement What is already known on this subject? There is a scarcity of literature about the design of optimal high-fidelity simulation training in childbirth. It is known that preparing simulator-based learning activities is a complex process. Simulator-based learning includes the following steps: briefing, simulation, debriefing and evaluation. The most important part of high-fidelity simulations is the debriefing. A good briefing and simulation are of high relevance in order to have a fruitful debriefing session. What do the results of this study add? Our study describes a full simulator-based learning activity on childbirth that can be reproduced in similar facilities. The findings of this study add that high-fidelity simulation training in

Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients.

PubMed

Valentin, Bernd; Grottke, Oliver; Skorning, Max; Bergrath, Sebastian; Fischermann, Harold; Rörtgen, Daniel; Mennig, Marie-Therese; Fitzner, Christina; Müller, Michael P; Kirschbaum, Clemens; Rossaint, Rolf; Beckers, Stefan K

2015-04-08

In emergency medicine, the benefits of high-fidelity simulation (SIM) are widely accepted and standardized patients (SP) are known to mimic real patients accurately. However, only limited data are available concerning physicians' stress markers within these training environments. The aim of this pilot study was to investigate repetitive stress among healthcare professionals in simulated pre-hospital emergency scenarios using either SIM or SPs. Teams with one emergency medical services (EMS) physician and two paramedics completed three SIM scenarios and two SP scenarios consecutively. To evaluate stress, salivary cortisol and alpha-amylase were measured in saliva samples taken before, during and after the scenarios. A total of 14 EMS physicians (29% female; mean age: 36.8 ± 5.0 years; mean duration of EMS-experience: 9.1 ± 5.8 years) and 27 paramedics (11% female; age: 30.9 ± 6.9 years; EMS experience: 8.1 ± 6.0 years) completed the study. Alpha-amylase and cortisol levels did not differ significantly between the two professions. Cortisol values showed a gradual and statistically significant reduction over time but little change was observed in response to each scenario. In contrast, alpha-amylase activity increased significantly in response to every SIM and SP scenario, but there was no clear trend towards an overall increase or decrease over time. Increases in salivary alpha-amylase activity suggest that both SIM and SP training produce stress among emergency healthcare professionals. Corresponding increases in salivary cortisol levels were not observed. Among physicians in the emergency setting, it appears that alpha-amylase provides a more sensitive measure of stress levels than cortisol.

Simulated patients in audiology education: student reports.

PubMed

Naeve-Velguth, Susan; Christensen, Sara A; Woods, Suzanne

2013-09-01

Despite increased attention in recent years to audiology counseling education, students remain concerned about their abilities to interact with patients in challenging situations, such as when breaking difficult news. Simulated patients, or actors trained to portray patients in clinical scenarios, have been used for many years in medical schools to teach and assess students' interpersonal skills, and are just beginning to be used in audiology programs. Although research suggests that medical students value simulated patient experiences, little is known about whether the same is true for audiology students. The purpose of this study was to survey audiology students who had completed a simulated patient counseling experience as part of their graduate coursework at Central Michigan University, to learn about their experiences and views of this instructional format. This study used descriptive and comparative statistics to report student observations and to determine if student responses to evaluative questions differed from chance. Study participants included 29 audiology students who had completed a "breaking difficult news" simulated patient experience as part of their required graduate coursework in patient counseling. Participants completed an online survey that included seven evaluative five-point Likert-scale questions about their simulated patient counseling experience. Participants also completed one multiple-choice question on suggestions for future simulated-patient sessions. For each of the seven evaluative questions, a majority of participants (76-100%) responded positively, agreeing or strongly agreeing that the experience was helpful to their learning. For each of these evaluative questions, a χ² analysis revealed that the distribution of positive (i.e., strongly agree and agree) to nonpositive (i.e., neutral, disagree, and strongly disagree) responses differed significantly from chance (p < .0001, df = 1). The results also indicated that when asked

Recognition and treatment of unstable supraventricular tachycardia by pediatric residents in a simulation scenario.

PubMed

Shilkofski, Nicole A; Nelson, Kristen L; Hunt, Elizabeth A

2008-01-01

Supraventricular tachycardia (SVT) is the most frequent tachydysrhythmia in children. SVT with hemodynamic compromise should be terminated by immediate electrical cardioversion. Study objectives were to: (1) establish time to recognition and cardioversion of simulated unstable SVT; and (2) document delays and mistakes made during cardioversion. Ten teams of pediatric residents were presented with an unresponsive "patient" (Laerdal SimMan) in unstable SVT. Actions of team members and simulator timestamps of key events were recorded. A retrospective review of events and time logs was performed with primary outcome measure of time to successful cardioversion. Median time to cardioversion was 8.9 minutes (range, 5.3 minutes to unsuccessful scenario terminated at 15 minutes). In 20% of scenarios, the patient was never cardioverted. Ninety percent of teams administered adenosine, but 44% of attempts demonstrated incorrect administration technique. Other maneuvers before cardioversion: 70% administered fluid, 60% attempted vagal maneuvers, 30% requested electrocardiogram, 30% requested antiarrhythmics. In 20% of scenarios, the rhythm was misidentified. When cardioversion was performed, 25% failed to use gel, 37.5% failed to synchronize, 25% used inappropriate energy doses. In 60% of scenarios, no oxygen was administered. In 90% there was no assignment of Glasgow Coma Scale, and no assessment of mental status in 30%. In 60% perfusion was not assessed. Median time to cardioversion of 8.9 minutes is inconsistent with AHA recommendations for treatment of unstable SVT with "immediate cardioversion." Delays were secondary to lack of recognition of "unstable" SVT, due to failure to assess perfusion and mental status. Errors encountered during simulation identify curriculum reform targets.

[The effect of a scenario-based simulation communication course on improving the communication skills of nurses].

PubMed

Huang, Ya-Hsuan; Hsieh, Suh-Ing; Hsu, Li-Ling

2014-04-01

Limited disease knowledge is frequently the cause of disease-related anxiety in myocardial infarction patients. The ability to communicate effectively serves multiple purposes in the professional nursing practice. By communicating effectively with myocardial infarction patients, nurses may help reduce their anxiety by keeping them well informed about their disease and teaching them self-care strategies. This research evaluates the communication skills of nurses following scenario-based simulation education in the context of communication with myocardial infarction patients. This study used an experimental design and an educational intervention. The target population comprised nurses of medicine (clinical qualified level N to N2 for nursing) working at a municipal hospital in Taipei City, Taiwan. A total 122 participants were enrolled. Stratified block randomization divided participants into an experimental group and a control group. The experimental group received clinical scenario-based simulation education for communication. The control group received traditional class-based education for communication. Both groups received a pre-test and a Communication Skills Checklist post-test assessment. Results were analyzed using SPSS 17.0 for Windows software. A t-test showed significant increases in communication skills (p < .001) in the experimental group and ANCOVA results identified significant between-group differences (p < .001) in communication skills following the education intervention. The results indicate that clinical scenario-based simulation education for communication is significantly more effective than traditional class-based education in enhancing the ability of nurses to communicate effectively with myocardial infarction patients.

A novel method for energy harvesting simulation based on scenario generation

NASA Astrophysics Data System (ADS)

Wang, Zhe; Li, Taoshen; Xiao, Nan; Ye, Jin; Wu, Min

2018-06-01

Energy harvesting network (EHN) is a new form of computer networks. It converts ambient energy into usable electric energy and supply the electrical energy as a primary or secondary power source to the communication devices. However, most of the EHN uses the analytical probability distribution function to describe the energy harvesting process, which cannot accurately identify the actual situation for the lack of authenticity. We propose an EHN simulation method based on scenario generation in this paper. Firstly, instead of setting a probability distribution in advance, it uses optimal scenario reduction technology to generate representative scenarios in single period based on the historical data of the harvested energy. Secondly, it uses homogeneous simulated annealing algorithm to generate optimal daily energy harvesting scenario sequences to get a more accurate simulation of the random characteristics of the energy harvesting network. Then taking the actual wind power data as an example, the accuracy and stability of the method are verified by comparing with the real data. Finally, we cite an instance to optimize the network throughput, which indicate the feasibility and effectiveness of the method we proposed from the optimal solution and data analysis in energy harvesting simulation.

Using Scenarios and Simulations to Plan Colleges

ERIC Educational Resources Information Center

McIntyre, Chuck

2004-01-01

Using a case study, this article describes a method by which higher education institutions construct and use multiple future scenarios and simulations to plan strategically: to create visions of their futures, chart broad directions (mission and goals), and select learning and delivery strategies so as to achieve those broad directions. The…

The Application of Neutron Transport Green's Functions to Threat Scenario Simulation

NASA Astrophysics Data System (ADS)

Thoreson, Gregory G.; Schneider, Erich A.; Armstrong, Hirotatsu; van der Hoeven, Christopher A.

2015-02-01

Radiation detectors provide deterrence and defense against nuclear smuggling attempts by scanning vehicles, ships, and pedestrians for radioactive material. Understanding detector performance is crucial to developing novel technologies, architectures, and alarm algorithms. Detection can be modeled through radiation transport simulations; however, modeling a spanning set of threat scenarios over the full transport phase-space is computationally challenging. Previous research has demonstrated Green's functions can simulate photon detector signals by decomposing the scenario space into independently simulated submodels. This paper presents decomposition methods for neutron and time-dependent transport. As a result, neutron detector signals produced from full forward transport simulations can be efficiently reconstructed by sequential application of submodel response functions.

Security Analysis of Selected AMI Failure Scenarios Using Agent Based Game Theoretic Simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abercrombie, Robert K; Schlicher, Bob G; Sheldon, Frederick T

Information security analysis can be performed using game theory implemented in dynamic Agent Based Game Theoretic (ABGT) simulations. Such simulations can be verified with the results from game theory analysis and further used to explore larger scale, real world scenarios involving multiple attackers, defenders, and information assets. We concentrated our analysis on the Advanced Metering Infrastructure (AMI) functional domain which the National Electric Sector Cyber security Organization Resource (NESCOR) working group has currently documented 29 failure scenarios. The strategy for the game was developed by analyzing five electric sector representative failure scenarios contained in the AMI functional domain. From thesemore » five selected scenarios, we characterize them into three specific threat categories affecting confidentiality, integrity and availability (CIA). The analysis using our ABGT simulation demonstrates how to model the AMI functional domain using a set of rationalized game theoretic rules decomposed from the failure scenarios in terms of how those scenarios might impact the AMI network with respect to CIA.« less

Implementation of an open-scenario, long-term space debris simulation approach

NASA Astrophysics Data System (ADS)

Stupl, J.; Nelson, B.; Faber, N.; Perez, A.; Carlino, R.; Yang, F.; Henze, C.; Karacalioglu, A.; O'Toole, C.; Swenson, J.

This paper provides a status update on the implementation of a flexible, long-term space debris simulation approach. The motivation is to build a tool that can assess the long-term impact of various options for debris-remediation, including the LightForce space debris collision avoidance scheme. State-of-the-art simulation approaches that assess the long-term development of the debris environment use either completely statistical approaches, or they rely on large time steps in the order of several (5-15) days if they simulate the positions of single objects over time. They cannot be easily adapted to investigate the impact of specific collision avoidance schemes or de-orbit schemes, because the efficiency of a collision avoidance maneuver can depend on various input parameters, including ground station positions, space object parameters and orbital parameters of the conjunctions and take place in much smaller timeframes than 5-15 days. For example, LightForce only changes the orbit of a certain object (aiming to reduce the probability of collision), but it does not remove entire objects or groups of objects. In the same sense, it is also not straightforward to compare specific de-orbit methods in regard to potential collision risks during a de-orbit maneuver. To gain flexibility in assessing interactions with objects, we implement a simulation that includes every tracked space object in LEO, propagates all objects with high precision, and advances with variable-sized time-steps as small as one second. It allows the assessment of the (potential) impact of changes to any object. The final goal is to employ a Monte Carlo approach to assess the debris evolution during the simulation time-frame of 100 years and to compare a baseline scenario to debris remediation scenarios or other scenarios of interest. To populate the initial simulation, we use the entire space-track object catalog in LEO. We then use a high precision propagator to propagate all objects over the

Implementation of an Open-Scenario, Long-Term Space Debris Simulation Approach

NASA Technical Reports Server (NTRS)

Nelson, Bron; Yang Yang, Fan; Carlino, Roberto; Dono Perez, Andres; Faber, Nicolas; Henze, Chris; Karacalioglu, Arif Goktug; O'Toole, Conor; Swenson, Jason; Stupl, Jan

2015-01-01

This paper provides a status update on the implementation of a flexible, long-term space debris simulation approach. The motivation is to build a tool that can assess the long-term impact of various options for debris-remediation, including the LightForce space debris collision avoidance concept that diverts objects using photon pressure [9]. State-of-the-art simulation approaches that assess the long-term development of the debris environment use either completely statistical approaches, or they rely on large time steps on the order of several days if they simulate the positions of single objects over time. They cannot be easily adapted to investigate the impact of specific collision avoidance schemes or de-orbit schemes, because the efficiency of a collision avoidance maneuver can depend on various input parameters, including ground station positions and orbital and physical parameters of the objects involved in close encounters (conjunctions). Furthermore, maneuvers take place on timescales much smaller than days. For example, LightForce only changes the orbit of a certain object (aiming to reduce the probability of collision), but it does not remove entire objects or groups of objects. In the same sense, it is also not straightforward to compare specific de-orbit methods in regard to potential collision risks during a de-orbit maneuver. To gain flexibility in assessing interactions with objects, we implement a simulation that includes every tracked space object in Low Earth Orbit (LEO) and propagates all objects with high precision and variable time-steps as small as one second. It allows the assessment of the (potential) impact of physical or orbital changes to any object. The final goal is to employ a Monte Carlo approach to assess the debris evolution during the simulation time-frame of 100 years and to compare a baseline scenario to debris remediation scenarios or other scenarios of interest. To populate the initial simulation, we use the entire space

Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness.

PubMed

Cooper, Simon; Kinsman, Leigh; Buykx, Penny; McConnell-Henry, Tracy; Endacott, Ruth; Scholes, Julie

2010-08-01

To examine, in a simulated environment, the ability of final-year nursing students to assess, identify and respond to patients either deteriorating or at risk of deterioration. The early identification and management of patient deterioration has a major impact on patient outcomes. 'Failure to rescue' is of international concern, with significant concerns over nurses' ability to detect deterioration, the reasons for which are unknown. Mixed methods incorporating quantitative measures of performance (knowledge, skill and situation awareness) and, to be reported at a later date, a qualitative reflective review of decision processes. Fifty-one final-year, final-semester student nurses attended a simulation laboratory. Students completed a knowledge questionnaire and two video-recorded simulated scenarios (mannequin based) to assess skill performance. The scenarios simulated deteriorating patients with hypovolaemic and septic shock. Situation awareness was measured by randomly stopping each scenario and asking a series of questions relating to the situation. The mean knowledge score was 74% (range 46-100%) and the mean skill performance score across both scenarios was 60% (range 30-78%). Skill performance improved significantly (p < 0.01) by the second scenario. However, skill performance declined significantly in both scenarios as the patient's condition deteriorated (hypovolaemia scenario: p = 0.012, septic scenario: p = 0.000). The mean situation awareness score across both scenarios was 59% (range 38-82%). Participants tended to identify physiological indicators of deterioration (77%) but had low comprehension scores (44%). Knowledge scores suggest, on average, a satisfactory academic preparation, but this study identified significant deficits in students' ability to manage patient deterioration. This study suggests that student nurses, at the point of qualification, may be inadequately prepared to identify and manage deteriorating patients in the clinical setting.

Creating Simulated Microgravity Patient Models

NASA Technical Reports Server (NTRS)

Hurst, Victor; Doerr, Harold K.; Bacal, Kira

2004-01-01

The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO).

Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation.

PubMed

Stanley, Claire; Lindsay, Sally; Parker, Kathryn; Kawamura, Anne; Samad Zubairi, Mohammad

2018-05-09

We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection. Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration. The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles. A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.

The Mediterranean surface wave climate inferred from future scenario simulations

NASA Astrophysics Data System (ADS)

Lionello, P.; Cogo, S.; Galati, M. B.; Sanna, A.

2008-09-01

This study is based on 30-year long simulations of the wind-wave field in the Mediterranean Sea carried out with the WAM model. Wave fields have been computed for the 2071-2100 period of the A2, B2 emission scenarios and for the 1961-1990 period of the present climate (REF). The wave model has been forced by the wind field computed by a regional climate model with 50 km resolution. The mean SWH (Significant Wave Height) field over large fraction of the Mediterranean sea is lower for the A2 scenario than for the present climate during winter, spring and autumn. During summer the A2 mean SWH field is also lower everywhere, except for two areas, those between Greece and Northern Africa and between Spain and Algeria, where it is significantly higher. All these changes are similar, though smaller and less significant, in the B2 scenario, except during winter in the north-western Mediterranean Sea, when the B2 mean SWH field is higher than in the REF simulation. Also extreme SWH values are smaller in future scenarios than in the present climate and such SWH change is larger for the A2 than for the B2 scenario. The only exception is the presence of higher SWH extremes in the central Mediterranean during summer for the A2 scenario. In general, changes of SWH, wind speed and atmospheric circulation are consistent, and results show milder marine storms in future scenarios than in the present climate.

Patient identification errors are common in a simulated setting.

PubMed

Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H

2010-06-01

We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

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

PubMed

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

2011-05-01

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. 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. 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. 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.

Extreme storm surge and wind wave climate scenario simulations at the Venetian littoral

NASA Astrophysics Data System (ADS)

Lionello, P.; Galati, M. B.; Elvini, E.

Scenario climate projections for extreme marine storms producing storm surges and wind waves are very important for the northern flat coast of the Adriatic Sea, where the area at risk includes a unique cultural and environmental heritage, and important economic activities. This study uses a shallow water model and a spectral wave model for computing the storm surge and the wind wave field, respectively, from the sea level pressure and wind fields that have been computed by the RegCM regional climate model. Simulations cover the period 1961-1990 for the present climate (control simulations) and the period 2071-2100 for the A2 and B2 scenarios. Generalized Extreme Value analysis is used for estimating values for the 10 and 100 year return times. The adequacy of these modeling tools for a reliable estimation of the climate change signal, without needing further downscaling is shown. However, this study has mainly a methodological value, because issues such as interdecadal variability and intermodel variability cannot be addressed, since the analysis is based on single model 30-year long simulations. The control simulation looks reasonably accurate for extreme value analysis, though it overestimates/underestimates the frequency of high/low surge and wind wave events with respect to observations. Scenario simulations suggest higher frequency of intense storms for the B2 scenario, but not for the A2. Likely, these differences are not the effect of climate change, but of climate multidecadal variability. Extreme storms are stronger in future scenarios, but differences are not statistically significant. Therefore this study does not provide convincing evidence for more stormy conditions in future scenarios.

Scenario management and automated scenario generation

NASA Astrophysics Data System (ADS)

McKeever, William; Gilmour, Duane; Lehman, Lynn; Stirtzinger, Anthony; Krause, Lee

2006-05-01

The military planning process utilizes simulation to determine the appropriate course of action (COA) that will achieve a campaign end state. However, due to the difficulty in developing and generating simulation level COAs, only a few COAs are simulated. This may have been appropriate for traditional conflicts but the evolution of warfare from attrition based to effects based strategies, as well as the complexities of 4 th generation warfare and asymmetric adversaries have placed additional demands on military planners and simulation. To keep pace with this dynamic, changing environment, planners must be able to perform continuous, multiple, "what-if" COA analysis. Scenario management and generation are critical elements to achieving this goal. An effects based scenario generation research project demonstrated the feasibility of automated scenario generation techniques which support multiple stove-pipe and emerging broad scope simulations. This paper will discuss a case study in which the scenario generation capability was employed to support COA simulations to identify plan effectiveness. The study demonstrated the effectiveness of using multiple simulation runs to evaluate the effectiveness of alternate COAs in achieving the overall campaign (metrics-based) objectives. The paper will discuss how scenario generation technology can be employed to allow military commanders and mission planning staff to understand the impact of command decisions on the battlespace of tomorrow.

Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios.

PubMed

Groen, Henk; Tonch, Nino; Simons, Arnold H M; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A

2013-12-01

Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a cost-effective alternative for one cycle of COH with strict application of single embryo transfer (SET). MNC is cheaper per cycle than COH but also less effective in terms of live birth rate (LBR). However, strict application of SET in COH cycles reduces effectiveness and up to three MNC cycles can be performed at the same costs as one COH cycle. The cost-effectiveness of MNC versus COH was evaluated in three simulated treatment scenarios: three cycles of MNC versus one cycle of COH with SET or double embryo transfer (DET) and subsequent transfer of cryopreserved embryos (Scenario 1); six cycles of MNC versus one cycle of COH with strictly SET and subsequent transfer of cryopreserved embryos (Scenario 2); six cycles of MNC with minimized medication (hCG ovulation trigger only) versus one cycle of COH with SET or DET and subsequent transfer of cryopreserved embryos (Scenario 3). We used baseline data obtained from two retrospective cohorts of consecutive patients (2005-2008) undergoing MNC in the University Medical Center Groningen (n = 499, maximum six cycles per patient) or their first COH cycle with subsequent transfer of cryopreserved embryos in the Academic Medical Center Amsterdam (n = 392). Data from 1994 MNC cycles (958 MNC-IVF and 1036 MNC-ICSI) and 392 fresh COH cycles (one per patient, 196 COH-IVF and 196 COH-ICSI) with subsequent transfer of cryopreserved embryos (n = 72 and n = 94 in MNC and COH cycles, respectively) in ovulatory, subfertile women <36 years of age served as baseline for the three simulated scenarios. To compare the scenarios, the incremental cost-effectiveness ratio (ICER) was calculated, defined as the ratio of the difference in IVF costs up to 6 weeks postpartum to the

Utah traffic lab driving simulator : user manual and flex lanes scenario development.

DOT National Transportation Integrated Search

2012-06-01

This report describes the University of Utah Traffic Lab (UTL) driving simulator, and a scenario development for Flex Lanes driving simulation. The first part describes the driving simulator in details. At the time of installation, the UTL driving si...

Utah Traffic Lab Driving Simulator : User Manual and Flex Lanes Scenario Development

DOT National Transportation Integrated Search

2012-06-01

This report describes the University of Utah Traffic Lab (UTL) driving simulator, and a scenario development for Flex Lanes driving simulation. The first part describes the driving simulator in details. At the time of installation, the UTL driving si...

Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios.

PubMed

Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter; Konge, Lars; Rosenberg, Jacob; Oestergaard, Doris

2013-11-01

Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training. A 1-day course was conducted for 15 general surgeons in which they rated surgeons' nontechnical skills in 9 video recordings of scenarios simulating real intraoperative situations. Data were gathered from 2 sessions separated by a 4-hour training session. Interrater reliability was high for both pretraining ratings (Cronbach's α = .97) and posttraining ratings (Cronbach's α = .98). There was no statistically significant development in assessment skills. The D study showed that 2 untrained raters or 1 trained rater was needed to obtain generalizability coefficients >.80. The high pretraining interrater reliability indicates that videos were easy to rate and Non-Technical Skills for Surgeons dk easy to use. This implies that Non-Technical Skills for Surgeons dk (NOTSSdk) could be an important tool in surgical training, potentially improving safety and quality for surgical patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Interprofessional Education Among Student Health Professionals Using Human Patient Simulation

PubMed Central

Chmil, Joyce V.

2014-01-01

Objective. To describe the planning, implementation, and outcomes of an interprofessional education clinical laboratory facilitated through human patient simulation. Design. An interprofessional education clinical laboratory was developed with a patient-care scenario of acute exacerbation of heart failure that incorporated the use of a high-fidelity patient simulator. Pharmacy and nursing students assumed clinical roles in this realistic scenario and collaborated to diagnose and treat the patient. Assessment. Student attitudes toward and readiness to participate in interprofessional education improved following participation in the laboratory. Students reported that the greatest benefit of the experience was in their communication skills. Conclusion. Students’ ability to participate in interprofessional education experiences and their attitudes toward them improved following participation in this curricular initiative. Further evaluation of the impact of interprofessional education on student learning outcomes and changes in practice is warranted. PMID:24954934

Simulation of groundwater flow and pumping scenarios for 1900–2050 near Mount Pleasant, South Carolina

USGS Publications Warehouse

Fine, Jason M.; Petkewich, Matthew D.; Campbell, Bruce G.

2017-10-31

Groundwater withdrawals from the Upper Cretaceous-age Middendorf aquifer in South Carolina have created a large, regional cone of depression in the potentiometric surface of the Middendorf aquifer in Charleston and Berkeley Counties, South Carolina. Groundwater-level declines of as much as 249 feet have been observed in wells over the past 125 years and are a result of groundwater use for public water supply, irrigation, and private industry. To address the concerns of users of the Middendorf aquifer, the U.S. Geological Survey, in cooperation with Mount Pleasant Waterworks (MPW), recalibrated an existing groundwater-flow model to incorporate additional groundwater-use and water-level data since 2008. This recalibration process consisted of a technique of parameter estimation that uses regularized inversion and employs “pilot points” for spatial hydraulic property characterization. The groundwater-flow system of the Coastal Plain physiographic province of South Carolina and parts of Georgia and North Carolina was simulated using the U.S. Geological Survey finite-difference computer code MODFLOW-2000.After the model recalibration, the following six predictive water-management scenarios were created to simulate potential changes in groundwater flow and groundwater-level conditions in the Mount Pleasant, South Carolina, area: Scenario 1—maximize MPW reverse-osmosis plant capacity by increasing groundwater withdrawals from the Middendorf aquifer from 3.9 million gallons per day (Mgal/d), which was the amount withdrawn in 2015, to 8.58 Mgal/d; Scenario 2—same as Scenario 1, but with the addition of a 0.5 Mgal/d supply well in the Middendorf aquifer near Moncks Corner, South Carolina; Scenario 3—same as Scenario 1, but with the addition of a 1.5 Mgal/d supply well in the Middendorf aquifer near Moncks Corner, South Carolina; Scenario 4—maximize MPW well capacity by increasing withdrawals from the Middendorf aquifer from 3.9 Mgal/d (in 2015) to 10.16 Mgal

Simulating Scenario Floods for Hazard Assessment on the Lower Bicol Floodplain, the Philippines

NASA Astrophysics Data System (ADS)

Usamah, Muhibuddin Bin; Alkema, Dinand

This paper describes the first results from a study to the behavior of floods in the lower Bicol area, the Philippines. A 1D2D dynamic hydraulic model was applied to simulate a set of scenario floods through the complex topography of the city Naga and surrounding area. The simulation results are integrated into a multi-parameter hazard zonation for the five scenario floods.

An Interprofessional Course Using Human Patient Simulation to Teach Patient Safety and Teamwork Skills

PubMed Central

McCulloh, Russell; Dyer, Carla; Gregory, Gretchen; Higbee, Dena

2012-01-01

Objectives. To assess the effectiveness of human patient simulation to teach patient safety, team-building skills, and the value of interprofessional collaboration to pharmacy students. Design. Five scenarios simulating semi-urgent situations that required interprofessional collaboration were developed. Groups of 10 to 12 health professions students that included 1 to 2 pharmacy students evaluated patients while addressing patient safety hazards. Assessment. Pharmacy students’ scores on 8 of 30 items on a post-simulation survey of knowledge, skills, and attitudes improved over pre-simulation scores. Students’ scores on 3 of 10 items on a team building and interprofessional communications survey also improved after participating in the simulation exercise. Over 90% of students reported that simulation increased their understanding of professional roles and the importance of interprofessional communication. Conclusions. Simulation training provided an opportunity to improve pharmacy students’ ability to recognize and react to patient safety concerns and enhanced their interprofessional collaboration and communication skills. PMID:22611280

Stress accumulation in the Marmara Sea estimated through ground-motion simulations from dynamic rupture scenarios

NASA Astrophysics Data System (ADS)

Aochi, Hideo; Douglas, John; Ulrich, Thomas

2017-03-01

We compare ground motions simulated from dynamic rupture scenarios, for the seismic gap along the North Anatolian Fault under the Marmara Sea (Turkey), to estimates from empirical ground motion prediction equations (GMPEs). Ground motions are simulated using a finite difference method and a 3-D model of the local crustal structure. They are analyzed at more than a thousand locations in terms of horizontal peak ground velocity. Characteristics of probable earthquake scenarios are strongly dependent on the hypothesized level of accumulated stress, in terms of a normalized stress parameter T. With respect to the GMPEs, it is found that simulations for many scenarios systematically overestimate the ground motions at all distances. Simulations for only some scenarios, corresponding to moderate stress accumulation, match the estimates from the GMPEs. The difference between the simulations and the GMPEs is used to quantify the relative probabilities of each scenario and, therefore, to revise the probability of the stress field. A magnitude Mw7+ operating at moderate prestress field (0.6 < T ≤ 0.7) is statistically more probable, as previously assumed in the logic tree of probabilistic assessment of rupture scenarios. This approach of revising the mechanical hypothesis by means of comparison to an empirical statistical model (e.g., a GMPE) is useful not only for practical seismic hazard assessments but also to understand crustal dynamics.

Qualitative evaluation of a standardized patient clinical simulation for nurse practitioner and pharmacy students.

PubMed

Koo, Laura; Layson-Wolf, Cherokee; Brandt, Nicole; Hammersla, Margaret; Idzik, Shannon; Rocafort, P Tim; Tran, Deanna; Wilkerson, R Gentry; Windemuth, Brenda

2014-11-01

This article describes a qualitative evaluation of an interprofessional educational experience for nurse practitioner and pharmacy students using standardized patients and physicians role-playing physicians in clinical scenarios. This experience included the development of two clinical scenarios; training of standardized patients, providers, and faculty facilitators; pre-briefing preparation; partial facilitator prompting simulations; and facilitated debriefings. Forty-six students participated in the formative simulation. Small groups of students and faculty facilitators worked through two clinical scenarios that were based on the expected emergence of the patient-centered medical homes. The scenarios incorporated different interprofessional communication modes, including in-person, telephonic, and video-conferencing. Time-in/time-out debriefings were incorporated to provide guidance to students about how to engage in interprofessional collaboration. After completion of the scenarios, facilitated group debriefings allowed for reflection on communication strategies and roles. Immediately following the learning activity, 30 volunteer focus group participants provided comments anonymously in a semi-structured format. Conventional content analysis was used to identify overarching themes. Participants expressed improved understanding of individual roles, increased confidence, and a better sense of interprofessional support. The educational experience themes included the benefits of a realistic nature of the simulation and the need for improved student orientation to roles and expectations prior to the clinical simulations. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Application of High Energy Resolution Green's Functions to Threat Scenario Simulation

NASA Astrophysics Data System (ADS)

Thoreson, Gregory G.; Schneider, Erich A.

2012-04-01

Radiation detectors installed at key interdiction points provide defense against nuclear smuggling attempts by scanning vehicles and traffic for illicit nuclear material. These hypothetical threat scenarios may be modeled using radiation transport simulations. However, high-fidelity models are computationally intensive. Furthermore, the range of smuggler attributes and detector technologies create a large problem space not easily overcome by brute-force methods. Previous research has demonstrated that decomposing the scenario into independently simulated components using Green's functions can simulate photon detector signals with coarse energy resolution. This paper extends this methodology by presenting physics enhancements and numerical treatments which allow for an arbitrary level of energy resolution for photon transport. As a result, spectroscopic detector signals produced from full forward transport simulations can be replicated while requiring multiple orders of magnitude less computation time.

The feasibility of sharing simulation-based evaluation scenarios in anesthesiology.

PubMed

Berkenstadt, Haim; Kantor, Gareth S; Yusim, Yakov; Gafni, Naomi; Perel, Azriel; Ezri, Tiberiu; Ziv, Amitai

2005-10-01

We prospectively assessed the feasibility of international sharing of simulation-based evaluation tools despite differences in language, education, and anesthesia practice, in an Israeli study, using validated scenarios from a multi-institutional United States (US) study. Thirty-one Israeli junior anesthesia residents performed four simulation scenarios. Training sessions were videotaped and performance was assessed using two validated scoring systems (Long and Short Forms) by two independent raters. Subjects scored from 37 to 95 (70 +/- 12) of 108 possible points with the "Long Form" and "Short Form" scores ranging from 18 to 35 (28.2 +/- 4.5) of 40 possible points. Scores >70% of the maximal score were achieved by 61% of participants in comparison to only 5% in the original US study. The scenarios were rated as very realistic by 80% of the participants (grade 4 on a 1-4 scale). Reliability of the original assessment tools was demonstrated by internal consistencies of 0.66 for the Long and 0.75 for the Short Form (Cronbach alpha statistic). Values in the original study were 0.72-0.76 for the Long and 0.71-0.75 for the Short Form. The reliability did not change when a revised Israeli version of the scoring was used. Interrater reliability measured by Pearson correlation was 0.91 for the Long and 0.96 for the Short Form (P < 0.01). The high scores for plausibility given to the scenarios and the similar reliability of the original assessment tool support the feasibility of using simulation-based evaluation tools, developed in the US, in Israel. The higher scores achieved by Israeli residents may be related to the fact that most Israeli residents are immigrants with previous training in anesthesia. Simulation-based assessment tools developed in a multi-institutional study in the United States can be used in Israel despite the differences in language, education, and medical system.

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

The effectiveness of virtual simulation in improving student nurses' knowledge and performance during patient deterioration: A pre and post test design.

PubMed

Borg Sapiano, Alexis; Sammut, Roberta; Trapani, Josef

2018-03-01

Preparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration. To investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration. A pre- and post-test design was used. Nursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST 2 ACTWeb™, using their own computer devices. A total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study. The simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database. Findings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, p<0.001). Highest mean performance scores were obtained in the last scenario (M=19.7, median: 20.0, s.d. 3.41) indicating a learning effect. Knowledge was not a predictor of students' performance in the scenarios. This study supports virtual simulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of

Probabilistic approach for earthquake scenarios in the Marmara region from dynamic rupture simulations

NASA Astrophysics Data System (ADS)

Aochi, Hideo

2014-05-01

The Marmara region (Turkey) along the North Anatolian fault is known as a high potential of large earthquakes in the next decades. For the purpose of seismic hazard/risk evaluation, kinematic and dynamic source models have been proposed (e.g. Oglesby and Mai, GJI, 2012). In general, the simulated earthquake scenarios depend on the hypothesis and cannot be verified before the expected earthquake. We then introduce a probabilistic insight to give the initial/boundary conditions to statistically analyze the simulated scenarios. We prepare different fault geometry models, tectonic loading and hypocenter locations. We keep the same framework of the simulation procedure as the dynamic rupture process of the adjacent 1999 Izmit earthquake (Aochi and Madariaga, BSSA, 2003), as the previous models were able to reproduce the seismological/geodetic aspects of the event. Irregularities in fault geometry play a significant role to control the rupture progress, and a relatively large change in geometry may work as barriers. The variety of the simulate earthquake scenarios should be useful for estimating the variety of the expected ground motion.

Simulation of scenario earthquake influenced field by using GIS

USGS Publications Warehouse

Zuo, H.-Q.; Xie, L.-L.; Borcherdt, R.D.

1999-01-01

The method for estimating the site effect on ground motion specified by Borcherdt (1994a, 1994b) is briefly introduced in the paper. This method and the detail geological data and site classification data in San Francisco bay area of California, the United States, are applied to simulate the influenced field of scenario earthquake by GIS technology, and the software for simulating has been drawn up. The paper is a partial result of cooperative research project between China Seismological Bureau and US Geological Survey.

Computer simulation of stair falls to investigate scenarios in child abuse.

PubMed

Bertocci, G E; Pierce, M C; Deemer, E; Aguel, F

2001-09-01

To demonstrate the usefulness of computer simulation techniques in the investigation of pediatric stair falls. Since stair falls are a common falsely reported injury scenario in child abuse, our specific aim was to investigate the influence of stair characteristics on injury biomechanics of pediatric stair falls by using a computer simulation model. Our long-term goal is to use knowledge of biomechanics to aid in distinguishing between accidents and abuse. A computer simulation model of a 3-year-old child falling down stairs was developed using commercially available simulation software. This model was used to investigate the influence that stair characteristics have on biomechanical measures associated with injury risk. Since femur fractures occur in unintentional and abuse scenarios, biomechanical measures were focused on the lower extremities. The number and slope of steps and stair surface friction and elasticity were found to affect biomechanical measures associated with injury risk. Computer simulation techniques are useful for investigating the biomechanics of stair falls. Using our simulation model, we determined that stair characteristics have an effect on potential for lower extremity injuries. Although absolute values of biomechanical measures should not be relied on in an unvalidated model such as this, relationships between accident-environment factors and biomechanical measures can be studied through simulation. Future efforts will focus on model validation.

Simulated tsunami inundation for a range of Cascadia megathrust earthquake scenarios at Bandon, Oregon, USA

USGS Publications Warehouse

Witter, Robert C.; Zhang, Yinglong J.; Wang, Kelin; Priest, George R.; Goldfinger, Chris; Stimely, Laura; English, John T.; Ferro, Paul A.

2013-01-01

Characterizations of tsunami hazards along the Cascadia subduction zone hinge on uncertainties in megathrust rupture models used for simulating tsunami inundation. To explore these uncertainties, we constructed 15 megathrust earthquake scenarios using rupture models that supply the initial conditions for tsunami simulations at Bandon, Oregon. Tsunami inundation varies with the amount and distribution of fault slip assigned to rupture models, including models where slip is partitioned to a splay fault in the accretionary wedge and models that vary the updip limit of slip on a buried fault. Constraints on fault slip come from onshore and offshore paleoseismological evidence. We rank each rupture model using a logic tree that evaluates a model’s consistency with geological and geophysical data. The scenarios provide inputs to a hydrodynamic model, SELFE, used to simulate tsunami generation, propagation, and inundation on unstructured grids with <5–15 m resolution in coastal areas. Tsunami simulations delineate the likelihood that Cascadia tsunamis will exceed mapped inundation lines. Maximum wave elevations at the shoreline varied from ∼4 m to 25 m for earthquakes with 9–44 m slip and Mw 8.7–9.2. Simulated tsunami inundation agrees with sparse deposits left by the A.D. 1700 and older tsunamis. Tsunami simulations for large (22–30 m slip) and medium (14–19 m slip) splay fault scenarios encompass 80%–95% of all inundation scenarios and provide reasonable guidelines for land-use planning and coastal development. The maximum tsunami inundation simulated for the greatest splay fault scenario (36–44 m slip) can help to guide development of local tsunami evacuation zones.

Medical Scenarios Relevant to Spaceflight

NASA Technical Reports Server (NTRS)

Bacal, Kira; Hurs, Victor; Doerr, Harold

2004-01-01

The Medical Operational Support Team (MOST) was tasked by the JSC Space Medicine and Life Sciences Directorate (SLSD) to incorporate medical simulation into 1) medical training for astronaut-crew medical officers (CMO) and medical flight control teams and 2) evaluations of procedures and resources required for medical care aboard the International Space Station (ISS). Development of evidence-based medical scenarios that mimic the physiology observed during spaceflight will be needed for the MOST to complete these two tasks. The MOST used a human patient simulator, the ISS-like resources in the Medical Simulation Laboratory (MSL), and evidence from space operations, military operations and medical literature to develop space relevant medical scenarios. These scenarios include conditions concerning airway management, Advanced Cardiac Life Support (ACLS) and mitigating anaphylactic symptoms. The MOST has used these space relevant medical scenarios to develop a preliminary space medical training regimen for NASA flight surgeons, Biomedical Flight Controllers (Biomedical Engineers; BME) and CMO-analogs. This regimen is conducted by the MOST in the MSL. The MOST has the capability to develop evidence-based space-relevant medical scenarios that can help SLSD I) demonstrate the proficiency of medical flight control teams to mitigate space-relevant medical events and 2) validate nextgeneration medical equipment and procedures for space medicine applications.

Simulation of groundwater withdrawal scenarios for the Redwall-Muav and Coconino Aquifer Systems of northern and central Arizona

USGS Publications Warehouse

Pool, D.R.

2016-09-23

The Northern Arizona Regional Groundwater Flow Model was used to estimate the hydrologic changes, including water-level change and groundwater discharge to streams and springs, that may result from future changes in groundwater withdrawals in and near the Coconino Plateau Water Advisory Council study area, Coconino and Navajo Counties, Arizona. Three future groundwater withdrawal scenarios for tribal and nontribal uses were developed by the Coconino Plateau Water Advisory Council and were simulated for the period representing the years from 2006 through 2105. Scenario 1 assumes no major changes in groundwater use except for increased demand based on population projections. Scenario 2 assumes that a pipeline will provide a source of surface water from Lake Powell to areas near Cameron and Moenkopi that would replace local groundwater withdrawals. Scenario 3 assumes that the pipeline extends to the Flagstaff and Williams areas, and would replace groundwater demands for water in the area.The Coconino Plateau Water Advisory Council withdrawal scenarios primarily influence water levels and groundwater discharge in the Coconino Plateau basin, near the western margin of the Little Colorado River Plateau basin, and the Verde Valley subbasin. Simulated effects of the withdrawal scenarios are superimposed on effects of previous variations in groundwater withdrawals and artificial and incidental recharge. Pre-scenario variations include changes in water-levels in wells; groundwater storage; discharge to streams and springs; and evapotranspiration by plants that use groundwater. Future variations in groundwater discharge and water-levels in wells will continue to occur as a result of both the past and any future changes.Water-level variations resulting from post-2005 stresses, including groundwater withdrawals and incidental and artificial recharge, in the area of the withdrawal scenarios are primarily localized and superimposed on the regional changes caused by variations in

A Global System for Transportation Simulation and Visualization in Emergency Evacuation Scenarios

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Wei; Liu, Cheng; Thomas, Neil

2015-01-01

Simulation-based studies are frequently used for evacuation planning and decision making processes. Given the transportation systems complexity and data availability, most evacuation simulation models focus on certain geographic areas. With routine improvement of OpenStreetMap road networks and LandScanTM global population distribution data, we present WWEE, a uniform system for world-wide emergency evacuation simulations. WWEE uses unified data structure for simulation inputs. It also integrates a super-node trip distribution model as the default simulation parameter to improve the system computational performance. Two levels of visualization tools are implemented for evacuation performance analysis, including link-based macroscopic visualization and vehicle-based microscopic visualization. Formore » left-hand and right-hand traffic patterns in different countries, the authors propose a mirror technique to experiment with both scenarios without significantly changing traffic simulation models. Ten cities in US, Europe, Middle East, and Asia are modeled for demonstration. With default traffic simulation models for fast and easy-to-use evacuation estimation and visualization, WWEE also retains the capability of interactive operation for users to adopt customized traffic simulation models. For the first time, WWEE provides a unified platform for global evacuation researchers to estimate and visualize their strategies performance of transportation systems under evacuation scenarios.« less

Examining the Societal Impacts of Nanotechnology through Simulation: NANO SCENARIO

ERIC Educational Resources Information Center

Jarmon, Leslie; Keating, Elizabeth; Toprac, Paul

2008-01-01

This article describes a university-sponsored experiential-based simulation, the NANO SCENARIO, to increase the public's awareness and affect attitudes on the societal implications of nanoscience and nanotechnology by bringing together diverse stakeholders' perspectives in a participatory learning environment. Nanotechnology has the potential for…

A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course.

PubMed

Li, Chih-Huang; Kuan, Win-Sen; Mahadevan, Malcolm; Daniel-Underwood, Lynda; Chiu, Te-Fa; Nguyen, H Bryant

2012-07-01

Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis. A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist. 98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8 ± 12.0% vs 65.4 ± 12.2%, p<0.01). There was no difference in pre-test scores between the two study groups. The lecture-first group had significantly higher post-test 1 scores than the simulation-first group (78.8 ± 10.6% vs 71.6 ± 12.6%, p<0.01). There was no difference in post-test 2 scores between the two groups. The simulated case scenario task performance completion was 90.8% (95% CI 86.6% to 95.0%) in the lecture-first group compared with 83.8% (95% CI 79.5% to 88.1%) in the simulation-first group (p=0.02). A medical simulation course can improve resident physician knowledge in the early management of severe sepsis. Such a course should include a comprehensive curriculum that includes didactic lectures followed by simulation experience.

Use of simulated pages to prepare medical students for internship and improve patient safety.

PubMed

Schwind, Cathy J; Boehler, Margaret L; Markwell, Stephen J; Williams, Reed G; Brenner, Michael J

2011-01-01

During the transition from medical school to internship, trainees experience high levels of stress related to pages on the inpatient wards. The steep learning curve during this period may also affect patient safety. The authors piloted the use of simulated pages to improve medical student preparedness, decrease stress related to pages, and familiarize medical students with common patient problems. A multidisciplinary team at Southern Illinois University School of Medicine developed simulated pages that were tested among senior medical students. Sixteen medical students were presented with 11 common patient scenarios. Data on assessment, management, and global performance were collected. Mean confidence levels were evaluated pre- and postintervention. Students were also surveyed on how the simulated pages program influenced their perceived comfort in managing patient care needs and the usefulness of the exercise in preparing them to handle inpatient pages. Mean scores on the assessment and management portions of the scenarios varied widely depending on the scenario (range -15.6 ± 41.6 to 95.7 ± 9.5). Pass rates based on global performance ranged from 12% to 93%. Interrater agreement was high (mean kappa = 0.88). Students' confidence ratings on a six-point scale increased from 1.87 preintervention to 3.53 postintervention (P < .0001). Simulated pages engage medical students and may foster medical student preparedness for internship. Students valued the opportunity to simulate "on call" responsibilities, and exposure to simulated pages significantly increased their confidence levels. Further studies are needed to determine effects on patient safety outcomes.

Simulation of Reclaimed-Water Injection and Pumping Scenarios and Particle-Tracking Analysis near Mount Pleasant, South Carolina

USGS Publications Warehouse

Petkewich, Matthew D.; Campbell, Bruce G.

2009-01-01

The effect of injecting reclaimed water into the Middendorf aquifer beneath Mount Pleasant, South Carolina, was simulated using a groundwater-flow model of the Coastal Plain Physiographic Province of South Carolina and parts of Georgia and North Carolina. Reclaimed water, also known as recycled water, is wastewater or stormwater that has been treated to an appropriate level so that the water can be reused. The scenarios were simulated to evaluate potential changes in groundwater flow and groundwater-level conditions caused by injecting reclaimed water into the Middendorf aquifer. Simulations included a Base Case and two injection scenarios. Maximum pumping rates were simulated as 6.65, 8.50, and 10.5 million gallons per day for the Base Case, Scenario 1, and Scenario 2, respectively. The Base Case simulation represents a non-injection estimate of the year 2050 groundwater levels for comparison purposes for the two injection scenarios. For Scenarios 1 and 2, the simulated injection of reclaimed water at 3 million gallons per day begins in 2012 and continues through 2050. The flow paths and time of travel for the injected reclaimed water were simulated using particle-tracking analysis. The simulations indicated a general decline of groundwater altitudes in the Middendorf aquifer in the Mount Pleasant, South Carolina, area between 2004 and 2050 for the Base Case and two injection scenarios. For the Base Case, groundwater altitudes generally declined about 90 feet from the 2004 groundwater levels. For Scenarios 1 and 2, although groundwater altitudes initially increased in the Mount Pleasant area because of the simulated injection, these higher groundwater levels declined as Mount Pleasant Waterworks pumping increased over time. When compared to the Base Case simulation, 2050 groundwater altitudes for Scenario 1 are between 15 feet lower to 23 feet higher for production wells, between 41 and 77 feet higher for the injection wells, and between 9 and 23 feet higher for

Basic Simulation Environment for Highly Customized Connected and Autonomous Vehicle Kinematic Scenarios.

PubMed

Chai, Linguo; Cai, Baigen; ShangGuan, Wei; Wang, Jian; Wang, Huashen

2017-08-23

To enhance the reality of Connected and Autonomous Vehicles (CAVs) kinematic simulation scenarios and to guarantee the accuracy and reliability of the verification, a four-layer CAVs kinematic simulation framework, which is composed with road network layer, vehicle operating layer, uncertainties modelling layer and demonstrating layer, is proposed in this paper. Properties of the intersections are defined to describe the road network. A target position based vehicle position updating method is designed to simulate such vehicle behaviors as lane changing and turning. Vehicle kinematic models are implemented to maintain the status of the vehicles when they are moving towards the target position. Priorities for individual vehicle control are authorized for different layers. Operation mechanisms of CAVs uncertainties, which are defined as position error and communication delay in this paper, are implemented in the simulation to enhance the reality of the simulation. A simulation platform is developed based on the proposed methodology. A comparison of simulated and theoretical vehicle delay has been analyzed to prove the validity and the creditability of the platform. The scenario of rear-end collision avoidance is conducted to verify the uncertainties operating mechanisms, and a slot-based intersections (SIs) control strategy is realized and verified in the simulation platform to show the supports of the platform to CAVs kinematic simulation and verification.

Basic Simulation Environment for Highly Customized Connected and Autonomous Vehicle Kinematic Scenarios

PubMed Central

Chai, Linguo; Cai, Baigen; ShangGuan, Wei; Wang, Jian; Wang, Huashen

2017-01-01

To enhance the reality of Connected and Autonomous Vehicles (CAVs) kinematic simulation scenarios and to guarantee the accuracy and reliability of the verification, a four-layer CAVs kinematic simulation framework, which is composed with road network layer, vehicle operating layer, uncertainties modelling layer and demonstrating layer, is proposed in this paper. Properties of the intersections are defined to describe the road network. A target position based vehicle position updating method is designed to simulate such vehicle behaviors as lane changing and turning. Vehicle kinematic models are implemented to maintain the status of the vehicles when they are moving towards the target position. Priorities for individual vehicle control are authorized for different layers. Operation mechanisms of CAVs uncertainties, which are defined as position error and communication delay in this paper, are implemented in the simulation to enhance the reality of the simulation. A simulation platform is developed based on the proposed methodology. A comparison of simulated and theoretical vehicle delay has been analyzed to prove the validity and the creditability of the platform. The scenario of rear-end collision avoidance is conducted to verify the uncertainties operating mechanisms, and a slot-based intersections (SIs) control strategy is realized and verified in the simulation platform to show the supports of the platform to CAVs kinematic simulation and verification. PMID:28832518

Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

PubMed

Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa

2017-01-01

Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by

Simulation of future stream alkalinity under changing deposition and climate scenarios.

PubMed

Welsch, Daniel L; Cosby, B Jack; Hornberger, George M

2006-08-31

Models of soil and stream water acidification have typically been applied under scenarios of changing acidic deposition, however, climate change is usually ignored. Soil air CO2 concentrations have potential to increase as climate warms and becomes wetter, thus affecting soil and stream water chemistry by initially increasing stream alkalinity at the expense of reducing base saturation levels on soil exchange sites. We simulate this change by applying a series of physically based coupled models capable of predicting soil air CO2 and stream water chemistry. We predict daily stream water alkalinity for a small catchment in the Virginia Blue Ridge for 60 years into the future given stochastically generated daily climate values. This is done for nine different combinations of climate and deposition. The scenarios for both climate and deposition include a static scenario, a scenario of gradual change, and a scenario of abrupt change. We find that stream water alkalinity continues to decline for all scenarios (average decrease of 14.4 microeq L-1) except where climate is gradually warming and becoming more moist (average increase of 13 microeq L-1). In all other scenarios, base cation removal from catchment soils is responsible for limited alkalinity increase resulting from climate change. This has implications given the extent that acidification models are used to establish policy and legislation concerning deposition and emissions.

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…

Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

PubMed

Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

2017-03-29

The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude 'handling errors' improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

Simulation and Particle-Tracking Analysis of Selected Ground-Water Pumping Scenarios at Vogtle Electric Generation Plant, Burke County, Georgia

USGS Publications Warehouse

Cherry, Gregory S.; Clarke, John S.

2007-01-01

The source of ground water to production wells at Vogtle Electric Generation Plant (VEGP), a nuclear power plant in Burke County, Georgia, was simulated under existing (2002) and potential future pumping conditions using an existing U.S. Geological Survey (USGS) MODFLOW ground-water flow model of a 4,455-square-mile area in the Coastal Plain of Georgia and South Carolina. Simulation results for three steady-state pumping scenarios were compared to each other and to a 2002 Base Case condition. The pumping scenarios focused on pumping increases at VEGP resulting from projected future demands and the addition of two electrical-generating reactor units. Scenarios simulated pumping increases at VEGP ranging from 1.09 to 3.42 million gallons per day (Mgal/d), with one of the scenarios simulating the elimination of 5.3 Mgal/d of pumping at the Savannah River Site (SRS), a U.S. Department of Energy facility located across the Savannah River from VEGP. The largest simulated water-level changes at VEGP were for the scenario whereby pumping at the facility was more than tripled, resulting in drawdown exceeding 4-8 feet (ft) in the aquifers screened in the production wells. For the scenario that eliminated pumping at SRS, water-level rises of as much as 4-8 ft were simulated in the same aquifers at SRS. Results of MODFLOW simulations were analyzed using the USGS particle-tracking code MODPATH to determine the source of water and associated time of travel to VEGP production wells. For each of the scenarios, most of the recharge to VEGP wells originated in an upland area near the county line between Burke and Jefferson Counties, Georgia, with none of the recharge originating on SRS or elsewhere in South Carolina. An exception occurs for the scenario whereby pumping at VEGP was more than tripled. For this scenario, some of the recharge originates in an upland area in eastern Barnwell County, South Carolina. Simulated mean time of travel from recharge areas to VEGP wells for the

Scenario simulation based assessment of subsurface energy storage

NASA Astrophysics Data System (ADS)

Beyer, C.; Bauer, S.; Dahmke, A.

2014-12-01

Energy production from renewable sources such as solar or wind power is characterized by temporally varying power supply. The politically intended transition towards renewable energies in Germany („Energiewende") hence requires the installation of energy storage technologies to compensate for the fluctuating production. In this context, subsurface energy storage represents a viable option due to large potential storage capacities and the wide prevalence of suited geological formations. Technologies for subsurface energy storage comprise cavern or deep porous media storage of synthetic hydrogen or methane from electrolysis and methanization, or compressed air, as well as heat storage in shallow or moderately deep porous formations. Pressure build-up, fluid displacement or temperature changes induced by such operations may affect local and regional groundwater flow, geomechanical behavior, groundwater geochemistry and microbiology. Moreover, subsurface energy storage may interact and possibly be in conflict with other "uses" like drinking water abstraction or ecological goods and functions. An utilization of the subsurface for energy storage therefore requires an adequate system and process understanding for the evaluation and assessment of possible impacts of specific storage operations on other types of subsurface use, the affected environment and protected entities. This contribution presents the framework of the ANGUS+ project, in which tools and methods are developed for these types of assessments. Synthetic but still realistic scenarios of geological energy storage are derived and parameterized for representative North German storage sites by data acquisition and evaluation, and experimental work. Coupled numerical hydraulic, thermal, mechanical and reactive transport (THMC) simulation tools are developed and applied to simulate the energy storage and subsurface usage scenarios, which are analyzed for an assessment and generalization of the imposed THMC

Simulating long-term effectiveness and efficiency of management scenarios for an invasive grass

USGS Publications Warehouse

Jarnevich, Catherine S.; Holcombe, Tracy R.; Cullinane Thomas, Catherine; Frid, Leonardo; Olsson, Aaryn D.

2015-01-01

Resource managers are often faced with trade-offs in allocating limited resources to manage plant invasions. These decisions must often be made with uncertainty about the location of infestations, their rate of spread and effectiveness of management actions. Landscape level simulation tools such as state-and-transition simulation models (STSMs) can be used to evaluate the potential long term consequences of alternative management strategies and help identify those strategies that make efficient use of resources. We analyzed alternative management scenarios for African buffelgrass (Pennisetum ciliare syn. Cenchrus ciliaris) at Ironwood Forest National Monument, Arizona using a spatially explicit STSM implemented in the Tool for Exploratory Landscape Scenario Analyses (TELSA). Buffelgrass is an invasive grass that is spreading rapidly in the Sonoran Desert, affecting multiple habitats and jurisdictions. This invasion is creating a novel fire risk and transforming natural ecosystems. The model used in this application incorporates buffelgrass dispersal and establishment and management actions and effectiveness including inventory, treatment and post-treatment maintenance. We simulated 11 alternative scenarios developed in consultation with buffelgrass managers and other stakeholders. The scenarios vary according to the total budget allocated for management and the allocation of that budget between different kinds of management actions. Scenario results suggest that to achieve an actual reduction and stabilization of buffelgrass populations, management unconstrained by fiscal restrictions and across all jurisdictions and private lands is required; without broad and aggressive management, buffelgrass populations are expected to increase over time. However, results also suggest that large upfront investments can achieve control results that require relatively minimal spending in the future. Investing the necessary funds upfront to control the invasion results in the most

Investigating the Extent Realistic Moulage Impacts on Immersion and Performance Among Undergraduate Paramedicine Students in a Simulation-based Trauma Scenario: A Pilot Study.

PubMed

Mills, Brennen W; Miles, Alecka K; Phan, Tina; Dykstra, Peggy M C; Hansen, Sara S; Walsh, Andrew S; Reid, David N; Langdon, Claire

2018-04-18

Many healthcare education commentators suggest that moulage can be used in simulation to enhance scenario realism. However, few studies investigate to what extent using moulage in simulation impacts learners. We undertook a mixed-methods pilot study investigating how moulage influences student immersion and performance in simulation. Fifty undergraduate paramedicine students were randomized into two groups completing a trauma-based scenario with or without patient moulage. Task immersion was determined via a self-report questionnaire (National Aeronautics and Space Administration Task Load Index), eye-tracking, and postsimulation interviews. Performance was measured via independent observation of video by two paramedic clinical educators and time-to-action-when students first applied pressure to the primary wound. Eye-tracking suggested that students attended to the thigh wound more often with the inclusion of moulage than without. National Aeronautics and Space Administration Task Load Index data suggested that the inclusion of moulage heightened students' feeling of being rushed throughout the scenario. This elicited an expedited performance of tasks with moulage present compared with not. Students experienced greater immersion with the inclusion of moulage. However, including moulage enhanced scenario difficulty to the extent that overall clinical performance was negatively affected. However, no differences were found when more heavily weighting items felt to contribute most to the survivability of the patient. Including moulage engendered immersion and a greater sense of urgency and did not sacrifice performance of key life-saving interventions. As a result of undertaking this pilot project, we suggest that a large-scale randomized controlled trial is feasible and should be undertaken before implementing change to curricula.

Immersive virtual reality-based training improves response in a simulated operating room fire scenario.

PubMed

Sankaranarayanan, Ganesh; Wooley, Lizzy; Hogg, Deborah; Dorozhkin, Denis; Olasky, Jaisa; Chauhan, Sanket; Fleshman, James W; De, Suvranu; Scott, Daniel; Jones, Daniel B

2018-01-25

SAGES FUSE curriculum provides didactic knowledge on OR fire prevention. The objective of this study is to evaluate the impact of an immersive virtual reality (VR)-based OR fire training simulation system in combination with FUSE didactics. The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about precautions and stopping an OR fire from the FUSE manual. The simulation group practiced on the OR fire simulation for one session that consisted of five trials within a week from the pre-test. One week later, both groups were reassessed using a questionnaire. A week after the post-test both groups also participated in a simulated OR fire scenario while their performance was videotaped for assessment. A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853). However, when tested in the mock OR fire scenario, 70% of the simulation group subjects were able to perform the correct sequence of steps in extinguishing the simulated fire whereas only 20% subjects in the control group were able to do so (p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition source (p = 0.014). Interactive VR-based hands-on training was found to be a relatively inexpensive and effective mode for teaching OR fire prevention and management scenarios.

Simulated patient training: Using inter-rater reliability to evaluate simulated patient consistency in nursing education.

PubMed

MacLean, Sharon; Geddes, Fiona; Kelly, Michelle; Della, Phillip

2018-03-01

Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances. The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs. A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS. Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills. The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

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. © 2011 Blackwell Publishing.

Advanced ST plasma scenario simulations for NSTX

NASA Astrophysics Data System (ADS)

Kessel, C. E.; Synakowski, E. J.; Bell, M. E.; Gates, D. A.; Harvey, R. W.; Kaye, S. M.; Mau, T. K.; Menard, J.; Phillips, C. K.; Taylor, G.; Wilson, R.; NSTX Research Team

2005-08-01

Integrated scenario simulations are done for NSTX that address four primary objectives for developing advanced spherical torus (ST) configurations: high β and high βN inductive discharges to study all aspects of ST physics in the high β regime; non-inductively sustained discharges for flattop times greater than the skin time to study the various current drive techniques; non-inductively sustained discharges at high β for flattop times much greater than a skin time which provides the integrated advanced ST target for NSTX and non-solenoidal startup and plasma current rampup. The simulations done here use the tokamak simulation code and are based on a discharge 109070. TRANSP analysis of the discharge provided the thermal diffusivities for electrons and ions, the neutral beam deposition profile and other characteristics. CURRAY is used to calculate the high harmonic fast wave (HHFW) heating depositions and current drive. GENRAY/CQL3D is used to establish the heating and CD deposition profiles for electron Bernstein waves (EBW). Analysis of the ideal MHD stability is done with JSOLVER, BALMSC and PEST2. The simulations indicate that the integrated advanced ST plasma is reachable, obtaining stable plasmas with βT ap 40% at βN's of 7.7-9, IP = 1.0 MA and BT = 0.35 T. The plasma is 100% non-inductive and has a flattop of four skin times. The resulting global energy confinement corresponds to a multiplier of H98(y),2 = 1.5. The simulations have demonstrated the importance of HHFW heating and CD, EBW off-axis CD, strong plasma shaping, density control and early heating/H-mode transition for producing and optimizing these plasma configurations.

A generic open-source software framework supporting scenario simulations in bioterrorist crises.

PubMed

Falenski, Alexander; Filter, Matthias; Thöns, Christian; Weiser, Armin A; Wigger, Jan-Frederik; Davis, Matthew; Douglas, Judith V; Edlund, Stefan; Hu, Kun; Kaufman, James H; Appel, Bernd; Käsbohrer, Annemarie

2013-09-01

Since the 2001 anthrax attack in the United States, awareness of threats originating from bioterrorism has grown. This led internationally to increased research efforts to improve knowledge of and approaches to protecting human and animal populations against the threat from such attacks. A collaborative effort in this context is the extension of the open-source Spatiotemporal Epidemiological Modeler (STEM) simulation and modeling software for agro- or bioterrorist crisis scenarios. STEM, originally designed to enable community-driven public health disease models and simulations, was extended with new features that enable integration of proprietary data as well as visualization of agent spread along supply and production chains. STEM now provides a fully developed open-source software infrastructure supporting critical modeling tasks such as ad hoc model generation, parameter estimation, simulation of scenario evolution, estimation of effects of mitigation or management measures, and documentation. This open-source software resource can be used free of charge. Additionally, STEM provides critical features like built-in worldwide data on administrative boundaries, transportation networks, or environmental conditions (eg, rainfall, temperature, elevation, vegetation). Users can easily combine their own confidential data with built-in public data to create customized models of desired resolution. STEM also supports collaborative and joint efforts in crisis situations by extended import and export functionalities. In this article we demonstrate specifically those new software features implemented to accomplish STEM application in agro- or bioterrorist crisis scenarios.

Does simulation enhance nurses' ability to assess deteriorating patients?

PubMed

Bliss, Maria; Aitken, Leanne M

2018-01-01

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care. Copyright © 2017 Elsevier Ltd. All rights reserved.

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. Copyright 2014, SLACK Incorporated.

Simulating post-wildfire forest trajectories under alternative climate and management scenarios

Treesearch

Alicia Azpeleta Tarancon; Peter Z. Fule; Kristen L. Shive; Carolyn H. Sieg; Andrew Sanchez Meador; Barbara Strom

2014-01-01

Post-fire predictions of forest recovery under future climate change and management actions are necessary for forest managers to make decisions about treatments. We applied the Climate-Forest Vegetation Simulator (Climate-FVS), a new version of a widely used forest management model, to compare alternative climate and management scenarios in a severely burned...

A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters.

PubMed

Carr, Brendan G; Walsh, Lauren; Williams, Justin C; Pryor, John P; Branas, Charles C

2016-08-01

Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters. A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events. To demonstrate the model's potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties. Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks

The effects of scenario-based simulation course training on nurses' communication competence and self-efficacy: a randomized controlled trial.

PubMed

Hsu, Li-Ling; Chang, Wen-Hui; Hsieh, Suh-Ing

2015-01-01

Studies have shown that an underappreciation of the importance of person-centered communication and inappropriate communication training could result in unsatisfactory communication performance from nurses. There are a large number of studies about communication training for nurses, but not so many about communication training in early stages of nursing career. The purpose of this study is to compare the effect of a traditional course versus scenario-based simulation training on nurses' communication competency, communication self-efficacy, and communication performance in discharge planning Objective Structured Clinical Examination (OSCE). A randomized controlled trial was used with a pretest and two posttests. The experimental group underwent the scenario-based simulation course, whereas the control group received the traditional course. A convenience sample of 116 nurses with qualifications ranging from N0 level (novice nurses) to N2 level (competent nurses) in Taiwan's clinical nursing ladder system was recruited from a medical center in northern Taiwan. Analysis of covariance was used to determine between-subjects effects on communication competency and self-efficacy, whereas independent t test and Mann-Whitney U test were used to examine between-subjects effects on learner satisfaction and discharge planning communication performance. Paired t test was used to determine communication self-efficacy. In this study, the nurses and independent raters found scenario-based simulation training more effective than traditional communication course. However, standardized patients reported no significant difference in communication performance between the two groups of nurses. Despite that traditional classroom lectures and simulation-based communication training could both produce enhanced communication competency and self-efficacy among nurses, this study has established that the latter may be better than the former in terms of learner satisfaction and communication

The effectiveness of a simulated scenario to teach nursing students how to perform a bed bath: A randomized clinical trial.

PubMed

Miranda, Renata Pinto Ribeiro; de Cássia Lopes Chaves, Érika; Silva Lima, Rogério; Braga, Cristiane Giffoni; Simões, Ivandira Anselmo Ribeiro; Fava, Silvana Maria Coelho Leite; Iunes, Denise Hollanda

2017-10-01

Simulation allows students to develop several skills during a bed bath that are difficult to teach only in traditional classroom lectures, such as problem-solving, student interactions with the simulator (patient), reasoning in clinical evaluations, evaluation of responses to interventions, teamwork, communication, security and privacy. This study aimed to evaluate the effectiveness of a simulated bed bath scenario on improving cognitive knowledge, practical performance and satisfaction among nursing students. Randomized controlled clinical trial. Nursing students that were in the fifth period from two educational institutions in Brazil. Nursing students (n=58). The data were collected using the assessments of cognitive knowledge, practical performance and satisfaction were made through a written test about bed baths, an Objective Structured Clinical Examination (OSCE) and a satisfaction questionnaire. We identified that the acquisition and assimilation of cognitive knowledge was significantly higher in the simulation group (p=0.001). The performance was similar in both groups regardless of the teaching strategy (p=0.435). At follow-up, the simulation group had significantly more satisfaction with the teaching method than the control group (p=0.007). The teaching strategy based on a simulated scenario of a bed bath proved to be effective for the acquisition of cognitive knowledge regarding bed baths in clinical practice and improved student satisfaction with the teaching process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of feedbacks from simulated crop growth on integrated regional hydrologic simulations under climate scenarios

NASA Astrophysics Data System (ADS)

van Walsum, P. E. V.

2011-11-01

Climate change impact modelling of hydrologic responses is hampered by climate-dependent model parameterizations. Reducing this dependency was one of the goals of extending the regional hydrologic modelling system SIMGRO with a two-way coupling to the crop growth simulation model WOFOST. The coupling includes feedbacks to the hydrologic model in terms of the root zone depth, soil cover, leaf area index, interception storage capacity, crop height and crop factor. For investigating whether such feedbacks lead to significantly different simulation results, two versions of the model coupling were set up for a test region: one with exogenous vegetation parameters, the "static" model, and one with endogenous simulation of the crop growth, the "dynamic" model WOFOST. The used parameterization methods of the static/dynamic vegetation models ensure that for the current climate the simulated long-term average of the actual evapotranspiration is the same for both models. Simulations were made for two climate scenarios. Owing to the higher temperatures in combination with a higher CO2-concentration of the atmosphere, a forward time shift of the crop development is simulated in the dynamic model; the used arable land crop, potatoes, also shows a shortening of the growing season. For this crop, a significant reduction of the potential transpiration is simulated compared to the static model, in the example by 15% in a warm, dry year. In consequence, the simulated crop water stress (the unit minus the relative transpiration) is lower when the dynamic model is used; also the simulated increase of crop water stress due to climate change is lower; in the example, the simulated increase is 15 percentage points less (of 55) than when a static model is used. The static/dynamic models also simulate different absolute values of the transpiration. The difference is most pronounced for potatoes at locations with ample moisture supply; this supply can either come from storage release of a

Multicriteria evaluation of simulated logging scenarios in a tropical rain forest.

PubMed

Huth, Andreas; Drechsler, Martin; Köhler, Peter

2004-07-01

Forest growth models are useful tools for investigating the long-term impacts of logging. In this paper, the results of the rain forest growth model FORMIND were assessed by a multicriteria decision analysis. The main processes covered by FORMIND include tree growth, mortality, regeneration and competition. Tree growth is calculated based on a carbon balance approach. Trees compete for light and space; dying large trees fall down and create gaps in the forest. Sixty-four different logging scenarios for an initially undisturbed forest stand at Deramakot (Malaysia) were simulated. The scenarios differ regarding the logging cycle, logging method, cutting limit and logging intensity. We characterise the impacts with four criteria describing the yield, canopy opening and changes in species composition. Multicriteria decision analysis was used for the first time to evaluate the scenarios and identify the efficient ones. Our results plainly show that reduced-impact logging scenarios are more 'efficient' than the others, since in these scenarios forest damage is minimised without significantly reducing yield. Nevertheless, there is a trade-off between yield and achieving a desired ecological state of logged forest; the ecological state of the logged forests can only be improved by reducing yields and enlarging the logging cycles. Our study also demonstrates that high cutting limits or low logging intensities cannot compensate for the high level of damage caused by conventional logging techniques.

Simulating post-wildfire forest trajectories under alternative climate and management scenarios.

PubMed

Tarancón, Alicia Azpeleta; Fulé, Peter Z; Shive, Kristen L; Sieg, Carolyn H; Meador, Andrew Sánchez; Strom, Barbara

Post-fire predictions of forest recovery under future climate change and management actions are necessary for forest managers to make decisions about treatments. We applied the Climate-Forest Vegetation Simulator (Climate-FVS), a new version of a widely used forest management model, to compare alternative climate and management scenarios in a severely burned multispecies forest of Arizona, USA. The incorporation of seven combinations of General Circulation Models (GCM) and emissions scenarios altered long-term (100 years) predictions of future forest condition compared to a No Climate Change (NCC) scenario, which forecast a gradual increase to high levels of forest density and carbon stock. In contrast, emissions scenarios that included continued high greenhouse gas releases led to near-complete deforestation by 2111. GCM-emissions scenario combinations that were less severe reduced forest structure and carbon stock relative to NCC. Fuel reduction treatments that had been applied prior to the severe wildfire did have persistent effects, especially under NCC, but were overwhelmed by increasingly severe climate change. We tested six management strategies aimed at sustaining future forests: prescribed burning at 5, 10, or 20-year intervals, thinning 40% or 60% of stand basal area, and no treatment. Severe climate change led to deforestation under all management regimes, but important differences emerged under the moderate scenarios: treatments that included regular prescribed burning fostered low density, wildfire-resistant forests composed of the naturally dominant species, ponderosa pine. Non-fire treatments under moderate climate change were forecast to become dense and susceptible to severe wildfire, with a shift to dominance by sprouting species. Current U.S. forest management requires modeling of future scenarios but does not mandate consideration of climate change effects. However, this study showed substantial differences in model outputs depending on climate

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

PubMed

Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly

2017-12-01

Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.

Capturing readiness to learn and collaboration as explored with an interprofessional simulation scenario: A mixed-methods research study.

PubMed

Rossler, Kelly L; Kimble, Laura P

2016-01-01

Didactic lecture does not lend itself to teaching interprofessional collaboration. High-fidelity human patient simulation with a focus on clinical situations/scenarios is highly conducive to interprofessional education. Consequently, a need for research supporting the incorporation of interprofessional education with high-fidelity patient simulation based technology exists. The purpose of this study was to explore readiness for interprofessional learning and collaboration among pre-licensure health professions students participating in an interprofessional education human patient simulation experience. Using a mixed methods convergent parallel design, a sample of 53 pre-licensure health professions students enrolled in nursing, respiratory therapy, health administration, and physical therapy programs within a college of health professions participated in high-fidelity human patient simulation experiences. Perceptions of interprofessional learning and collaboration were measured with the revised Readiness for Interprofessional Learning Scale (RIPLS) and the Health Professional Collaboration Scale (HPCS). Focus groups were conducted during the simulation post-briefing to obtain qualitative data. Statistical analysis included non-parametric, inferential statistics. Qualitative data were analyzed using a phenomenological approach. Pre- and post-RIPLS demonstrated pre-licensure health professions students reported significantly more positive attitudes about readiness for interprofessional learning post-simulation in the areas of team work and collaboration, negative professional identity, and positive professional identity. Post-simulation HPCS revealed pre-licensure nursing and health administration groups reported greater health collaboration during simulation than physical therapy students. Qualitative analysis yielded three themes: "exposure to experiential learning," "acquisition of interactional relationships," and "presence of chronology in role preparation

Implementation and outcome evaluation of high-fidelity simulation scenarios to integrate cognitive and psychomotor skills for Korean nursing students.

PubMed

Ahn, Heejung; Kim, Hyun-Young

2015-05-01

This study is involved in designing high-fidelity simulations reflecting the Korean nursing education environment. In addition, it evaluated the simulations by nursing students' learning outcomes and perceptions of the simulation design features. A quantitative design was used in two separate phases. For the first phase, five nursing experts participated in verifying the appropriateness of two simulation scenarios that reflected the intended learning objectives. For the second phase, 69 nursing students in the third year of a bachelor's degree at a nursing school participated in evaluating the simulations and were randomized according to their previous course grades. The first phase verified the two simulation scenarios using a questionnaire. The second phase evaluated students' perceptions of the simulation design, self-confidence, and critical thinking skills using a quasi-experimental post-test design. ANCOVA was used to compare the experimental and control groups, and correlation coefficient analysis was used to determine the correlation among them. We created 2 simulation scenarios to integrate cognitive and psychomotor skills according to the learning objectives and clinical environment in Korea. The experimental group had significantly higher scores on self-confidence in the first scenario. The positive correlations between perceptions of the simulation design features, self-confidence, and critical thinking skill scores were statistically significant. Students with a more positive perception of the design features of the simulations had better learning outcomes. Based on this result, simulations need to be designed and implemented with more differentiation in order to be perceived more appropriately by students. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and

Mental simulation of future scenarios in transient global amnesia.

PubMed

Juskenaite, Aurelija; Quinette, Peggy; Desgranges, Béatrice; de La Sayette, Vincent; Viader, Fausto; Eustache, Francis

2014-10-01

Researchers exploring mental time travel into the future have emphasized the role played by episodic memory and its cerebral substrates. Recently, owing to controversial findings in amnesic patients, this role has become a matter of intense debate. In order to understand whether episodic memory is indeed crucial to future thinking, we assessed this ability in 11 patients during an episode of transient global amnesia (TGA), a unique and severe amnesic syndrome that primarily affects episodic memory. In the first of two experiments, TGA patients were asked to recall personal past events as well as to imagine personal future events, without any guidance regarding content. Under this condition, compared with controls, they provided fewer past and fewer future events, and the latter were less closely related to their personal goals. Furthermore, TGA patients׳ descriptions of past and future events were scant, containing fewer descriptive elements in total and fewer internal details. In order to assess whether TGA patients might have been basing their future event narratives on their general knowledge about how these events usually unfold, in our second experiment, we asked them to imagine future events in response to short descriptions of common scenarios. Under this condition, inherently eliciting less detailed descriptions, not only were all the TGA patients able to describe common events as happening in the future, but their narratives contained comparable amounts of internal detail to those of controls, despite being less detailed overall. Taken together, our results indicate that severe amnesia interferes with TGA patients׳ ability to envisage their personal past and future on a general level as well as in detail, but less severely affects their ability to imagine common scenarios, which are not related to their personal goals, probably owing to their preserved semantic memory, logical reasoning and ability to create vivid mental images. Copyright © 2014

Measuring Workload Differences Between Short-term Memory and Long-term Memory Scenarios in a Simulated Flight Environment

NASA Technical Reports Server (NTRS)

Berg, S. L.; Sheridan, T. B.

1984-01-01

Four highly experienced Air Force pilots each flew four simulated flight scenarios. Two scenarios required a great deal of aircraft maneuvering. The other two scenarios involved less maneuvering, but required remembering a number of items. All scenarios were designed to be equaly challenging. Pilot's Subjective Ratings for Activity-level, Complexity, Difficulty, Stress, and Workload were higher for the manuevering scenarios than the memory scenarios. At a moderate workload level, keeping the pilots active resulted in better aircraft control. When required to monitor and remember items, aircraft control tended to decrease. Pilots tended to weigh information about the spatial positioning and performance of their aircraft more heavily than other items.

Evaluation of ecosystem service based on scenario simulation of land use in Yunnan Province

NASA Astrophysics Data System (ADS)

Zhang, Hong; Liao, Xiaoli; Zhai, Tianlin

2018-04-01

Climate change and rapid urbanization are important factors restricting future land use. Situational analysis, as an important foundation for the optimization of land use, needs to focus on the impact of climate factors and socio-economic factors. In this paper, the Markov model and the DLS (Simulation of Land System Dynamics) model are combined for the first time, and the land use pattern in 2020 is simulated based on the data of land use in 2000 and 2010 as well as the climate, soil, topography and socio-economic factors of Yunnan Province. In his paper, we took Yunnan Province as the case study area, and selected 12 driving factors by logistic regression method, then the land use demands and layout of Yunnan Province in 2020 has been forecasted and simulated under business as usual (BAU) scenario and farmland protection (FP) scenario and the changes in ecosystem service value has been calculated. The result shows that: (1) after the regression analysis and ROC (Relative Operating Characteristics) test, the 12 factors selected in this paper have a strong ability to explain the land use change in Yunnan Province. (2) Under the two scenarios, the significant reduction of arable land area is a common feature of land use change in Yunnan Province in the future, and its main land use type will be construction land. However, under FP scenario, the current situation where construction land encroach on arable land will be improved. Compared with the change from 2000 to 2010, the trend of arable land, forest land, water area, construction land and unused land will be the same under the two scenarios, whereas the change trend of grassland was opposite. (3) From 2000 to 2020, the value of ecosystem services in Yunnan Province is on the rise, but the ecosystem service value under FP scenario is higher than that of the ecosystem services under BAU scenario. In general, land use in 2020 in Yunnan Province continues the pattern of 2010, but there are also significant spatial

Integrating Simulation Scenarios and Clinical Practices Guided by Concepts of Translational Medicine

ERIC Educational Resources Information Center

Yang, Jing; Huang, Si-min; Li, Ze-jian; Feng, Lie; Lu, Chun-ting

2018-01-01

Purpose: To develop a novel method for closely and effectively integrating simulation scenarios and clinical practices to improve clinical skills training in the concepts of translational medicine. Methods: Forty-two and 38 third-year medical students in the classes of 2010 and 2009 at Jinan University were selected as an observation group and a…

An intersubject variable regional anesthesia simulator with a virtual patient architecture.

PubMed

Ullrich, Sebastian; Grottke, Oliver; Fried, Eduard; Frommen, Thorsten; Liao, Wei; Rossaint, Rolf; Kuhlen, Torsten; Deserno, Thomas M

2009-11-01

The main purpose is to provide an intuitive VR-based training environment for regional anesthesia (RA). The research question is how to process subject-specific datasets, organize them in a meaningful way and how to perform the simulation for peripheral regions. We propose a flexible virtual patient architecture and methods to process datasets. Image acquisition, image processing (especially segmentation), interactive nerve modeling and permutations (nerve instantiation) are described in detail. The simulation of electric impulse stimulation and according responses are essential for the training of peripheral RA and solved by an approach based on the electric distance. We have created an XML-based virtual patient database with several subjects. Prototypes of the simulation are implemented and run on multimodal VR hardware (e.g., stereoscopic display and haptic device). A first user pilot study has confirmed our approach. The virtual patient architecture enables support for arbitrary scenarios on different subjects. This concept can also be used for other simulators. In future work, we plan to extend the simulation and conduct further evaluations in order to provide a tool for routine training for RA.

Development of a patient-specific surgical simulator for pediatric laparoscopic procedures.

PubMed

Saber, Nikoo R; Menon, Vinay; St-Pierre, Jean C; Looi, Thomas; Drake, James M; Cyril, Xavier

2014-01-01

The purpose of this study is to develop and evaluate a pediatric patient-specific surgical simulator for the planning, practice, and validation of laparoscopic surgical procedures prior to intervention, initially focusing on the choledochal cyst resection and reconstruction scenario. The simulator is comprised of software elements including a deformable body physics engine, virtual surgical tools, and abdominal organs. Hardware components such as haptics-enabled hand controllers and a representative endoscopic tool have also been integrated. The prototype is able to perform a number of surgical tasks and further development work is under way to simulate the complete procedure with acceptable fidelity and accuracy.

Physical Simulation for Low-Energy Astrobiology Environmental Scenarios

NASA Astrophysics Data System (ADS)

Gormly, Sherwin; Adams, V. D.; Marchand, Eric

2003-12-01

Speculations about the extent of life of independent origin and the potential for sustaining Earth-based life in subsurface environments on both Europa and Mars are of current and relevant interest. Theoretical modeling based on chemical energetics has demonstrated potential options for viable biochemical metabolism (metabolic pathways) in these types of environments. Also, similar environments on Earth show microbial activity. However, actual physical simulation testing of specific environments is required to confidently determine the interplay of various physical and chemical parameters on the viability of relevant metabolic pathways. This testing is required to determine the potential to sustain life in these environments on a specific scenario by scenario basis. This study examines the justification, design, and fabrication of, as well as the culture selection and screening for, a psychrophilic/halophilic/anaerobic digester. This digester is specifically designed to conform to physical testing needs of research relating to potential extent physical environments on Europa and other planetary bodies in the Solar System. The study is a long-term effort and is currently in an early phase, with only screening-level data at this time. Full study results will likely take an additional 2 years. However, researchers in electromagnetic biosignature and in situ instrument development should be aware of the study at this time, as they are invited to participate in planning for future applications of the digester facility.

Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

PubMed Central

Patel, Archita D.; Meurer, David A.; Shuster, Jonathan J.

2016-01-01

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P < 0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77). Conclusion. Simulation training improved prehospital care providers' confidence level in performing two life-saving procedures. PMID:27563467

Linking state-and-transition simulation and timber supply models for forest biomass production scenarios

USGS Publications Warehouse

Costanza, Jennifer; Abt, Robert C.; McKerrow, Alexa; Collazo, Jaime

2015-01-01

We linked state-and-transition simulation models (STSMs) with an economics-based timber supply model to examine landscape dynamics in North Carolina through 2050 for three scenarios of forest biomass production. Forest biomass could be an important source of renewable energy in the future, but there is currently much uncertainty about how biomass production would impact landscapes. In the southeastern US, if forests become important sources of biomass for bioenergy, we expect increased land-use change and forest management. STSMs are ideal for simulating these landscape changes, but the amounts of change will depend on drivers such as timber prices and demand for forest land, which are best captured with forest economic models. We first developed state-and-transition model pathways in the ST-Sim software platform for 49 vegetation and land-use types that incorporated each expected type of landscape change. Next, for the three biomass production scenarios, the SubRegional Timber Supply Model (SRTS) was used to determine the annual areas of thinning and harvest in five broad forest types, as well as annual areas converted among those forest types, agricultural, and urban lands. The SRTS output was used to define area targets for STSMs in ST-Sim under two scenarios of biomass production and one baseline, business-as-usual scenario. We show that ST-Sim output matched SRTS targets in most cases. Landscape dynamics results indicate that, compared with the baseline scenario, forest biomass production leads to more forest and, specifically, more intensively managed forest on the landscape by 2050. Thus, the STSMs, informed by forest economics models, provide important information about potential landscape effects of bioenergy production.

Broadband Ground Motion Simulation Recipe for Scenario Hazard Assessment in Japan

NASA Astrophysics Data System (ADS)

Koketsu, K.; Fujiwara, H.; Irikura, K.

2014-12-01

The National Seismic Hazard Maps for Japan, which consist of probabilistic seismic hazard maps (PSHMs) and scenario earthquake shaking maps (SESMs), have been published every year since 2005 by the Earthquake Research Committee (ERC) in the Headquarter for Earthquake Research Promotion, which was established in the Japanese government after the 1995 Kobe earthquake. The publication was interrupted due to problems in the PSHMs revealed by the 2011 Tohoku earthquake, and the Subcommittee for Evaluations of Strong Ground Motions ('Subcommittee') has been examining the problems for two and a half years (ERC, 2013; Fujiwara, 2014). However, the SESMs and the broadband ground motion simulation recipe used in them are still valid at least for crustal earthquakes. Here, we outline this recipe and show the results of validation tests for it.Irikura and Miyake (2001) and Irikura (2004) developed a recipe for simulating strong ground motions from future crustal earthquakes based on a characterization of their source models (Irikura recipe). The result of the characterization is called a characterized source model, where a rectangular fault includes a few rectangular asperities. Each asperity and the background area surrounding the asperities have their own uniform stress drops. The Irikura recipe defines the parameters of the fault and asperities, and how to simulate broadband ground motions from the characterized source model. The recipe for the SESMs was constructed following the Irikura recipe (ERC, 2005). The National Research Institute for Earth Science and Disaster Prevention (NIED) then made simulation codes along this recipe to generate SESMs (Fujiwara et al., 2006; Morikawa et al., 2011). The Subcommittee in 2002 validated a preliminary version of the SESM recipe by comparing simulated and observed ground motions for the 2000 Tottori earthquake. In 2007 and 2008, the Subcommittee carried out detailed validations of the current version of the SESM recipe and the NIED

Logs Analysis of Adapted Pedagogical Scenarios Generated by a Simulation Serious Game Architecture

ERIC Educational Resources Information Center

Callies, Sophie; Gravel, Mathieu; Beaudry, Eric; Basque, Josianne

2017-01-01

This paper presents an architecture designed for simulation serious games, which automatically generates game-based scenarios adapted to learner's learning progression. We present three central modules of the architecture: (1) the learner model, (2) the adaptation module and (3) the logs module. The learner model estimates the progression of the…

Uncertainty of simulated groundwater levels arising from stochastic transient climate change scenarios

NASA Astrophysics Data System (ADS)

Goderniaux, Pascal; Brouyère, Serge; Blenkinsop, Stephen; Burton, Aidan; Fowler, Hayley; Dassargues, Alain

2010-05-01

The evaluation of climate change impact on groundwater reserves represents a difficult task because both hydrological and climatic processes are complex and difficult to model. In this study, we present an innovative methodology that combines the use of integrated surface - subsurface hydrological models with advanced stochastic transient climate change scenarios. This methodology is applied to the Geer basin (480 km²) in Belgium, which is intensively exploited to supply the city of Liège (Belgium) with drinking water. The physically-based, spatially-distributed, surface-subsurface flow model has been developed with the finite element model HydroGeoSphere . The simultaneous solution of surface and subsurface flow equations in HydroGeoSphere, as well as the internal calculation of the actual evapotranspiration as a function of the soil moisture at each node of the evaporative zone, enables a better representation of interconnected processes in all domains of the catchment (fully saturated zone, partially saturated zone, surface). Additionally, the use of both surface and subsurface observed data to calibrate the model better constrains the calibration of the different water balance terms. Crucially, in the context of climate change impacts on groundwater resources, the evaluation of groundwater recharge is improved. . This surface-subsurface flow model is combined with advanced climate change scenarios for the Geer basin. Climate change simulations were obtained from six regional climate model (RCM) scenarios assuming the SRES A2 greenhouse gases emission (medium-high) scenario. These RCM scenarios were statistically downscaled using a transient stochastic weather generator technique, combining 'RainSim' and the 'CRU weather generator' for temperature and evapotranspiration time series. This downscaling technique exhibits three advantages compared with the 'delta change' method usually used in groundwater impact studies. (1) Corrections to climate model output are

Widespread, Very Heavy Precipitation Events in Contemporary and Scenario Summer Climates from NARCCAP Simulations

NASA Astrophysics Data System (ADS)

Kawazoe, S.; Gutowski, W. J., Jr.

2015-12-01

We analyze the ability of regional climate models (RCMs) to simulate very heavy daily precipitation and supporting processes for both contemporary and future-scenario simulations during summer (JJA). RCM output comes from North American Regional Climate Change Assessment Program (NARCCAP) simulations, which are all run at a spatial resolution of 50 km. Analysis focuses on the upper Mississippi basin for summer, between 1982-1998 for the contemporary climate, and 2052-2068 during the scenario climate. We also compare simulated precipitation and supporting processes with those obtained from observed precipitation and reanalysis atmospheric states. Precipitation observations are from the University of Washington (UW) and the Climate Prediction Center (CPC) gridded dataset. Utilizing two observational datasets helps determine if any uncertainties arise from differences in precipitation gridding schemes. Reanalysis fields come from the North American Regional Reanalysis. The NARCCAP models generally reproduce well the precipitation-vs.-intensity spectrum seen in observations, while producing overly strong precipitation at high intensity thresholds. In the future-scenario climate, there is a decrease in frequency for light to moderate precipitation intensities, while an increase in frequency is seen for the higher intensity events. Further analysis focuses on precipitation events exceeding the 99.5 percentile that occur simultaneously at several points in the region, yielding so-called "widespread events". For widespread events, we analyze local and large scale environmental parameters, such as 2-m temperature and specific humidity, 500-hPa geopotential heights, Convective Available Potential Energy (CAPE), vertically integrated moisture flux convergence, among others, to compare atmospheric states and processes leading to such events in the models and observations. The results suggest that an analysis of atmospheric states supporting very heavy precipitation events is a

Simulating Crop Evapotranspiration Response under Different Planting Scenarios by Modified SWAT Model in an Irrigation District, Northwest China.

PubMed

Liu, Xin; Wang, Sufen; Xue, Han; Singh, Vijay P

2015-01-01

Modelling crop evapotranspiration (ET) response to different planting scenarios in an irrigation district plays a significant role in optimizing crop planting patterns, resolving agricultural water scarcity and facilitating the sustainable use of water resources. In this study, the SWAT model was improved by transforming the evapotranspiration module. Then, the improved model was applied in Qingyuan Irrigation District of northwest China as a case study. Land use, soil, meteorology, irrigation scheduling and crop coefficient were considered as input data, and the irrigation district was divided into subdivisions based on the DEM and local canal systems. On the basis of model calibration and verification, the improved model showed better simulation efficiency than did the original model. Therefore, the improved model was used to simulate the crop evapotranspiration response under different planting scenarios in the irrigation district. Results indicated that crop evapotranspiration decreased by 2.94% and 6.01% under the scenarios of reducing the planting proportion of spring wheat (scenario 1) and summer maize (scenario 2) by keeping the total cultivated area unchanged. However, the total net output values presented an opposite trend under different scenarios. The values decreased by 3.28% under scenario 1, while it increased by 7.79% under scenario 2, compared with the current situation. This study presents a novel method to estimate crop evapotranspiration response under different planting scenarios using the SWAT model, and makes recommendations for strategic agricultural water management planning for the rational utilization of water resources and development of local economy by studying the impact of planting scenario changes on crop evapotranspiration and output values in the irrigation district of northwest China.

Simulating Crop Evapotranspiration Response under Different Planting Scenarios by Modified SWAT Model in an Irrigation District, Northwest China

PubMed Central

Liu, Xin; Wang, Sufen; Xue, Han; Singh, Vijay P.

2015-01-01

Modelling crop evapotranspiration (ET) response to different planting scenarios in an irrigation district plays a significant role in optimizing crop planting patterns, resolving agricultural water scarcity and facilitating the sustainable use of water resources. In this study, the SWAT model was improved by transforming the evapotranspiration module. Then, the improved model was applied in Qingyuan Irrigation District of northwest China as a case study. Land use, soil, meteorology, irrigation scheduling and crop coefficient were considered as input data, and the irrigation district was divided into subdivisions based on the DEM and local canal systems. On the basis of model calibration and verification, the improved model showed better simulation efficiency than did the original model. Therefore, the improved model was used to simulate the crop evapotranspiration response under different planting scenarios in the irrigation district. Results indicated that crop evapotranspiration decreased by 2.94% and 6.01% under the scenarios of reducing the planting proportion of spring wheat (scenario 1) and summer maize (scenario 2) by keeping the total cultivated area unchanged. However, the total net output values presented an opposite trend under different scenarios. The values decreased by 3.28% under scenario 1, while it increased by 7.79% under scenario 2, compared with the current situation. This study presents a novel method to estimate crop evapotranspiration response under different planting scenarios using the SWAT model, and makes recommendations for strategic agricultural water management planning for the rational utilization of water resources and development of local economy by studying the impact of planting scenario changes on crop evapotranspiration and output values in the irrigation district of northwest China. PMID:26439928

Model-Simulated Northern Winter Cyclone and Anticyclone Activity under a Greenhouse Warming Scenario.

NASA Astrophysics Data System (ADS)

Zhang, Yi; Wang, Wei-Chyung

1997-07-01

Two 100-yr equilibrium simulations from the NCAR Community Climate Model coupled to a nondynamic slab ocean are used to investigate the activity of northern winter extratropical cyclones and anticyclones under a greenhouse warming scenario. The first simulation uses the 1990 observed CO2, CH4, N2O, CFC-11, and CFC-12 concentrations, and the second adopts the year 2050 concentrations according to the Intergovernmental Panel on Climate Change business-as-usual scenario. Variables that describe the characteristic properties of the cyclone-scale eddies, such as surface cyclone and anticyclone frequency and the bandpassed root-mean-square of 500-hPa geopotential height, along with the Eady growth rate maximum, form a framework for the analysis of the cyclone and anticyclone activity.Objective criteria are developed for identifying cyclone and anticyclone occurrences based on the 1000-hPa geopotential height and vorticity fields and tested using ECMWF analyses. The potential changes of the eddy activity under the greenhouse warming climate are then examined. Results indicate that the activity of cyclone-scale eddies decreases under the greenhouse warming scenario. This is not only reflected in the surface cyclone and anticyclone frequency and in the bandpassed rms of 500-hPa geopotential height, but is also discerned from the Eady growth rate maximum. Based on the analysis, three different physical mechanisms responsible for the decreased eddy activity are discussed: 1) a decrease of the extratropical meridional temperature gradient from the surface to the midtroposphere, 2) a reduction in the land-sea thermal contrast in the east coastal regions of the Asian and North American continents, and 3) an increase in the eddy meridional latent heat fluxes. Uncertainties in the results related to the limitations of the model and the model equilibrium simulations are discussed.

ISS emergency scenarios and a virtual training simulator for Flight Controllers

NASA Astrophysics Data System (ADS)

Uhlig, Thomas; Roshani, Frank-Cyrus; Amodio, Ciro; Rovera, Alessandro; Zekusic, Nikola; Helmholz, Hannes; Fairchild, Matthew

2016-11-01

The current emergency response concept for the International Space Station (ISS) includes the support of the Flight Control Team. Therefore, the team members need to be trained in emergencies and the corresponding crew procedures to ensure a smooth collaboration between crew and ground. In the case where the astronaut and ground personnel training is not collocated it is a challenging endeavor to ensure and maintain proper knowledge and skills for the Flight Control Team. Therefore, a virtual 3D simulator at the Columbus Control Center (Col-CC) is presented, which is used for ground personnel training in the on-board emergency response. The paper briefly introduces the main ISS emergency scenarios and the corresponding response strategy, details the resulting learning objectives for the Flight Controllers and elaborates on the new simulation method, which will be used in the future. The status of the 3D simulator, first experiences and further plans are discussed.

A DYNAMIC PHYSIOLOGICALLY-BASED TOXICOKINETIC (DPBTK) MODEL FOR SIMULATION OF COMPLEX TOLUENE EXPOSURE SCENARIOS IN HUMANS

EPA Science Inventory

A GENERAL PHYSIOLOGICAL AND TOXICOKINETIC (GPAT) MODEL FOR SIMULATION OF COMPLEX TOLUENE EXPOSURE SCENARIOS IN HUMANS. E M Kenyon1, T Colemen2, C R Eklund1 and V A Benignus3. 1U.S. EPA, ORD, NHEERL, ETD, PKB, RTP, NC, USA; 2Biological Simulators, Inc., Jackson MS, USA, 3U.S. EP...

The effect of role assignment in high fidelity patient simulation on nursing students: An experimental research study.

PubMed

Weiler, Dustin T; Gibson, Andrea L; Saleem, Jason J

2018-04-01

Previous studies have evaluated the effectiveness of high fidelity patient simulators (HFPS) on nursing training; however, a gap exists on the effects of role assignment on critical thinking, self-efficacy, and situation awareness skills in team-based simulation scenarios. This study aims to determine if role assignment and the involvement level related to the roles yields significant effects and differences in critical thinking, situation awareness and self-efficacy scores in team-based high-fidelity simulation scenarios. A single factorial design with five levels and random assignment was utilized. A public university-sponsored simulation center in the United States of America. A convenience sample of 69 junior-level baccalaureate nursing students was recruited for participation. Participants were randomly assigned one of five possible roles and completed pre-simulation critical thinking and self-efficacy assessments prior to the simulation beginning. Playing within their assigned roles, participants experienced post-partum hemorrhaging scenario using an HFPS. After completing the simulation, participants completed a situation awareness assessment and a post-simulation critical thinking and self-efficacy assessment. Role assignment was found to have a statistically significant effect on critical thinking skills and a statistically significant difference in various areas of self-efficacy was also noted. However, no statistical significance in situation awareness abilities was found. Results support the notion that certain roles required the participant to be more involved with the simulation scenario, which may have yielded higher critical thinking and self-efficacy scores than roles that required a lesser level of involvement. Copyright © 2018 Elsevier Ltd. All rights reserved.

Undergraduate nursing students' experiences when examining nursing skills in clinical simulation laboratories with high-fidelity patient simulators: A phenomenological research study.

PubMed

Sundler, Annelie J; Pettersson, Annika; Berglund, Mia

2015-12-01

Simulation has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, the evidence in favour of this pedagogical approach is weak, and more knowledge is needed in support of its use. The aim of this study was (a) to explore the experiences of undergraduate nursing students when examining knowledge, skills and competences in clinical simulation laboratories with high-fidelity patient simulators and (b) to analyse these students' learning experiences during the examination. A phenomenological approach was used, and qualitative interviews were conducted among 23 second-year undergraduate nursing students-17 women and 6 men. The findings revealed that, irrespective of whether they passed or failed the examination, it was experienced as a valuable assessment of the students' knowledge and skills. Even if the students felt that the examination was challenging, they described it as a learning opportunity. In the examination, the students were able to integrate theory with practice, and earlier established knowledge was scrutinised when reflecting on the scenarios. The examination added aspects to the students' learning that prepared them for the real world of nursing in a safe environment without risking patient safety. The study findings suggest that examinations in clinical simulation laboratories can be a useful teaching strategy in nursing education. The use of high-fidelity patient simulators made the examination authentic. The reflections and feedback on the scenario were described as significant for the students' learning. Undergraduate nursing students can improve their knowledge, understanding, competence and skills when such examinations are performed in the manner used in this study. Copyright © 2015 Elsevier Ltd. All rights reserved.

Merging Methods to Manage Uncertainty: Combining Simulation Modeling and Scenario Planning to Inform Resource Management Under Climate Change

NASA Astrophysics Data System (ADS)

Miller, B. W.; Schuurman, G. W.; Symstad, A.; Fisichelli, N. A.; Frid, L.

2017-12-01

Managing natural resources in this era of anthropogenic climate change is fraught with uncertainties around how ecosystems will respond to management actions and a changing climate. Scenario planning (oftentimes implemented as a qualitative, participatory exercise for exploring multiple possible futures) is a valuable tool for addressing this challenge. However, this approach may face limits in resolving responses of complex systems to altered climate and management conditions, and may not provide the scientific credibility that managers often require to support actions that depart from current practice. Quantitative information on projected climate changes and ecological responses is rapidly growing and evolving, but this information is often not at a scale or in a form that is `actionable' for resource managers. We describe a project that sought to create usable information for resource managers in the northern Great Plains by combining qualitative and quantitative methods. In particular, researchers, resource managers, and climate adaptation specialists co-produced a simulation model in conjunction with scenario planning workshops to inform natural resource management in southwest South Dakota. Scenario planning for a wide range of resources facilitated open-minded thinking about a set of divergent and challenging, yet relevant and plausible, climate scenarios and management alternatives that could be implemented in the simulation. With stakeholder input throughout the process, we built a simulation of key vegetation types, grazing, exotic plants, fire, and the effects of climate and management on rangeland productivity and composition. By simulating multiple land management jurisdictions, climate scenarios, and management alternatives, the model highlighted important tradeoffs between herd sizes and vegetation composition, and between the short- versus long-term costs of invasive species management. It also identified impactful uncertainties related to the

Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

PubMed

Persona, Paolo; Saraceni, Elisabetta; Facchin, Francesca; Petranzan, Enrico; Parotto, Matteo; Baratto, Fabio; Ori, Carlo; Rossi, Sandra

2017-10-03

The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min -1 and the MostCare-CO values from 2.8 to 6.4 L min -1 . The mean difference between HPS-CO and MostCare-CO was - 0.3 L min -1 and the limits of agreement were - 1.5 and 0.9 L min -1 . The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.

Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education.

PubMed

Ryu, Won Hyung A; Dharampal, Navjit; Mostafa, Ahmed E; Sharlin, Ehud; Kopp, Gail; Jacobs, William Bradley; Hurlbert, Robin John; Chan, Sonny; Sutherland, Garnette R

Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A Study on Regional Rainfall Frequency Analysis for Flood Simulation Scenarios

NASA Astrophysics Data System (ADS)

Jung, Younghun; Ahn, Hyunjun; Joo, Kyungwon; Heo, Jun-Haeng

2014-05-01

Recently, climate change has been observed in Korea as well as in the entire world. The rainstorm has been gradually increased and then the damage has been grown. It is very important to manage the flood control facilities because of increasing the frequency and magnitude of severe rain storm. For managing flood control facilities in risky regions, data sets such as elevation, gradient, channel, land use and soil data should be filed up. Using this information, the disaster situations can be simulated to secure evacuation routes for various rainfall scenarios. The aim of this study is to investigate and determine extreme rainfall quantile estimates in Uijeongbu City using index flood method with L-moments parameter estimation. Regional frequency analysis trades space for time by using annual maximum rainfall data from nearby or similar sites to derive estimates for any given site in a homogeneous region. Regional frequency analysis based on pooled data is recommended for estimation of rainfall quantiles at sites with record lengths less than 5T, where T is return period of interest. Many variables relevant to precipitation can be used for grouping a region in regional frequency analysis. For regionalization of Han River basin, the k-means method is applied for grouping regions by variables of meteorology and geomorphology. The results from the k-means method are compared for each region using various probability distributions. In the final step of the regionalization analysis, goodness-of-fit measure is used to evaluate the accuracy of a set of candidate distributions. And rainfall quantiles by index flood method are obtained based on the appropriate distribution. And then, rainfall quantiles based on various scenarios are used as input data for disaster simulations. Keywords: Regional Frequency Analysis; Scenarios of Rainfall Quantile Acknowledgements This research was supported by a grant 'Establishing Active Disaster Management System of Flood Control Structures

[Using the simulated patient methodology to assess counselling for acute diarrhoea - evidence from Germany].

PubMed

Langer, Bernhard; Bull, Elisa; Burgsthaler, Tina; Glawe, Julia; Schwobeda, Monique; Simon, Karen

2016-01-01

First, to assess the quality of counselling for acute diarrhoea; second, to evaluate the patient's approach and different user groups as a determinant of counselling. The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city with a population of about 63,000. Four scenarios related to self-medication for acute diarrhoea were developed and used in all pharmacies (total: 84 visits). Two scenarios were direct product-based requests for loperamide (scenario 1: a 74-year old woman with diabetes and hypertension; scenario 3: a 30-year old man with no primary disease). Scenario 2 and 4 were symptom-based requests asking for medicine for acute diarrhoea (scenario 2: a 74-year old woman with diabetes and hypertension; scenario 4: a 30-year old man with no primary disease). The assessment sheet included 9 objective items relating to the pharmacological advice to avoid a subjective evaluation by the mystery shoppers (e. g., the friendliness of the customer contact). Simulated patient visits were conducted covertly by five untrained female master students. After evaluation of the data every pharmacy received an individual performance feedback to encourage behavioural change and improve counselling quality. Overall, the quality of counselling was quite poor (277 out of 756 possible points). The most commonly provided information was dosage (86.9 %); information on adverse effects was least commonly provided (3.6 %). Furthermore, there was a huge difference in the counselling quality between the pharmacies (minimum 4 points, maximum 20 points out of 36 possible points). The symptom-based requests scored significantly better (95 and 85 out of 189 possible points) than the direct product-based requests (42 and 55 out of 189 possible points). The symptom-based requests had a significantly better counselling quality for an older woman with primary disease than for a younger man without any primary disease. This difference was not

Enhancements to the Mississippi Embayment Regional Aquifer Study (MERAS) groundwater-flow model and simulations of sustainable water-level scenarios

USGS Publications Warehouse

Clark, Brian R.; Westerman, Drew A.; Fugitt, D. Todd

2013-01-01

Arkansas continues to be one of the largest users of groundwater in the Nation. As such, long-term planning and management are essential to ensure continued availability of groundwater and surface water for years to come. The Mississippi Embayment Regional Aquifer Study (MERAS) model was developed previously as a tool to evaluate groundwater availability within the Mississippi embayment, which encompasses much of eastern Arkansas where the majority of groundwater is used. The Arkansas Water Plan is being updated for the first time since 1990 and serves as the State’s primary, comprehensive water-resources planning and guidance document. The MERAS model was selected as the best available tool for evaluation of specific water-use pumping scenarios that are currently being considered by the State of Arkansas. The model, developed as part of the U.S. Geological Survey Groundwater Resources Program’s assessment of the Nation’s groundwater availability, is proving to be invaluable to the State as it works toward development of a sustained yield pumping strategy. One aspect of this investigation was to evaluate multiple methods to improve the match of observed to simulated groundwater levels within the Mississippi River Valley alluvial and middle Claiborne (Sparta) aquifers in the MERAS model. Five primary methods were evaluated: (1) explicit simulation of evapotranspiration (ET), (2) upgrade of the Multi-Node Well (MNW2) Package, (3) geometry improvement within the Streamflow Routing (SFR) Package, (4) parameter estimation of select aquifer properties with pilot points, and (5) modification of water-use estimates. For the planning purposes of the Arkansas Water Plan, three scenarios were developed to evaluate potential future conditions: (1) simulation of previously optimized pumping values within the Mississippi River Valley alluvial and the middle Claiborne aquifers, (2) simulated prolonged effects of pumping at average recent (2000–5) rates, and (3) simulation

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. Copyright © 2012 IPEM. Published by

Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study.

PubMed

Bogossian, Fiona; Cooper, Simon; Cant, Robyn; Beauchamp, Alison; Porter, Joanne; Kain, Victoria; Bucknall, Tracey; Phillips, Nicole M

2014-05-01

Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills. This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Mixed-method multi-centre study. High fidelity simulated acute clinical environment in three Australian universities. A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios

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

2016-08-08

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.

Multiple methods for multiple futures: Integrating qualitative scenario planning and quantitative simulation modeling for natural resource decision making

USGS Publications Warehouse

Symstad, Amy J.; Fisichelli, Nicholas A.; Miller, Brian W.; Rowland, Erika; Schuurman, Gregor W.

2017-01-01

Scenario planning helps managers incorporate climate change into their natural resource decision making through a structured “what-if” process of identifying key uncertainties and potential impacts and responses. Although qualitative scenarios, in which ecosystem responses to climate change are derived via expert opinion, often suffice for managers to begin addressing climate change in their planning, this approach may face limits in resolving the responses of complex systems to altered climate conditions. In addition, this approach may fall short of the scientific credibility managers often require to take actions that differ from current practice. Quantitative simulation modeling of ecosystem response to climate conditions and management actions can provide this credibility, but its utility is limited unless the modeling addresses the most impactful and management-relevant uncertainties and incorporates realistic management actions. We use a case study to compare and contrast management implications derived from qualitative scenario narratives and from scenarios supported by quantitative simulations. We then describe an analytical framework that refines the case study’s integrated approach in order to improve applicability of results to management decisions. The case study illustrates the value of an integrated approach for identifying counterintuitive system dynamics, refining understanding of complex relationships, clarifying the magnitude and timing of changes, identifying and checking the validity of assumptions about resource responses to climate, and refining management directions. Our proposed analytical framework retains qualitative scenario planning as a core element because its participatory approach builds understanding for both managers and scientists, lays the groundwork to focus quantitative simulations on key system dynamics, and clarifies the challenges that subsequent decision making must address.

Stress levels during emergency care: A comparison between reality and simulated scenarios.

PubMed

Daglius Dias, Roger; Scalabrini Neto, Augusto

2016-06-01

Medical simulation is fast becoming a standard of health care training throughout undergraduate, postgraduate and continuing medical education. Our aim was to evaluate if simulated scenarios have a high psychological fidelity and induce stress levels similarly to real emergency medical situations. Medical residents had their stress levels measured during emergency care (real-life and simulation) in baseline (T1) and immediately post-emergencies (T2). Parameters measuring acute stress were: heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary interleukin-1β, and State-Trait Anxiety Inventory score. Twenty-eight internal medicine residents participated in 32 emergency situations (16 real-life and 16 simulated emergencies). In the real-life group, all parameters increased significantly (P < .05) between T1 and T2. In the simulation group, only heart rate and interleukin-1β increased significantly after emergencies. The comparison between groups demonstrates that acute stress response (T2 - T1) and State-Trait Anxiety Inventory score (in T2) did not differ between groups. Acute stress response did not differ between both groups. Our results indicate that emergency medicine simulation may create a high psychological fidelity environment similarly to what is observed in a real emergency room. Copyright © 2016 Elsevier Inc. All rights reserved.

GOCE gravity field simulation based on actual mission scenario

NASA Astrophysics Data System (ADS)

Pail, R.; Goiginger, H.; Mayrhofer, R.; Höck, E.; Schuh, W.-D.; Brockmann, J. M.; Krasbutter, I.; Fecher, T.; Gruber, T.

2009-04-01

In the framework of the ESA-funded project "GOCE High-level Processing Facility", an operational hardware and software system for the scientific processing (Level 1B to Level 2) of GOCE data has been set up by the European GOCE Gravity Consortium EGG-C. One key component of this software system is the processing of a spherical harmonic Earth's gravity field model and the corresponding full variance-covariance matrix from the precise GOCE orbit and calibrated and corrected satellite gravity gradiometry (SGG) data. In the framework of the time-wise approach a combination of several processing strategies for the optimum exploitation of the information content of the GOCE data has been set up: The Quick-Look Gravity Field Analysis is applied to derive a fast diagnosis of the GOCE system performance and to monitor the quality of the input data. In the Core Solver processing a rigorous high-precision solution of the very large normal equation systems is derived by applying parallel processing techniques on a PC cluster. Before the availability of real GOCE data, by means of a realistic numerical case study, which is based on the actual GOCE orbit and mission scenario and simulation data stemming from the most recent ESA end-to-end simulation, the expected GOCE gravity field performance is evaluated. Results from this simulation as well as recently developed features of the software system are presented. Additionally some aspects on data combination with complementary data sources are addressed.

Discrete event simulation of patient admissions to a neurovascular unit.

PubMed

Hahn-Goldberg, S; Chow, E; Appel, E; Ko, F T F; Tan, P; Gavin, M B; Ng, T; Abrams, H B; Casaubon, L K; Carter, M W

2014-01-01

Evidence exists that clinical outcomes improve for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital created a Neurovascular Unit (NVU) using beds from general internal medicine, Neurology and Neurosurgery to care for patients with stroke and acute neurovascular conditions. Using patient-level data for NVU-eligible patients, a discrete event simulation was created to study changes in patient flow and length of stay pre- and post-NVU implementation. Varying patient volumes and resources were tested to determine the ideal number of beds under various conditions. In the first year of operation, the NVU admitted 507 patients, over 66% of NVU-eligible patient volumes. With the introduction of the NVU, length of stay decreased by around 8%. Scenario testing showed that the current level of 20 beds is sufficient for accommodating the current demand and would continue to be sufficient with an increase in demand of up to 20%.

An Innovative and Successful Simulation Day.

PubMed

Bowling, Ann M; Eismann, Michelle

This article discusses the development of a creative and innovative plan to incorporate independent activities, including skill reviews and scenarios, into a single eight-hour day, using small student groups to enhance the learning process for pediatric nursing students. The simulation day consists of skills activities and pediatric simulation scenarios using the human patient simulator. Using small student groups in simulation captures the students' attention and enhances motivation to learn. The simulation day is a work in progress; appropriate changes are continually being made to improve the simulation experience for students.

Simulated effects of ground-water management scenarios on the Santa Fe group aquifer system, Middle Rio Grande Basin, New Mexico, 2001-40

USGS Publications Warehouse

Bexfield, Laura M.; McAda, Douglas P.

2003-01-01

Future conditions in the Santa Fe Group aquifer system through 2040 were simulated using the most recent revision of the U.S. Geological Survey groundwater- flow model for the Middle Rio Grande Basin. Three simulations were performed to investigate the likely effects of different scenarios of future groundwater pumping by the City of Albuquerque on the ground-water system. For simulation I, pumping was held constant at known year-2000 rates. For simulation II, pumping was increased to simulate the use of pumping to meet all projected city water demand through 2040. For simulation III, pumpingwas reduced in accordance with a plan by the City of Albuquerque to use surfacewater to meet most of the projectedwater demand. The simulations indicate that for each of the three pumping scenarios, substantial additional watertable declines would occur in some areas of the basin through 2040. However, the reduced pumping scenario of simulation III also results in water-table rise over a broad area of the city. All three scenarios indicate that the contributions of aquifer storage and river leakage to the ground-water system would change between 2000 and 2040. Comparisons among the results for simulations I, II, and III indicate that the various pumping scenarios have substantially different effects on water-level declines in the Albuquerque area and on the contribution of each water-budget component to the total budget for the ground-water system. Between 2000 and 2040, water-level declines for continued pumping at year-2000 rates are as much as 120 feet greater than for reduced pumping; water-level declines for increased pumping to meet all projected city demand are as much as 160 feet greater. Over the same time period, reduced pumping results in retention in aquifer storage of about 1,536,000 acre-feet of ground water as compared with continued pumping at year- 2000 rates and of about 2,257,000 acre-feet as compared with increased pumping. The quantity of water retained in

Fertilizer Emission Scenario Tool for crop management system scenarios

EPA Pesticide Factsheets

The Fertilizer Emission Scenario Tool for CMAQ is a high-end computer interface that simulates daily fertilizer application information for any gridded domain. It integrates the Weather Research and Forecasting model and CMAQ.

Ground-motion modeling of Hayward fault scenario earthquakes, part II: Simulation of long-period and broadband ground motions

USGS Publications Warehouse

Aagaard, Brad T.; Graves, Robert W.; Rodgers, Arthur; Brocher, Thomas M.; Simpson, Robert W.; Dreger, Douglas; Petersson, N. Anders; Larsen, Shawn C.; Ma, Shuo; Jachens, Robert C.

2010-01-01

We simulate long-period (T>1.0–2.0 s) and broadband (T>0.1 s) ground motions for 39 scenario earthquakes (Mw 6.7–7.2) involving the Hayward, Calaveras, and Rodgers Creek faults. For rupture on the Hayward fault, we consider the effects of creep on coseismic slip using two different approaches, both of which reduce the ground motions, compared with neglecting the influence of creep. Nevertheless, the scenario earthquakes generate strong shaking throughout the San Francisco Bay area, with about 50% of the urban area experiencing modified Mercalli intensity VII or greater for the magnitude 7.0 scenario events. Long-period simulations of the 2007 Mw 4.18 Oakland earthquake and the 2007 Mw 5.45 Alum Rock earthquake show that the U.S. Geological Survey’s Bay Area Velocity Model version 08.3.0 permits simulation of the amplitude and duration of shaking throughout the San Francisco Bay area for Hayward fault earthquakes, with the greatest accuracy in the Santa Clara Valley (San Jose area). The ground motions for the suite of scenarios exhibit a strong sensitivity to the rupture length (or magnitude), hypocenter (or rupture directivity), and slip distribution. The ground motions display a much weaker sensitivity to the rise time and rupture speed. Peak velocities, peak accelerations, and spectral accelerations from the synthetic broadband ground motions are, on average, slightly higher than the Next Generation Attenuation (NGA) ground-motion prediction equations. We attribute much of this difference to the seismic velocity structure in the San Francisco Bay area and how the NGA models account for basin amplification; the NGA relations may underpredict amplification in shallow sedimentary basins. The simulations also suggest that the Spudich and Chiou (2008) directivity corrections to the NGA relations could be improved by increasing the areal extent of rupture directivity with period.

3D and 4D Simulations for Landscape Reconstruction and Damage Scenarios: GIS Pilot Applications

ERIC Educational Resources Information Center

Pesaresi, Cristano; Van Der Schee, Joop; Pavia, Davide

2017-01-01

The project "3D and 4D Simulations for Landscape Reconstruction and Damage Scenarios: GIS Pilot Applications" has been devised with the intention to deal with the demand for research, innovation and applicative methodology on the part of the international programme, requiring concrete results to increase the capacity to know, anticipate…

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.

Simulation and Feedback in Health Education: A Mixed Methods Study Comparing Three Simulation Modalities.

PubMed

Tait, Lauren; Lee, Kenneth; Rasiah, Rohan; Cooper, Joyce M; Ling, Tristan; Geelan, Benjamin; Bindoff, Ivan

2018-05-03

Background . There are numerous approaches to simulating a patient encounter in pharmacy education. However, little direct comparison between these approaches has been undertaken. Our objective was to investigate student experiences, satisfaction, and feedback preferences between three scenario simulation modalities (paper-, actor-, and computer-based). Methods . We conducted a mixed methods study with randomized cross-over of simulation modalities on final-year Australian graduate-entry Master of Pharmacy students. Participants completed case-based scenarios within each of three simulation modalities, with feedback provided at the completion of each scenario in a format corresponding to each simulation modality. A post-simulation questionnaire collected qualitative and quantitative responses pertaining to participant satisfaction, experiences, and feedback preferences. Results . Participants reported similar levels satisfaction across all three modalities. However, each modality resulted in unique positive and negative experiences, such as student disengagement with paper-based scenarios. Conclusion . Importantly, the themes of guidance and opportunity for peer discussion underlie the best forms of feedback for students. The provision of feedback following simulation should be carefully considered and delivered, with all three simulation modalities producing both positive and negative experiences in regard to their feedback format.

Exploring an Ecologically Sustainable Scheme for Landscape Restoration of Abandoned Mine Land: Scenario-Based Simulation Integrated Linear Programming and CLUE-S Model

PubMed Central

Zhang, Liping; Zhang, Shiwen; Huang, Yajie; Cao, Meng; Huang, Yuanfang; Zhang, Hongyan

2016-01-01

Understanding abandoned mine land (AML) changes during land reclamation is crucial for reusing damaged land resources and formulating sound ecological restoration policies. This study combines the linear programming (LP) model and the CLUE-S model to simulate land-use dynamics in the Mentougou District (Beijing, China) from 2007 to 2020 under three reclamation scenarios, that is, the planning scenario based on the general land-use plan in study area (scenario 1), maximal comprehensive benefits (scenario 2), and maximal ecosystem service value (scenario 3). Nine landscape-scale graph metrics were then selected to describe the landscape characteristics. The results show that the coupled model presented can simulate the dynamics of AML effectively and the spatially explicit transformations of AML were different. New cultivated land dominates in scenario 1, while construction land and forest land account for major percentages in scenarios 2 and 3, respectively. Scenario 3 has an advantage in most of the selected indices as the patches combined most closely. To conclude, reclaiming AML by transformation into more forest can reduce the variability and maintain the stability of the landscape ecological system in study area. These findings contribute to better mapping AML dynamics and providing policy support for the management of AML. PMID:27023575

Exploring an Ecologically Sustainable Scheme for Landscape Restoration of Abandoned Mine Land: Scenario-Based Simulation Integrated Linear Programming and CLUE-S Model.

PubMed

Zhang, Liping; Zhang, Shiwen; Huang, Yajie; Cao, Meng; Huang, Yuanfang; Zhang, Hongyan

2016-03-24

Understanding abandoned mine land (AML) changes during land reclamation is crucial for reusing damaged land resources and formulating sound ecological restoration policies. This study combines the linear programming (LP) model and the CLUE-S model to simulate land-use dynamics in the Mentougou District (Beijing, China) from 2007 to 2020 under three reclamation scenarios, that is, the planning scenario based on the general land-use plan in study area (scenario 1), maximal comprehensive benefits (scenario 2), and maximal ecosystem service value (scenario 3). Nine landscape-scale graph metrics were then selected to describe the landscape characteristics. The results show that the coupled model presented can simulate the dynamics of AML effectively and the spatially explicit transformations of AML were different. New cultivated land dominates in scenario 1, while construction land and forest land account for major percentages in scenarios 2 and 3, respectively. Scenario 3 has an advantage in most of the selected indices as the patches combined most closely. To conclude, reclaiming AML by transformation into more forest can reduce the variability and maintain the stability of the landscape ecological system in study area. These findings contribute to better mapping AML dynamics and providing policy support for the management of AML.

Simulation of water-use conservation scenarios for the Mississippi Delta using an existing regional groundwater flow model

USGS Publications Warehouse

Barlow, Jeannie R.B.; Clark, Brian R.

2011-01-01

The Mississippi River alluvial plain in northwestern Mississippi (referred to as the Delta), once a floodplain to the Mississippi River covered with hardwoods and marshland, is now a highly productive agricultural region of large economic importance to Mississippi. Water for irrigation is supplied primarily by the Mississippi River Valley alluvial aquifer, and although the alluvial aquifer has a large reserve, there is evidence that the current rate of water use from the alluvial aquifer is not sustainable. Using an existing regional groundwater flow model, conservation scenarios were developed for the alluvial aquifer underlying the Delta region in northwestern Mississippi to assess where the implementation of water-use conservation efforts would have the greatest effect on future water availability-either uniformly throughout the Delta, or focused on a cone of depression in the alluvial aquifer underlying the central part of the Delta. Five scenarios were simulated with the Mississippi Embayment Regional Aquifer Study groundwater flow model: (1) a base scenario in which water use remained constant at 2007 rates throughout the entire simulation; (2) a 5-percent 'Delta-wide' conservation scenario in which water use across the Delta was decreased by 5 percent; (3) a 5-percent 'cone-equivalent' conservation scenario in which water use within the area of the cone of depression was decreased by 11 percent (a volume equivalent to the 5-percent Delta-wide conservation scenario); (4) a 25-percent Delta-wide conservation scenario in which water use across the Delta was decreased by 25 percent; and (5) a 25-percent cone-equivalent conservation scenario in which water use within the area of the cone of depression was decreased by 55 percent (a volume equivalent to the 25-percent Delta-wide conservation scenario). The Delta-wide scenarios result in greater average water-level improvements (relative to the base scenario) for the entire Delta area than the cone

Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario.

PubMed

Tofil, Nancy M; Lin, Yiqun; Zhong, John; Peterson, Dawn Taylor; White, Marjorie Lee; Grant, Vincent; Grant, David J; Gottesman, Ronald; Sudikoff, Stephanie N; Adler, Mark; Marohn, Kimberly; Davidson, Jennifer; Cheng, Adam

2017-09-01

Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40-60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that team leaders would have a higher workload than team members. Multicenter observational study. Nine pediatric simulation centers (five United States, three Canada, and one United Kingdom). Team leaders and team members during a 12-minute pediatric sepsis scenario. National Aeronautics and Space Administration-Task Load Index. One hundred twenty-seven teams were recruited from nine sites. One hundred twenty-seven team leaders and 253 team members completed the National Aeronautics and Space Administration-Task Load Index. Team leader had significantly higher overall workload than team member (51 ± 11 vs 44 ± 13; p < 0.01). Team leader had higher workloads in all subcategories except in performance where the values were equal and in physical demand where team members were higher than team leaders (29 ± 22 vs 18 ± 16; p < 0.01). The highest category for each group was mental 73 ± 13 for team leader and 60 ± 20 for team member. For team leader, two categories, mental (73 ± 17) and effort (66 ± 16), were high workload, most domains for team member were moderate workload levels. Team leader and team member are under moderate workloads during a pediatric sepsis scenario with team leader under high workloads (> 60) in the mental demand and effort subscales. Team leader average significantly higher workloads. Consideration of decreasing

Estimation of slip scenarios of mega-thrust earthquakes and strong motion simulations for Central Andes, Peru

NASA Astrophysics Data System (ADS)

Pulido, N.; Tavera, H.; Aguilar, Z.; Chlieh, M.; Calderon, D.; Sekiguchi, T.; Nakai, S.; Yamazaki, F.

2012-12-01

We have developed a methodology for the estimation of slip scenarios for megathrust earthquakes based on a model of interseismic coupling (ISC) distribution in subduction margins obtained from geodetic data, as well as information of recurrence of historical earthquakes. This geodetic slip model (GSM) delineates the long wavelength asperities within the megathrust. For the simulation of strong ground motion it becomes necessary to introduce short wavelength heterogeneities to the source slip to be able to efficiently simulate high frequency ground motions. To achieve this purpose we elaborate "broadband" source models constructed by combining the GSM with several short wavelength slip distributions obtained from a Von Karman PSD function with random phases. Our application of the method to Central Andes in Peru, show that this region has presently the potential of generating an earthquake with moment magnitude of 8.9, with a peak slip of 17 m and a source area of approximately 500 km along strike and 165 km along dip. For the strong motion simulations we constructed 12 broadband slip models, and consider 9 possible hypocenter locations for each model. We performed strong motion simulations for the whole central Andes region (Peru), spanning an area from the Nazca ridge (16^o S) to the Mendana fracture (9^o S). For this purpose we use the hybrid strong motion simulation method of Pulido et al. (2004), improved to handle a general slip distribution. Our simulated PGA and PGV distributions indicate that a region of at least 500 km along the coast of central Andes is subjected to a MMI intensity of approximately 8, for the slip model that yielded the largest ground motions among the 12 slip models considered, averaged for all assumed hypocenter locations. This result is in agreement with the macroseismic intensity distribution estimated for the great 1746 earthquake (M~9) in central Andes (Dorbath et al. 1990). Our results indicate that the simulated PGA and PGV for

Changes in land-uses and ecosystem services under multi-scenarios simulation.

PubMed

Liu, Jingya; Li, Jing; Qin, Keyu; Zhou, Zixiang; Yang, Xiaonan; Li, Ting

2017-05-15

Social economy of China has been rapidly developing for more than 30years with efficient reforms and policies being issued. Societal developments have resulted in a greater use of many natural resources to the extent that the ecosystem can no longer self-regulate, thus severely damaging the balance of the ecosystem itself. This in turn has led to a deterioration in people's living environments. Our research is based on a combination of climate scenarios presented in the fifth report of the Intergovernmental Panel on Climate Change (IPCC) and policy scenarios, including the one-child policy and carbon tax policy. We adopted Land Change Modeler of IDRISI software to simulate and analyze land-use change under 16 future scenarios in 2050. Carbon sequestration, soil conservation and water yields were quantified, based on those land-use maps and different ecosystem models. We also analyzed trade-offs and synergy among each ecosystem service and discussed why those interactions happened. The results show that: (1) Global climate change has a strong influence on future changes in land-use. (2) Carbon sequestration, water yield and soil conservation have a mutual relationship in the Guanzhong-Tianshui economic region. (3) Climate change and implementation of policy have a conspicuous impact on the changes in ecosystem services in the Guanzhong-Tianshui economic region. This paper can be used as a reference for further related research, and provide a reliable basis for achieving the sustainable development of the ecosystem. Copyright © 2017 Elsevier B.V. All rights reserved.

Climate-methane cycle feedback in global climate model model simulations forced by RCP scenarios

NASA Astrophysics Data System (ADS)

Eliseev, Alexey V.; Denisov, Sergey N.; Arzhanov, Maxim M.; Mokhov, Igor I.

2013-04-01

Methane cycle module of the global climate model of intermediate complexity developed at the A.M. Obukhov Institute of Atmospheric Physics, Russian Academy of Sciences (IAP RAS CM) is extended by coupling with a detailed module for thermal and hydrological processes in soil (Deep Soil Simulator, (Arzhanov et al., 2008)). This is an important improvement with respect with the earlier IAP RAS CM version (Eliseev et al., 2008) which has employed prescribed soil hydrology to simulate CH4 emissions from soil. Geographical distribution of water inundated soil in the model was also improved by replacing the older Olson's ecosystem data base by the data based on the SCIAMACHY retrievals (Bergamaschi et al., 2007). New version of the IAP RAS CM module for methane emissions from soil is validated by using the simulation protocol adopted in the WETCHIMP (Wetland and Wetland CH4 Inter-comparison of Models Project). In addition, atmospheric part of the IAP RAS CM methane cycle is extended by temperature dependence of the methane life-time in the atmosphere in order to mimic the respective dependence of the atmospheric methane chemistry (Denisov et al., 2012). The IAP RAS CM simulations are performed for the 18th-21st centuries according with the CMIP5 protocol taking into account natural and anthropogenic forcings. The new IAP RAS CM version realistically reproduces pre-industrial and present-day characteristics of the global methane cycle including CH4 concentration qCH4 in the atmosphere and CH4 emissions from soil. The latter amounts 150 - 160 TgCH4-yr for the late 20th century and increases to 170 - 230 TgCH4-yr in the late 21st century. Atmospheric methane concentration equals 3900 ppbv under the most aggressive anthropogenic scenario RCP 8.5 and 1850 - 1980 ppbv under more moderate scenarios RCP 6.0 and RCP 4.5. Under the least aggressive scenario RCP 2.6 qCH4 reaches maximum 1730 ppbv in 2020s and declines afterwards. Climate change impact on the methane emissions from

Using a human patient simulation mannequin to teach interdisciplinary team skills to pharmacy students.

PubMed

Fernandez, Rosemarie; Parker, Dennis; Kalus, James S; Miller, Douglas; Compton, Scott

2007-06-15

To determine the effectiveness and student acceptance of using a human patient simulation (HPS) training module focused on interdisciplinary teamwork skills. During their second-professional year, all pharmacy students were in enrolled in Principles of Pharmacotherapy 4: Cardiovascular Diseases and Patient Care Lab IV, a problem-based learning course. As part of the patient care laboratory, students participated in a simulated case of an acutely ill patient with a hypertensive emergency. During the simulation, students performed a history and physical examination. They then worked as a team to make treatment recommendations to the nursing and physician staff members. Following the exercise, a facilitated debriefing session was conducted. Students completed satisfaction surveys to assess the quality and effectiveness of the session. Over 98% of students agreed or strongly agreed that they learned material relevant to their current studies. When compared to student lectures, 90% of students felt that they learned clinical patient care better when using a HPS mannequin in simulated patient scenarios. HPS-based learning offers a realistic training experience through which clinical knowledge and interpersonal teamwork skills can be taught. Students enjoy the experience and find it relevant to their future practice. Simulation-based training may teach certain topics better than traditional lecture formats and as such could help to fill gaps in the current pharmacy curriculum.

Flood Scenario Simulation and Disaster Estimation of Ba-Ma Creek Watershed in Nantou County, Taiwan

NASA Astrophysics Data System (ADS)

Peng, S. H.; Hsu, Y. K.

2018-04-01

The present study proposed several scenario simulations of flood disaster according to the historical flood event and planning requirement in Ba-Ma Creek Watershed located in Nantou County, Taiwan. The simulations were made using the FLO-2D model, a numerical model which can compute the velocity and depth of flood on a two-dimensional terrain. Meanwhile, the calculated data were utilized to estimate the possible damage incurred by the flood disaster. The results thus obtained can serve as references for disaster prevention. Moreover, the simulated results could be employed for flood disaster estimation using the method suggested by the Water Resources Agency of Taiwan. Finally, the conclusions and perspectives are presented.

NPE 2010 results - Independent performance assessment by simulated CTBT violation scenarios

NASA Astrophysics Data System (ADS)

Ross, O.; Bönnemann, C.; Ceranna, L.; Gestermann, N.; Hartmann, G.; Plenefisch, T.

2012-04-01

earthquakes by seismological analysis. The remaining event at Black Thunder Mine, Wyoming, on 23 Oct at 21:15 UTC showed clear explosion characteristics. It caused also Infrasound detections at one station in Canada. An infrasonic one station localization algorithm led to event localization results comparable in precision to the teleseismic localization. However, the analysis of regional seismological stations gave the most accurate result giving an error ellipse of about 60 square kilometer. Finally a forward ATM simulation was performed with the candidate event as source in order to reproduce the original detection scenario. The ATM results showed a simulated station fingerprint in the IMS very similar to the fictitious detections given in the NPE 2010 scenario which is an additional confirmation that the event was correctly identified. The shown event analysis of the NPE 2010 serves as successful example for Data Fusion between the technology of radionuclide detection supported by ATM and seismological methodology as well as infrasound signal processing.

Scenario-based and scenario-neutral assessment of climate change impacts on operational performance of a multipurpose reservoir

Treesearch

Allison G. Danner; Mohammad Safeeq; Gordon E. Grant; Charlotte Wickham; Desirée Tullos; Mary V. Santelmann

2017-01-01

Scenario-based and scenario-neutral impacts assessment approaches provide complementary information about how climate change-driven effects on streamflow may change the operational performance of multipurpose dams. Examining a case study of Cougar Dam in Oregon, United States, we simulated current reservoir operations under scenarios of plausible future hydrology....

[Prediction and simulation of urban area expansion in Pearl River Delta Region under the RCPs climate scenarios].

PubMed

Jiang, Oun-ou; Deng, Xiang-zheng; Ke, Xin-li; Zhao, Chun-hong; Zhang, Wei

2014-12-01

The sizes and number of cities in China are increasing rapidly and complicated changes of urban land use system have occurred as the social economy develops rapidly. This study took the urban agglomeration of Pearl River Delta Region as the study area to explore the driving mechanism of dynamic changes of urban area in the urbanization process under the joint influence of natural environment and social economic conditions. Then the CA (cellular automata) model was used to predict and simulate the urban area changes until 2030 under the designed scenarios of planning and RCPs (representative concentration pathways). The results indicated that urbanization was mainly driven by the non-agricultural population growth and social-economic development, and the transportation had played a fundamental role in the whole process, while the areas with high elevation or steep slope restricted the urbanization. Besides, the urban area would keep an expanding trend regardless of the scenarios, however, the expanding speed would slow down with different inflection points under different scenarios. The urban expansion speed increased in the sequence of the planning scenario, MESSAGE scenario and AIM scenario, and that under the MESSAGE climate scenario was more consistent with the current urban development trend. In addition, the urban expansion would mainly concentrate in regions with the relatively high urbanization level, e.g., Guangzhou, Dongguan, Foshan, Shenzhen, Zhanjiang and Chaoshan.

Probabilistic Simulation of Territorial Seismic Scenarios

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baratta, Alessandro; Corbi, Ileana

2008-07-08

The paper is focused on a stochastic process for the prevision of seismic scenarios on the territory and developed by means of some basic assumptions in the procedure and by elaborating the fundamental parameters recorded during some ground motions occurred in a seismic area.

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).

PubMed

Ward, Elizabeth C; Hill, Anne E; Nund, Rebecca L; Rumbach, Anna F; Walker-Smith, Katie; Wright, Sarah E; Kelly, Kris; Dodrill, Pamela

2015-06-01

The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Comparing Real-time Versus Delayed Video Assessments for Evaluating ACGME Sub-competency Milestones in Simulated Patient Care Environments

PubMed Central

Stiegler, Marjorie; Hobbs, Gene; Martinelli, Susan M; Zvara, David; Arora, Harendra; Chen, Fei

2018-01-01

Background Simulation is an effective method for creating objective summative assessments of resident trainees. Real-time assessment (RTA) in simulated patient care environments is logistically challenging, especially when evaluating a large group of residents in multiple simulation scenarios. To date, there is very little data comparing RTA with delayed (hours, days, or weeks later) video-based assessment (DA) for simulation-based assessments of Accreditation Council for Graduate Medical Education (ACGME) sub-competency milestones. We hypothesized that sub-competency milestone evaluation scores obtained from DA, via audio-video recordings, are equivalent to the scores obtained from RTA. Methods Forty-one anesthesiology residents were evaluated in three separate simulated scenarios, representing different ACGME sub-competency milestones. All scenarios had one faculty member perform RTA and two additional faculty members perform DA. Subsequently, the scores generated by RTA were compared with the average scores generated by DA. Variance component analysis was conducted to assess the amount of variation in scores attributable to residents and raters. Results Paired t-tests showed no significant difference in scores between RTA and averaged DA for all cases. Cases 1, 2, and 3 showed an intraclass correlation coefficient (ICC) of 0.67, 0.85, and 0.50 for agreement between RTA scores and averaged DA scores, respectively. Analysis of variance of the scores assigned by the three raters showed a small proportion of variance attributable to raters (4% to 15%). Conclusions The results demonstrate that video-based delayed assessment is as reliable as real-time assessment, as both assessment methods yielded comparable scores. Based on a department’s needs or logistical constraints, our findings support the use of either real-time or delayed video evaluation for assessing milestones in a simulated patient care environment. PMID:29736352

Simulation analysis of resource flexibility on healthcare processes

PubMed Central

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

Purpose This paper uses discrete event simulation to explore the best resource flexibility scenario and examine the effect of implementing resource flexibility on different stages of patient treatment process. Specifically we investigate the effect of resource flexibility on patient waiting time and throughput in an orthopedic care process. We further seek to explore on how implementation of resource flexibility on patient treatment processes affects patient access to healthcare services. We focus on two resources, namely, orthopedic surgeon and operating room. Methods The observational approach was used to collect process data. The developed model was validated by comparing the simulation output with actual patient data collected from the studied orthopedic care process. We developed different scenarios to identify the best resource flexibility scenario and explore the effect of resource flexibility on patient waiting time, throughput, and future changes in demand. The developed scenarios focused on creating flexibility on service capacity of this care process by altering the amount of additional human resource capacity at different stages of patient care process and extending the use of operating room capacity. Results The study found that resource flexibility can improve responsiveness to patient demand in the treatment process. Testing different scenarios showed that the introduction of resource flexibility reduces patient waiting time and improves throughput. The simulation results show that patient access to health services can be improved by implementing resource flexibility at different stages of the patient treatment process. Conclusion This study contributes to the current health care literature by explaining how implementing resource flexibility at different stages of patient care processes can improve ability to respond to increasing patients demands. This study was limited to a single patient process; studies focusing on additional processes are

Simulation analysis of resource flexibility on healthcare processes.

PubMed

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

This paper uses discrete event simulation to explore the best resource flexibility scenario and examine the effect of implementing resource flexibility on different stages of patient treatment process. Specifically we investigate the effect of resource flexibility on patient waiting time and throughput in an orthopedic care process. We further seek to explore on how implementation of resource flexibility on patient treatment processes affects patient access to healthcare services. We focus on two resources, namely, orthopedic surgeon and operating room. The observational approach was used to collect process data. The developed model was validated by comparing the simulation output with actual patient data collected from the studied orthopedic care process. We developed different scenarios to identify the best resource flexibility scenario and explore the effect of resource flexibility on patient waiting time, throughput, and future changes in demand. The developed scenarios focused on creating flexibility on service capacity of this care process by altering the amount of additional human resource capacity at different stages of patient care process and extending the use of operating room capacity. The study found that resource flexibility can improve responsiveness to patient demand in the treatment process. Testing different scenarios showed that the introduction of resource flexibility reduces patient waiting time and improves throughput. The simulation results show that patient access to health services can be improved by implementing resource flexibility at different stages of the patient treatment process. This study contributes to the current health care literature by explaining how implementing resource flexibility at different stages of patient care processes can improve ability to respond to increasing patients demands. This study was limited to a single patient process; studies focusing on additional processes are recommended.

Estimation of dose rates at the entrance surface for exposure scenarios of total body irradiation using MCNPX code

NASA Astrophysics Data System (ADS)

Cunha, J. S.; Cavalcante, F. R.; Souza, S. O.; Souza, D. N.; Santos, W. S.; Carvalho Júnior, A. B.

2017-11-01

One of the main criteria that must be held in Total Body Irradiation (TBI) is the uniformity of dose in the body. In TBI procedures the certification that the prescribed doses are absorbed in organs is made with dosimeters positioned on the patient skin. In this work, we modelled TBI scenarios in the MCNPX code to estimate the entrance dose rate in the skin for comparison and validation of simulations with experimental measurements from literature. Dose rates were estimated simulating an ionization chamber laterally positioned on thorax, abdomen, leg and thigh. Four exposure scenarios were simulated: ionization chamber (S1), TBI room (S2), and patient represented by hybrid phantom (S3) and water stylized phantom (S4) in sitting posture. The posture of the patient in experimental work was better represented by S4 compared with hybrid phantom, and this led to minimum and maximum percentage differences of 1.31% and 6.25% to experimental measurements for thorax and thigh regions, respectively. As for all simulations reported here the percentage differences in the estimated dose rates were less than 10%, we considered that the obtained results are consistent with experimental measurements and the modelled scenarios are suitable to estimate the absorbed dose in organs during TBI procedure.

Scenarios of land use change for agriculture: the role of Land Evaluation in improving model simulation

NASA Astrophysics Data System (ADS)

Mereu, V.; Santini, M.; Dettori, G.; Muresu, P.; Spano, D.; Duce, P.

2009-12-01

Integrated scenarios of future climate and land use represent a useful input for impact studies about global changes. In particular, improving future land use simulations is essential for the agricultural sector, which is influenced by both biogeophysical constraints and human needs. Often land use change models are mainly based on statistical relationships between known land use distribution and biophysical or socio-economic factors, neglecting the necessary consideration of physical constraints that interact in making lands more or less capable for agriculture and suitable for supporting specific crops. In this study, a well developed land use change model (CLUE@CMCC) was suited for the Mediterranean basin case study, focusing on croplands. Several climate scenarios and future demands for croplands were combined to drive the model, while the same climate scenarios were used to more reliably allocate crops in the most suitable areas on the basis of Land Evaluation techniques. The probability for each map unit to sustain a specific crop, usually related to location characteristics, elasticity to conversion and competition among land use types, now includes specific crop-favoring location characteristics. Results, besides improving the consistency of the land use change model to allocate land for the future, can have the main feedback to suggest feasibility or reasonable thresholds to adjust land use demands during dynamic simulations.

The cost of harm and savings through safety: using simulated patients for leadership decision support.

PubMed

Denham, Charles R; Guilloteau, Franck R

2012-09-01

The ultimate objective of this program is to provide an approach to understanding and communicating health-care harm and cost to compel health-care provider leadership teams to vote "yes" to investments in patient safety initiatives, with the confidence that clinical, financial, and operational performance will be improved by such programs. Through a coordinated combination of literature evaluations, careful mapping of high impact scenarios using simulated patients and consensus review of clinical, operational, and financial factors, we confirmed value in such approaches to decision support information for hospital leadership teams to invest in patient safety projects. The study resulted in the following preliminary findings: ·Communication between hospital quality and finance departments can be much improved by direct collaborative relationships through regular meetings to help both clarify direct costs, indirect costs, and the savings of waste and harm to patients by avoidance of infections. ·Governance leaders and the professional administrative leaders should consider establishing the structures and systems necessary to act on risks and hazards as they evolve to deploy resources to areas of harm and risk. ·Quality and Infection Control Professionals can best wage their war on healthcare waste and harm by keeping abreast of the latest literature regarding the latest measures, standards, and safe practices for healthcare-acquired infections and hospital-acquired conditions. ·Regular reviews of patients with health-careYassociated infections, with direct attention to the attributable cost of treatment and how financial waste and harm to patients may be avoided, may provide hospital leaders with new insights for improvement. ·If hospitals developed their own risk scenarios to determine impact of harm and waste from hospital-acquired conditions in addition to impact scenarios for specific processes through technology and process innovations, they would have

Simulation of patient flow in multiple healthcare units using process and data mining techniques for model identification.

PubMed

Kovalchuk, Sergey V; Funkner, Anastasia A; Metsker, Oleg G; Yakovlev, Aleksey N

2018-06-01

An approach to building a hybrid simulation of patient flow is introduced with a combination of data-driven methods for automation of model identification. The approach is described with a conceptual framework and basic methods for combination of different techniques. The implementation of the proposed approach for simulation of the acute coronary syndrome (ACS) was developed and used in an experimental study. A combination of data, text, process mining techniques, and machine learning approaches for the analysis of electronic health records (EHRs) with discrete-event simulation (DES) and queueing theory for the simulation of patient flow was proposed. The performed analysis of EHRs for ACS patients enabled identification of several classes of clinical pathways (CPs) which were used to implement a more realistic simulation of the patient flow. The developed solution was implemented using Python libraries (SimPy, SciPy, and others). The proposed approach enables more a realistic and detailed simulation of the patient flow within a group of related departments. An experimental study shows an improved simulation of patient length of stay for ACS patient flow obtained from EHRs in Almazov National Medical Research Centre in Saint Petersburg, Russia. The proposed approach, methods, and solutions provide a conceptual, methodological, and programming framework for the implementation of a simulation of complex and diverse scenarios within a flow of patients for different purposes: decision making, training, management optimization, and others. Copyright © 2018 Elsevier Inc. All rights reserved.

Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

PubMed

Arora, Sonal; Hull, Louise; Fitzpatrick, Maureen; Sevdalis, Nick; Birnbach, David J

2015-05-01

To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward. Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment. A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills. Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P < 0.001). Clinically, improvements were obtained posttraining in residents' ability to recognize/respond to falling saturations (pre = 73.7% vs post = 94.8%, P < 0.01), check circulatory status (pre = 21.1% vs post = 84.2% P < 0.001), continuously reassess patient (pre = 42.1% vs post = 100%, P < 0.001), and call for help (pre = 36.8% vs post = 89.8%, P < 0.001). Regarding teamwork, there was a significant improvement in residents' communication (pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001). The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews.

PubMed

Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart; Kunstek, Pina; Hellebek, Annemarie

2016-12-01

Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. The study design is qualitative and exploratory, with a convenience sample of 10 nurses and 10 physicians from different acute care specialties working in hospitals in the Capital Region of Denmark. In 2 patient simulation scenarios and a sorting task, the participants selected the medicines from a range of ampules, vials, and infusion bags. After each scenario and in the end of the study, the participants were interviewed. Notes were validated with the participants, and content was analyzed. The label design benefited from the standardized construction of the labels, the clear layout and font, and some warning signs. The complexity of the system and some inconsistencies (different meaning of colors) posed challenges, when considered with the actual application context, in which there is little time to get familiar with the design features. For optimizing medicine labels and obtaining the full benefit of label design features on patient safety, it is necessary to consider the context in which they are used.

Development of a database-driven system for simulating water temperature in the lower Yakima River main stem, Washington, for various climate scenarios

USGS Publications Warehouse

Voss, Frank; Maule, Alec

2013-01-01

A model for simulating daily maximum and mean water temperatures was developed by linking two existing models: one developed by the U.S. Geological Survey and one developed by the Bureau of Reclamation. The study area included the lower Yakima River main stem between the Roza Dam and West Richland, Washington. To automate execution of the labor-intensive models, a database-driven model automation program was developed to decrease operation costs, to reduce user error, and to provide the capability to perform simulations quickly for multiple management and climate change scenarios. Microsoft© SQL Server 2008 R2 Integration Services packages were developed to (1) integrate climate, flow, and stream geometry data from diverse sources (such as weather stations, a hydrologic model, and field measurements) into a single relational database; (2) programmatically generate heavily formatted model input files; (3) iteratively run water temperature simulations; (4) process simulation results for export to other models; and (5) create a database-driven infrastructure that facilitated experimentation with a variety of scenarios, node permutations, weather data, and hydrologic conditions while minimizing costs of running the model with various model configurations. As a proof-of-concept exercise, water temperatures were simulated for a "Current Conditions" scenario, where local weather data from 1980 through 2005 were used as input, and for "Plus 1" and "Plus 2" climate warming scenarios, where the average annual air temperatures used in the Current Conditions scenario were increased by 1degree Celsius (°C) and by 2°C, respectively. Average monthly mean daily water temperatures simulated for the Current Conditions scenario were compared to measured values at the Bureau of Reclamation Hydromet gage at Kiona, Washington, for 2002-05. Differences ranged between 1.9° and 1.1°C for February, March, May, and June, and were less than 0.8°C for the remaining months of the year

Introducing Teamwork Challenges in Simulation Using Game Cards.

PubMed

Chang, Todd P; Kwan, Karen Y; Liberman, Danica; Song, Eric; Dao, Eugene H; Chung, Dayun; Morton, Inge; Festekjian, Ara

2015-08-01

Poor teamwork and communication during resuscitations are linked to patient safety problems and poorer outcomes. We present a novel simulation-based educational intervention using game cards to introduce challenges in teamwork. This intervention uses sets of game cards that designate roles, limitations, or communication challenges designed to introduce common communication or teamwork problems. Game cards are designed to be applicable for any simulation-based scenario and are independent from patient physiology. In our example, participants were pediatric emergency medicine fellows undergoing simulation training for orientation. We describe the use of card sets in different scenarios with increasing teamwork challenge and difficulty. Both postscenario and summative debriefings were facilitated to allow participants to reflect on their performance and discover ways to apply their strategies to real resuscitations. In this article, we present our experience with the novel use of game cards to modify simulation scenarios to improve communication and teamwork skills.

Land-use impacts on water resources and protected areas: applications of state-and-transition simulation modeling of future scenarios

NASA Astrophysics Data System (ADS)

Wilson, T. S.; Sleeter, B. M.; Sherba, J.; Cameron, D.

2014-12-01

Human land use will increasingly contribute to habitat losses and water shortages in California, given future population projections and associated demand for agricultural land. Understanding how land-use change may impact future water use and where existing protected areas may be threatened by land-use conversion will be important if effective, sustainable management approaches are to be implemented. We used a state-and-transition simulation modeling (STSM) framework to simulate spatially-explicit (1 km2) historical (1992-2010) and future (2011-2060) land-use change for 52 California counties within the Mediterranean California ecoregion. Historical land use change estimates were derived from the Farmland Mapping and Monitoring Program (FMMP) dataset and attributed with county-level agricultural water-use data from the California Department of Water Resources (CDWR). Six future alternative land-use scenarios were developed and modeled using the historical land-use change estimates and land-use projections based on the Intergovernmental Panel on Climate Change's (IPCC) Special Report on Emission Scenarios (SRES) A2 and B1 scenarios. Resulting spatial land-use scenario outputs were combined based on scenario agreement and a land conversion threat index developed to evaluate vulnerability of existing protected areas. Modeled scenario output of county-level agricultural water use data were also summarized, enabling examination of alternative water use futures. We present results of two separate applications of STSM of land-use change, demonstrating the utility of STSM in analyzing land-use related impacts on water resources as well as potential threats to existing protected land. Exploring a range of alternative, yet plausible, land-use change impacts will help to better inform resource management and mitigation strategies.

Understanding Land System Change Through Scenario-Based Simulations: A Case Study from the Drylands in Northern China

NASA Astrophysics Data System (ADS)

Liu, Zhifeng; Verburg, Peter H.; Wu, Jianguo; He, Chunyang

2017-03-01

The drylands in northern China are expected to face dramatic land system change in the context of socioeconomic development and environmental conservation. Recent studies have addressed changes of land cover with socioeconomic development in the drylands in northern China. However, the changes in land use intensity and the potential role of environmental conservation measures have yet to be adequately examined. Given the importance of land management intensity to the ecological conditions and regional sustainability, our study projected land system change in Hohhot city in the drylands in northern China from 2013 to 2030. Here, land systems are defined as combinations of land cover and land use intensity. Using the CLUMondo model, we simulated land system change in Hohhot under three scenarios: a scenario following historical trends, a scenario with strong socioeconomic and land use planning, and a scenario focused on achieving environmental conservation targets. Our results showed that Hohhot is likely to experience agricultural intensification and urban growth under all three scenarios. The agricultural intensity and the urban growth rate were much higher under the historical trend scenario compared to those with more planning interventions. The dynamics of grasslands depend strongly on projections of livestock and other claims on land resources. In the historical trend scenario, intensively grazed grasslands increase whereas a large amount of the current area of grasslands with livestock converts to forest under the scenario with strong planning. Strong conversion from grasslands with livestock and extensive cropland to semi-natural grasslands was estimated under the conservation scenario. The findings provide an input into discussions about environmental management, planning and sustainable land system design for Hohhot.

The ShakeOut earthquake scenario: Verification of three simulation sets

USGS Publications Warehouse

Bielak, J.; Graves, R.W.; Olsen, K.B.; Taborda, R.; Ramirez-Guzman, L.; Day, S.M.; Ely, G.P.; Roten, D.; Jordan, T.H.; Maechling, P.J.; Urbanic, J.; Cui, Y.; Juve, G.

2010-01-01

This paper presents a verification of three simulations of the ShakeOut scenario, an Mw 7.8 earthquake on a portion of the San Andreas fault in southern California, conducted by three different groups at the Southern California Earthquake Center using the SCEC Community Velocity Model for this region. We conducted two simulations using the finite difference method, and one by the finite element method, and performed qualitative and quantitative comparisons between the corresponding results. The results are in good agreement with each other; only small differences occur both in amplitude and phase between the various synthetics at ten observation points located near and away from the fault-as far as 150 km away from the fault. Using an available goodness-of-fit criterion all the comparisons scored above 8, with most above 9.2. This score would be regarded as excellent if the measurements were between recorded and synthetic seismograms. We also report results of comparisons based on time-frequency misfit criteria. Results from these two criteria can be used for calibrating the two methods for comparing seismograms. In those cases in which noticeable discrepancies occurred between the seismograms generated by the three groups, we found that they were the product of inherent characteristics of the various numerical methods used and their implementations. In particular, we found that the major source of discrepancy lies in the difference between mesh and grid representations of the same material model. Overall, however, even the largest differences in the synthetic seismograms are small. Thus, given the complexity of the simulations used in this verification, it appears that the three schemes are consistent, reliable and sufficiently accurate and robust for use in future large-scale simulations. ?? 2009 The Authors Journal compilation ?? 2009 RAS.

Framing of outcome and probability of recurrence: breast cancer patients' choice of adjuvant chemotherapy (ACT) in hypothetical patient scenarios.

PubMed

Zimmermann, C; Baldo, C; Molino, A

2000-03-01

To examine the effects of framing of outcome and probabilities of cancer occurrence on the treatment preference which breast cancer patients indicate for hypothetical patient scenarios. A modified version of the Decision Board Instrument (Levine et al. 1992) was administered to 35 breast cancer patients with past ACT experience. Patients expressed their choice regarding ACT for six scenarios which were characterized by either negative or positive framing of outcome and by one of the three levels of probability of recurrence (high, medium, low). The framing had no influence on ACT choices over all three probability levels. The majority chose ACT for high and medium risk and one third switched from ACT to No ACT in the low-risk condition. This switch was statistically significant. Hypothetical treatment decisions against ACT occur only when the probability of recurrence is low and the benefit of ACT is small. This finding for patients with past experience of ACT is similar to those reported for other oncological patient groups still in treatment.

Patient Scenarios Illustrating Benefits of Automation in DoD Medical Treatment Facilities.

DTIC Science & Technology

1981-10-23

d-ntif by block nmber) This report outlines the difference that automation may make in patient encounters within the military health care system. Two...automation may make in patient encounters with the military health care system, as part of a task to characterize the benefit set of automation in...FI-RI4 323 PATIENT SCENARIOS ILLUSTRATING BENEFITS OF AUTOM ATION 1/1 IDOD MEDICAL TREATMENT FACILITIES(U) LITTLE (ARTHUR D) INC CAMBRIDGE MR

Influence of ecohydrologic feedbacks from simulated crop growth on integrated regional hydrologic simulations under climate scenarios

NASA Astrophysics Data System (ADS)

van Walsum, P. E. V.; Supit, I.

2012-06-01

Hydrologic climate change modelling is hampered by climate-dependent model parameterizations. To reduce this dependency, we extended the regional hydrologic modelling framework SIMGRO to host a two-way coupling between the soil moisture model MetaSWAP and the crop growth simulation model WOFOST, accounting for ecohydrologic feedbacks in terms of radiation fraction that reaches the soil, crop coefficient, interception fraction of rainfall, interception storage capacity, and root zone depth. Except for the last, these feedbacks are dependent on the leaf area index (LAI). The influence of regional groundwater on crop growth is included via a coupling to MODFLOW. Two versions of the MetaSWAP-WOFOST coupling were set up: one with exogenous vegetation parameters, the "static" model, and one with endogenous crop growth simulation, the "dynamic" model. Parameterization of the static and dynamic models ensured that for the current climate the simulated long-term averages of actual evapotranspiration are the same for both models. Simulations were made for two climate scenarios and two crops: grass and potato. In the dynamic model, higher temperatures in a warm year under the current climate resulted in accelerated crop development, and in the case of potato a shorter growing season, thus partly avoiding the late summer heat. The static model has a higher potential transpiration; depending on the available soil moisture, this translates to a higher actual transpiration. This difference between static and dynamic models is enlarged by climate change in combination with higher CO2 concentrations. Including the dynamic crop simulation gives for potato (and other annual arable land crops) systematically higher effects on the predicted recharge change due to climate change. Crop yields from soils with poor water retention capacities strongly depend on capillary rise if moisture supply from other sources is limited. Thus, including a crop simulation model in an integrated

Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.

PubMed

Rosen, Michael A; Goeschel, Christine A; Che, Xin-Xuan; Fawole, Joseph Oluyinka; Rees, Dianne; Curran, Rosemary; Gelinas, Lillee; Martin, Jessica N; Kosel, Keith C; Pronovost, Peter J; Weaver, Sallie J

2015-12-01

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations. We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants. Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience. This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

Simulation training for geriatric medicine.

PubMed

Mehdi, Zehra; Ross, Alastair; Reedy, Gabriel; Roots, Angela; Ernst, Thomas; Jaye, Peter; Birns, Jonathan

2014-08-01

Geriatric medicine encompasses a diverse nature of medical, social and ethical challenges, and requires a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of the elderly, and it is therefore vital that specialist trainees in geriatric medicine are afforded opportunities to develop their skills in managing this complex patient population. Simulation has been widely adopted as a teaching tool in medicine; however, its use in geriatric medicine to date has involved primarily role-play or discrete clinical skills training. This article outlines the development of a bespoke, multimodal, simulation course for specialist trainees in geriatric medicine. A 1-day multimodal and interprofessional simulation course was created specifically for specialist trainees in geriatric medicine, using six curriculum-mapped scenarios in which the patient perspective was central to the teaching objectives. Various simulation techniques were used, including high-fidelity human patient manikins, patient actors, with integrated clinical skills using part-task trainers, and role-play exercises. Debriefs by trained faculty members were completed after each scenario. Twenty-six candidates attended four similar courses in 2012. Quantitative analysis of pre- and post-course questionnaires revealed an improvement of self-reported confidence in managing geriatric scenarios (Z = 4.1; p < 0.001), and thematic analysis of candidate feedback was supportive of simulation as a useful teaching tool, with reported benefits for both technical and non-technical skills. Simulation is an exciting and novel method of delivering teaching for specialist trainees in geriatric medicine. This teaching modality could be integrated into the training curriculum for geriatric medicine, to allow a wider application. © 2014 John Wiley & Sons Ltd.

Tropical peatland carbon dynamics simulated for scenarios of disturbance and restoration and climate change

NASA Astrophysics Data System (ADS)

Frolking, S. E.; Warren, M.; Dai, Z.; Kurnianto, S.; Hagen, S. C.

2015-12-01

Tropical peatlands contain a globally significant carbon pool. Southeast Asian peatlands are being deforested, drained and burned at very high rates, mostly for conversion to industrial oil palm or pulp and paper plantations. The climate mitigation potential of tropical peatlands has gained increasing attention in recent years as persistent greenhouse gas emissions can be avoided or decreased if peatlands remain intact or are rehabilitated. In addition, peatland conservation or rehabilitation for climate mitigation also includes multiple co-benefits such as maintenance of ecosystem services, biodiversity, and air quality from reduced fire occurrence. Inventory guidelines and methodologies have only recently become available, and are based on few data from a limited number of sites. Few heuristic tools are available to evaluate the impact of management practices on carbon dynamics in tropical peatlands, and the potential climate mitigation benefits of peatland restoration. We used a process based dynamic tropical peatland model to explore the C dynamics of several peatland management trajectories represented by hypothetical scenarios, within the context of simulated 21st century climate change. All scenarios with land use, including those with optimal restoration, simulate C loss over the 21st century, with C losses ranging from 10% to essentially 100% of pre-disturbance values. Fire, either prescribed as part of a crop rotation cycle, or stochastic occurrences in sub-optimally managed degraded land can be the dominant C-loss pathway, particularly in the drier climate scenario we tested. A single 25-year oil palm rotation, with a prescribed initial burn, lost 40-50 kg C/m2, equivalent to accumulation during the previous 500 years, 10-30% of which was restored in 75 years of optimal restoration. Our results indicate that even under the most optimistic scenario of hydrological and forest restoration and the wettest climate regime, only about one-third of the carbon

Ventriculostomy Simulation Using Patient-Specific Ventricular Anatomy, 3D Printing, and Hydrogel Casting.

PubMed

Ryan, Justin R; Chen, Tsinsue; Nakaji, Peter; Frakes, David H; Gonzalez, L Fernando

2015-11-01

Educational simulators provide a means for students and experts to learn and refine surgical skills. Educators can leverage the strengths of medical simulators to effectively teach complex and high-risk surgical procedures, such as placement of an external ventricular drain. Our objective was to develop a cost-effective, patient-derived medical simulacrum for cerebral lateral ventriculostomy. A cost-effective, patient-derived medical simulacrum was developed for placement of an external lateral ventriculostomy. Elastomeric and gel casting techniques were used to achieve realistic brain geometry and material properties. 3D printing technology was leveraged to develop accurate cranial properties and dimensions. An economical, gravity-driven pump was developed to provide normal and abnormal ventricular pressures. A small pilot study was performed to gauge simulation efficacy using a technology acceptance model. An accurate geometric representation of the brain was developed with independent lateral cerebral ventricular chambers. A gravity-driven pump pressurized the ventricular cavities to physiologic values. A qualitative study illustrated that the simulation has potential as an educational tool to train medical professionals in the ventriculostomy procedure. The ventricular simulacrum can improve learning in a medical education environment. Rapid prototyping and multi-material casting techniques can produce patient-derived models for cost-effective and realistic surgical training scenarios. Copyright © 2015 Elsevier Inc. All rights reserved.

The Number of Patients and Events Required to Limit the Risk of Overestimation of Intervention Effects in Meta-Analysis—A Simulation Study

PubMed Central

Thorlund, Kristian; Imberger, Georgina; Walsh, Michael; Chu, Rong; Gluud, Christian; Wetterslev, Jørn; Guyatt, Gordon; Devereaux, Philip J.; Thabane, Lehana

2011-01-01

Background Meta-analyses including a limited number of patients and events are prone to yield overestimated intervention effect estimates. While many assume bias is the cause of overestimation, theoretical considerations suggest that random error may be an equal or more frequent cause. The independent impact of random error on meta-analyzed intervention effects has not previously been explored. It has been suggested that surpassing the optimal information size (i.e., the required meta-analysis sample size) provides sufficient protection against overestimation due to random error, but this claim has not yet been validated. Methods We simulated a comprehensive array of meta-analysis scenarios where no intervention effect existed (i.e., relative risk reduction (RRR) = 0%) or where a small but possibly unimportant effect existed (RRR = 10%). We constructed different scenarios by varying the control group risk, the degree of heterogeneity, and the distribution of trial sample sizes. For each scenario, we calculated the probability of observing overestimates of RRR>20% and RRR>30% for each cumulative 500 patients and 50 events. We calculated the cumulative number of patients and events required to reduce the probability of overestimation of intervention effect to 10%, 5%, and 1%. We calculated the optimal information size for each of the simulated scenarios and explored whether meta-analyses that surpassed their optimal information size had sufficient protection against overestimation of intervention effects due to random error. Results The risk of overestimation of intervention effects was usually high when the number of patients and events was small and this risk decreased exponentially over time as the number of patients and events increased. The number of patients and events required to limit the risk of overestimation depended considerably on the underlying simulation settings. Surpassing the optimal information size generally provided sufficient protection

Group 1: Scenario design and development issues

NASA Technical Reports Server (NTRS)

Sherwin, P.

1981-01-01

All LOFT scenarios and flight segments should be designed on the basis of a detailed statement of specific objectives. These objectives must state what kind of situation is to be addressed and why. The origin, routing, and destination of a particular scenario should be dictated by the specific objectives for that scenario or leg. Other factors to be considered are the desired weather, climate, etc. Simulator visual system, as well as other capabilities and limitations must be considered at a very early stage of scenario design. The simulator navigation area must be apropriate and must coincide with current Jeppeson charts. Much of the realism of LOFT is destroyed if the crew is unable to use current manuals and other materials.

Use of simulated patients to assess the clinical and communication skills of community pharmacists.

PubMed

Weiss, Marjorie C; Booth, Anneka; Jones, Bethan; Ramjeet, Sarah; Wong, Eva

2010-06-01

To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. Community pharmacies in the southwest of England during 2007. Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.

Modeling and Composing Scenario-Based Requirements with Aspects

NASA Technical Reports Server (NTRS)

Araujo, Joao; Whittle, Jon; Ki, Dae-Kyoo

2004-01-01

There has been significant recent interest, within the Aspect-Oriented Software Development (AOSD) community, in representing crosscutting concerns at various stages of the software lifecycle. However, most of these efforts have concentrated on the design and implementation phases. We focus in this paper on representing aspects during use case modeling. In particular, we focus on scenario-based requirements and show how to compose aspectual and non-aspectual scenarios so that they can be simulated as a whole. Non-aspectual scenarios are modeled as UML sequence diagram. Aspectual scenarios are modeled as Interaction Pattern Specifications (IPS). In order to simulate them, the scenarios are transformed into a set of executable state machines using an existing state machine synthesis algorithm. Previous work composed aspectual and non-aspectual scenarios at the sequence diagram level. In this paper, the composition is done at the state machine level.

Land-use impacts on water resources and protected areas: applications of state-and-transition simulation modeling of future scenarios

USGS Publications Warehouse

Wilson, Tamara; Sleeter, Benjamin M.; Sherba, Jason T.; Dick Cameron,

2015-01-01

Human land use will increasingly contribute to habitat loss and water shortages in California, given future population projections and associated land-use demand. Understanding how land-use change may impact future water use and where existing protected areas may be threatened by land-use conversion will be important if effective, sustainable management approaches are to be implemented. We used a state-and-transition simulation modeling (STSM) framework to simulate spatially-explicit (1 km2) historical (1992-2010) and future (2011-2060) land-use change for 52 California counties within Mediterranean California ecoregions. Historical land use and land cover (LULC) change estimates were derived from the Farmland Mapping and Monitoring Program dataset and attributed with county-level agricultural water-use data from the California Department of Water Resources. Five future alternative land-use scenarios were developed and modeled using the historical land-use change estimates and land-use projections based on the Intergovernmental Panel on Climate Change's Special Report on Emission Scenarios A2 and B1 scenarios. Spatial land-use transition outputs across scenarios were combined to reveal scenario agreement and a land conversion threat index was developed to evaluate vulnerability of existing protected areas to proximal land conversion. By 2060, highest LULC conversion threats were projected to impact nearly 10,500 km2 of land area within 10 km of a protected area boundary and over 18,000 km2 of land area within essential habitat connectivity areas. Agricultural water use declined across all scenarios perpetuating historical drought-related land use from 2008-2010 and trends of annual cropland conversion into perennial woody crops. STSM is useful in analyzing land-use related impacts on water resource use as well as potential threats to existing protected land. Exploring a range of alternative, yet plausible, LULC change impacts will help to better inform resource

Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios.

PubMed

Nicksa, Grace A; Anderson, Cristan; Fidler, Richard; Stewart, Lygia

2015-03-01

The Accreditation Council for Graduate Medical Education core competencies stress nontechnical skills that can be difficult to evaluate and teach to surgical residents. During emergencies, surgeons work in interprofessional teams and are required to perform certain procedures. To obtain proficiency in these skills, residents must be trained. To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of interprofessional simulations. SimMan 3GS was used to simulate high-risk clinical scenarios (15-20 minutes), followed by debriefings with real-time feedback (30 minutes). A modified Oxford Non-Technical Skills scale (score range, 1-4) was used to assess surgical resident performance during the first half of the academic year (July-December 2012) and the second half of the academic year (January-June 2013). Anonymous online surveys were used to solicit participant feedback. Simulations were conducted in the operating room, intensive care unit, emergency department, ward, and simulation center. A total of 43 surgical residents (postgraduate years [PGYs] 1 and 2) participated in interdisciplinary clinical scenarios, with other health care professionals (nursing, anesthesia, critical care, medicine, respiratory therapy, and pharmacy; mean number of nonsurgical participants/session: 4, range 0-9). Thirty seven surgical residents responded to the survey. Simulation of high-risk clinical scenarios: postoperative pulmonary embolus, pneumothorax, myocardial infarction, gastrointestinal bleeding, anaphylaxis with a difficult airway, and pulseless electrical activity arrest. Evaluation of resident skills: communication, leadership, teamwork, problem solving, situation awareness, and confidence in performing emergency procedures (eg, cricothyroidotomy). A total of 31 of 35 (89%) of the residents responding found the sessions useful. Additionally, 28 of 33 (85%) reported improved confidence

Simulation-Based Assessment of ECMO Clinical Specialists.

PubMed

Fehr, James J; Shepard, Mark; McBride, Mary E; Mehegan, Mary; Reddy, Kavya; Murray, David J; Boulet, John R

2016-06-01

The aims of the study were (1) to create multiple scenarios that simulate a range of urgent and emergent extracorporeal membrane oxygenation (ECMO) events and (2) to determine whether these scenarios can provide reliable and valid measures of a specialist's advanced skill in managing ECMO emergencies. Multiscenario simulation-based performance assessment was performed. The study was conducted in the Saigh Pediatric Simulation Center at St. Louis Children's Hospital. ECMO clinical specialists participated in the study. Twenty-five ECMO specialists completed 8 scenarios presenting acute events in simulated ECMO patients. Participants were evaluated by 2 separate reviewers for completion of key actions and for global performance. The scores were highest for the hemodilution scenario, whereas the air entrainment scenario had the lowest scores. Psychometric analysis demonstrated that ECMO specialists with more than 1 year of experience outperformed the specialists with less than 1 year of experience. Participants endorsed these sessions as important and representative of events that might be encountered in practice. The scenarios could serve as a component of an ECMO education curriculum and be used to assess clinical specialists' readiness to manage ECMO emergencies.

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning.

PubMed

Bogossian, Fiona E; Cooper, Simon J; Cant, Robyn; Porter, Joanne; Forbes, Helen

2015-10-01

High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. A population of 489 final-year nursing students in programs of study leading to license to practice. Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001. The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. The web-based e-simulation program FIRST

Simulation of groundwater flow and chloride transport in the “1,200-foot” sand with scenarios to mitigate saltwater migration in the “2,000-foot” sand in the Baton Rouge area, Louisiana

USGS Publications Warehouse

Heywood, Charles E.; Lovelace, John K.; Griffith, Jason M.

2015-07-16

Seven hypothetical scenarios predict the effects of different groundwater withdrawal options on groundwater levels and the transport of chloride within the “1,200-foot” sand and the “2,000-foot” sand during 2015–2112. The predicted water levels and concentrations for all scenarios are depicted in maps for the years 2047 and 2112. The first scenario is a base case for comparison to the six other scenarios and simulates continuation of 2012 reported groundwater withdrawals through 2112 (100 years). The second scenario that simulates increased withdrawals from industrial wells in the “1,200-foot” sand predicts that water levels will be 12–25 ft lower by 2047 and that there will be a negligible difference in chloride concentrations within the “1,200-foot” sand. The five other scenarios simulate the effects of various withdrawal schemes on water levels and chloride concentrations within the “2,000-foot” sand. Amongst these five other scenarios, three of the scenarios simulate only various withdrawal reductions, whereas the two others also incorporate withdrawals from a scavenger well that is designed to extract salty water from the base of the “2,000-foot” sand. Two alternative pumping rates (2.5 Mgal/d and 1.25 Mgal/d) are simulated in each of the scavenger-well scenarios. For the “2,000-foot” sand scenarios, comparison of the predicted effects of the scenarios is facilitated by graphs of predicted chloride concentrations through time at selected observation wells, plots of salt mass in the aquifer through time, and a summary of the predicted plume area and average concentration. In all scenarios, water levels essentially equilibrate by 2047, after 30 years of simulated constant withdrawal rates. Although predicted water-level recovery within the “2,000-foot” sand is greatest for the scenario with the greatest reduction in groundwater withdrawal from that aquifer, the scavenger-well scenarios are most effective in mitigating the

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.

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient.

PubMed

Liaw, Sok Ying; Zhou, Wen Tao; Lau, Tang Ching; Siau, Chiang; Chan, Sally Wai-Chi

2014-02-01

Communication and teamwork between doctors and nurses are critical for optimal patient care. Simulation and interprofessional team learning are emerging as significant learning strategies to promote teamwork and communication between different health professionals. The aim of the study is to describe the development, implementation and evaluation of a simulation-based interprofessional educational (Sim-IPE) program, using a presage-process-product (3P) model, for improving medical and nursing students' communication skills in caring of a patient with physiological deterioration. The program was conducted using full-scale simulation and communication strategies adapted from Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). 127 medical and nursing students participated in a 3-hour small group interprofessional learning that incorporated simulation scenarios of deteriorating patients. Pre and post-tests were conducted to assess the students' self-confidence in interprofessional communication and perception in interprofessional learning. After the training, the students completed a satisfaction questionnaire. Both medicine and nursing groups demonstrated a significant improvement on post-test score from pre-test score for self-confidence (p<.0001) and perception (p<.0001) with no significant differences detected between the two groups. The participants were highly satisfied with their simulation learning. The Sim-IPE has better prepared the medical and nursing students in communicating with one another in providing safe care for deteriorating patient. In addition, it has improved their perception towards interprofessional learning. This pre-registration interprofessional education could prepare them for more comprehensive interprofessional team learning at post-registration level. Copyright © 2014 Elsevier Ltd. All rights reserved.

Simulation supported scenario analysis for water resources planning: a case study in northern italy

NASA Astrophysics Data System (ADS)

Facchi, A.; Gandolfi, C.; Ortuani, B.; Maggi, D.

2003-04-01

The work presents the results of a comprehensive modelling study of surface and groundwater systems, including the interaction between irrigation and groundwater resources, for the Muzza-Bassa Lodigiana irrigation district, placed in the southern part of the densely-settled Lombardia plain (northern Italy). The area, of approximately 700 km2, has been selected as: a) it is representative of agricultural and irrigation practices in a wide portion of the plain of Lombardia; b) it has well defined hydrogeological borders, represented by the Adda, Po, and Lambro rivers (respectively East, South and West) and by the Muzza canal (North). The objective of the study is to assess the impact of land use and irrigation water availability on the distribution of crop water consumption in space and time, as well as on the groundwater resources in this wide portion of the Lombardia plain. To achieve this goal, a number of realistic management scenarios, currently under discussion with the regional water authority, have been taken into account. A standard 'base case' has been defined to allow comparative analysis of the results of different scenarios. To carry out the research, an integrated, distributed, catchment-scale simulation package, already developed and applied to the study area, has been used. The simulation system is based on the integration of two hydrological models - a conceptual vadose zone model and the groundwater model MODFLOW. An interface performs the explicit coupling in space and time between the two models. A GIS manages all the information relevant to the study area, as well as all the input, the spatially distributed parameters and the output of the system. The simulation package has been verified for the years 1999-2000 using land use derived from remote-sensed images, reported water availability for irrigation, observed water stage in rivers as well as groundwater level in the alluvial aquifer system.

How sleep problems contribute to simulator sickness: Preliminary results from a realistic driving scenario.

PubMed

Altena, Ellemarije; Daviaux, Yannick; Sanz-Arigita, Ernesto; Bonhomme, Emilien; de Sevin, Étienne; Micoulaud-Franchi, Jean-Arthur; Bioulac, Stéphanie; Philip, Pierre

2018-04-17

Virtual reality and simulation tools enable us to assess daytime functioning in environments that simulate real life as close as possible. Simulator sickness, however, poses a problem in the application of these tools, and has been related to pre-existing health problems. How sleep problems contribute to simulator sickness has not yet been investigated. In the current study, 20 female chronic insomnia patients and 32 female age-matched controls drove in a driving simulator covering realistic city, country and highway scenes. Fifty percent of the insomnia patients as opposed to 12.5% of controls reported excessive simulator sickness leading to experiment withdrawal. In the remaining participants, patients with insomnia showed overall increased levels of oculomotor symptoms even before driving, while nausea symptoms further increased after driving. These results, as well as the realistic simulation paradigm developed, give more insight on how vestibular and oculomotor functions as well as interoceptive functions are affected in insomnia. Importantly, our results have direct implications for both the actual driving experience and the wider context of deploying simulation techniques to mimic real life functioning, in particular in those professions often exposed to sleep problems. © 2018 European Sleep Research Society.

An integrated fuzzy-based advanced eutrophication simulation model to develop the best management scenarios for a river basin.

PubMed

Srinivas, Rallapalli; Singh, Ajit Pratap

2018-03-01

Assessment of water quality status of a river with respect to its discharge has become prerequisite to sustainable river basin management. The present paper develops an integrated model for simulating and evaluating strategies for water quality management in a river basin management by controlling point source pollutant loadings and operations of multi-purpose projects. Water Quality Analysis and Simulation Program (WASP version 8.0) has been used for modeling the transport of pollutant loadings and their impact on water quality in the river. The study presents a novel approach of integrating fuzzy set theory with an "advanced eutrophication" model to simulate the transmission and distribution of several interrelated water quality variables and their bio-physiochemical processes in an effective manner in the Ganges river basin, India. After calibration, simulated values are compared with the observed values to validate the model's robustness. Fuzzy technique of order preference by similarity to ideal solution (F-TOPSIS) has been used to incorporate the uncertainty associated with the water quality simulation results. The model also simulates five different scenarios for pollution reduction, to determine the maximum pollutant loadings during monsoon and dry periods. The final results clearly indicate how modeled reduction in the rate of wastewater discharge has reduced impacts of pollutants in the downstream. Scenarios suggesting a river discharge rate of 1500 m 3 /s during the lean period, in addition to 25 and 50% reduction in the load rate, are found to be the most effective option to restore quality of river Ganges. Thus, the model serves as an important hydrologic tool to the policy makers by suggesting appropriate remediation action plans.

Simulated ground motion in Santa Clara Valley, California, and vicinity from M≥6.7 scenario earthquakes

USGS Publications Warehouse

Harmsen, Stephen C.; Hartzell, Stephen

2008-01-01

Models of the Santa Clara Valley (SCV) 3D velocity structure and 3D finite-difference software are used to predict ground motions from scenario earthquakes on the San Andreas (SAF), Monte Vista/Shannon, South Hayward, and Calaveras faults. Twenty different scenario ruptures are considered that explore different source models with alternative hypocenters, fault dimensions, and rupture velocities and three different velocity models. Ground motion from the full wave field up to 1 Hz is exhibited as maps of peak horizontal velocity and pseudospectral acceleration at periods of 1, 3, and 5 sec. Basin edge effects and amplification in sedimentary basins of the SCV are observed that exhibit effects from shallow sediments with relatively low shear-wave velocity (330 m/sec). Scenario earthquakes have been simulated for events with the following magnitudes: (1) M 6.8–7.4 Calaveras sources, (2) M 6.7–6.9 South Hayward sources, (3) M 6.7 Monte Vista/Shannon sources, and (4) M 7.1–7.2 Peninsula segment of the SAF sources. Ground motions are strongly influenced by source parameters such as rupture velocity, rise time, maximum depth of rupture, hypocenter, and source directivity. Cenozoic basins also exert a strong influence on ground motion. For example, the Evergreen Basin on the northeastern side of the SCV is especially responsive to 3–5-sec energy from most scenario earthquakes. The Cupertino Basin on the southwestern edge of the SCV tends to be highly excited by many Peninsula and Monte Vista fault scenarios. Sites over the interior of the Evergreen Basin can have long-duration coda that reflect the trapping of seismic energy within this basin. Plausible scenarios produce predominantly 5-sec wave trains with greater than 30 cm/sec sustained ground-motion amplitude with greater than 30 sec duration within the Evergreen Basin.

The response of vegetation distribution, ecosystem productivity, and fire in California to future climate scenarios simulated by the MC1 dynamic vegetation dynamic.

Treesearch

James M. Lenihan; Dominique Bachelet; Raymond Drapek; Ronald P. Neilson

2006-01-01

The objective of this study was to dynamically simulate the response of vegetation distribution, carbon, and fire to three scenarios of future climate change for California using the MAPSS-CENTURY (MCI) dynamic general vegetation model. Under all three scenarios, Alpine/Subalpine Forest cover declined with increased growing season length and warmth, and increases in...

Variation and adaptation: learning from success in patient safety-oriented simulation training.

PubMed

Dieckmann, Peter; Patterson, Mary; Lahlou, Saadi; Mesman, Jessica; Nyström, Patrik; Krage, Ralf

2017-01-01

Simulation is traditionally used to reduce errors and their negative consequences. But according to modern safety theories, this focus overlooks the learning potential of the positive performance, which is much more common than errors. Therefore, a supplementary approach to simulation is needed to unfold its full potential. In our commentary, we describe the learning from success (LFS) approach to simulation and debriefing. Drawing on several theoretical frameworks, we suggest supplementing the widespread deficit-oriented, corrective approach to simulation with an approach that focusses on systematically understanding how good performance is produced in frequent (mundane) simulation scenarios. We advocate to investigate and optimize human activity based on the connected layers of any setting: the embodied competences of the healthcare professionals, the social and organizational rules that guide their actions, and the material aspects of the setting. We discuss implications of these theoretical perspectives for the design and conduct of simulation scenarios, post-simulation debriefings, and faculty development programs.

The Scenario Model Intercomparison Project (ScenarioMIP) for CMIP6

DOE PAGES

O'Neill, Brian C.; Tebaldi, Claudia; van Vuuren, Detlef P.; ...

2016-09-28

emissions and land use scenarios generated with integrated assessment models will be provided to participating climate modeling groups by late 2016, with the climate model simulations run within the 2017–2018 time frame, and output from the climate model projections made available and analyses performed over the 2018–2020 period.« less

The Scenario Model Intercomparison Project (ScenarioMIP) for CMIP6

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Neill, Brian C.; Tebaldi, Claudia; van Vuuren, Detlef P.

2016-01-01

explicit emissions and land use scenarios generated with integrated assessment models will be provided to participating climate modeling groups by late 2016, with the climate model simulations run within the 2017–2018 time frame, and output from the climate model projections made available and analyses performed over the 2018–2020 period.« less

The Scenario Model Intercomparison Project (ScenarioMIP) for CMIP6

NASA Astrophysics Data System (ADS)

O'Neill, Brian C.; Tebaldi, Claudia; van Vuuren, Detlef P.; Eyring, Veronika; Friedlingstein, Pierre; Hurtt, George; Knutti, Reto; Kriegler, Elmar; Lamarque, Jean-Francois; Lowe, Jason; Meehl, Gerald A.; Moss, Richard; Riahi, Keywan; Sanderson, Benjamin M.

2016-09-01

emissions and land use scenarios generated with integrated assessment models will be provided to participating climate modeling groups by late 2016, with the climate model simulations run within the 2017-2018 time frame, and output from the climate model projections made available and analyses performed over the 2018-2020 period.

Integrating surrogate models into subsurface simulation framework allows computation of complex reactive transport scenarios

NASA Astrophysics Data System (ADS)

De Lucia, Marco; Kempka, Thomas; Jatnieks, Janis; Kühn, Michael

2017-04-01

Reactive transport simulations - where geochemical reactions are coupled with hydrodynamic transport of reactants - are extremely time consuming and suffer from significant numerical issues. Given the high uncertainties inherently associated with the geochemical models, which also constitute the major computational bottleneck, such requirements may seem inappropriate and probably constitute the main limitation for their wide application. A promising way to ease and speed-up such coupled simulations is achievable employing statistical surrogates instead of "full-physics" geochemical models [1]. Data-driven surrogates are reduced models obtained on a set of pre-calculated "full physics" simulations, capturing their principal features while being extremely fast to compute. Model reduction of course comes at price of a precision loss; however, this appears justified in presence of large uncertainties regarding the parametrization of geochemical processes. This contribution illustrates the integration of surrogates into the flexible simulation framework currently being developed by the authors' research group [2]. The high level language of choice for obtaining and dealing with surrogate models is R, which profits from state-of-the-art methods for statistical analysis of large simulations ensembles. A stand-alone advective mass transport module was furthermore developed in order to add such capability to any multiphase finite volume hydrodynamic simulator within the simulation framework. We present 2D and 3D case studies benchmarking the performance of surrogates and "full physics" chemistry in scenarios pertaining the assessment of geological subsurface utilization. [1] Jatnieks, J., De Lucia, M., Dransch, D., Sips, M.: "Data-driven surrogate model approach for improving the performance of reactive transport simulations.", Energy Procedia 97, 2016, p. 447-453. [2] Kempka, T., Nakaten, B., De Lucia, M., Nakaten, N., Otto, C., Pohl, M., Chabab [Tillner], E., Kühn, M

Patterns of communication in high-fidelity simulation.

PubMed

Anderson, Judy K; Nelson, Kimberly

2015-01-01

High-fidelity simulation is commonplace in nursing education. However, critical thinking, decision making, and psychomotor skills scenarios are emphasized. Scenarios involving communication occur in interprofessional or intraprofessional settings. The importance of effective nurse-patient communication is reflected in statements from the American Nurses Association and Quality and Safety Education for Nurses, and in the graduate outcomes of most nursing programs. This qualitative study examined the patterns of communication observed in video recordings of a medical-surgical scenario with 71 senior students in a baccalaureate program. Thematic analysis revealed patterns of (a) focusing on tasks, (b) communicating-in-action, and (c) being therapeutic. Additional categories under the patterns included missing opportunities, viewing the "small picture," relying on informing, speaking in "medical tongues," offering choices…okay?, feeling uncomfortable, and using therapeutic techniques. The findings suggest the importance of using high-fidelity simulation to develop expertise in communication. In addition, the findings reinforce the recommendation to prioritize communication aspects of scenarios and debriefing for all simulations. Copyright 2015, SLACK Incorporated.

Biogeophysical consequences of a tropical deforestation scenario: A GCM simulation study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sud, Y.C.; Lau, W.K.M.; Walker, G.K.

1996-12-01

Two 3-year (1979-1982) integrations were carried out with a version of the GLA GCM that contains the Simple Biosphere Model (SiB) for simulating land-atmosphere interactions. The control case used the usual SiB vegetation cover (comprising 12 vegetation types), while its twin, the deforestation case, imposed a scenario in which all tropical rainforests were entirely replaced by grassland. Except for this difference, all other initial and prescribed boundary conditions were kept identical in both integrations. An intercomparison of the integrations shows that tropical: deforestation decreases evapotranspiration and increases land surface outgoing longwave radiation and sensible heat flux, thereby warming and dryingmore » the planetary boundary layer. This happens despite the reduced absorption of solar radiation due to higher surface albedo of the deforested land. Produces significant and robust local as well as global climate changes. The local effect includes significant changes (mostly reductions) in precipitation and diabatic heating, while the large-scale effect is to weaken the Hadley circulation but invigorate the southern Ferrel cell, drawing larger air mass from the indirect polar cells. Decreases the surface stress (drag force) owing to reduced surface roughness of deforested land, which in turn intensifies winds in the planetary boundary layer, thereby affecting the dynamic structure of moisture convergence. The simulated surface winds are about 70% stronger and are accompanied by significant changes in the power spectrum of the annual cycle of surface and PBL winds and precipitation. Our results broadly confirm several findings of recent tropical deforestation simulation experiments. In addition, some global-scale climatic influences of deforestation not identified in earlier studies are delineated. 57 refs., 10 figs., 3 tabs.« less

Acute hypoxia in a simulated high-altitude airdrop scenario due to oxygen system failure.

PubMed

Ottestad, William; Hansen, Tor Are; Pradhan, Gaurav; Stepanek, Jan; Høiseth, Lars Øivind; Kåsin, Jan Ivar

2017-12-01

High-Altitude High Opening (HAHO) is a military operational procedure in which parachute jumps are performed at high altitude requiring supplemental oxygen, putting personnel at risk of acute hypoxia in the event of oxygen equipment failure. This study was initiated by the Norwegian Army to evaluate potential outcomes during failure of oxygen supply, and to explore physiology during acute severe hypobaric hypoxia. A simulated HAHO without supplemental oxygen was carried out in a hypobaric chamber with decompression to 30,000 ft (9,144 m) and then recompression to ground level with a descent rate of 1,000 ft/min (305 m/min). Nine subjects were studied. Repeated arterial blood gas samples were drawn throughout the entire hypoxic exposure. Additionally, pulse oximetry, cerebral oximetry, and hemodynamic variables were monitored. Desaturation evolved rapidly and the arterial oxygen tensions are among the lowest ever reported in volunteers during acute hypoxia. Pa O 2 decreased from baseline 18.4 (17.3-19.1) kPa, 138.0 (133.5-143.3) mmHg, to a minimum value of 3.3 (2.9-3.7) kPa, 24.8 (21.6-27.8) mmHg, after 180 (60-210) s, [median (range)], N = 9. Hyperventilation with ensuing hypocapnia was associated with both increased arterial oxygen saturation and cerebral oximetry values, and potentially improved tolerance to severe hypoxia. One subject had a sharp drop in heart rate and cardiac index and lost consciousness 4 min into the hypoxic exposure. A simulated high-altitude airdrop scenario without supplemental oxygen results in extreme hypoxemia and may result in loss of consciousness in some individuals. NEW & NOTEWORTHY This is the first study to investigate physiology and clinical outcome of oxygen system failure in a simulated HAHO scenario. The acquired knowledge is of great value to make valid risk-benefit analyses during HAHO training or operations. The arterial oxygen tensions reported in this hypobaric chamber study are among the lowest ever reported during acute

Simulating Future GPS Clock Scenarios with Two Composite Clock Algorithms

NASA Technical Reports Server (NTRS)

Suess, Matthias; Matsakis, Demetrios; Greenhall, Charles A.

2010-01-01

Using the GPS Toolkit, the GPS constellation is simulated using 31 satellites (SV) and a ground network of 17 monitor stations (MS). At every 15-minutes measurement epoch, the monitor stations measure the time signals of all satellites above a parameterized elevation angle. Once a day, the satellite clock estimates the station and satellite clocks. The first composite clock (B) is based on the Brown algorithm, and is now used by GPS. The second one (G) is based on the Greenhall algorithm. The composite clock of G and B performance are investigated using three ground-clock models. Model C simulates the current GPS configuration, in which all stations are equipped with cesium clocks, except for masers at USNO and Alternate Master Clock (AMC) sites. Model M is an improved situation in which every station is equipped with active hydrogen masers. Finally, Models F and O are future scenarios in which the USNO and AMC stations are equipped with fountain clocks instead of masers. Model F is a rubidium fountain, while Model O is more precise but futuristic Optical Fountain. Each model is evaluated using three performance metrics. The timing-related user range error having all satellites available is the first performance index (PI1). The second performance index (PI2) relates to the stability of the broadcast GPS system time itself. The third performance index (PI3) evaluates the stability of the time scales computed by the two composite clocks. A distinction is made between the "Signal-in-Space" accuracy and that available through a GNSS receiver.

Analysis of JT-60SA operational scenarios

NASA Astrophysics Data System (ADS)

Garzotti, L.; Barbato, E.; Garcia, J.; Hayashi, N.; Voitsekhovitch, I.; Giruzzi, G.; Maget, P.; Romanelli, M.; Saarelma, S.; Stankiewitz, R.; Yoshida, M.; Zagórski, R.

2018-02-01

Reference scenarios for the JT-60SA tokamak have been simulated with one-dimensional transport codes to assess the stationary state of the flat-top phase and provide a profile database for further physics studies (e.g. MHD stability, gyrokinetic analysis) and diagnostics design. The types of scenario considered vary from pulsed standard H-mode to advanced non-inductive steady-state plasmas. In this paper we present the results obtained with the ASTRA, CRONOS, JINTRAC and TOPICS codes equipped with the Bohm/gyro-Bohm, CDBM and GLF23 transport models. The scenarios analysed here are: a standard ELMy H-mode, a hybrid scenario and a non-inductive steady state plasma, with operational parameters from the JT-60SA research plan. Several simulations of the scenarios under consideration have been performed with the above mentioned codes and transport models. The results from the different codes are in broad agreement and the main plasma parameters generally agree well with the zero dimensional estimates reported previously. The sensitivity of the results to different transport models and, in some cases, to the ELM/pedestal model has been investigated.

Evaluating Global Land-use Change Scenario: Carbon Emission in RCP Scenarios and its Effects on Climate Response

NASA Astrophysics Data System (ADS)

Kato, E.; Kawamiya, M.

2011-12-01

In CMIP5 experiments, new emissions scenarios for GCMs and Earth System Models (ESMs) have been constructed as Representative Concentration Pathways (RCPs) by a community effort of Integrated Assessment Modeling (IAM) groups. In RCP scenarios, regional land-use scenarios have been depicted based on the socio-economic assumption of IAMs, and also downscaled spatially explicit land-use maps from the regional scenarios are prepared. In the land-use harmonization project, integrated gridded land-use transition data for the past and future time period has been developed from the reconstruction based on HYDE 3 agricultural data and FAO wood harvest data, and the future land-use scenarios from IAMs. These gridded land-use dataset are used as a forcing of some ESMs participating to the CMIP5 experiments, to assess the biogeochemical and biogeophysical effects of land-use and land cover change in the climate change simulation. In this study, global net CO2 emissions from land-use change for RCP scenarios are evaluated with an offline terrestrial biogeochemical model, VISIT (Vegetation Integrative SImulation Tool). Also the emissions are evaluated with coupled ESM, MIROC-ESM following the LUCID-CMIP5 protocol to see the effect of land-use and land cover change on climate response. Using the model output, consistency of the land-use change CO2 emission scenarios provided by RCPs are evaluated in terms of effect of CO2 fertilization, climate change, and land-use transition itself including the effect of biomass crops production with CCS. We find that a land-use scenario with decreased agricultural land-use intensity such as RCP 6.0 shows possibility of further absorption of CO2 through the climate-carbon feedback, and cooling effect through both biogeochemical and biogeophysical effects.

Designing Asteroid Impact Scenario Trajectories

NASA Astrophysics Data System (ADS)

Chodas, Paul

2016-05-01

In order to study some of the technical and geopolitical issues of dealing with an asteroid on impact trajectory, a number of hypothetical impact scenarios have been presented over the last ten years or so. These have been used, for example, at several of the Planetary Defense Conferences (PDCs), as well as in tabletop exercises with the Federal Emergency Management Agency (FEMA), along with other government agencies. The exercise at the 2015 PDC involved most of the attendees, consisted of seven distinct steps (“injects”), and with all the presentations and discussions, took up nearly 10 hours of conference time. The trajectory for the PDC15 scenario was entirely realistic, and was posted ahead of the meeting. It was made available in the NEO Program’s Horizons ephemeris service so that users could , for example, design their own deflection missions. The simulated asteroid and trajectory had to meet numerous very exacting requirements: becoming observable on the very first day of the conference, yet remaining very difficult to observe for the following 7 years, and far enough away from Earth that it was out of reach of radar until just before impact. It had to be undetectable in the past, and yet provide multiple perihelion opportunities for deflection in the future. It had to impact in a very specific region of the Earth, a specific number of years after discovery. When observations of the asteroid are simulated to generate an uncertainty region, that entire region must impact the Earth along an axis that cuts across specific regions of the Earth, the “risk corridor”. This is important because asteroid deflections generally move an asteroid impact point along this corridor. One scenario had a requirement that the asteroid pass through a keyhole several years before impact. The PDC15 scenario had an additional constraint that multiple simulated kinetic impactor missions altered the trajectory at a deflection point midway between discovery and impact

Assessing Orchestrated Simulation Through Modeling to Quantify the Benefits of Unmanned-Teaming in a Tactical ASW Scenario

DTIC Science & Technology

2018-03-01

Results are compared to a previous study using a similar design of experiments but different simulation software. The baseline scenario for exploring the...behaviors are mimicked in this research, enabling Solem’s MANA results to be compared to our LITMUS’ results. By design , the principal difference...missions when using the second order NOLH, and compares favorably with the over six million in the full factorial design . 3. Advantages of Cluster

The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma

PubMed Central

Kunimatsu-Sanuki, Shiho; Iwase, Aiko; Araie, Makoto; Aoki, Yuki; Hara, Takeshi; Fukuchi, Takeo; Udagawa, Sachiko; Ohkubo, Shinji; Sugiyama, Kazuhisa; Matsumoto, Chota; Nakazawa, Toru; Yamaguchi, Takuhiro; Ono, Hiroshi

2017-01-01

Background/aims To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. Methods Normal subjects and patients with glaucoma with mean deviation <–12 dB in both eyes (Humphrey Field Analyzer 24-2 SITA-S program) used a driving simulator (DS; Honda Motor, Tokyo). Two scenarios in which oncoming cars turned right crossing the driver's path were chosen. We compared the binocular integrated visual field (IVF) in the patients who were involved in collisions and those who were not. We performed a multivariate logistic regression analysis; the dependent parameter was collision involvement, and the independent parameters were age, visual acuity and mean sensitivity of the IVF subfields. Results The study included 43 normal subjects and 100 patients with advanced glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (p<0.001). The patients with advanced glaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (p<0.001) and had lower mean IVF sensitivity in the inferior hemifield, both 0°–12° and 13°–24° in comparison with who were not involved in collisions (p=0.012 and p=0.034). A logistic regression analysis revealed that collision involvement was significantly associated with decreased inferior IVF mean sensitivity from 13° to 24° (p=0.041), in addition to older age and lower visual acuity (p=0.018 and p<0.001). Conclusions Our data suggest that the inferior hemifield was associated with the incidence of motor vehicle collisions with oncoming cars in patients with advanced glaucoma. PMID:28400370

Simulated groundwater flow in the Ogallala and Arikaree aquifers, Rosebud Indian Reservation area, South Dakota - Revisions with data through water year 2008 and simulations of potential future scenarios

USGS Publications Warehouse

Long, Andrew J.; Putnam, Larry D.

2010-01-01

The Ogallala and Arikaree aquifers are important water resources in the Rosebud Indian Reservation area and are used extensively for irrigation, municipal, and domestic water supplies. Drought or increased withdrawals from the Ogallala and Arikaree aquifers in the Rosebud Indian Reservation area have the potential to affect water levels in these aquifers. This report documents revisions and recalibration of a previously published three-dimensional, numerical groundwater-flow model for this area. Data for a 30-year period (water years 1979 through 2008) were used in steady-state and transient numerical simulations of groundwater flow. In the revised model, revisions include (1) extension of the transient calibration period by 10 years, (2) the use of inverse modeling for steady-state calibration, (3) model calibration to base flow for an additional four surface-water drainage basins, (4) improved estimation of transient aquifer recharge, (5) improved delineation of vegetation types, and (6) reduced cell size near large capacity water-supply wells. In addition, potential future scenarios were simulated to assess the potential effects of drought and increased groundwater withdrawals.The model comprised two layers: the upper layer represented the Ogallala aquifer and the lower layer represented the Arikaree aquifer. The model’s grid had 168 rows and 202 columns, most of which were 1,640 feet (500 meters) wide, with narrower rows and columns near large water-supply wells. Recharge to the Ogallala and Arikaree aquifers occurs from precipitation on the outcrop areas. The average recharge rates used for the steady-state simulation were 2.91 and 1.45 inches per year for the Ogallala aquifer and Arikaree aquifer, respectively, for a total rate of 255.4 cubic feet per second (ft3/s). Discharge from the aquifers occurs through evapotranspiration, discharge to streams as base flow and spring flow, and well withdrawals. Discharge rates for the steady-state simulation were 171

The role of patient simulation and incident reporting in the development and evaluation of medical devices and the training of their users.

PubMed

Dieckmann, P; Rall, M; Ostergaard, D

2009-01-01

We describe how simulation and incident reporting can be used in combination to make the interaction between people, (medical) technology and organisation safer for patients and users. We provide the background rationale for our conceptual ideas and apply the concepts to the analysis of an actual incident report. Simulation can serve as a laboratory to analyse such cases and to create relevant and effective training scenarios based on such analyses. We will describe a methodological framework for analysing simulation scenarios in a way that allows discovering and discussing mismatches between conceptual models of the device design and mental models users hold about the device and its use. We further describe how incident reporting systems can be used as one source of data to conduct the necessary needs analyses - both for training and further needs for closer analysis of specific devices or some of their special features or modes during usability analyses.

The effect of improving task representativeness on capturing nurses’ risk assessment judgements: a comparison of written case simulations and physical simulations

PubMed Central

2013-01-01

Background The validity of studies describing clinicians’ judgements based on their responses to paper cases is questionable, because - commonly used - paper case simulations only partly reflect real clinical environments. In this study we test whether paper case simulations evoke similar risk assessment judgements to the more realistic simulated patients used in high fidelity physical simulations. Methods 97 nurses (34 experienced nurses and 63 student nurses) made dichotomous assessments of risk of acute deterioration on the same 25 simulated scenarios in both paper case and physical simulation settings. Scenarios were generated from real patient cases. Measures of judgement ‘ecology’ were derived from the same case records. The relationship between nurses’ judgements, actual patient outcomes (i.e. ecological criteria), and patient characteristics were described using the methodology of judgement analysis. Logistic regression models were constructed to calculate Lens Model Equation parameters. Parameters were then compared between the modeled paper-case and physical-simulation judgements. Results Participants had significantly less achievement (ra) judging physical simulations than when judging paper cases. They used less modelable knowledge (G) with physical simulations than with paper cases, while retaining similar cognitive control and consistency on repeated patients. Respiration rate, the most important cue for predicting patient risk in the ecological model, was weighted most heavily by participants. Conclusions To the extent that accuracy in judgement analysis studies is a function of task representativeness, improving task representativeness via high fidelity physical simulations resulted in lower judgement performance in risk assessments amongst nurses when compared to paper case simulations. Lens Model statistics could prove useful when comparing different options for the design of simulations used in clinical judgement analysis. The approach

Accounting for costs, QALYs, and capacity constraints: using discrete-event simulation to evaluate alternative service delivery and organizational scenarios for hospital-based glaucoma services.

PubMed

Crane, Glenis J; Kymes, Steven M; Hiller, Janet E; Casson, Robert; Martin, Adam; Karnon, Jonathan D

2013-11-01

Decision-analytic models are routinely used as a framework for cost-effectiveness analyses of health care services and technologies; however, these models mostly ignore resource constraints. In this study, we use a discrete-event simulation model to inform a cost-effectiveness analysis of alternative options for the organization and delivery of clinical services in the ophthalmology department of a public hospital. The model is novel, given that it represents both disease outcomes and resource constraints in a routine clinical setting. A 5-year discrete-event simulation model representing glaucoma patient services at the Royal Adelaide Hospital (RAH) was implemented and calibrated to patient-level data. The data were sourced from routinely collected waiting and appointment lists, patient record data, and the published literature. Patient-level costs and quality-adjusted life years were estimated for a range of alternative scenarios, including combinations of alternate follow-up times, booking cycles, and treatment pathways. The model shows that a) extending booking cycle length from 4 to 6 months, b) extending follow-up visit times by 2 to 3 months, and c) using laser in preference to medication are more cost-effective than current practice at the RAH eye clinic. The current simulation model provides a useful tool for informing improvements in the organization and delivery of glaucoma services at a local level (e.g., within a hospital), on the basis of expected effects on costs and health outcomes while accounting for current capacity constraints. Our model may be adapted to represent glaucoma services at other hospitals, whereas the general modeling approach could be applied to many other clinical service areas.

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

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

PubMed

Barnett, Susanne G; Gallimore, Casey E; Pitterle, Michael; Morrill, Josh

2016-02-25

To evaluate online case simulation vs a paper case on student confidence and engagement. 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. 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. 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.

Exploring the use of high-fidelity simulation training to enhance clinical skills.

PubMed

Ann Kirkham, Lucy

2018-02-07

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Aerosol effect on climate extremes in Europe under different future scenarios

NASA Astrophysics Data System (ADS)

Sillmann, J.; Pozzoli, L.; Vignati, E.; Kloster, S.; Feichter, J.

2013-05-01

This study investigates changes in extreme temperature and precipitation events under different future scenarios of anthropogenic aerosol emissions (i.e., SO2 and black and organic carbon) simulated with an aerosol-climate model (ECHAM5-HAM) with focus on Europe. The simulations include a maximum feasible aerosol reduction (MFR) scenario and a current legislation emission (CLEmod) scenario where Europe implements the MFR scenario, but the rest of the world follows the current legislation scenario and a greenhouse gas scenario. The strongest changes relative to the year 2000 are projected for the MFR scenario, in which the global aerosol reduction greatly enforces the general warming effect due to greenhouse gases and results in significant increases of temperature and precipitation extremes in Europe. Regional warming effects can also be identified from aerosol reductions under the CLEmodscenario. This becomes most obvious in the increase of the hottest summer daytime temperatures in Northern Europe.

Methodological advances: using greenhouses to simulate climate change scenarios.

PubMed

Morales, F; Pascual, I; Sánchez-Díaz, M; Aguirreolea, J; Irigoyen, J J; Goicoechea, N; Antolín, M C; Oyarzun, M; Urdiain, A

2014-09-01

Human activities are increasing atmospheric CO2 concentration and temperature. Related to this global warming, periods of low water availability are also expected to increase. Thus, CO2 concentration, temperature and water availability are three of the main factors related to climate change that potentially may influence crops and ecosystems. In this report, we describe the use of growth chamber - greenhouses (GCG) and temperature gradient greenhouses (TGG) to simulate climate change scenarios and to investigate possible plant responses. In the GCG, CO2 concentration, temperature and water availability are set to act simultaneously, enabling comparison of a current situation with a future one. Other characteristics of the GCG are a relative large space of work, fine control of the relative humidity, plant fertirrigation and the possibility of light supplementation, within the photosynthetic active radiation (PAR) region and/or with ultraviolet-B (UV-B) light. In the TGG, the three above-mentioned factors can act independently or in interaction, enabling more mechanistic studies aimed to elucidate the limiting factor(s) responsible for a given plant response. Examples of experiments, including some aimed to study photosynthetic acclimation, a phenomenon that leads to decreased photosynthetic capacity under long-term exposures to elevated CO2, using GCG and TGG are reported. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The use of cognitive continuum theory and patient scenarios to explore nurse prescribers' pharmacological knowledge and decision-making.

PubMed

Offredy, Maxine; Kendall, Sally; Goodman, Claire

2008-06-01

Nurses have been involved in prescribing in England since 1996, and to date over 41,000 nurses are registered with the Nursing and Midwifery Council as prescribers. The majority of evaluative research on nurse prescribing is descriptive and relies on self-report and assessment of patient satisfaction. To explore and test nurse prescribers' pharmacological knowledge and decision-making. An exploratory approach to test the usefulness of patient scenarios in addressing the reasons why nurses decide whether or not to prescribe was utilised. Semi-structured interviews with nurse prescribers using patient scenarios were used as proxy methods of assessment of how nurses made their prescribing decisions. Two primary care trusts in the southeast of England were the settings for this study. Purposive sampling to ensure there was a mixed group of prescribers was used to enable detailed exploration of the research objectives and to obtain in-depth understanding of the complex activities involved in nurse prescribing. Interviews and case scenarios. The use of cognitive continuum theory guided the analysis. The majority of participants were unable to identify the issues involved in all the scenarios; they also failed to provide an acceptable solution to the problem, suggesting that they would refer the patient to the general practitioner. A similar number described themselves as 'very confident' while seven participants felt that they were 'not confident' in dealing with medication issues, four of whom were practising prescribing. The effects of social and institutional factors are important in the decision-making process. The lack of appropriate pharmacological knowledge coupled with lack of confidence in prescribing was demonstrated. The scenarios used in this study indicate that nurses are perhaps knowledgeable in their small area of practise but flounder outside this. Further research could be conducted with a larger sample and with more scenarios to explore the decision

Use of multiple patient simulators to enhance prioritizing and delegating skills for senior nursing students.

PubMed

Kaplan, Barbara; Ura, Darla

2010-07-01

The student clinical experience is rich, yet challenges arise in providing experiences where leadership skills can be developed and used in nursing practice. To increase student confidence and enhance student ability to safely and effectively prioritize, delegate, and implement care for numerous patients, a simulation-based learning (SBL) experience was developed. The SBL experience involves multiple patient simulators, case study analysis, and a debriefing session. Ninety-seven senior nursing students participated in this program. Students reported through Likert surveys to either "agree" or "strongly agree" that the SBL was well organized (87%, n = 84), prompted realistic expectations (59%, n = 57), the scenarios were believable (73%, n = 71), case studies increased understanding (66%, n = 64), and that the SBL experience increased understanding of prioritizing and delegating care (69%, n = 67). Seventy-eight percent (n = 76) reported "more confidence in ability to work as a team" and 55% (n = 52) reported "more confidence in prioritizing and delegating care." Copyright 2010, SLACK Incorporated.

Two graphical user interfaces for managing and analyzing MODFLOW groundwater-model scenarios

USGS Publications Warehouse

Banta, Edward R.

2014-01-01

Scenario Manager and Scenario Analyzer are graphical user interfaces that facilitate the use of calibrated, MODFLOW-based groundwater models for investigating possible responses to proposed stresses on a groundwater system. Scenario Manager allows a user, starting with a calibrated model, to design and run model scenarios by adding or modifying stresses simulated by the model. Scenario Analyzer facilitates the process of extracting data from model output and preparing such display elements as maps, charts, and tables. Both programs are designed for users who are familiar with the science on which groundwater modeling is based but who may not have a groundwater modeler’s expertise in building and calibrating a groundwater model from start to finish. With Scenario Manager, the user can manipulate model input to simulate withdrawal or injection wells, time-variant specified hydraulic heads, recharge, and such surface-water features as rivers and canals. Input for stresses to be simulated comes from user-provided geographic information system files and time-series data files. A Scenario Manager project can contain multiple scenarios and is self-documenting. Scenario Analyzer can be used to analyze output from any MODFLOW-based model; it is not limited to use with scenarios generated by Scenario Manager. Model-simulated values of hydraulic head, drawdown, solute concentration, and cell-by-cell flow rates can be presented in display elements. Map data can be represented as lines of equal value (contours) or as a gradated color fill. Charts and tables display time-series data obtained from output generated by a transient-state model run or from user-provided text files of time-series data. A display element can be based entirely on output of a single model run, or, to facilitate comparison of results of multiple scenarios, an element can be based on output from multiple model runs. Scenario Analyzer can export display elements and supporting metadata as a Portable

Does extreme precipitation intensity depend on the emissions scenario?

NASA Astrophysics Data System (ADS)

Pendergrass, Angeline; Lehner, Flavio; Sanderson, Benjamin; Xu, Yangyang

2016-04-01

The rate of increase of global-mean precipitation per degree surface temperature increase differs for greenhouse gas and aerosol forcings, and therefore depends on the change in composition of the emissions scenario used to drive climate model simulations for the remainder of the century. We investigate whether or not this is also the case for extreme precipitation simulated by a multi-model ensemble driven by four realistic emissions scenarios. In most models, the rate of increase of maximum annual daily rainfall per degree global warming in the multi-model ensemble is statistically indistinguishable across the four scenarios, whether this extreme precipitation is calculated globally, over all land, or over extra-tropical land. These results indicate that, in most models, extreme precipitation depends on the total amount of warming and does not depend on emissions scenario, in contrast to mean precipitation.

Patients with Chronic Conditions: Simulate to Educate?

ERIC Educational Resources Information Center

Lefèvre, Thomas; Gagnayre, Rémi; Gignon, Maxime

2017-01-01

Simulation in healthcare in an way to train professionals but it is not yet use commonly to train patient or their caregivers. Recently, it has been suggested to extend simulations to patients with chronic conditions. Simulations could help patients and caregivers to acquire psychosocial and self-management skills. This approach proved to be…

Integrated assessment and scenarios simulation of urban water security system in the southwest of China with system dynamics analysis.

PubMed

Yin, Su; Dongjie, Guan; Weici, Su; Weijun, Gao

2017-11-01

The demand for global freshwater is growing, while global freshwater available for human use is limited within a certain time and space. Its security has significant impacts on both the socio-economic system and ecological system. Recently, studies have focused on the urban water security system (UWSS) in terms of either water quantity or water quality. In this study, water resources, water environment, and water disaster issues in the UWSS were combined to establish an evaluation index system with system dynamics (SD) and geographic information systems (GIS). The GIS method performs qualitative analysis from the perspective of the spatial dimension; meanwhile, the SD method performs quantitative calculation about related water security problems from the perspective of the temporal dimension. We established a UWSS model for Guizhou province, China to analyze influencing factors, main driving factors, and system variation law, by using the SD method. We simulated the water security system from 2005 to 2025 under four scenarios (Guiyang scenario, Zunyi scenario, Bijie scenario and combined scenario). The results demonstrate that: (1) the severity of water security in cities is ranked as follows: three cities are secure in Guizhou province, four cities are in basic security and two cities are in a situation of insecurity from the spatial dimension of GIS through water security synthesis; and (2) the major driving factors of UWSS in Guizhou province include agricultural irrigation water demand, soil and water losses area, a ratio increase to the standard of water quality, and investment in environmental protection. A combined scenario is the best solution for UWSS by 2025 in Guizhou province under the four scenarios from the temporal dimension of SD. The results of this study provide a useful suggestion for the management of freshwater for the cities of Guizhou province in southwest China.

Dry forest resilience varies under simulated climate‐management scenarios in a central Oregon, USA landscape.

PubMed

Halofsky, Joshua S; Halofsky, Jessica E; Burcsu, Theresa; Hemstrom, Miles A

Determining appropriate actions to create or maintain landscapes resilient to climate change is challenging because of uncertainty associated with potential effects of climate change and their interactions with land management. We used a set of climate-informed state-and-transition models to explore the effects of management and natural disturbances on vegetation composition and structure under different future climates. Models were run for dry forests of central Oregon under a fire suppression scenario (i.e., no management other than the continued suppression of wildfires) and an active management scenario characterized by light to moderate thinning from below and some prescribed fire, planting, and salvage logging. Without climate change, area in dry province forest types remained constant. With climate change, dry mixed-conifer forests increased in area (by an average of 21–26% by 2100), and moist mixed-conifer forests decreased in area (by an average of 36–60% by 2100), under both management scenarios. Average area in dry mixed-conifer forests varied little by management scenario, but potential decreases in the moist mixed-conifer forest were lower with active management. With changing climate in the dry province of central Oregon, our results suggest the likelihood of sustaining current levels of dense, moist mixed-conifer forests with large-diameter, old trees is low (less than a 10% chance) irrespective of management scenario; an opposite trend was observed under no climate change simulations. However, results also suggest active management within the dry and moist mixed-conifer forests that creates less dense forest conditions can increase the persistence of larger-diameter, older trees across the landscape. Owing to projected increases in wildfire, our results also suggest future distributions of tree structures will differ from the present. Overall, our projections indicate proactive management can increase forest resilience and sustain some societal

Immersive simulated reality scenarios for enhancing students' experience of people with learning disabilities across all fields of nurse education.

PubMed

Saunder, Lorna; Berridge, Emma-Jane

2015-11-01

Poor preparation of nurses, regarding learning disabilities can have devastating consequences. High-profile reports and the Nursing and Midwifery Council requirements led this University to introduce Shareville into the undergraduate and postgraduate nursing curriculum. Shareville is a virtual environment developed at Birmingham City University, in which student nurses learn from realistic, problem-based scenarios featuring people with learning disabilities. Following the implementation of the resource an evaluation of both staff and student experience was undertaken. Students reported that problem-based scenarios were sufficiently real and immersive. Scenarios presented previously unanticipated considerations, offering new insights, and giving students the opportunity to practise decision-making in challenging scenarios before encountering them in practice. The interface and the quality of the graphics were criticised, but, this did not interfere with learning. Nine lecturers were interviewed, they generally felt positively towards the resource and identified strengths in terms of blended learning and collaborative teaching. The evaluation contributes to understandings of learning via simulated reality, and identifies process issues that will inform the development of further resources and their roll-out locally, and may guide other education providers in developing and implementing resources of this nature. There was significant parity between lecturers' expectations of students' experience of Shareville. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impacts of future radiation management scenarios on terrestrial carbon dynamics simulated with fully coupled NorESM

NASA Astrophysics Data System (ADS)

Ekici, Altug; Tjiputra, Jerry; Grini, Alf; Muri, Helene

2017-04-01

We have simulated 3 different radiation management geoengineering methods (CCT - cirrus cloud thinning; SAI - stratospheric aerosol injection; MSB - marine sky brightening) on top of future RCP8.5 scenario with the fully coupled Norwegian Earth System Model (NorESM). A globally consistent cooling in both atmosphere and soil is observed with all methods. However, precipitation patterns are dependent on the used method. Globally CCT and MSB methods do not affect the vegetation carbon budget, while SAI leads to a loss compared to RCP8.5 simulations. Spatially the most sensitive region is the tropics. Here, the changes in vegetation carbon content are related to the precipitation changes. Increase in soil carbon is projected in all three methods, the biggest change seen in SAI method. Simulations with CCT method leads to twice as much soil carbon retention in the tropics compared to the MSB method. Our findings show that there are unforeseen regional consequences of such geoengineering methods in the biogeochemical cycles and they should be considered with care in future climate policies.

Decision making in trauma settings: simulation to improve diagnostic skills.

PubMed

Murray, David J; Freeman, Brad D; Boulet, John R; Woodhouse, Julie; Fehr, James J; Klingensmith, Mary E

2015-06-01

In the setting of acute injury, a wrong, missed, or delayed diagnosis can impact survival. Clinicians rely on pattern recognition and heuristics to rapidly assess injuries, but an overreliance on these approaches can result in a diagnostic error. Simulation has been advocated as a method for practitioners to learn how to recognize the limitations of heuristics and develop better diagnostic skills. The objective of this study was to determine whether simulation could be used to provide teams the experiences in managing scenarios that require the use of heuristic as well as analytic diagnostic skills to effectively recognize and treat potentially life-threatening injuries. Ten scenarios were developed to assess the ability of trauma teams to provide initial care to a severely injured patient. Seven standard scenarios simulated severe injuries that once diagnosed could be effectively treated using standard Advanced Trauma Life Support algorithms. Because diagnostic error occurs more commonly in complex clinical settings, 3 complex scenarios required teams to use more advanced diagnostic skills to uncover a coexisting condition and treat the patient. Teams composed of 3 to 5 practitioners were evaluated in the performance of 7 (of 10) randomly selected scenarios (5 standard, 2 complex). Expert rates scored teams using standardized checklists and global scores. Eighty-three surgery, emergency medicine, and anesthesia residents constituted 21 teams. Expert raters were able to reliably score the scenarios. Teams accomplished fewer checklist actions and received lower global scores on the 3 analytic scenarios (73.8% [12.3%] and 5.9 [1.6], respectively) compared with the 7 heuristic scenarios (83.2% [11.7%] and 6.6 [1.3], respectively; P < 0.05 for both). Teams led by more junior residents received higher global scores on the analytic scenarios (6.4 [1.3]) than the more senior team leaders (5.3 [1.7]). This preliminary study indicates that teams led by more senior residents

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.

Recent advancements in medical simulation: patient-specific virtual reality simulation.

PubMed

Willaert, Willem I M; Aggarwal, Rajesh; Van Herzeele, Isabelle; Cheshire, Nicholas J; Vermassen, Frank E

2012-07-01

Patient-specific virtual reality simulation (PSVR) is a new technological advancement that allows practice of upcoming real operations and complements the established role of VR simulation as a generic training tool. This review describes current developments in PSVR and draws parallels with other high-stake industries, such as aviation, military, and sports. A review of the literature was performed using PubMed and Internet search engines to retrieve data relevant to PSVR in medicine. All reports pertaining to PSVR were included. Reports on simulators that did not incorporate a haptic interface device were excluded from the review. Fifteen reports described 12 simulators that enabled PSVR. Medical procedures in the field of laparoscopy, vascular surgery, orthopedics, neurosurgery, and plastic surgery were included. In all cases, source data was two-dimensional CT or MRI data. Face validity was most commonly reported. Only one (vascular) simulator had undergone face, content, and construct validity. Of the 12 simulators, 1 is commercialized and 11 are prototypes. Five simulators have been used in conjunction with real patient procedures. PSVR is a promising technological advance within medicine. The majority of simulators are still in the prototype phase. As further developments unfold, the validity of PSVR will have to be examined much like generic VR simulation for training purposes. Nonetheless, similar to the aviation, military, and sport industries, operative performance and patient safety may be enhanced by the application of this novel technology.

Simulation and evaluation of pollution load reduction scenarios for water environmental management: a case study of inflow river of Taihu Lake, China.

PubMed

Zhang, Ruibin; Qian, Xin; Zhu, Wenting; Gao, Hailong; Hu, Wei; Wang, Jinhua

2014-09-09

In the beginning of the 21st century, the deterioration of water quality in Taihu Lake, China, has caused widespread concern. The primary source of pollution in Taihu Lake is river inflows. Effective pollution load reduction scenarios need to be implemented in these rivers in order to improve the water quality of Taihu Lake. It is important to select appropriate pollution load reduction scenarios for achieving particular goals. The aim of this study was to facilitate the selection of appropriate scenarios. The QUAL2K model for river water quality was used to simulate the effects of a range of pollution load reduction scenarios in the Wujin River, which is one of the major inflow rivers of Taihu Lake. The model was calibrated for the year 2010 and validated for the year 2011. Various pollution load reduction scenarios were assessed using an analytic hierarchy process, and increasing rates of evaluation indicators were predicted using the Delphi method. The results showed that control of pollution from the source is the optimal method for pollution prevention and control, and the method of "Treatment after Pollution" has bad environmental, social and ecological effects. The method applied in this study can assist for environmental managers to select suitable pollution load reduction scenarios for achieving various objectives.

Simulation and Evaluation of Pollution Load Reduction Scenarios for Water Environmental Management: A Case Study of Inflow River of Taihu Lake, China

PubMed Central

Zhang, Ruibin; Qian, Xin; Zhu, Wenting; Gao, Hailong; Hu, Wei; Wang, Jinhua

2014-01-01

In the beginning of the 21st century, the deterioration of water quality in Taihu Lake, China, has caused widespread concern. The primary source of pollution in Taihu Lake is river inflows. Effective pollution load reduction scenarios need to be implemented in these rivers in order to improve the water quality of Taihu Lake. It is important to select appropriate pollution load reduction scenarios for achieving particular goals. The aim of this study was to facilitate the selection of appropriate scenarios. The QUAL2K model for river water quality was used to simulate the effects of a range of pollution load reduction scenarios in the Wujin River, which is one of the major inflow rivers of Taihu Lake. The model was calibrated for the year 2010 and validated for the year 2011. Various pollution load reduction scenarios were assessed using an analytic hierarchy process, and increasing rates of evaluation indicators were predicted using the Delphi method. The results showed that control of pollution from the source is the optimal method for pollution prevention and control, and the method of “Treatment after Pollution” has bad environmental, social and ecological effects. The method applied in this study can assist for environmental managers to select suitable pollution load reduction scenarios for achieving various objectives. PMID:25207492

The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma.

PubMed

Kunimatsu-Sanuki, Shiho; Iwase, Aiko; Araie, Makoto; Aoki, Yuki; Hara, Takeshi; Fukuchi, Takeo; Udagawa, Sachiko; Ohkubo, Shinji; Sugiyama, Kazuhisa; Matsumoto, Chota; Nakazawa, Toru; Yamaguchi, Takuhiro; Ono, Hiroshi

2017-07-01

To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. Normal subjects and patients with glaucoma with mean deviation <-12 dB in both eyes (Humphrey Field Analyzer 24-2 SITA-S program) used a driving simulator (DS; Honda Motor, Tokyo). Two scenarios in which oncoming cars turned right crossing the driver's path were chosen. We compared the binocular integrated visual field (IVF) in the patients who were involved in collisions and those who were not. We performed a multivariate logistic regression analysis; the dependent parameter was collision involvement, and the independent parameters were age, visual acuity and mean sensitivity of the IVF subfields. The study included 43 normal subjects and 100 patients with advanced glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (p<0.001). The patients with advanced glaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (p<0.001) and had lower mean IVF sensitivity in the inferior hemifield, both 0°-12° and 13°-24° in comparison with who were not involved in collisions (p=0.012 and p=0.034). A logistic regression analysis revealed that collision involvement was significantly associated with decreased inferior IVF mean sensitivity from 13° to 24° (p=0.041), in addition to older age and lower visual acuity (p=0.018 and p<0.001). Our data suggest that the inferior hemifield was associated with the incidence of motor vehicle collisions with oncoming cars in patients with advanced glaucoma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

A framework for modeling scenario-based barrier island storm impacts

USGS Publications Warehouse

Mickey, Rangley; Long, Joseph W.; Dalyander, P. Soupy; Plant, Nathaniel G.; Thompson, David M.

2018-01-01

Methods for investigating the vulnerability of existing or proposed coastal features to storm impacts often rely on simplified parametric models or one-dimensional process-based modeling studies that focus on changes to a profile across a dune or barrier island. These simple studies tend to neglect the impacts to curvilinear or alongshore varying island planforms, influence of non-uniform nearshore hydrodynamics and sediment transport, irregular morphology of the offshore bathymetry, and impacts from low magnitude wave events (e.g. cold fronts). Presented here is a framework for simulating regionally specific, low and high magnitude scenario-based storm impacts to assess the alongshore variable vulnerabilities of a coastal feature. Storm scenarios based on historic hydrodynamic conditions were derived and simulated using the process-based morphologic evolution model XBeach. Model results show that the scenarios predicted similar patterns of erosion and overwash when compared to observed qualitative morphologic changes from recent storm events that were not included in the dataset used to build the scenarios. The framework model simulations were capable of predicting specific areas of vulnerability in the existing feature and the results illustrate how this storm vulnerability simulation framework could be used as a tool to help inform the decision-making process for scientists, engineers, and stakeholders involved in coastal zone management or restoration projects.

Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice.

PubMed

Goldberg, A; Silverman, E; Samuelson, S; Katz, D; Lin, H M; Levine, A; DeMaria, S

2015-05-01

Anaesthetists may fail to recognize and manage certain rare intraoperative events. Simulation has been shown to be an effective educational adjunct to typical operating room-based education to train for these events. It is yet unclear, however, why simulation has any benefit. We hypothesize that learners who are allowed to manage a scenario independently and allowed to fail, thus causing simulated morbidity, will consequently perform better when re-exposed to a similar scenario. Using a randomized, controlled, observer-blinded design, 24 first-year residents were exposed to an oxygen pipeline contamination scenario, either where patient harm occurred (independent group, n=12) or where a simulated attending anaesthetist intervened to prevent harm (supervised group, n=12). Residents were brought back 6 months later and exposed to a different scenario (pipeline contamination) with the same end point. Participants' proper treatment, time to diagnosis, and non-technical skills (measured using the Anaesthetists' Non-Technical Skills Checklist, ANTS) were measured. No participants provided proper treatment in the initial exposure. In the repeat encounter 6 months later, 67% in the independent group vs 17% in the supervised group resumed adequate oxygen delivery (P=0.013). The independent group also had better ANTS scores [median (interquartile range): 42.3 (31.5-53.1) vs 31.3 (21.6-41), P=0.015]. There was no difference in time to treatment if proper management was provided [602 (490-820) vs 610 (420-800) s, P=0.79]. Allowing residents to practise independently in the simulation laboratory, and subsequently, allowing them to fail, can be an important part of simulation-based learning. This is not feasible in real clinical practice but appears to have improved resident performance in this study. The purposeful use of independent practice and its potentially negative outcomes thus sets simulation-based learning apart from traditional operating room learning. © The Author

Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit.

PubMed

Ventre, Kathleen M; Barry, James S; Davis, Deborah; Baiamonte, Veronica L; Wentworth, Allen C; Pietras, Michele; Coughlin, Liza; Barley, Gwyn

2014-04-01

Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. This project took place at a 314-bed, university-affiliated children's hospital. We developed 3 full-scale simulation scenarios depicting a concurrent maternal and neonatal emergency. One scenario began with a standardized patient experiencing admission; the mannequin portrayed a mother during delivery. We ran all 3 scenarios on 2 dates scheduled several weeks apart. We ran 2 of the scenarios on a third day to verify the reliability of key processes. During the simulations, content experts completed equipment checklists, and participants identified latent safety hazards. Each simulation involved a unique combination of scheduled participants who were supplemented by providers from responding ancillary services. The simulations involved 133 scheduled participants representing OB, neonatology, and anesthesiology. We exposed and addressed operational deficiencies involving equipment availability, staffing, interprofessional communication, and systems issues such as transfusion protocol failures and electronic order entry challenges. Process changes between simulation days 1 to 3 decreased the elapsed time between transfusion protocol activation and blood arrival to the operating room and labor/delivery/recovery/postpartum setting. In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.

Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students: Nursing Care With Increased Intracranial Pressure Patient.

PubMed

Lee, Myung-Nam; Nam, Kyung-Dong; Kim, Hyeon-Young

2017-03-01

Nursing care for patients with central nervous system problems requires advanced professional knowledge and care skills. Nursing students are more likely to have difficulty in dealing with adult patients who have severe neurological problems in clinical practice. This study investigated the effect on the metacognition, team efficacy, and learning attitude of nursing students after an integrated simulation and problem-based learning program. A real scenario of a patient with increased intracranial pressure was simulated for the students. The results showed that this method was effective in improving the metacognitive ability of the students. Furthermore, we used this comprehensive model of simulation with problem-based learning in order to assess the consequences of student satisfaction with the nursing major, interpersonal relationships, and importance of simulation-based education in relation to the effectiveness of the integrated simulation with problem-based learning. The results can be used to improve the design of clinical practicum and nursing education.

Teaching clinical opioid pharmacology with the Human Patient Simulator.

PubMed

Hassan, Zaki; DiLorenzo, Amy; Sloan, Paul

2010-01-01

Postoperative pain should be aggressively treated to decrease the development of chronic postsurgical pain. There has been an increase in the use of Human Patient Simulator (HPS) for teaching advanced courses in pharmacology to medical students, residents, and nurses. The aim of this educational investigation was to pilot the HPS for the training of medical students and surgical recovery room staff nurses in the pharmacology of opioids for the management of postoperative pain. The computerized HPS mannequin is fully monitored with appropriate displays and includes a voice speaker mounted in the head. Medical students and Postanesthesia care unit nurses, led by faculty in the Department of Anesthesiology in small groups of 4-6, participated in a 2- to 3-hour HPS course on the use of opioids for the management of acute postoperative pain. Trainees were asked to treat the acute and severe postoperative pain of a simulated patient. Opioid effects and side effects (such as respiratory depression) were presented on the mannequin in real time to the participants. Side effects of naloxone to reverse opioid depression were presented as a crisis in real time to the participants. Participants completed a 10-item course evaluation using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Twenty-two nurses and nine medical students completed the HPS opioid pharmacology scenario. Almost all participants rated the HPS course very highly and rated every item as either agree or strongly agree. Most participants agreed that the simulator session improved their understanding of opioid pharmacology including opioid side effects and management of opioid complications. Course participants felt most strongly (median, interquartile range) that the simulator session improved their understanding of naloxone pharmacology (5, 0), simulators serve as a useful teaching tool (5, 0), and that they would be pleased to participate in any additional HPS teaching sessions (5, 0). The

Simulation of groundwater flow in the "1,500-foot" sand and "2,000-foot" sand, with scenarios to mitigate saltwater migration in the "2,000-foot" sand of the Baton Rouge area, Louisiana

USGS Publications Warehouse

Heywood, Charles E.; Griffith, Jason M.; Lovelace, John K.

2014-01-01

Groundwater withdrawals have caused saltwater to encroach into freshwater-bearing aquifers beneath Baton Rouge, Louisiana. Groundwater investigations in the 1960s identified a freshwater-saltwater interface located at the Baton Rouge Fault, across which abrupt changes in water levels occur. Aquifers south of the fault generally contain saltwater, and aquifers north of the fault contain freshwater, though limited saltwater encroachment has been detected within 7 of the 10 aquifers north of the fault. The 10 aquifers beneath the Baton Rouge area, which includes East and West Baton Rouge Parishes, Pointe Coupee Parish, and East and West Feliciana Parishes, provided about 167 million gallons per day (Mgal/d) for public supply and industrial use in 2010. Groundwater withdrawals from the “2,000-foot” sand in East Baton Rouge Parish have caused water-level drawdown as great as 356 feet (ft) and induced saltwater movement northward across the fault. Saltwater encroachment threatens industrial wells that are located about 3 miles north of the fault. Constant and variable-density groundwater models were developed with the MODFLOW and SEAWAT groundwater modeling codes to evaluate strategies to control saltwater migration, including changes in the distribution of groundwater withdrawals and installation of “scavenger” wells to intercept saltwater before it reaches existing production wells. Six hypothetical scenarios simulated the effects of different groundwater withdrawal options on groundwater levels within the “1,500-foot” sand and the “2,000-foot” sand and the transport of saltwater within the “2,000-foot” sand during 2008–47. Scenario 1 is considered a base case for comparison to the other five scenarios and simulates continuation of 2007 reported groundwater withdrawals. Scenario 2 simulates discontinuation of withdrawals from seven selected industrial wells located in the northwest corner of East Baton Rouge Parish and predicts that water levels

[Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?].

PubMed

Agra Tuñas, M C; Sánchez Santos, L; Busto Cuiñas, M; Rodríguez Núñez, A

2015-11-01

Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problem. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Virtual reality simulator for vitreoretinal surgery using integrated OCT data.

PubMed

Kozak, Igor; Banerjee, Pat; Luo, Jia; Luciano, Cristian

2014-01-01

Operative practice using surgical simulators has become a part of training in many surgical specialties, including ophthalmology. We introduce a virtual reality retina surgery simulator capable of integrating optical coherence tomography (OCT) scans from real patients for practicing vitreoretinal surgery using different pathologic scenarios.

Evaluation of Resident Evacuations in Urban Rainstorm Waterlogging Disasters Based on Scenario Simulation: Daoli District (Harbin, China) as an Example

PubMed Central

Chen, Peng; Zhang, Jiquan; Zhang, Lifeng; Sun, Yingyue

2014-01-01

With the acceleration of urbanization, waterlogging has become an increasingly serious issue. Road waterlogging has a great influence on residents’ travel and traffic safety. Thus, evaluation of residents’ travel difficulties caused by rainstorm waterlogging disasters is of great significance for their travel safety and emergency shelter needs. This study investigated urban rainstorm waterlogging disasters, evaluating the impact of the evolution of such disasters’ evolution on residents’ evacuation, using Daoli District (Harbin, China) as the research demonstration area to perform empirical research using a combination of scenario simulations, questionnaires, GIS spatial technology analysis and a hydrodynamics method to establish an urban rainstorm waterlogging numerical simulation model. The results show that under the conditions of a 10-year frequency rainstorm, there are three street sections in the study area with a high difficulty index, five street sections with medium difficulty index and the index is low at other districts, while under the conditions of a 50-year frequency rainstorm, there are five street sections with a high difficulty index, nine street sections with a medium difficulty index and the other districts all have a low index. These research results can help set the foundation for further small-scale urban rainstorm waterlogging disaster scenario simulations and emergency shelter planning as well as forecasting and warning, and provide a brand-new thought and research method for research on residents’ safe travel. PMID:25264676

Using a medical simulation center as an electronic health record usability laboratory

PubMed Central

Landman, Adam B; Redden, Lisa; Neri, Pamela; Poole, Stephen; Horsky, Jan; Raja, Ali S; Pozner, Charles N; Schiff, Gordon; Poon, Eric G

2014-01-01

Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR. Meticulous planning and close collaboration with expert simulation staff was important for designing test scenarios, pilot testing, and running the sessions. Similarly, working with information systems teams was important for integration of the EHR. Electronic tools are needed to facilitate entry of fictitious clinical results while the simulation scenario is unfolding. EHRs can be successfully integrated into existing simulation centers, which may provide realistic environments for usability testing, training, and evaluation of human–computer interactions. PMID:24249778

The Many Faces of Patient-Centered Simulation: Implications for Researchers.

PubMed

Arnold, Jennifer L; McKenzie, Frederic Rick D; Miller, Jane Lindsay; Mancini, Mary E

2018-06-01

Patient-centered simulation for nonhealthcare providers is an emerging and innovative application for healthcare simulation. Currently, no consensus exists on what patient-centered simulation encompasses and outcomes research in this area is limited. Conceptually, patient-centered simulation aligns with the principles of patient- and family-centered care bringing this educational tool directly to patients and caregivers with the potential to improve patient care and outcomes. This descriptive article is a summary of findings presented at the 2nd International Meeting for Simulation in Healthcare Research Summit. Experts in the field delineated a categorization for better describing patient-centered simulation and reviewed the literature to identify a research agenda. Three types of patient-centered simulation patient-directed, patient-driven, and patient-specific are presented with research priorities identified for each. Patient-centered simulation has been shown to be an effective educational tool and has the potential to directly improve patient care outcomes. Presenting a typology for patient-centered simulation provides direction for future research.

Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial.

PubMed

Kerr, Brendan; Hawkins, Trisha Lee-Ann; Herman, Robert; Barnes, Sue; Kaufmann, Stephanie; Fraser, Kristin; Ma, Irene W Y

2013-07-18

Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Participants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop. Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= - 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all). However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group). At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived. The use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial.

Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial

PubMed Central

Kerr, Brendan; Hawkins, Trisha Lee-Ann; Herman, Robert; Barnes, Sue; Kaufmann, Stephanie; Fraser, Kristin; Ma, Irene W. Y.

2013-01-01

Introduction Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Methods Participants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop. Results Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= − 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all). However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group). At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived. Discussion The use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial. PMID:23870304

Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial.

PubMed

Kerr, Brendan; Lee-Ann Hawkins, Trisha; Herman, Robert; Barnes, Sue; Kaufmann, Stephanie; Fraser, Kristin; Ma, Irene W Y

2013-01-01

Introduction Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Methods Participants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop. Results Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= - 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all). However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group). At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived. Discussion The use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial.

Driving simulator scenarios and measures to faithfully evaluate risky driving behavior: A comparative study of different driver age groups

PubMed Central

Chaumillon, Romain; Nguyen-Tri, David; Watanabe, Donald; Hirsch, Pierro; Bellavance, Francois; Giraudet, Guillaume; Bernardin, Delphine; Faubert, Jocelyn

2017-01-01

To investigate the links between mental workload, age and risky driving, a cross-sectional study was conducted on a driving simulator using several established and some novel measures of driving ability and scenarios of varying complexity. A sample of 115 drivers was divided into three age and experience groups: young inexperienced (18–21 years old), adult experienced (25–55 years old) and older adult (70–86 years old). Participants were tested on three different scenarios varying in mental workload from low to high. Additionally, to gain a better understanding of individuals’ ability to capture and integrate relevant information in a highly complex visual environment, the participants’ perceptual-cognitive capacity was evaluated using 3-dimensional multiple object tracking (3D-MOT). Results indicate moderate scenario complexity as the best suited to highlight well-documented differences in driving ability between age groups and to elicit naturalistic driving behavior. Furthermore, several of the novel driving measures were shown to provide useful, non-redundant information about driving behavior, complementing more established measures. Finally, 3D-MOT was demonstrated to be an effective predictor of elevated crash risk as well as decreased naturally-adopted mean driving speed, particularly among older adults. In sum, the present experiment demonstrates that in cases of either extreme high or low task demands, drivers can become overloaded or under aroused and thus task measures may lose sensitivity. Moreover, insights from the present study should inform methodological considerations for future driving simulator research. Importantly, future research should continue to investigate the predictive utility of perceptual-cognitive tests in the domain of driving risk assessment. PMID:29016693

Climate-change scenarios

USGS Publications Warehouse

Wagner, Frederic H.; Stohlgren, T.J.; Baldwin, C.K.; Mearns, L.O.; Wagner, Frederic H.

2003-01-01

Three procedures were used to develop a set of plausible scenarios of anthropogenic climate change by the year 2100 that could be posed to the sectors selected for assessment (Fig. 2.2). First, a workshop of climatologists with expertise in western North American climates was convened from September 10-12, 1998 at the National Center for Ecological Analysis and Synthesis in Santa Barbara, CA to discuss and propose a set of scenarios for the Rocky Mountain/Great Basin (RMGB) region.Secondly, the 20th-century climate record was analyzed to determine what trends might have occurred during the period. Since CO2 and other greenhouse gases increased during the century, it was reasonable to examine whether the changes projected for the 21st century had begun to appear during the 20th, at least qualitatively though not quantitatively.Third, on the assumption of a two-fold increase in atmospheric CO2 by 2100, climate-change scenarios for the 21st century were projected with two, state-of-the-art computer models that simulate the complex interactions between earth, atmosphere, and ocean to produce the earth’s climate system. Each of the last two procedures has its strengths and weaknesses, and each can function to some degree as a check on the other. The historical analysis has the advantage of using empirical measurements of actual climate change taken over an extensive network of measuring stations. These make it possible to subdivide a large region like the RMGB into subreqions to assess the uniformity of climate and climate change over the region. And the historical measurements can to some degree serve as a check on the GCM simulations when the two are compared over the same time period.

The pedagogical ebb and flow of human patient simulation: empowering through a process of fading support.

PubMed

Parker, Brian Corey; Myrick, Florence

2012-07-01

The use of the high-fidelity human patient simulator (HPS)-based clinical scenario in undergraduate nursing education is a powerful learning tool, well suited to modern nursing students' preference for immersive construction of knowledge through the provision of contextually rich reality-based practice and social discourse. The purpose of this study was to explore the social-psychological processes that occur within HPS-based clinical scenarios. Grounded theory method was used to study students and faculty sampled from a Western Canadian baccalaureate nursing program. The process of leveled coding generated a substantive theory that has the potential to enable educators to empower students through the use of fading support, a twofold process composed of adaptive scaffolding and dynamic assessment that challenges students to realistically self-regulate and transform their frame of reference for nursing practice, while limiting the threats that traditional HPS-based curriculum can impose. Copyright 2012, SLACK Incorporated.

The Clinical Health Economics System Simulation (CHESS): a teaching tool for systems- and practice-based learning.

PubMed

Voss, John D; Nadkarni, Mohan M; Schectman, Joel M

2005-02-01

Academic medical centers face barriers to training physicians in systems- and practice-based learning competencies needed to function in the changing health care environment. To address these problems, at the University of Virginia School of Medicine the authors developed the Clinical Health Economics System Simulation (CHESS), a computerized team-based quasi-competitive simulator to teach the principles and practical application of health economics. CHESS simulates treatment costs to patients and society as well as physician reimbursement. It is scenario based with residents grouped into three teams, each team playing CHESS using differing (fee-for-service or capitated) reimbursement models. Teams view scenarios and select from two or three treatment options that are medically justifiable yet have different potential cost implications. CHESS displays physician reimbursement and patient and societal costs for each scenario as well as costs and income summarized across all scenarios extrapolated to a physician's entire patient panel. The learners are asked to explain these findings and may change treatment options and other variables such as panel size and case mix to conduct sensitivity analyses in real time. Evaluations completed in 2003 by 68 (94%) CHESS resident and faculty participants at 19 U.S. residency programs preferred CHESS to a traditional lecture-and-discussion format to learn about medical decision making, physician reimbursement, patient costs, and societal costs. Ninety-eight percent reported increased knowledge of health economics after viewing the simulation. CHESS demonstrates the potential of computer simulation to teach health economics and other key elements of practice- and systems-based competencies.

Toward XML Representation of NSS Simulation Scenario for Mission Scenario Exchange Capability

DTIC Science & Technology

2003-09-01

app.html Deitel , H. M., Deitel , P. J., Nieto, T. R., Lin, T. M., Sadhu, P. (2001). XML How to Program . Upper Saddle River: Prentice Hall...Combat XXI Program ...........................13 2. Transition NSS to a Java Environment ...........................................13 3. Shift to an...STATEMENT The Naval Simulation System (NSS) is a powerful computer program developed by the Navy to provide a force-on-force modeling and simulation

Simulation training with structured debriefing improves residents' pediatric disaster triage performance.

PubMed

Cicero, Mark X; Auerbach, Marc A; Zigmont, Jason; Riera, Antonio; Ching, Kevin; Baum, Carl R

2012-06-01

Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance. A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations. A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001

Risk analysis of technological hazards: Simulation of scenarios and application of a local vulnerability index.

PubMed

Sanchez, E Y; Represa, S; Mellado, D; Balbi, K B; Acquesta, A D; Colman Lerner, J E; Porta, A A

2018-06-15

The potential impact of a technological accident can be assessed by risk estimation. Taking this into account, the latent or potential condition can be warned and mitigated. In this work we propose a methodology to estimate risk of technological hazards, focused on two components. The first one is the processing of meteorological databases to define the most probably and conservative scenario of study, and the second one, is the application of a local social vulnerability index to classify the population. In this case of study, the risk was estimated for a hypothetical release of liquefied ammonia in a meat-packing industry in the city of La Plata, Argentina. The method consists in integrating the simulated toxic threat zone with ALOHA software, and the layer of sociodemographic classification of the affected population. The results show the areas associated with higher risks of exposure to ammonia, which are worth being addressed for the prevention of disasters in the region. Advantageously, this systemic approach is methodologically flexible as it provides the possibility of being applied in various scenarios based on the available information of both, the exposed population and its meteorology. Furthermore, this methodology optimizes the processing of the input data and its calculation. Copyright © 2018 Elsevier B.V. All rights reserved.

Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital.

PubMed

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

2014-08-01

Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments 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. We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified 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). The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) 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). Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient

Model Performance Evaluation and Scenario Analysis (MPESA)

EPA Pesticide Factsheets

Model Performance Evaluation and Scenario Analysis (MPESA) assesses the performance with which models predict time series data. The tool was developed Hydrological Simulation Program-Fortran (HSPF) and the Stormwater Management Model (SWMM)

Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure.

PubMed

Weigl, Matthias; Stefan, Philipp; Abhari, Kamyar; Wucherer, Patrick; Fallavollita, Pascal; Lazarovici, Marc; Weidert, Simon; Euler, Ekkehard; Catchpole, Ken

2016-02-01

Surgical flow disruptions occur frequently and jeopardize perioperative care and surgical performance. So far, insights into subjective and cognitive implications of intra-operative disruptions for surgeons and inherent consequences for performance are inconsistent. This study aimed to investigate the effect of surgical flow disruption on surgeon's intra-operative workload and technical performance. In a full-scale OR simulation, 19 surgeons were randomly allocated to either of the two disruption scenarios (telephone call vs. patient discomfort). Using a mixed virtual reality simulator with a computerized, high-fidelity mannequin, all surgeons were trained in performing a vertebroplasty procedure and subsequently performed such a procedure under experimental conditions. Standardized measures on subjective workload and technical performance (trocar positioning deviation from expert-defined standard, number, and duration of X-ray acquisitions) were collected. Intra-operative workload during simulated disruption scenarios was significantly higher compared to training sessions (p < .01). Surgeons in the telephone call scenario experienced significantly more distraction compared to their colleagues in the patient discomfort scenario (p < .05). However, workload tended to be increased in surgeons who coped with distractions due to patient discomfort. Technical performance was not significantly different between both disruption scenarios. We found a significant association between surgeons' intra-operative workload and technical performance such that surgeons with increased mental workload tended to perform worse (β = .55, p = .04). Surgical flow disruptions affect surgeons' intra-operative workload. Increased mental workload was associated with inferior technical performance. Our simulation-based findings emphasize the need to establish smooth surgical flow which is characterized by a low level of process deviations and disruptions.

Deterministic earthquake scenario for the Basel area: Simulating strong motions and site effects for Basel, Switzerland

NASA Astrophysics Data System (ADS)

OpršAl, Ivo; FäH, Donat; Mai, P. Martin; Giardini, Domenico

2005-04-01

The Basel earthquake of 18 October 1356 is considered one of the most serious earthquakes in Europe in recent centuries (I0 = IX, M ≈ 6.5-6.9). In this paper we present ground motion simulations for earthquake scenarios for the city of Basel and its vicinity. The numerical modeling combines the finite extent pseudodynamic and kinematic source models with complex local structure in a two-step hybrid three-dimensional (3-D) finite difference (FD) method. The synthetic seismograms are accurate in the frequency band 0-2.2 Hz. The 3-D FD is a linear explicit displacement formulation using an irregular rectangular grid including topography. The finite extent rupture model is adjacent to the free surface because the fault has been recognized through trenching on the Reinach fault. We test two source models reminiscent of past earthquakes (the 1999 Athens and the 1989 Loma Prieta earthquake) to represent Mw ≈ 5.9 and Mw ≈ 6.5 events that occur approximately to the south of Basel. To compare the effect of the same wave field arriving at the site from other directions, we considered the same sources placed east and west of the city. The local structural model is determined from the area's recently established P and S wave velocity structure and includes topography. The selected earthquake scenarios show strong ground motion amplification with respect to a bedrock site, which is in contrast to previous 2-D simulations for the same area. In particular, we found that the edge effects from the 3-D structural model depend strongly on the position of the earthquake source within the modeling domain.

A simulation method for combining hydrodynamic data and acoustic tag tracks to predict the entrainment of juvenile salmonids onto the Yolo Bypass under future engineering scenarios

USGS Publications Warehouse

Blake, Aaron R.; Stumpner, Paul; Burau, Jon R.

2017-01-01

under the modification scenarios. Because of this variability, accurately evaluating the entrainment potential of possible notch locations for each scenario required combining historic abundance data for juvenile Sacramento River Chinook salmon with historic hydraulic data for the Sacramento River in the vicinity of the Fremont Weir, so that the entrainment estimates would reflect the covariance between Sacramento River stage, Sacramento River discharge, and juvenile salmon abundance within the historic record.We used a Monte Carlo simulation framework to combine the high resolution hydrodynamic data and acoustic tag track data collected in 2016 with historic juvenile salmon abundance, Sacramento River stage, and Sacramento River discharge data from a period spanning water years 1996-2010 to assess the entrainment potential of different weir modification scenarios under historic conditions. The scenarios we simulated consisted of four single notch configurations, and two multiple notch configurations in the vicinity of the western end of the Fremont Weir. For each notch configuration the 15-water-year entrainment simulation was repeated for 63 possible notch locations in the vicinity of the western end of the Fremont Weir. This approach allowed us to assess the effect of notch location on the entrainment of juvenile salmonids onto the Yolo Bypass for each of the six notch configurations that we evaluated.The entrainment simulations showed that the location of each notch configuration had a major impact on the entrainment for each scenario; the predicted entrainment of some scenarios varied by as much as 400% based on where the notch (or notches) was (were) located in the study area. All of the single notch scenarios performed best when they were located within a 330 ft (100 meter) long section of the Sacramento River bank adjacent to the western terminus of the Fremont Weir (Table 1). Both of the multiple notch scenarios performed best when their upstream notches were

Educating the delivery of bad news in medicine: Preceptorship versus simulation

PubMed Central

Jacques, Andrew P; Adkins, Eric J; Knepel, Sheri; Boulger, Creagh; Miller, Jessica; Bahner, David P

2011-01-01

Simulation experiences have begun to replace traditional education models of teaching the skill of bad news delivery in medical education. The tiered apprenticeship model of medical education emphasizes experiential learning. Studies have described a lack of support in bad news delivery and inadequacy of training in this important clinical skill as well as poor familial comprehension and dissatisfaction on the part of physicians in training regarding the resident delivery of bad news. Many residency training programs lacked a formalized training curriculum in the delivery of bad news. Simulation teaching experiences may address these noted clinical deficits in the delivery of bad news to patients and their families. Unique experiences can be role-played with this educational technique to simulate perceived learner deficits. A variety of scenarios can be constructed within the framework of the simulation training method to address specific cultural and religious responses to bad news in the medical setting. Even potentially explosive and violent scenarios can be role-played in order to prepare physicians for these rare and difficult situations. While simulation experiences cannot supplant the model of positive, real-life clinical teaching in the delivery of bad news, simulation of clinical scenarios with scripting, self-reflection, and peer-to-peer feedback can be powerful educational tools. Simulation training can help to develop the skills needed to effectively and empathetically deliver bad news to patients and families in medical practice. PMID:22229135

Educating the delivery of bad news in medicine: Preceptorship versus simulation.

PubMed

Jacques, Andrew P; Adkins, Eric J; Knepel, Sheri; Boulger, Creagh; Miller, Jessica; Bahner, David P

2011-07-01

Simulation experiences have begun to replace traditional education models of teaching the skill of bad news delivery in medical education. The tiered apprenticeship model of medical education emphasizes experiential learning. Studies have described a lack of support in bad news delivery and inadequacy of training in this important clinical skill as well as poor familial comprehension and dissatisfaction on the part of physicians in training regarding the resident delivery of bad news. Many residency training programs lacked a formalized training curriculum in the delivery of bad news. Simulation teaching experiences may address these noted clinical deficits in the delivery of bad news to patients and their families. Unique experiences can be role-played with this educational technique to simulate perceived learner deficits. A variety of scenarios can be constructed within the framework of the simulation training method to address specific cultural and religious responses to bad news in the medical setting. Even potentially explosive and violent scenarios can be role-played in order to prepare physicians for these rare and difficult situations. While simulation experiences cannot supplant the model of positive, real-life clinical teaching in the delivery of bad news, simulation of clinical scenarios with scripting, self-reflection, and peer-to-peer feedback can be powerful educational tools. Simulation training can help to develop the skills needed to effectively and empathetically deliver bad news to patients and families in medical practice.

Convoy Protection under Multi-Threat Scenario

DTIC Science & Technology

2017-06-01

14. SUBJECT TERMS antisubmarine warfare, convoy protection, screening, design of experiments, agent-based simulation 15. NUMBER OF...46 5. Scenarios 33–36 (Red Submarine Tactic-2) ...............................46 IV. DESIGN OF EXPERIMENT...47 C. NEARLY ORTHOGONAL LATIN HYPERCUBE DESIGN ............51 V. DATA ANALYSIS

A methodology for modeling barrier island storm-impact scenarios

USGS Publications Warehouse

Mickey, Rangley C.; Long, Joseph W.; Plant, Nathaniel G.; Thompson, David M.; Dalyander, P. Soupy

2017-02-16

A methodology for developing a representative set of storm scenarios based on historical wave buoy and tide gauge data for a region at the Chandeleur Islands, Louisiana, was developed by the U.S. Geological Survey. The total water level was calculated for a 10-year period and analyzed against existing topographic data to identify when storm-induced wave action would affect island morphology. These events were categorized on the basis of the threshold of total water level and duration to create a set of storm scenarios that were simulated, using a high-fidelity, process-based, morphologic evolution model, on an idealized digital elevation model of the Chandeleur Islands. The simulated morphological changes resulting from these scenarios provide a range of impacts that can help coastal managers determine resiliency of proposed or existing coastal structures and identify vulnerable areas within those structures.

Ash fallout scenarios at Vesuvius: Numerical simulations and implications for hazard assessment

NASA Astrophysics Data System (ADS)

Macedonio, G.; Costa, A.; Folch, A.

2008-12-01

Volcanic ash fallout subsequent to a possible renewal of the Vesuvius activity represents a serious threat to the highly urbanized area around the volcano. In order to assess the relative hazard we consider three different possible scenarios such as those following Plinian, Sub-Plinian, and violent Strombolian eruptions. Reference eruptions for each scenario are similar to the 79 AD (Pompeii), the 1631 AD (or 472 AD) and the 1944 AD Vesuvius events, respectively. Fallout deposits for the first two scenarios are modeled using HAZMAP, a model based on a semi-analytical solution of the 2D advection-diffusion-sedimentation equation. In contrast, fallout following a violent Strombolian event is modeled by means of FALL3D, a numerical model based on the solution of the full 3D advection-diffusion-sedimentation equation which is valid also within the atmospheric boundary layer. Inputs for models are total erupted mass, eruption column height, bulk grain-size, bulk component distribution, and a statistical set of wind profiles obtained by the NCEP/NCAR re-analysis. We computed ground load probability maps for different ash loadings. In the case of a Sub-Plinian scenario, the most representative tephra loading maps in 16 cardinal directions were also calculated. The probability maps obtained for the different scenarios are aimed to give support to the risk mitigation strategies.

Clinical Simulation: A Protocol for Evaluation of Mobile Technology.

PubMed

Mather, Carey; Jensen, Sanne; Cummings, Elizabeth

2017-01-01

For mobile technology to be accepted at point of care in healthcare environments there is a need to demonstrate benefits whilst ameliorating the risks and challenges. To provide a standardised approach to evaluation of mobile technology a simulation protocol was developed to provide guidance for its use in healthcare environments. Simulated conditions provide the opportunity to assess intended and unintended consequences and identify potential workarounds when using technology. The protocol can also be used to demonstrate the importance of the development of digital professionalism by end-users prior to students entering the clinical practice setting. The mobile technology protocol was adapted from a health information systems protocol developed and used at the ITX Lab, Denmark for use in other simulation laboratories. Use case scenarios were developed to enable evaluation of mobile technology for mobile learning of nurses, nurse supervisors, students and patients. The scenarios can be used in a range of simulated environments including hospital bedside, outpatient clinic or community settings. A case study exemplar of a nurse and patient is included to demonstrate how the mobile technology protocol can be applied.

Prospective scenarios of nuclear energy evolution over the 21. century

DOE Office of Scientific and Technical Information (OSTI.GOV)

Massara, S.; Tetart, P.; Garzenne, C.

2006-07-01

In this paper, different world scenarios of nuclear energy development over the 21. century are analyzed, by means of the EDF fuel cycle simulation code for nuclear scenario studies, TIRELIRE - STRATEGIE. Three nuclear demand scenarios are considered, and the performance of different nuclear strategies in satisfying these scenarios is analyzed and discussed, focusing on natural uranium consumption and industrial requirements related to the nuclear reactors and the associated fuel cycle facilities. Both thermal-spectrum systems (Pressurized Water Reactor and High Temperature Gas-cooled Reactor) and Fast Reactors are investigated. (authors)

Nursing students' perceptions of high- and low-fidelity simulation used as learning methods.

PubMed

Tosterud, Randi; Hedelin, Birgitta; Hall-Lord, Marie Louise

2013-07-01

Due to the increasing focus on simulation used in nursing education, there is a need to examine how the scenarios and different simulation methods used are perceived by students. The aim of this study was to examine nursing students' perceptions of scenarios played out in different simulation methods, and whether their educational level influenced their perception. The study had a quantitative, evaluative and comparative design. The sample consisted of baccalaureate nursing students (n = 86) within various educational levels. The students were randomly divided into groups. They solved a patient case adapted to their educational level by using a high-fidelity patient simulator, a static mannequin or a paper/pencil case study. Data were collected by three instruments developed by the National League for Nursing. The results showed that the nursing students reported satisfaction with the implementation of the scenarios regardless of the simulation methods used. The findings indicated that the students who used the paper/pencil case study were the most satisfied. Moreover, educational level did not seem to influence their perceptions. Independent of educational level, the findings indicated that simulation with various degrees of fidelity could be used in nursing education. There is a need for further research to examine more closely the rationale behind the students' perception of the simulation methods. Copyright © 2013 Elsevier Ltd. All rights reserved.

Climate change streamflow scenarios designed for critical period water resources planning studies

NASA Astrophysics Data System (ADS)

Hamlet, A. F.; Snover, A. K.; Lettenmaier, D. P.

2003-04-01

Long-range water planning in the United States is usually conducted by individual water management agencies using a critical period planning exercise based on a particular period of the observed streamflow record and a suite of internally-developed simulation tools representing the water system. In the context of planning for climate change, such an approach is flawed in that it assumes that the future climate will be like the historic record. Although more sophisticated planning methods will probably be required as time goes on, a short term strategy for incorporating climate uncertainty into long-range water planning as soon as possible is to create alternate inputs to existing planning methods that account for climate uncertainty as it affects both supply and demand. We describe a straight-forward technique for constructing streamflow scenarios based on the historic record that include the broad-based effects of changed regional climate simulated by several global climate models (GCMs). The streamflow scenarios are based on hydrologic simulations driven by historic climate data perturbed according to regional climate signals from four GCMs using the simple "delta" method. Further data processing then removes systematic hydrologic model bias using a quantile-based bias correction scheme, and lastly, the effects of random errors in the raw hydrologic simulations are removed. These techniques produce streamflow scenarios that are consistent in time and space with the historic streamflow record while incorporating fundamental changes in temperature and precipitation from the GCM scenarios. Planning model simulations based on these climate change streamflow scenarios can therefore be compared directly to planning model simulations based on the historic record of streamflows to help planners understand the potential impacts of climate uncertainty. The methods are currently being tested and refined in two large-scale planning exercises currently being conducted in the

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education.

PubMed

Dunbar-Reid, Kylie; Sinclair, Peter M; Hudson, Denis

2015-06-01

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction. This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes. Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Reevaluating simulation in nursing education: beyond the human patient simulator.

PubMed

Schiavenato, Martin

2009-07-01

The human patient simulator or high-fidelity mannequin has become synonymous with the word simulation in nursing education. Founded on a historical context and on an evaluation of the current application of simulation in nursing education, this article challenges that assumption as limited and restrictive. A definition of simulation and a broader conceptualization of its application in nursing education are presented. The need for an ideological basis for simulation in nursing education is highlighted. The call is made for theory to answer the question of why simulation is used in nursing to anchor its proper and effective application in nursing education.

Possible climate change over Eurasia under different emission scenarios

NASA Astrophysics Data System (ADS)

Sokolov, A. P.; Monier, E.; Scott, J. R.; Forest, C. E.; Schlosser, C. A.

2011-12-01

In an attempt to evaluate possible climate change over EURASIA, we analyze results of six AMIP type simulations with CAM version 3 (CAM3) at 2x2.5 degree resolution. CAM3 is driven by time series of sea surface temperatures (SSTs) and sea ice obtained by running the MIT IGSM2.3, which consists of a 3D ocean GCM coupled to a zonally-averaged atmospheric climate-chemistry model. In addition to changes in SSTs, CAM3 is forced by changes in greenhouse gases and ozone concentrations, sulfate aerosol forcing and black carbon loading calculated by the IGSM2.3. An essential feature of the IGSM is the possibility to vary its climate sensitivity (using a cloud adjustment technique) and the strength of the aerosol forcing. For consistency, new modules were developed in CAM3 to modify its climate sensitivity and aerosol forcing to match those used in the simulations with the IGSM2.3. The simulations presented in this paper were carried out for two emission scenarios, a "Business as usual" scenario and a 660 ppm of CO2-EQ stabilization, which are similar to the RCP8.5 and RCP4.5 scenarios, respectively. Values of climate sensitivity used in the simulations within the IGSM-CAM framework are median and the bounds of the 90% probability interval of the probability distribution obtained by comparing the 20th century climate simulated by different versions of the IGSM with observations. The associated strength of the aerosol forcing was chosen to ensure a good agreement with the observed climate change over the 20th century. Because the concentration of sulfate aerosol significantly decreases over the 21st century in both emissions scenarios, climate changes obtained in these simulations provide a good approximation for the median, and the 5th and 95th percentiles of the probability distribution of 21st century climate change.

Possible climate change over Eurasia under different emission scenarios

NASA Astrophysics Data System (ADS)

Sokolov, A. P.; Monier, E.; Gao, X.

2012-12-01

In an attempt to evaluate possible climate change over EURASIA, we analyze results of six AMIP type simulations with CAM version 3 (CAM3) at 2x2.5 degree resolution. CAM3 is driven by time series of sea surface temperatures (SSTs) and sea ice obtained by running the MIT IGSM2.3, which consists of a 3D ocean GCM coupled to a zonally-averaged atmospheric climate-chemistry model. In addition to changes in SSTs, CAM3 is forced by changes in greenhouse gases and ozone concentrations, sulfate aerosol forcing and black carbon loading calculated by the IGSM2.3. An essential feature of the IGSM is the possibility to vary its climate sensitivity (using a cloud adjustment technique) and the strength of the aerosol forcing. For consistency, new modules were developed in CAM3 to modify its climate sensitivity and aerosol forcing to match those used in the simulations with the IGSM2.3. The simulations presented in this paper were carried out for two emission scenarios, a "Business as usual" scenario and a 660 ppm of CO2-EQ stabilization, which are similar to the RCP8.5 and RCP4.5 scenarios, respectively. Values of climate sensitivity used in the simulations within the IGSM-CAM framework are median and the bounds of the 90% probability interval of the probability distribution obtained by comparing the 20th century climate simulated by different versions of the IGSM with observations. The associated strength of the aerosol forcing was chosen to ensure a good agreement with the observed climate change over the 20th century. Because the concentration of sulfate aerosol significantly decreases over the 21st century in both emissions scenarios, climate changes obtained in these simulations provide a good approximation for the median, and the 5th and 95th percentiles of the probability distribution of 21st century climate change.

Simulation Genres and Student Uptake: The Patient Health Record in Clinical Nursing Simulations

ERIC Educational Resources Information Center

Campbell, Lilly

2017-01-01

Drawing on fieldwork, this article examines nursing students' design and use of a patient health record during clinical simulations, where small teams of students provide nursing care for a robotic patient. The student-designed patient health record provides a compelling example of how simulation genres can both authentically coordinate action…

Model Performance Evaluation and Scenario Analysis ...

EPA Pesticide Factsheets

This tool consists of two parts: model performance evaluation and scenario analysis (MPESA). The model performance evaluation consists of two components: model performance evaluation metrics and model diagnostics. These metrics provides modelers with statistical goodness-of-fit measures that capture magnitude only, sequence only, and combined magnitude and sequence errors. The performance measures include error analysis, coefficient of determination, Nash-Sutcliffe efficiency, and a new weighted rank method. These performance metrics only provide useful information about the overall model performance. Note that MPESA is based on the separation of observed and simulated time series into magnitude and sequence components. The separation of time series into magnitude and sequence components and the reconstruction back to time series provides diagnostic insights to modelers. For example, traditional approaches lack the capability to identify if the source of uncertainty in the simulated data is due to the quality of the input data or the way the analyst adjusted the model parameters. This report presents a suite of model diagnostics that identify if mismatches between observed and simulated data result from magnitude or sequence related errors. MPESA offers graphical and statistical options that allow HSPF users to compare observed and simulated time series and identify the parameter values to adjust or the input data to modify. The scenario analysis part of the too

Clinical simulation practise framework.

PubMed

Khalili, Hossein

2015-02-01

Historically, simulation has mainly been used to teach students hands-on skills in a relatively safe environment. With changes in the patient population, professional regulations and clinical environments, clinical simulation practise (CSP) must assist students to integrate and apply their theoretical knowledge and skills with their critical thinking, clinical judgement, prioritisation, problem solving, decision making, and teamwork skills to provide holistic care and treatment to their patients. CSP holds great potential to derive a positive transformation in students' transition into the workplace, by associating and consolidating learning from classrooms to clinical settings, and creating bridges between theory and practice. For CSP to be successful in filling the gap, the design and management of the simulation is crucial. In this article a new framework called 'Clinical simulation practise framework: A knowledge to action strategy in health professional education' is being introduced that aims to assist educators and curriculum developers in designing and managing their simulations. This CSP framework theorises that simulation as an experiential educational tool could improve students' competence, confidence and collaboration in performing professional practice in real settings if the CSP provides the following three dimensions: (1) a safe, positive, reflective and fun simulated learning environment; (2) challenging, but realistic, and integrated simulated scenarios; and (3) interactive, inclusive, interprofessional patient-centred simulated practise. © 2015 John Wiley & Sons Ltd.

Future Water-Supply Scenarios, Cape May County, New Jersey, 2003-2050

USGS Publications Warehouse

Lacombe, Pierre J.; Carleton, Glen B.; Pope, Daryll A.; Rice, Donald E.

2009-01-01

Stewards of the water supply in New Jersey are interested in developing a plan to supply potable and non-potable water to residents and businesses of Cape May County until at least 2050. The ideal plan would meet projected demands and minimize adverse effects on currently used sources of potable, non-potable, and ecological water supplies. This report documents past and projected potable, non-potable, and ecological water-supply demands. Past and ongoing adverse effects to production and domestic wells caused by withdrawals include saltwater intrusion and water-level declines in the freshwater aquifers. Adverse effects on the ecological water supplies caused by groundwater withdrawals include premature drying of seasonal wetlands, delayed recovery of water levels in the water-table aquifer, and reduced streamflow. To predict the effects of future actions on the water supplies, three baseline and six future scenarios were created and simulated. Baseline Scenarios 1, 2, and 3 represent withdrawals using existing wells projected until 2050. Baseline Scenario 1 represents average 1998-2003 withdrawals, and Scenario 2 represents New Jersey Department of Environmental Protection (NJDEP) full allocation withdrawals. These withdrawals do not meet projected future water demands. Baseline Scenario 3 represents the estimated full build-out water demands. Results of simulations of the three baseline scenarios indicate that saltwater would intrude into the Cohansey aquifer as much as 7,100 feet (ft) to adversely affect production wells used by Lower Township and the Wildwoods, as well as some other near-shore domestic wells; water-level altitudes in the Atlantic City 800-foot sand would decline to -156 ft; base flow in streams would be depleted by 0 to 26 percent; and water levels in the water-table aquifer would decline as much as 0.7ft. [Specific water-level altitudes, land-surface altitudes, and present sea level when used in this report are referenced to the North American

Case Study: Influences of Uncertainties and Traffic Scenario Difficulties in a Human-in-the-Loop Simulation

NASA Technical Reports Server (NTRS)

Bienert, Nancy; Mercer, Joey; Homola, Jeffrey; Morey, Susan; Prevot, Thomas

2014-01-01

This paper presents a case study of how factors such as wind prediction errors and metering delays can influence controller performance and workload in Human-In-The-Loop simulations. Retired air traffic controllers worked two arrival sectors adjacent to the terminal area. The main tasks were to provide safe air traffic operations and deliver the aircraft to the metering fix within +/- 25 seconds of the scheduled arrival time with the help of provided decision support tools. Analyses explore the potential impact of metering delays and system uncertainties on controller workload and performance. The results suggest that trajectory prediction uncertainties impact safety performance, while metering fix accuracy and workload appear subject to the scenario difficulty.

Simulations of the failure scenarios of the crab cavities for the nominal scheme of the LHC

NASA Astrophysics Data System (ADS)

Yee, B.; Calaga, R.; Zimmermann, F.; Lopez, R.

2012-02-01

The Crab Cavity (CC) represents a possible solution to the problem of the reduction in luminosity due to the impact angle of two colliding beams. The CC is a Radio Frequency (RF) superconducting cavity which applies a transversal kick into a bunch of particles producing a rotation in order to have a head-on collision to improve the luminosity. For this reason people at the Beams Department-Accelerators & Beams Physics of CERN (BE-ABP) have studied the implementation of the CC scheme at the LHC. It is essential to study the failure scenarios and the damage that can be produced to the lattice devices. We have performed simulations of these failures for the nominal scheme.

Can a Rescuer or Simulated Patient Accurately Assess Motion During Cervical Spine Stabilization Practice Sessions?

PubMed Central

Shrier, Ian; Boissy, Patrick; Brière, Simon; Mellette, Jay; Fecteau, Luc; Matheson, Gordon O.; Garza, Daniel; Meeuwisse, Willem H.; Segal, Eli; Boulay, John; Steele, Russell J.

2012-01-01

Context: Health care providers must be prepared to manage all potential spine injuries as if they are unstable. Therefore, most sport teams devote resources to training for sideline cervical spine (C-spine) emergencies. Objective: To determine (1) how accurately rescuers and simulated patients can assess motion during C-spine stabilization practice and (2) whether providing performance feedback to rescuers influences their choice of stabilization technique. Design: Crossover study. Setting: Training studio. Patients or Other Participants: Athletic trainers, athletic therapists, and physiotherapists experienced at managing suspected C-spine injuries. Intervention(s): Twelve lead rescuers (at the patient's head) performed both the head-squeeze and trap-squeeze C-spine stabilization maneuvers during 4 test scenarios: lift-and-slide and log-roll placement on a spine board and confused patient trying to sit up or rotate the head. Main Outcome Measure(s): Interrater reliability between rescuer and simulated patient quality scores for subjective evaluation of C-spine stabilization during trials (0 = best, 10 = worst), correlation between rescuers' quality scores and objective measures of motion with inertial measurement units, and frequency of change in preference for the head-squeeze versus trap-squeeze maneuver. Results: Although the weighted κ value for interrater reliability was acceptable (0.71–0.74), scores varied by 2 points or more between rescuers and simulated patients for approximately 10% to 15% of trials. Rescuers' scores correlated with objective measures, but variability was large: 38% of trials scored as 0 or 1 by the rescuer involved more than 10° of motion in at least 1 direction. Feedback did not affect the preference for the lift-and-slide placement. For the log-roll placement, 6 of 8 participants who preferred the head squeeze at baseline preferred the trap squeeze after feedback. For the confused patient, 5 of 5 participants initially preferred

High-resolution interpolation of climate scenarios for Canada derived from general circulation model simulations

Treesearch

D. T. Price; D. W. McKenney; L. A. Joyce; R. M. Siltanen; P. Papadopol; K. Lawrence

2011-01-01

Projections of future climate were selected for four well-established general circulation models (GCMs) forced by each of three greenhouse gas (GHG) emissions scenarios recommended by the Intergovernmental Panel on Climate Change (IPCC), namely scenarios A2, A1B, and B1 of the IPCC Special Report on Emissions Scenarios. Monthly data for the period 1961-2100 were...

The design of scenario-based training from the resilience engineering perspective: a study with grid electricians.

PubMed

Saurin, Tarcisio Abreu; Wachs, Priscila; Righi, Angela Weber; Henriqson, Eder

2014-07-01

Although scenario-based training (SBT) can be an effective means to help workers develop resilience skills, it has not yet been analyzed from the resilience engineering (RE) perspective. This study introduces a five-stage method for designing SBT from the RE view: (a) identification of resilience skills, work constraints and actions for re-designing the socio-technical system; (b) design of template scenarios, allowing the simulation of the work constraints and the use of resilience skills; (c) design of the simulation protocol, which includes briefing, simulation and debriefing; (d) implementation of both scenarios and simulation protocol; and (e) evaluation of the scenarios and simulation protocol. It is reported how the method was applied in an electricity distribution company, in order to train grid electricians. The study was framed as an application of design science research, and five research outputs are discussed: method, constructs, model of the relationships among constructs, instantiations of the method, and theory building. Concerning the last output, the operationalization of the RE perspective on three elements of SBT is presented: identification of training objectives; scenario design; and debriefing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations.

PubMed

Fernandez, Rosemarie; Pearce, Marina; Grand, James A; Rench, Tara A; Jones, Kerin A; Chao, Georgia T; Kozlowski, Steve W J

2013-11-01

To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low

Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation.

PubMed

Friederichs, Hendrik; Weissenstein, Anne; Ligges, Sandra; Möller, David; Becker, Jan C; Marschall, Bernhard

2014-12-01

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients. Copyright © 2014 The American Physiological Society.

A Computer Simulation of Community Pharmacy Practice for Educational Use.

PubMed

Bindoff, Ivan; Ling, Tristan; Bereznicki, Luke; Westbury, Juanita; Chalmers, Leanne; Peterson, Gregory; Ollington, Robert

2014-11-15

To provide a computer-based learning method for pharmacy practice that is as effective as paper-based scenarios, but more engaging and less labor-intensive. We developed a flexible and customizable computer simulation of community pharmacy. Using it, the students would be able to work through scenarios which encapsulate the entirety of a patient presentation. We compared the traditional paper-based teaching method to our computer-based approach using equivalent scenarios. The paper-based group had 2 tutors while the computer group had none. Both groups were given a prescenario and postscenario clinical knowledge quiz and survey. Students in the computer-based group had generally greater improvements in their clinical knowledge score, and third-year students using the computer-based method also showed more improvements in history taking and counseling competencies. Third-year students also found the simulation fun and engaging. Our simulation of community pharmacy provided an educational experience as effective as the paper-based alternative, despite the lack of a human tutor.

Simulation of the 1992 Tessina landslide by a cellular automata model and future hazard scenarios

NASA Astrophysics Data System (ADS)

Avolio, MV; Di Gregorio, Salvatore; Mantovani, Franco; Pasuto, Alessandro; Rongo, Rocco; Silvano, Sandro; Spataro, William

Cellular Automata are a powerful tool for modelling natural and artificial systems, which can be described in terms of local interactions of their constituent parts. Some types of landslides, such as debris/mud flows, match these requirements. The 1992 Tessina landslide has characteristics (slow mud flows) which make it appropriate for modelling by means of Cellular Automata, except for the initial phase of detachment, which is caused by a rotational movement that has no effect on the mud flow path. This paper presents the Cellular Automata approach for modelling slow mud/debris flows, the results of simulation of the 1992 Tessina landslide and future hazard scenarios based on the volumes of masses that could be mobilised in the future. They were obtained by adapting the Cellular Automata Model called SCIDDICA, which has been validated for very fast landslides. SCIDDICA was applied by modifying the general model to the peculiarities of the Tessina landslide. The simulations obtained by this initial model were satisfactory for forecasting the surface covered by mud. Calibration of the model, which was obtained from simulation of the 1992 event, was used for forecasting flow expansion during possible future reactivation. For this purpose two simulations concerning the collapse of about 1 million m 3 of material were tested. In one of these, the presence of a containment wall built in 1992 for the protection of the Tarcogna hamlet was inserted. The results obtained identified the conditions of high risk affecting the villages of Funes and Lamosano and show that this Cellular Automata approach can have a wide range of applications for different types of mud/debris flows.

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…

The role of simulation training in anesthesiology resident education.

PubMed

Yunoki, Kazuma; Sakai, Tetsuro

2018-06-01

An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.

Simulation laboratories for training in obstetrics and gynecology.

PubMed

Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

2003-08-01

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

Partial Ambiguity Resolution for Ground and Space-Based Applications in a GPS+Galileo scenario: A simulation study

NASA Astrophysics Data System (ADS)

Nardo, A.; Li, B.; Teunissen, P. J. G.

2016-01-01

Integer Ambiguity Resolution (IAR) is the key to fast and precise GNSS positioning. The proper diagnostic metric for successful IAR is provided by the ambiguity success rate being the probability of correct integer estimation. In this contribution we analyse the performance of different GPS+Galileo models in terms of number of epochs needed to reach a pre-determined success rate, for various ground and space-based applications. The simulation-based controlled model environment enables us to gain insight into the factors contributing to the ambiguity resolution strength of the different GPS+Galileo models. Different scenarios of modernized GPS+Galileo are studied, encompassing the long baseline ground case as well as the medium dynamics case (airplane) and the space-based Low Earth Orbiter (LEO) case. In our analyses of these models the capabilities of partial ambiguity resolution (PAR) are demonstrated and compared to the limitations of full ambiguity resolution (FAR). The results show that PAR is generally a more efficient way than FAR to reduce the time needed to achieve centimetre-level positioning precision. For long single baselines, PAR can achieve time reductions of fifty percent to achieve such precision levels, while for multiple baselines it even becomes more effective, reaching reductions up to eighty percent for four station networks. For a LEO, the rapidly changing observation geometry does not even allow FAR, while PAR is then still possible for both dual- and triple-frequency scenarios. With the triple-frequency GPS+Galileo model the availability of precise positioning improves by fifteen percent with respect to the dual-frequency scenario.

Simulating nitrogen budgets in complex farming systems using INCA: calibration and scenario analyses for the Kervidy catchment (W. France)

NASA Astrophysics Data System (ADS)

Durand, P.

The integrated nitrogen model INCA (Integrated Nitrogen in Catchments) was used to analyse the nitrogen dynamics in a small rural catchment in Western France. The agrosystem studied is very complex, with: extensive use of different organic fertilisers, a variety of crop rotations, a structural excess of nitrogen (i.e. more animal N produced by the intensive farming than the N requirements of the crops and pastures), and nitrate retention in both hydrological stores and riparian zones. The original model features were adapted here to describe this complexity. The calibration results are satisfactory, although the daily variations in stream nitrate are not simulated in detail. Different climate scenarios, based on observed climate records, were tested; all produced a worsening of the pollution in the short term. Scenarios of alternative agricultural practices (reduced fertilisation and catch crops) were also analysed, suggesting that a reduction by 40% of the fertilisation combined with the introduction of catch crops would be necessary to stop the degradation of water quality.

Skills of novices early trained or traditionaly trained versus experienced drivers confronted to simulated urban accidents' scenarios.

PubMed

Berthelon, Catherine; Damm, Loïc

2012-01-01

In order to prevent the over-representation of young drivers in car crashes, France instated an early driver training from the age of 16, but the positive effects of this opportunity have not yet been proven. Three groups of male drivers (12 subjects each) were confronted with some prototypical accident scenarios introduced in a simulated urban circuit. The first and second groups were composed of young drivers having less than one month of driving licence; twelve have had a traditional learning course, and twelve had followed, in addition to the initial course, an early driver training under the supervision of an adult. The third group was composed of experienced drivers. Strategies of the three groups were analyzed through their response time, speed and maneuvers. No difference appeared across groups regarding obstacle detection. But traditionally-trained drivers' position control was more conservative than the two others groups, which were more likely to involve efficient evasive action. The exposure gained during early training could thus increase the development of visuo-motor coordination and involve better skills in case of difficult situations. Others accidents' scenarios could be used to confront young drivers with difficult situations not commonly encountered in natural driving.

Developing Simulated Cyber Attack Scenarios Against Virtualized Adversary Networks

DTIC Science & Technology

2017-03-01

MAST is a custom software framework originally designed to facilitate the training of network administrators on live networks using SimWare. The MAST...or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington headquarters Services ...scenario development and testing in a virtual test environment. Commercial and custom software tools that provide the ability to conduct network

Feasibility of Augmented Reality in Clinical Simulations: Using Google Glass With Manikins.

PubMed

Chaballout, Basil; Molloy, Margory; Vaughn, Jacqueline; Brisson Iii, Raymond; Shaw, Ryan

2016-03-07

Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as a teaching and learning tool in a continual effort to make simulations more realistic for students. The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students. Students performed a clinical simulation while watching a video through Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned if they would recommend continued use of this technology in clinical simulation experiences. We were able to have students watch a video in their field of vision of a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass. However, there were technical and usability challenges with the device. As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations.

Towards the new CH2018 climate scenarios for Switzerland

NASA Astrophysics Data System (ADS)

Fischer, Andreas; Schär, Christoph; Croci-Maspoli, Mischa; Knutti, Reto; Liniger, Mark; Strassmann, Kuno

2017-04-01

There is a growing demand for regional assessments of future climate change and its impacts on society and ecosystems to inform and facilitate appropriate adaptation strategies. The basis for such assessments are consistent and up-to-date climate change scenarios on the local to regional scale. In Switzerland, an important step has been accomplished by the release of the climate scenarios in 2011 ("CH2011"). Since then, new climate model simulations have become available and the scientific understanding has improved. It is hence desirable to update these national scenarios. The new CH2018 scenarios are developed in the framework of the recently founded National Center for Climate Services (NCCS), a network consisting of several federal offices and academic partners. The CH2018 scenarios will build primarily upon the latest Euro-CORDEX regional climate model simulations assuming different pathways of future greenhouse gas concentrations. Compared to CH2011, more emphasis will be put on changes in extremes and in putting the projected changes in the context of observed variability. Results of a recently conducted survey on end-user needs in Switzerland will guide the development process toward the CH2018 scenarios. It ensures that the scenarios are presented and communicated in a user-oriented format and find a wide applicability across different sectors in Switzerland. In the presentation we will show the full methodological setup to generate the CH2018 scenarios and how consistency across the methods and products is maximized. First results on mean changes and selected indices will be presented. In terms of dissemination, the results of the user survey show the necessity to address all different user types of climate scenarios, especially the non-experts. Compared to CH2011, this implies a stronger focus on consulting, condensing complex information and providing tutorials. In the presentation, we will outline our plans on dissemination in order to adequately

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

New climate change scenarios for the Netherlands.

PubMed

van den Hurk, B; Tank, A K; Lenderink, G; Ulden, A van; Oldenborgh, G J van; Katsman, C; Brink, H van den; Keller, F; Bessembinder, J; Burgers, G; Komen, G; Hazeleger, W; Drijfhout, S

2007-01-01

A new set of climate change scenarios for 2050 for the Netherlands was produced recently. The scenarios span a wide range of possible future climate conditions, and include climate variables that are of interest to a broad user community. The scenario values are constructed by combining output from an ensemble of recent General Climate Model (GCM) simulations, Regional Climate Model (RCM) output, meteorological observations and a touch of expert judgment. For temperature, precipitation, potential evaporation and wind four scenarios are constructed, encompassing ranges of both global mean temperature rise in 2050 and the strength of the response of the dominant atmospheric circulation in the area of interest to global warming. For this particular area, wintertime precipitation is seen to increase between 3.5 and 7% per degree global warming, but mean summertime precipitation shows opposite signs depending on the assumed response of the circulation regime. Annual maximum daily mean wind speed shows small changes compared to the observed (natural) variability of this variable. Sea level rise in the North Sea in 2100 ranges between 35 and 85 cm. Preliminary assessment of the impact of the new scenarios on water management and coastal defence policies indicate that particularly dry summer scenarios and increased intensity of extreme daily precipitation deserves additional attention in the near future.

Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

PubMed

Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

2012-01-01

Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

Estimating ICU bed capacity using discrete event simulation.

PubMed

Zhu, Zhecheng; Hen, Bee Hoon; Teow, Kiok Liang

2012-01-01

The intensive care unit (ICU) in a hospital caters for critically ill patients. The number of the ICU beds has a direct impact on many aspects of hospital performance. Lack of the ICU beds may cause ambulance diversion and surgery cancellation, while an excess of ICU beds may cause a waste of resources. This paper aims to develop a discrete event simulation (DES) model to help the healthcare service providers determine the proper ICU bed capacity which strikes the balance between service level and cost effectiveness. The DES model is developed to reflect the complex patient flow of the ICU system. Actual operational data, including emergency arrivals, elective arrivals and length of stay, are directly fed into the DES model to capture the variations in the system. The DES model is validated by open box test and black box test. The validated model is used to test two what-if scenarios which the healthcare service providers are interested in: the proper number of the ICU beds in service to meet the target rejection rate and the extra ICU beds in service needed to meet the demand growth. A 12-month period of actual operational data was collected from an ICU department with 13 ICU beds in service. Comparison between the simulation results and the actual situation shows that the DES model accurately captures the variations in the system, and the DES model is flexible to simulate various what-if scenarios. DES helps the healthcare service providers describe the current situation, and simulate the what-if scenarios for future planning.

Visualization and simulation techniques for surgical simulators using actual patient's data.

PubMed

Radetzky, Arne; Nürnberger, Andreas

2002-11-01

Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators. Copyright 2002 Elsevier Science B.V.

Impact of Spatial Scales on the Intercomparison of Climate Scenarios

DOE Office of Scientific and Technical Information (OSTI.GOV)

Luo, Wei; Steptoe, Michael; Chang, Zheng

2017-01-01

Scenario analysis has been widely applied in climate science to understand the impact of climate change on the future human environment, but intercomparison and similarity analysis of different climate scenarios based on multiple simulation runs remain challenging. Although spatial heterogeneity plays a key role in modeling climate and human systems, little research has been performed to understand the impact of spatial variations and scales on similarity analysis of climate scenarios. To address this issue, the authors developed a geovisual analytics framework that lets users perform similarity analysis of climate scenarios from the Global Change Assessment Model (GCAM) using a hierarchicalmore » clustering approach.« less

Scoping Future Policy Dynamics in Raw Materials Through Scenarios Testing

NASA Astrophysics Data System (ADS)

Correia, Vitor; Keane, Christopher; Sturm, Flavius; Schimpf, Sven; Bodo, Balazs

2017-04-01

The International Raw Materials Observatory (INTRAW) project is working towards a sustainable future for the European Union in access to raw materials, from an availability, economical, and environmental framework. One of the major exercises for the INTRAW project is the evaluation of potential future scenarios for 2050 to frame economic, research, and environmental policy towards a sustainable raw materials supply. The INTRAW consortium developed three possible future scenarios that encompass defined regimes of political, economic, and technological norms. The first scenario, "Unlimited Trade," reflects a world in which free trade continues to dominate the global political and economic environment, with expectations of a growing demand for raw materials from widely distributed global growth. The "National Walls" scenario reflects a world where nationalism and economic protectionism begins to dominate, leading to stagnating economic growth and uneven dynamics in raw materials supply and demand. The final scenario, "Sustainability Alliance," examines the dynamics of a global political and economic climate that is focused on environmental and economic sustainability, leading towards increasingly towards a circular raw materials economy. These scenarios were reviewed, tested, and provided simulations of impacts with members of the Consortium and a panel of global experts on international raw materials issues which led to expected end conditions for 2050. Given the current uncertainty in global politics, these scenarios are informative to identifying likely opportunities and crises. The details of these simulations and expected responses to the research demand, technology investments, and economic components of raw materials system will be discussed.

Developing integrated patient pathways using hybrid simulation

NASA Astrophysics Data System (ADS)

Zulkepli, Jafri; Eldabi, Tillal

2016-10-01

Integrated patient pathways includes several departments, i.e. healthcare which includes emergency care and inpatient ward; intermediate care which patient(s) will stay for a maximum of two weeks and at the same time be assessed by assessment team to find the most suitable care; and social care. The reason behind introducing the intermediate care in western countries was to reduce the rate of patients that stays in the hospital especially for elderly patients. This type of care setting has been considered to be set up in some other countries including Malaysia. Therefore, to assess the advantages of introducing this type of integrated healthcare setting, we suggest develop the model using simulation technique. We argue that single simulation technique is not viable enough to represent this type of patient pathways. Therefore, we suggest develop this model using hybrid techniques, i.e. System Dynamics (SD) and Discrete Event Simulation (DES). Based on hybrid model result, we argued that the result is viable to be as references for decision making process.

Simulation-based interpersonal communication skills training for neurosurgical residents.

PubMed

Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

2013-09-01

Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study.

PubMed

Rajan, Shobana; Khanna, Ashish; Argalious, Maged; Kimatian, Stephen J; Mascha, Edward J; Makarova, Natalya; Nada, Eman M; Elsharkawy, Hesham; Firoozbakhsh, Farhad; Avitsian, Rafi

2016-02-01

Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. Prospective, nonblinded quasi-crossover study. Cleveland Clinic. Anesthesiology residents. Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency. Copyright © 2016 Elsevier Inc. All rights reserved.

Numerical Simulation of cardiovascular deconditioning in different reduced gravity exposure scenarios. Parabolic flight validation.

NASA Astrophysics Data System (ADS)

Perez-Poch, Antoni; Gonzalez, Daniel

Numerical models and simulations are an emerging area of research in human physiology. As complex numerical models are available, along with high-speed computing technologies, it is possible to produce more accurate predictions of the long-term effects of reduced gravity on the human body. NELME (Numerical Emulation of Long-Term Microgravity Effects) has been developed as an electrical-like control system model of the pysiological changes that may arise when gravity changes are applied to the cardiovascular system. Validation of the model has been carried out in parabolic flights at UPC BarcelonaTech Platform. A number of parabolas of up to 8 seconds were performed at Sabadell Airport with an aerobatic single-engine CAP10B plane capable of performing such maneuvres. Heart rate, arterial pressure, and gravity data was collected and compared to the output obtained from the model in order to optimize its parameters. The model is then able to perform simulations for long-term periods of exposure to microgravity, and then the risk for a major malfunction is evaluated. Vascular resistance is known to be impaired during a long-term mission. This effects are not fully understood, and the model is capable of providing a continuous thread of simulated scenarios, while varying gravity in a nearly-continuous way. Aerobic exercise as countermeasure has been simulated as a periodic perturbation into the simulated physiological system. Results are discussed in terms of the validaty and reliability of the outcomes from the model, that have been found compatible with the available data in the literature. Different gender sensitivities to microgravity exposure are discussed. Also thermal stress along with exercise, as it happens in the case of Extravehicular activity is smulated. Results show that vascular resistance is significantly impared (p<0,05) at gravity levels less than 0,4g, when exposed for a period of time longer than 16 days. This degree of impairement is comparable with

Is it beneficial to increase the provision of thrombolysis?-- a discrete-event simulation model.

PubMed

Barton, M; McClean, S; Gillespie, J; Garg, L; Wilson, D; Fullerton, K

2012-07-01

Although Thrombolysis has been licensed in the UK since 2003, it is still administered only to a small percentage of eligible patients. We consider the impact of investing the impact of thrombolysis on important acute stroke services, and the effect on quality of life. The concept is illustrated using data from the Northern Ireland Stroke Service. Retrospective study. We first present results of survival analysis utilizing length of stay (LOS) for discharge destinations, based on data from the Belfast City Hospital (BCH). None of these patients actually received thrombolysis but from those who would have been eligible, we created two initial groups, the first representing a scenario where they received thrombolysis and the second comprising those who do not receive thrombolysis. On the basis of the survival analysis, we created several subgroups based on discharge destination. We then developed a discrete event simulation (DES) model, where each group is a patient pathway within the simulation. Coxian phase type distributions were used to model the group LOS. Various scenarios were explored focusing on cost-effectiveness across hospital, community and social services had thrombolysis been administered to these patients, and the possible improvement in quality of life, should the proportion of patients who are administered thrombolysis be increased. Our aim in simulating various scenarios for this historical group of patients is to assess what the cost-effectiveness of thrombolysis would have been under different scenarios; from this we can infer the likely cost-effectiveness of future policies. The cost of thrombolysis is offset by reduction in hospital, community rehabilitation and institutional care costs, with a corresponding improvement in quality of life. Our model suggests that provision of thrombolysis would produce moderate overall improvement to the service assuming current levels of funding.

Cost analysis of cassava cellulose utilization scenarios for ethanol production on flowsheet simulation platform.

PubMed

Zhang, Jian; Fang, Zhenhong; Deng, Hongbo; Zhang, Xiaoxi; Bao, Jie

2013-04-01

Cassava cellulose accounts for one quarter of cassava residues and its utilization is important for improving the efficiency and profit in commercial scale cassava ethanol industry. In this study, three scenarios of cassava cellulose utilization for ethanol production were experimentally tested under same conditions and equipment. Based on the experimental results, a rigorous flowsheet simulation model was established on Aspen plus platform and the cost of cellulase enzyme and steam energy in the three cases was calculated. The results show that the simultaneous co-saccharification of cassava starch/cellulose and ethanol fermentation process (Co-SSF) provided a cost effective option of cassava cellulose utilization for ethanol production, while the utilization of cassava cellulose from cassava ethanol fermentation residues was not economically sound. Comparing to the current fuel ethanol selling price, the Co-SSF process may provide an important choice for enhancing cassava ethanol production efficiency and profit in commercial scale. Copyright © 2013 Elsevier Ltd. All rights reserved.

River flood risk in Jakarta under scenarios of future change

NASA Astrophysics Data System (ADS)

Budiyono, Yus; Aerts, Jeroen C. J. H.; Tollenaar, Daniel; Ward, Philip J.

2016-03-01

Given the increasing impacts of flooding in Jakarta, methods for assessing current and future flood risk are required. In this paper, we use the Damagescanner-Jakarta risk model to project changes in future river flood risk under scenarios of climate change, land subsidence, and land use change. Damagescanner-Jakarta is a simple flood risk model that estimates flood risk in terms of annual expected damage, based on input maps of flood hazard, exposure, and vulnerability. We estimate baseline flood risk at USD 186 million p.a. Combining all future scenarios, we simulate a median increase in risk of +180 % by 2030. The single driver with the largest contribution to that increase is land subsidence (+126 %). We simulated the impacts of climate change by combining two scenarios of sea level rise with simulations of changes in 1-day extreme precipitation totals from five global climate models (GCMs) forced by the four Representative Concentration Pathways (RCPs). The results are highly uncertain; the median change in risk due to climate change alone by 2030 is a decrease by -46 %, but we simulate an increase in risk under 12 of the 40 GCM-RCP-sea level rise combinations. Hence, we developed probabilistic risk scenarios to account for this uncertainty. If land use change by 2030 takes places according to the official Jakarta Spatial Plan 2030, risk could be reduced by 12 %. However, if land use change in the future continues at the same rate as the last 30 years, large increases in flood risk will take place. Finally, we discuss the relevance of the results for flood risk management in Jakarta.

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Future climate change scenarios in Central America at high spatial resolution.

PubMed

Imbach, Pablo; Chou, Sin Chan; Lyra, André; Rodrigues, Daniela; Rodriguez, Daniel; Latinovic, Dragan; Siqueira, Gracielle; Silva, Adan; Garofolo, Lucas; Georgiou, Selena

2018-01-01

The objective of this work is to assess the downscaling projections of climate change over Central America at 8-km resolution using the Eta Regional Climate Model, driven by the HadGEM2-ES simulations of RCP4.5 emission scenario. The narrow characteristic of continent supports the use of numerical simulations at very high-horizontal resolution. Prior to assessing climate change, the 30-year baseline period 1961-1990 is evaluated against different sources of observations of precipitation and temperature. The mean seasonal precipitation and temperature distribution show reasonable agreement with observations. Spatial correlation of the Eta, 8-km resolution, simulations against observations show clear advantage over the driver coarse global model simulations. Seasonal cycle of precipitation confirms the added value of the Eta at 8-km over coarser resolution simulations. The Eta simulations show a systematic cold bias in the region. Climate features of the Mid-Summer Drought and the Caribbean Low-Level Jet are well simulated by the Eta model at 8-km resolution. The assessment of the future climate change is based on the 30-year period 2021-2050, under RCP4.5 scenario. Precipitation is generally reduced, in particular during the JJA and SON, the rainy season. Warming is expected over the region, but stronger in the northern portion of the continent. The Mid-Summer Drought may develop in regions that do not occur during the baseline period, and where it occurs the strength may increase in the future scenario. The Caribbean Low-Level Jet shows little change in the future. Extreme temperatures have positive trend within the period 2021-2050, whereas extreme precipitation, measured by R50mm and R90p, shows positive trend in the eastern coast, around Costa Rica, and negative trends in the northern part of the continent. Negative trend in the duration of dry spell, which is an estimate based on evapotranspiration, is projected in most part of the continent. Annual mean water

Exact-Differential Large-Scale Traffic Simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hanai, Masatoshi; Suzumura, Toyotaro; Theodoropoulos, Georgios

2015-01-01

Analyzing large-scale traffics by simulation needs repeating execution many times with various patterns of scenarios or parameters. Such repeating execution brings about big redundancy because the change from a prior scenario to a later scenario is very minor in most cases, for example, blocking only one of roads or changing the speed limit of several roads. In this paper, we propose a new redundancy reduction technique, called exact-differential simulation, which enables to simulate only changing scenarios in later execution while keeping exactly same results as in the case of whole simulation. The paper consists of two main efforts: (i) amore » key idea and algorithm of the exact-differential simulation, (ii) a method to build large-scale traffic simulation on the top of the exact-differential simulation. In experiments of Tokyo traffic simulation, the exact-differential simulation shows 7.26 times as much elapsed time improvement in average and 2.26 times improvement even in the worst case as the whole simulation.« less

Simulation-based estimates of effectiveness and cost-effectiveness of smoking cessation in patients with chronic obstructive pulmonary disease.

PubMed

Atsou, Kokuvi; Chouaid, Christos; Hejblum, Gilles

2011-01-01

The medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. Here, considering a COPD smoking patient, the specific burden of continuous smoking was estimated, as well as the effectiveness and the cost-effectiveness of smoking cessation. A multi-state Markov model adopting society's perspective was developed. Simulated cohorts of English COPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were compared to identical cohorts of patients who quit smoking at cohort initialization. Life expectancy, quality adjusted life-years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: £/QALY) were estimated, considering smoking cessation programs with various possible scenarios of success rates and costs. Sensitivity analyses included the variation of model key parameters. At the horizon of a smoking COPD patient's remaining lifetime, smoking cessation at cohort intitialization, relapses being allowed as observed in practice, would result in gains (mean) of 1.27 life-years and 0.68 QALY, and induce savings of -1824 £/patient in the disease-related costs. The corresponding ICER was -2686 £/QALY. Smoking cessation resulted in 0.72, 0.69, 0.64 and 0.42 QALY respectively gained per mild, moderate, severe, and very severe COPD patient, but was nevertheless cost-effective for mild to severe COPD patients in most scenarios, even when hypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon, the burden of continuous smoking in English COPD patients was estimated to cost a total of 1657 M£ while 452516 QALY would be simultaneously lost. The study results are a useful support for the setting of smoking cessation programmes specifically targeted to COPD patients.

A simulator for surgery training: optimal sensory stimuli in a bone pinning simulation

NASA Astrophysics Data System (ADS)

Daenzer, Stefan; Fritzsche, Klaus

2008-03-01

Currently available low cost haptic devices allow inexpensive surgical training with no risk to patients. Major drawbacks of lower cost devices include limited maximum feedback force and the incapability to expose occurring moments. Aim of this work was the design and implementation of a surgical simulator that allows the evaluation of multi-sensory stimuli in order to overcome the occurring drawbacks. The simulator was built following a modular architecture to allow flexible combinations and thorough evaluation of different multi-sensory feedback modules. A Kirschner-Wire (K-Wire) tibial fracture fixation procedure was defined and implemented as a first test scenario. A set of computational metrics has been derived from the clinical requirements of the task to objectively assess the trainees performance during simulation. Sensory feedback modules for haptic and visual feedback have been developed, each in a basic and additionally in an enhanced form. First tests have shown that specific visual concepts can overcome some of the drawbacks coming along with low cost haptic devices. The simulator, the metrics and the surgery scenario together represent an important step towards a better understanding of the perception of multi-sensory feedback in complex surgical training tasks. Field studies on top of the architecture can open the way to risk-less and inexpensive surgical simulations that can keep up with traditional surgical training.

Flooding Capability for River-based Scenarios

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Curtis L.; Prescott, Steven; Ryan, Emerald

2015-10-01

This report describes the initial investigation into modeling and simulation tools for application of riverine flooding representation as part of the Risk-Informed Safety Margin Characterization (RISMC) Pathway external hazards evaluations. The report provides examples of different flooding conditions and scenarios that could impact river and watershed systems. Both 2D and 3D modeling approaches are described.

Database of tsunami scenario simulations for Western Iberia: a tool for the TRIDEC Project Decision Support System for tsunami early warning

NASA Astrophysics Data System (ADS)

Armigliato, Alberto; Pagnoni, Gianluca; Zaniboni, Filippo; Tinti, Stefano

2013-04-01

TRIDEC is a EU-FP7 Project whose main goal is, in general terms, to develop suitable strategies for the management of crises possibly arising in the Earth management field. The general paradigms adopted by TRIDEC to develop those strategies include intelligent information management, the capability of managing dynamically increasing volumes and dimensionality of information in complex events, and collaborative decision making in systems that are typically very loosely coupled. The two areas where TRIDEC applies and tests its strategies are tsunami early warning and industrial subsurface development. In the field of tsunami early warning, TRIDEC aims at developing a Decision Support System (DSS) that integrates 1) a set of seismic, geodetic and marine sensors devoted to the detection and characterisation of possible tsunamigenic sources and to monitoring the time and space evolution of the generated tsunami, 2) large-volume databases of pre-computed numerical tsunami scenarios, 3) a proper overall system architecture. Two test areas are dealt with in TRIDEC: the western Iberian margin and the eastern Mediterranean. In this study, we focus on the western Iberian margin with special emphasis on the Portuguese coasts. The strategy adopted in TRIDEC plans to populate two different databases, called "Virtual Scenario Database" (VSDB) and "Matching Scenario Database" (MSDB), both of which deal only with earthquake-generated tsunamis. In the VSDB we simulate numerically few large-magnitude events generated by the major known tectonic structures in the study area. Heterogeneous slip distributions on the earthquake faults are introduced to simulate events as "realistically" as possible. The members of the VSDB represent the unknowns that the TRIDEC platform must be able to recognise and match during the early crisis management phase. On the other hand, the MSDB contains a very large number (order of thousands) of tsunami simulations performed starting from many different

Driving-forces model on individual behavior in scenarios considering moving threat agents

NASA Astrophysics Data System (ADS)

Li, Shuying; Zhuang, Jun; Shen, Shifei; Wang, Jia

2017-09-01

The individual behavior model is a contributory factor to improve the accuracy of agent-based simulation in different scenarios. However, few studies have considered moving threat agents, which often occur in terrorist attacks caused by attackers with close-range weapons (e.g., sword, stick). At the same time, many existing behavior models lack validation from cases or experiments. This paper builds a new individual behavior model based on seven behavioral hypotheses. The driving-forces model is an extension of the classical social force model considering scenarios including moving threat agents. An experiment was conducted to validate the key components of the model. Then the model is compared with an advanced Elliptical Specification II social force model, by calculating the fitting errors between the simulated and experimental trajectories, and being applied to simulate a specific circumstance. Our results show that the driving-forces model reduced the fitting error by an average of 33.9% and the standard deviation by an average of 44.5%, which indicates the accuracy and stability of the model in the studied situation. The new driving-forces model could be used to simulate individual behavior when analyzing the risk of specific scenarios using agent-based simulation methods, such as risk analysis of close-range terrorist attacks in public places.

Scenario-Led Habitat Modelling of Land Use Change Impacts on Key Species

PubMed Central

Geary, Matthew; Fielding, Alan H.; McGowan, Philip J. K.; Marsden, Stuart J.

2015-01-01

Accurate predictions of the impacts of future land use change on species of conservation concern can help to inform policy-makers and improve conservation measures. If predictions are spatially explicit, predicted consequences of likely land use changes could be accessible to land managers at a scale relevant to their working landscape. We introduce a method, based on open source software, which integrates habitat suitability modelling with scenario-building, and illustrate its use by investigating the effects of alternative land use change scenarios on landscape suitability for black grouse Tetrao tetrix. Expert opinion was used to construct five near-future (twenty years) scenarios for the 800 km2 study site in upland Scotland. For each scenario, the cover of different land use types was altered by 5–30% from 20 random starting locations and changes in habitat suitability assessed by projecting a MaxEnt suitability model onto each simulated landscape. A scenario converting grazed land to moorland and open forestry was the most beneficial for black grouse, and ‘increased grazing’ (the opposite conversion) the most detrimental. Positioning of new landscape blocks was shown to be important in some situations. Increasing the area of open-canopy forestry caused a proportional decrease in suitability, but suitability gains for the ‘reduced grazing’ scenario were nonlinear. ‘Scenario-led’ landscape simulation models can be applied in assessments of the impacts of land use change both on individual species and also on diversity and community measures, or ecosystem services. A next step would be to include landscape configuration more explicitly in the simulation models, both to make them more realistic, and to examine the effects of habitat placement more thoroughly. In this example, the recommended policy would be incentives on grazing reduction to benefit black grouse. PMID:26569604

Simulating crop yield losses in Switzerland for historical and present Tambora climate scenarios

NASA Astrophysics Data System (ADS)

Flückiger, Simon; Brönnimann, Stefan; Holzkämper, Annelie; Fuhrer, Jürg; Krämer, Daniel; Pfister, Christian; Rohr, Christian

2017-07-01

Severe climatic anomalies in summer 1816, partly due to the eruption of Tambora in April 1815, contributed to delayed growth and poor harvests of important crops in Central Europe. Coinciding with adverse socio-economic conditions, this event triggered the last subsistence crisis in the western World. Here, we model reductions in potential crop yields for 1816 and 1817 and address the question, what impact a similar climatic anomaly would have today. We reconstructed daily weather for Switzerland for 1816/17 on a 2 km grid using historical observations and an analogue resampling method. These data were used to simulate potential crop yields for potato, grain maize, and winter barley using the CropSyst model calibrated for current crop cultivars. We also simulated yields for the same weather anomalies, but referenced to a present-day baseline temperature. Results show that reduced temperature delayed growth and harvest considerably, and in combination with reduced solar irradiance led to a substantial reduction (20%-50%) in the potential yield of potato in 1816. Effects on winter barley were smaller. Significant reductions were also modelled for 1817 and were mainly due to a cold late spring. Relative reductions for the present-day scenario for the two crops were almost indistinguishable from the historical ones. An even stronger response was found for maize, which was not yet common in 1816/17. Waterlogging, which we assessed using a stress-day approach, likely added to the simulated reductions. The documented, strong east-west gradient in malnutrition across Switzerland in 1817/18 could not be explained by biophysical yield limitations (though excess-water limitation might have contributed), but rather by economic, political and social factors. This highlights the importance of these factors for a societies’ ability to cope with extreme climate events. While the adaptive capacity of today’s society in Switzerland is much greater than in the early 19th century

Generating Virtual Patients by Multivariate and Discrete Re-Sampling Techniques.

PubMed

Teutonico, D; Musuamba, F; Maas, H J; Facius, A; Yang, S; Danhof, M; Della Pasqua, O

2015-10-01

Clinical Trial Simulations (CTS) are a valuable tool for decision-making during drug development. However, to obtain realistic simulation scenarios, the patients included in the CTS must be representative of the target population. This is particularly important when covariate effects exist that may affect the outcome of a trial. The objective of our investigation was to evaluate and compare CTS results using re-sampling from a population pool and multivariate distributions to simulate patient covariates. COPD was selected as paradigm disease for the purposes of our analysis, FEV1 was used as response measure and the effects of a hypothetical intervention were evaluated in different populations in order to assess the predictive performance of the two methods. Our results show that the multivariate distribution method produces realistic covariate correlations, comparable to the real population. Moreover, it allows simulation of patient characteristics beyond the limits of inclusion and exclusion criteria in historical protocols. Both methods, discrete resampling and multivariate distribution generate realistic pools of virtual patients. However the use of a multivariate distribution enable more flexible simulation scenarios since it is not necessarily bound to the existing covariate combinations in the available clinical data sets.

Scenario Analysis of Soil and Water Conservation in Xiejia Watershed Based on Improved CSLE Model

NASA Astrophysics Data System (ADS)

Liu, Jieying; Yu, Ming; Wu, Yong; Huang, Yao; Nie, Yawen

2018-01-01

According to the existing research results and related data, use the scenario analysis method, to evaluate the effects of different soil and water conservation measures on soil erosion in a small watershed. Based on the analysis of soil erosion scenarios and model simulation budgets in the study area, it is found that all scenarios simulated soil erosion rates are lower than the present situation of soil erosion in 2013. Soil and water conservation measures are more effective in reducing soil erosion than soil and water conservation biological measures and soil and water conservation tillage measures.

The effects of simulated patients and simulated gynecologic models on student anxiety in providing IUD services.

PubMed

Khadivzadeh, Talat; Erfanian, Fatemeh

2012-10-01

Midwifery students experience high levels of stress during their initial clinical practices. Addressing the learner's source of anxiety and discomfort can ease the learning experience and lead to better outcomes. The aim of this study was to find out the effect of a simulation-based course, using simulated patients and simulated gynecologic models on student anxiety and comfort while practicing to provide intrauterine device (IUD) services. Fifty-six eligible midwifery students were randomly allocated into simulation-based and traditional training groups. They participated in a 12-hour workshop in providing IUD services. The simulation group was trained through an educational program including simulated gynecologic models and simulated patients. The students in both groups then practiced IUD consultation and insertion with real patients in the clinic. The students' anxiety in IUD insertion was assessed using the "Spielberger anxiety test" and the "comfort in providing IUD services" questionnaire. There were significant differences between students in 2 aspects of anxiety including state (P < 0.001) and trait (P = 0.024) and the level of comfort (P = 0.000) in providing IUD services in simulation and traditional groups. "Fear of uterine perforation during insertion" was the most important cause of students' anxiety in providing IUD services, which was reported by 74.34% of students. Simulated patients and simulated gynecologic models are effective in optimizing students' anxiety levels when practicing to deliver IUD services. Therefore, it is recommended that simulated patients and simulated gynecologic models be used before engaging students in real clinical practice.

A GIS-based protocol for the simulation and evaluation of realistic 3-D thinning scenarios in recreational forest management.

PubMed

Lin, Chinsu; Thomson, Gavin; Hung, Shih-Hsiang; Lin, Yu-Dung

2012-12-30

This study introduces a GIS-based protocol for the simulation and evaluation of thinning treatments in recreational forest management. The protocol was implemented in a research study based on an area of recreational forest in Alishan National Scenic Area, Taiwan. Ground survey data were mapped to a GIS database, to create a precise, yet flexible, GIS-based digital forest. The digital forest model was used to generate 18 different thinning scenario images and one image of the existing unthinned forest. A questionnaire was completed by 456 participants while simultaneously viewing the scenario images. The questionnaire was used to determine the scenic beauty preferences of the respondents. Statistical analysis of the data revealed that the respondents preferred low density, upper-storey thinning treatments and a dispersed retention pattern of the remaining trees. High density upper-storey treatments evoked a strongly negative reaction in the observers. The experiment demonstrated that the proposed protocol is suitable for selecting an appropriate thinning strategy for recreational forest and that the protocol has practical value in recreational forest management. Copyright © 2012 Elsevier Ltd. All rights reserved.

Interprofessional team debriefings with or without an instructor after a simulated crisis scenario: An exploratory case study.

PubMed

Boet, Sylvain; Pigford, Ashlee-Ann; Fitzsimmons, Amber; Reeves, Scott; Triby, Emmanuel; Bould, M Dylan

2016-11-01

The value of debriefing after an interprofessional simulated crisis is widely recognised; however, little is known about the content of debriefings and topics that prompt reflection. This study aimed to describe the content and topics that facilitate reflection among learners in two types of interprofessional team debriefings (with or without an instructor) following simulated practice. Interprofessional operating room (OR) teams (one anaesthesia trainee, one surgical trainee, and one staff circulating OR nurse) managed a simulated crisis scenario and were randomised to one of two debriefing groups. Within-team groups used low-level facilitation (i.e., no instructor but a one-page debriefing form based on the Ottawa Global Rating Scale). The instructor-led group used high-level facilitation (i.e., gold standard instructor-led debriefing). All debriefings were recorded, transcribed, and thematically analysed using the inductive qualitative methodology. Thirty-seven interprofessional team-debriefing sessions were included in the analysis. Regardless of group allocation (within-team or instructor-led), the debriefings centred on targeted crisis resource management (CRM) content (i.e., communication, leadership, situation awareness, roles, and responsibilities). In both types of debriefings, three themes emerged as topics for entry points into reflection: (1) the process of the debriefing itself, (2) experience of the simulation model, including simulation fidelity, and (3) perceived performance, including the assessment of CRM. Either with or without an instructor, interprofessional teams focused their debriefing discussion on targeted CRM content. We report topics that allowed learners to enter reflection. This is important for understanding how to maximise learning opportunities when creating education activities for healthcare providers that work in interprofessional settings.

A Generic Simulation Model of the Relative Cost-Effectiveness of ICU Versus Step-Down (IMCU) Expansion.

PubMed

Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-01-01

Many jurisdictions are facing increased demand for intensive care. There are two long-term investment options: intensive care unit (ICU) versus step-down or intermediate care unit (IMCU) capacity expansion. Relative cost-effectiveness of the two investment strategies with regard to patient lives saved has not been studied to date. We expand a generic system dynamics simulation model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to estimate the long-term effects of expanding ICU versus IMCU beds on patient lives saved under a common assumption of 2.1% annual increase in hospital arrivals. Two alternative policies of expanding ICU by two beds versus introducing a two-bed IMCU are compared over a ten-year simulation period. Russel equation is used to calculate total cost of patients' hospitalization. Using two possible values for the ratio of ICU to IMCU cost per inpatient day and four possible values for the percentage of patients transferred from ICU to IMCU found in the literature, nine scenarios are compared against the baseline scenario of no capacity expansion. Expanding ICU capacity by two beds is demonstrated as the most cost-effective scenario with an incremental cost-effectiveness ratio of 3684 (US $) per life saved against the baseline scenario. Sensitivity analyses on the mortality rate of patients in IMCU, direct transfer of IMCU-destined patients to the ward upon completing required IMCU length of stay in the ICU, admission of IMCU patient to ICU, adding two ward beds, and changes in hospital size do not change the superiority of ICU expansion over other scenarios. In terms of operational costs, ICU beds are more cost effective for saving patients than IMCU beds. However, capital costs of setting up ICU versus IMCU beds should be considered for a complete economic analysis.

Probabilistic Wind Power Ramp Forecasting Based on a Scenario Generation Method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Qin; Florita, Anthony R; Krishnan, Venkat K

Wind power ramps (WPRs) are particularly important in the management and dispatch of wind power and currently drawing the attention of balancing authorities. With the aim to reduce the impact of WPRs for power system operations, this paper develops a probabilistic ramp forecasting method based on a large number of simulated scenarios. An ensemble machine learning technique is first adopted to forecast the basic wind power forecasting scenario and calculate the historical forecasting errors. A continuous Gaussian mixture model (GMM) is used to fit the probability distribution function (PDF) of forecasting errors. The cumulative distribution function (CDF) is analytically deduced.more » The inverse transform method based on Monte Carlo sampling and the CDF is used to generate a massive number of forecasting error scenarios. An optimized swinging door algorithm is adopted to extract all the WPRs from the complete set of wind power forecasting scenarios. The probabilistic forecasting results of ramp duration and start-time are generated based on all scenarios. Numerical simulations on publicly available wind power data show that within a predefined tolerance level, the developed probabilistic wind power ramp forecasting method is able to predict WPRs with a high level of sharpness and accuracy.« less

Economic and financial viability of small-scale dairy systems in central Mexico: economic scenario 2010-2018.

PubMed

Posadas-Domínguez, R R; Callejas-Juárez, N; Arriaga-Jordán, C M; Martínez-Castañeda, F E

2016-12-01

A simulation Monte Carlo model was used to assess the economic and financial viability of 130 small-scale dairy farms in central Mexico, through a Representative Small-Scale Dairy Farm. Net yields were calculated for a 9-year planning horizon by means of simulated values for the distribution of input and product prices taking 2010 as base year and considering four scenarios which were compared against the scenario of actual production. The other scenarios were (1) total hiring in of needed labour; (2) external purchase of 100 % of inputs and (3) withdrawal of subsidies to production. A stochastic modelling approach was followed to determine the scenario with the highest economic and financial viability. Results show a viable economic and financial situation for the real production scenario, as well as the scenarios for total hiring of labour and of withdrawal of subsidies, but the scenario when 100 % of feed inputs for the herd are bought-in was not viable.

Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

PubMed

Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

2015-04-01

This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (P<0.001). The time to complete each scenario and its decrease from day 1 to day 3 were detected equally in the two groups (P<0.05). Virtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

Economic Analysis of Different Electric Vehicle Charging Scenarios

NASA Astrophysics Data System (ADS)

Ying, Li; Haiming, Zhou; Xiufan, Ma; Hao, Wang

2017-05-01

Influence of electric vehicles (EV) to grid cannot be ignored. Research on the economy analysis of different charging scenarios is helpful to guide the user to charge or discharge orderly. EV charging models are built such as disordered charging, valley charging, intelligent charging, and V2G (Vehicle to Grid), by which changes of charging load in different scenarios can be seen to analyze the influence to initial load curve, and comparison can be done about user’s average cost. Monte Carlo method is used to simulate the electric vehicle charging behavior, cost in different charging scenarios are compared, social cost is introduced in V2G scene, and the relationship between user’s average cost and social cost is analyzed. By test, it is proved that user’s cost is the lowest in V2G scenario, and the larger the scale of vehicles is, the more the social cost can save.

Development of optimization-based probabilistic earthquake scenarios for the city of Tehran

NASA Astrophysics Data System (ADS)

Zolfaghari, M. R.; Peyghaleh, E.

2016-01-01

This paper presents the methodology and practical example for the application of optimization process to select earthquake scenarios which best represent probabilistic earthquake hazard in a given region. The method is based on simulation of a large dataset of potential earthquakes, representing the long-term seismotectonic characteristics in a given region. The simulation process uses Monte-Carlo simulation and regional seismogenic source parameters to generate a synthetic earthquake catalogue consisting of a large number of earthquakes, each characterized with magnitude, location, focal depth and fault characteristics. Such catalogue provides full distributions of events in time, space and size; however, demands large computation power when is used for risk assessment, particularly when other sources of uncertainties are involved in the process. To reduce the number of selected earthquake scenarios, a mixed-integer linear program formulation is developed in this study. This approach results in reduced set of optimization-based probabilistic earthquake scenario, while maintaining shape of hazard curves and full probabilistic picture by minimizing the error between hazard curves driven by full and reduced sets of synthetic earthquake scenarios. To test the model, the regional seismotectonic and seismogenic characteristics of northern Iran are used to simulate a set of 10,000-year worth of events consisting of some 84,000 earthquakes. The optimization model is then performed multiple times with various input data, taking into account probabilistic seismic hazard for Tehran city as the main constrains. The sensitivity of the selected scenarios to the user-specified site/return period error-weight is also assessed. The methodology could enhance run time process for full probabilistic earthquake studies like seismic hazard and risk assessment. The reduced set is the representative of the contributions of all possible earthquakes; however, it requires far less

The educational impact of web-based and face-to-face patient deterioration simulation programs: An interventional trial.

PubMed

Chung, Catherine; Cooper, Simon J; Cant, Robyn P; Connell, Cliff; McKay, Angela; Kinsman, Leigh; Gazula, Swapnali; Boyle, Jayne; Cameron, Amanda; Cash, Penny; Evans, Lisa; Kim, Jeong-Ah; Masud, Rana; McInnes, Denise; Norman, Lisa; Penz, Erika; Rotter, Thomas; Tanti, Erin; Breakspear, Tom

2018-05-01

There are international concerns relating to the management of patient deterioration. The "failure to rescue" literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses' recognition and management of patient deterioration. To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. Nursing staff working in four public and private hospital medical wards in the State of Victoria. In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. Both WB and F2F participants' knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups' performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education

Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study.

PubMed

Egenberg, Signe; Masenga, Gileard; Bru, Lars Edvin; Eggebø, Torbjørn Moe; Mushi, Cecilia; Massay, Deodatus; Øian, Pål

2017-09-05

Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome. This quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants. To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression. The random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with

Possible scenarios for occurrence of M ~ 7 interplate earthquakes prior to and following the 2011 Tohoku-Oki earthquake based on numerical simulation.

PubMed

Nakata, Ryoko; Hori, Takane; Hyodo, Mamoru; Ariyoshi, Keisuke

2016-05-10

We show possible scenarios for the occurrence of M ~ 7 interplate earthquakes prior to and following the M ~ 9 earthquake along the Japan Trench, such as the 2011 Tohoku-Oki earthquake. One such M ~ 7 earthquake is so-called the Miyagi-ken-Oki earthquake, for which we conducted numerical simulations of earthquake generation cycles by using realistic three-dimensional (3D) geometry of the subducting Pacific Plate. In a number of scenarios, the time interval between the M ~ 9 earthquake and the subsequent Miyagi-ken-Oki earthquake was equal to or shorter than the average recurrence interval during the later stage of the M ~ 9 earthquake cycle. The scenarios successfully reproduced important characteristics such as the recurrence of M ~ 7 earthquakes, coseismic slip distribution, afterslip distribution, the largest foreshock, and the largest aftershock of the 2011 earthquake. Thus, these results suggest that we should prepare for future M ~ 7 earthquakes in the Miyagi-ken-Oki segment even though this segment recently experienced large coseismic slip in 2011.

Possible scenarios for occurrence of M ~ 7 interplate earthquakes prior to and following the 2011 Tohoku-Oki earthquake based on numerical simulation

PubMed Central

Nakata, Ryoko; Hori, Takane; Hyodo, Mamoru; Ariyoshi, Keisuke

2016-01-01

We show possible scenarios for the occurrence of M ~ 7 interplate earthquakes prior to and following the M ~ 9 earthquake along the Japan Trench, such as the 2011 Tohoku-Oki earthquake. One such M ~ 7 earthquake is so-called the Miyagi-ken-Oki earthquake, for which we conducted numerical simulations of earthquake generation cycles by using realistic three-dimensional (3D) geometry of the subducting Pacific Plate. In a number of scenarios, the time interval between the M ~ 9 earthquake and the subsequent Miyagi-ken-Oki earthquake was equal to or shorter than the average recurrence interval during the later stage of the M ~ 9 earthquake cycle. The scenarios successfully reproduced important characteristics such as the recurrence of M ~ 7 earthquakes, coseismic slip distribution, afterslip distribution, the largest foreshock, and the largest aftershock of the 2011 earthquake. Thus, these results suggest that we should prepare for future M ~ 7 earthquakes in the Miyagi-ken-Oki segment even though this segment recently experienced large coseismic slip in 2011. PMID:27161897

Atmospheric circulation and hydroclimate impacts of alternative warming scenarios for the Eocene

NASA Astrophysics Data System (ADS)

Carlson, Henrik; Caballero, Rodrigo

2017-08-01

Recent work in modelling the warm climates of the early Eocene shows that it is possible to obtain a reasonable global match between model surface temperature and proxy reconstructions, but only by using extremely high atmospheric CO2 concentrations or more modest CO2 levels complemented by a reduction in global cloud albedo. Understanding the mix of radiative forcing that gave rise to Eocene warmth has important implications for constraining Earth's climate sensitivity, but progress in this direction is hampered by the lack of direct proxy constraints on cloud properties. Here, we explore the potential for distinguishing among different radiative forcing scenarios via their impact on regional climate changes. We do this by comparing climate model simulations of two end-member scenarios: one in which the climate is warmed entirely by CO2 (which we refer to as the greenhouse gas (GHG) scenario) and another in which it is warmed entirely by reduced cloud albedo (which we refer to as the low CO2-thin clouds or LCTC scenario) . The two simulations have an almost identical global-mean surface temperature and equator-to-pole temperature difference, but the LCTC scenario has ˜ 11 % greater global-mean precipitation than the GHG scenario. The LCTC scenario also has cooler midlatitude continents and warmer oceans than the GHG scenario and a tropical climate which is significantly more El Niño-like. Extremely high warm-season temperatures in the subtropics are mitigated in the LCTC scenario, while cool-season temperatures are lower at all latitudes. These changes appear large enough to motivate further, more detailed study using other climate models and a more realistic set of modelling assumptions.

HEADWAY TIME AND CRASHES AMONG NOVICE TEENS AND EXPERIENCED ADULT DRIVERS IN A SIMULATED LEAD TRUCK BRAKING SCENARIO

PubMed Central

McDonald, Catherine C.; Seacrist, Thomas S.; Lee, Yi-Ching; Loeb, Helen; Kandadai, Venk; Winston, Flaura K.

2014-01-01

Summary Driving simulators can be used to evaluate driving performance under controlled, safe conditions. Teen drivers are at particular risk for motor vehicle crashes and simulated driving can provide important information on performance. We developed a new simulator protocol, the Simulated Driving Assessment (SDA), with the goal of providing a new tool for driver assessment and a common outcome measure for evaluation of training programs. As an initial effort to examine the validity of the SDA to differentiate performance according to experience, this analysis compared driving behaviors and crashes between novice teens (n=20) and experienced adults (n=17) on a high fidelity simulator for one common crash scenario, a rear-end crash. We examined headway time and crashes during a lead truck with sudden braking event in our SDA. We found that 35% of the novice teens crashed and none of the experienced adults crashed in this lead truck braking event; 50% of the teens versus 25% of the adults had a headway time <3 seconds at the time of truck braking. Among the 10 teens with <3 seconds headway time, 70% crashed. Among all participants with a headway time of 2–3 seconds, further investigation revealed descriptive differences in throttle position and brake pedal force when comparing teens who crashed, teens who did not crash and adults (none of whom crashed). Even with a relatively small sample, we found statistically significant differences in headway time for adults and teens, providing preliminary construct validation for our new SDA. PMID:25197724

Development of High Fidelity Mobility Simulation of an Autonomous Vehicle in an Off-Road Scenario Using Integrated Sensor, Controller, and Multi-Body Dynamics

DTIC Science & Technology

2011-08-01

VEHICLE IN AN OFF-ROAD SCENARIO USING INTEGRATED SENSOR, CONTROLLER, AND MULTI-BODY DYNAMICS Paramsothy Jayakumar , PhD William Smith US Army...environment for a control system, mechanical system dynamics , and sensor simulation for an improved assessment of the vehicle system performance...improve vehicle dynamic performance; we must also evaluate and improve the sensor suite employed on the vehicle, and the controller used to operate

Development of High Fidelity Mobility Simulation of an Autonomous Vehicle in an Off-Road Scenario Using Integrated Sensor, Controller, and Multi-Body Dynamics

DTIC Science & Technology

2011-08-04

AND MULTI-BODY DYNAMICS Jayakumar , Smith, Ross, Jategaonkar, Konarzewski 4 August 2011 UNCLASSIFIED: Distribution Statement A. Approved for public...Autonomous Vehicle in an Off-Road Scenario Using Integrated Sensor, Controller, and Multi-Body Dynamics 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...Cannot neglect vehicle dynamics 4 August 2011 3 UNCLASSIFIED Importance of Simulation Fidelity • Performance evaluation requires entire system

An evaluation of an expert system for detecting critical events during anesthesia in a human patient simulator: a prospective randomized controlled study.

PubMed

Görges, Matthias; Winton, Pamela; Koval, Valentyna; Lim, Joanne; Stinson, Jonathan; Choi, Peter T; Schwarz, Stephan K W; Dumont, Guy A; Ansermino, J Mark

2013-08-01

Perioperative monitoring systems produce a large amount of uninterpreted data, use threshold alarms prone to artifacts, and rely on the clinician to continuously visually track changes in physiological data. To address these deficiencies, we developed an expert system that provides real-time clinical decisions for the identification of critical events. We evaluated the efficacy of the expert system for enhancing critical event detection in a simulated environment. We hypothesized that anesthesiologists would identify critical ventilatory events more rapidly and accurately with the expert system. We used a high-fidelity human patient simulator to simulate an operating room environment. Participants managed 4 scenarios (anesthetic vapor overdose, tension pneumothorax, anaphylaxis, and endotracheal tube cuff leak) in random order. In 2 of their 4 scenarios, participants were randomly assigned to the expert system, which provided trend-based alerts and potential differential diagnoses. Time to detection and time to treatment were measured. Workload questionnaires and structured debriefings were completed after each scenario, and a usability questionnaire at the conclusion of the session. Data were analyzed using a mixed-effects linear regression model; Fisher exact test was used for workload scores. Twenty anesthesiology trainees and 15 staff anesthesiologists with a combined median (range) of 36 (29-66) years of age and 6 (1-38) years of anesthesia experience participated. For the endotracheal tube cuff leak, the expert system caused mean reductions of 128 (99% confidence interval [CI], 54-202) seconds in time to detection and 140 (99% CI, 79-200) seconds in time to treatment. In the other 3 scenarios, a best-case decrease of 97 seconds (lower 99% CI) in time to diagnosis for anaphylaxis and a worst-case increase of 63 seconds (upper 99% CI) in time to treatment for anesthetic vapor overdose were found. Participants were highly satisfied with the expert system (median

Valuating Indonesian upstream oil management scenario through system dynamics modelling

NASA Astrophysics Data System (ADS)

Ketut Gunarta, I.; Putri, F. A.

2018-04-01

Under the existing regulation in Constitution Number 22 Year 2001 (UU No 22 Tahun 2001), Production Sharing Contract (PSC) continues to be the scenario in conducting oil and gas upstream mining activities as the previous regulation (UU No. 8 Tahun 1971). Because of the high costs and risks in upstream mining activities, the contractors are dominated by foreign companies, meanwhile National Oil Company (NOC) doesn’t act much. The domination of foreign contractor companies also warned Indonesia in several issues addressing to energy independence and energy security. Therefore, to achieve the goals of energy which is independence and security, there need to be a revision in upstream oil activities regulating scenario. The scenarios will be comparing the current scenario, which is PSC, with the “full concession” scenario for National Oil Company (NOC) in managing oil upstream mining activities. Both scenario will be modelled using System Dynamics methodology and assessed furthermore using financial valuation method of income approach. Under the 2 scenarios, the author will compare which scenario is better for upstream oil management in reaching the goals mentioned before and more profitable in financial aspect. From the simulation, it is gathered that concession scenario offers better option than PSC in reaching energy independence and energy security.

Does the sex of a simulated patient affect CPR?

PubMed

Kramer, Chelsea E; Wilkins, Matthew S; Davies, Jan M; Caird, Jeff K; Hallihan, Gregory M

2015-01-01

While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest. Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples. While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Using simulation to train orthopaedic trainees in non-technical skills: A pilot study.

PubMed

Heaton, Samuel R; Little, Zoe; Akhtar, Kash; Ramachandran, Manoj; Lee, Joshua

2016-08-18

To enhance non-technical skills and to analyse participant's experience of a course tailored for orthopaedic surgeons. A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself. Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the

Future climate change scenarios in Central America at high spatial resolution

PubMed Central

Imbach, Pablo; Chou, Sin Chan; Rodrigues, Daniela; Rodriguez, Daniel; Latinovic, Dragan; Siqueira, Gracielle; Silva, Adan; Garofolo, Lucas; Georgiou, Selena

2018-01-01

The objective of this work is to assess the downscaling projections of climate change over Central America at 8-km resolution using the Eta Regional Climate Model, driven by the HadGEM2-ES simulations of RCP4.5 emission scenario. The narrow characteristic of continent supports the use of numerical simulations at very high-horizontal resolution. Prior to assessing climate change, the 30-year baseline period 1961–1990 is evaluated against different sources of observations of precipitation and temperature. The mean seasonal precipitation and temperature distribution show reasonable agreement with observations. Spatial correlation of the Eta, 8-km resolution, simulations against observations show clear advantage over the driver coarse global model simulations. Seasonal cycle of precipitation confirms the added value of the Eta at 8-km over coarser resolution simulations. The Eta simulations show a systematic cold bias in the region. Climate features of the Mid-Summer Drought and the Caribbean Low-Level Jet are well simulated by the Eta model at 8-km resolution. The assessment of the future climate change is based on the 30-year period 2021–2050, under RCP4.5 scenario. Precipitation is generally reduced, in particular during the JJA and SON, the rainy season. Warming is expected over the region, but stronger in the northern portion of the continent. The Mid-Summer Drought may develop in regions that do not occur during the baseline period, and where it occurs the strength may increase in the future scenario. The Caribbean Low-Level Jet shows little change in the future. Extreme temperatures have positive trend within the period 2021–2050, whereas extreme precipitation, measured by R50mm and R90p, shows positive trend in the eastern coast, around Costa Rica, and negative trends in the northern part of the continent. Negative trend in the duration of dry spell, which is an estimate based on evapotranspiration, is projected in most part of the continent. Annual mean

Dose Titration of Pregabalin in Patients with Painful Diabetic Peripheral Neuropathy: Simulation Based on Observational Study Patients Enriched with Data from Randomized Studies.

PubMed

Alexander, Joe; Edwards, Roger A; Manca, Luigi; Grugni, Roberto; Bonfanti, Gianluca; Emir, Birol; Whalen, Edward; Watt, Stephen; Parsons, Bruce

2018-03-01

Achieving a therapeutic response to pregabalin in patients with painful diabetic peripheral neuropathy (pDPN) requires adequate upward dose titration. Our goal was to identify relationships between titration and response to pregabalin in patients with pDPN. Data were integrated from nine randomized, placebo-controlled clinical trials as well as one 6-week open-label observational study conducted by 5808 physicians (2642 patients with pDPN) in standard outpatient settings in Germany. These studies evaluated pregabalin for treatment of pDPN. Using these data, we examined "what if" scenarios using a microsimulation platform that integrates data from randomized and observational sources as well as autoregressive-moving-average with exogenous inputs models that predict pain outcomes, taking into account weekly changes in pain, sleep interference, dose, and other patient characteristics that were unchanging. Final pain levels were significantly different depending on dose changes (P < 0.0001), with greater proportions improving with upward titration regardless of baseline pain severity. Altogether, 78.5% of patients with pDPN had 0-1 dose change, and 15.2% had ≥ 2 dose changes. Simulation demonstrated that the 4.8% of inadequately titrated patients who did not improve/very much improve their pain levels would have benefited from ≥ 2 dose changes. Patient satisfaction with tolerability (range 90.3-96.2%) was similar, regardless of baseline pain severity, number of titrations, or extent of improvement, suggesting that tolerability did not influence treatment response patterns. Upward dose titration reduced pain in patients with pDPN who actually received it. Simulation also predicted pain reduction in an inadequately titrated nonresponder subgroup of patients had they actually received adequate titration. The decision not to uptitrate must have been driven by factors other than tolerability. Pfizer, Inc.

Simulating forensic casework scenarios in experimental studies: The generation of footwear marks in blood.

PubMed

McElhone, Rachel L; Meakin, Georgina E; French, James C; Alexander, Tracy; Morgan, Ruth M

2016-07-01

A study was designed to investigate the effects of external variables, including blood type, flooring surface, footwear tread depth and blood dryness, on the appearance of blood-based footwear marks, with particular reference to simulating a specific casework scenario. Results showed that footwear marks left in human blood tended to be of greater quality than those in equine blood, highlighting a potential issue in applying data generated with equine blood to human bloodstains in casework. Footwear tread effects were also dependent on blood type, but the type of flooring surface did not affect the appearance of the mark. Under some conditions, as the blood dried, the amount of detail retained from footwear contact decreased. These results provide the beginnings of an empirical evidence base to allow a more accurate interpretation of blood-based footwear marks in forensic casework. When applied to a disputed bloodstain in a specific case, these results also demonstrate the importance of such experiments in narrowing the range of explanations possible in the interpretation of forensic evidence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cognitive deficits are associated with poorer simulated driving in older adults with heart failure

PubMed Central

2013-01-01

Background Cognitive impairment is prevalent in older adults with heart failure (HF) and associated with reduced functional independence. HF patients appear at risk for reduced driving ability, as past work in other medical samples has shown cognitive dysfunction to be an important contributor to driving performance. The current study examined whether cognitive dysfunction was independently associated with reduced driving simulation performance in a sample of HF patients. Methods 18 persons with HF (67.72; SD = 8.56 year) completed echocardiogram and a brief neuropsychological test battery assessing global cognitive function, attention/executive function, memory and motor function. All participants then completed the Kent Multidimensional Assessment Driving Simulation (K-MADS), a driving simulator scenario with good psychometric properties. Results The sample exhibited an average Mini Mental State Examination (MMSE) score of 27.83 (SD = 2.09). Independent sample t-tests showed that HF patients performed worse than healthy adults on the driving simulation scenario. Finally, partial correlations showed worse attention/executive and motor function were independently associated with poorer driving simulation performance across several indices reflective of driving ability (i.e., centerline crossings, number of collisions, % of time over the speed limit, among others). Conclusion The current findings showed that reduced cognitive function was associated with poor simulated driving performance in older adults with HF. If replicated using behind-the-wheel testing, HF patients may be at elevated risk for unsafe driving and routine driving evaluations in this population may be warranted. PMID:24499466

Clinical results of computerized tomography-based simulation with laser patient marking.

PubMed

Ragan, D P; Forman, J D; He, T; Mesina, C F

1996-02-01

Accuracy of a patient treatment portal marking device and computerized tomography (CT) simulation have been clinically tested. A CT-based simulator has been assembled based on a commercial CT scanner. This includes visualization software and a computer-controlled laser drawing device. This laser drawing device is used to transfer the setup, central axis, and/or radiation portals from the CT simulator to the patient for appropriate patient skin marking. A protocol for clinical testing is reported. Twenty-five prospectively, sequentially accessioned patients have been analyzed. The simulation process can be completed in an average time of 62 min. Under many cases, the treatment portals can be designed and the patient marked in one session. Mechanical accuracy of the system was found to be within +/- 1mm. The portal projection accuracy in clinical cases is observed to be better than +/- 1.2 mm. Operating costs are equivalent to the conventional simulation process it replaces. Computed tomography simulation is a clinical accurate substitute for conventional simulation when used with an appropriate patient marking system and digitally reconstructed radiographs. Personnel time spent in CT simulation is equivalent to time in conventional simulation.

Using Simulation in a Psychiatric Mental Health Nurse Practitioner Doctoral Program.

PubMed

Calohan, Jess; Pauli, Eric; Combs, Teresa; Creel, Andrea; Convoy, Sean; Owen, Regina

The use and effectiveness of simulation with standardized patients in undergraduate and graduate nursing education programs is well documented. Simulation has been primarily used to develop health assessment skills. Evidence supports using simulation and standardized patients in psychiatric-mental health nurse practitioner (PMHNP) programs is useful in developing psychosocial assessment skills. These interactions provide individualized and instantaneous clinical feedback to the student from faculty, peers, and standardized patients. Incorporating simulation into advanced practice psychiatric-mental health nursing curriculum allows students to develop the necessary requisite skills and principles needed to safely and effectively provide care to patients. There are no documented standardized processes for using simulation throughout a doctor of nursing practice PMHNP curriculum. The purpose of this article is to describe a framework for using simulation with standardized patients in a PMHNP curriculum. Students report high levels of satisfaction with the simulation experience and believe that they are more prepared for clinical rotations. Faculty feedback indicates that simulated clinical scenarios are a method to ensure that each student experiences demonstrate a minimum standard of competency ahead of clinical rotations with live patients. Initial preceptor feedback indicates that students are more prepared for clinical practice and function more independently than students that did not experience this standardized clinical simulation framework. Published by Elsevier Inc.

Aviation Safety Simulation Model

NASA Technical Reports Server (NTRS)

Houser, Scott; Yackovetsky, Robert (Technical Monitor)

2001-01-01

The Aviation Safety Simulation Model is a software tool that enables users to configure a terrain, a flight path, and an aircraft and simulate the aircraft's flight along the path. The simulation monitors the aircraft's proximity to terrain obstructions, and reports when the aircraft violates accepted minimum distances from an obstruction. This model design facilitates future enhancements to address other flight safety issues, particularly air and runway traffic scenarios. This report shows the user how to build a simulation scenario and run it. It also explains the model's output.

Comparison of Metal and Plastic Disposable Laryngoscope Blade with Reusable Macintosh Blade in Difficult and Inhalation Injury Airway Scenario: A Manikin Study.

PubMed

Moritz, Andreas; Heinrich, Sebastian; Irouschek, Andrea; Birkholz, Torsten; Prottengeier, Johannes; Schmidt, Joachim

2017-01-01

Single-use plastic blades (SUPB) and single-use metal blades (SUMB) for direct laryngoscopy and tracheal intubation have not yet been compared with reusable metal blades (RUMB) in difficult airway scenarios. The purpose of our manikin study was to compare the effectiveness of these different laryngoscope blades in a difficult airway scenario, as well as in a difficult airway scenario with simulated severe inhalation injury. Thirty anesthetists performed tracheal intubation (TI) with each of the three laryngoscope blades in the two scenario manikins. In the inhalation injury scenario, SUPB were associated with prolonged intubation times when compared with the metal blades. In the inhalation injury scenario, both metal laryngoscope blades provided a quicker, easier, and safer TI. In the difficult airway scenario, intubation times were significantly prolonged in the SUPB group in comparison to the RUMB group, but there were no significant differences between the SUPB and the SUMB. In this scenario, the RUMB demonstrated the shortest intubation times and seems to be the most effective device. Generally, results are in line with previous studies showing significant disadvantages of SUPB in both manikin scenarios. Therefore, metal blades might be beneficial, especially in the airway management of patients with inhalation injury. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and validation of health related quality of life questionnaire (Indian scenario) in diabetic foot ulcer patients.

PubMed

Kateel, Ramya; Augustine, Alfred J; Ullal, Sheetal; Prabhu, Shivananda; Bhat, Rahul; Adhikari, Prabha

2017-12-01

To develop and validate Health Related Quality of Life Questionnaire in Diabetic Foot Ulcer Patients (HRQLQDFU) for Indian scenario. This study was conducted in two phases. First phase was Development of HRQLQDFU which included literature search and expert interview. Second phase was validation of HRQLQDFL which included face validation, content validation and construct validation. Face validation was done by ten diabetic foot ulcer patients, ten practicing nurses and ten care givers. They were asked to read and respond to questionnaire and report any difficulty in understanding the questions. Further they were asked to add any item to the questionnaire which according to them has a significant effect on quality of life. Content validation was done by six subject experts who judged the content relevance of questionnaire with score ranging from zero to four; zero being least relevant and four being most relevant. Content validity index was calculated for each question. Questions having content validity index≥0.8 were selected for the study. Reliability was tested by calculating Cronbach's alpha. In the development phase a questionnaire containing 37 questions with six domains was developed. None of patient had difficulty in understanding questions. After content validation a new questionnaire containing 20 questions was developed. Cronbach's alpha was 0.86 which shows good reliability. The new health related quality of life questionnaire on diabetic foot ulcer patients for an Indian scenario is validated and can be a reliably measure for quality of life in diabetic foot ulcer patients. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Validation of Variations in Mental Workload as a Function of Scenario Difficulty: Traffic Density and Visibility

NASA Technical Reports Server (NTRS)

2003-01-01

Fluctuations in mental workload can be expected as a function of traffic density and visibility. The aim of the current investigation was to establish simulation scenarios that differed in attentional processing requirements. Four scenarios were created and tested representing two levels of traffic density (urban versus freeway) and two levels of visibility (clear versus foggy). An array of mental workload assessment measures were used to exam changes in attentional processing requirements in each scenario. The assessment array consisted of physiological (P300 amplitude and latency) and behavioral (RT and accuracy) indices. Preliminary results indicate that workload differs significantly as a function of traffic density in rural versus freeway scenarios. Workload also differs significantly in rural versus freeway scenarios as a function of visibility as observed by a significant interaction between the two variables of interest. Results are discussed in terms of their application for validating the difficulty level of simulation scenarios as a format for examining mental workload.

Dark scenarios

NASA Astrophysics Data System (ADS)

Ahonen, Pasi; Alahuhta, Petteri; Daskala, Barbara; Delaitre, Sabine; Hert, Paul De; Lindner, Ralf; Maghiros, Ioannis; Moscibroda, Anna; Schreurs, Wim; Verlinden, Michiel

In this chapter, we present four "dark scenarios" that highlight the key socio-economic, legal, technological and ethical risks to privacy, identity, trust, security and inclusiveness posed by new AmI technologies. We call them dark scenarios, because they show things that could go wrong in an AmI world, because they present visions of the future that we do not want to become reality. The scenarios expose threats and vulnerabilities as a way to inform policy-makers and planners about issues they need to take into account in developing new policies or updating existing legislation. Before presenting the four scenarios and our analysis of each, we describe the process of how we created the scenarios as well as the elements in our methodology for analysing the scenarios.

Streamflow changes in the Sierra Nevada, California, simulated using a statistically downscaled general circulation model scenario of climate change

USGS Publications Warehouse

Wilby, Robert L.; Dettinger, Michael D.

2000-01-01

Simulations of future climate using general circulation models (GCMs) suggest that rising concentrations of greenhouse gases may have significant consequences for the global climate. Of less certainty is the extent to which regional scale (i.e., sub-GCM grid) environmental processes will be affected. In this chapter, a range of downscaling techniques are critiqued. Then a relatively simple (yet robust) statistical downscaling technique and its use in the modelling of future runoff scenarios for three river basins in the Sierra Nevada, California, is described. This region was selected because GCM experiments driven by combined greenhouse-gas and sulphate-aerosol forcings consistently show major changes in the hydro-climate of the southwest United States by the end of the 21st century. The regression-based downscaling method was used to simulate daily rainfall and temperature series for streamflow modelling in three Californian river basins under current-and future-climate conditions. The downscaling involved just three predictor variables (specific humidity, zonal velocity component of airflow, and 500 hPa geopotential heights) supplied by the U.K. Meteorological Office couple ocean-atmosphere model (HadCM2) for the grid point nearest the target basins. When evaluated using independent data, the model showed reasonable skill at reproducing observed area-average precipitation, temperature, and concomitant streamflow variations. Overall, the downscaled data resulted in slight underestimates of mean annual streamflow due to underestimates of precipitation in spring and positive temperature biases in winter. Differences in the skill of simulated streamflows amongst the three basins were attributed to the smoothing effects of snowpack on streamflow responses to climate forcing. The Merced and American River basins drain the western, windward slope of the Sierra Nevada and are snowmelt dominated, whereas the Carson River drains the eastern, leeward slope and is a mix of

Tailored scenarios for streamflow climate change impacts based on the perturbation of precipitation and evapotranspiration

NASA Astrophysics Data System (ADS)

Ntegeka, Victor; Willems, Patrick; Baguis, Pierre; Roulin, Emmanuel

2015-04-01

It is advisable to account for a wide range of uncertainty by including the maximum possible number of climate models and scenarios for future impacts. As this is not always feasible, impact assessments are inevitably performed with a limited set of scenarios. The development of tailored scenarios is a challenge that needs more attention as the number of available climate change simulations grows. Whether these scenarios are representative enough for climate change impacts is a question that needs addressing. This study presents a methodology of constructing tailored scenarios for assessing runoff flows including extreme conditions (peak flows) from an ensemble of future climate change signals of precipitation and potential evapotranspiration (ETo) derived from the climate model simulations. The aim of the tailoring process is to formulate scenarios that can optimally represent the uncertainty spectrum of climate scenarios. These tailored scenarios have the advantage of being few in number as well as having a clear description of the seasonal variation of the climate signals, hence allowing easy interpretation of the implications of future changes. The tailoring process requires an analysis of the hydrological impacts from the likely future change signals from all available climate model simulations in a simplified (computationally less expensive) impact model. Historical precipitation and ETo time series are perturbed with the climate change signals based on a quantile perturbation technique that accounts for the changes in extremes. For precipitation, the change in wetday frequency is taken into account using a markov-chain approach. Resulting hydrological impacts from the perturbed time series are then subdivided into high, mean and low hydrological impacts using a quantile change analysis. From this classification, the corresponding precipitation and ETo change factors are back-tracked on a seasonal basis to determine precipitation-ETo covariation. The

Probabilistic Wind Power Ramp Forecasting Based on a Scenario Generation Method: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Qin; Florita, Anthony R; Krishnan, Venkat K

2017-08-31

Wind power ramps (WPRs) are particularly important in the management and dispatch of wind power, and they are currently drawing the attention of balancing authorities. With the aim to reduce the impact of WPRs for power system operations, this paper develops a probabilistic ramp forecasting method based on a large number of simulated scenarios. An ensemble machine learning technique is first adopted to forecast the basic wind power forecasting scenario and calculate the historical forecasting errors. A continuous Gaussian mixture model (GMM) is used to fit the probability distribution function (PDF) of forecasting errors. The cumulative distribution function (CDF) ismore » analytically deduced. The inverse transform method based on Monte Carlo sampling and the CDF is used to generate a massive number of forecasting error scenarios. An optimized swinging door algorithm is adopted to extract all the WPRs from the complete set of wind power forecasting scenarios. The probabilistic forecasting results of ramp duration and start time are generated based on all scenarios. Numerical simulations on publicly available wind power data show that within a predefined tolerance level, the developed probabilistic wind power ramp forecasting method is able to predict WPRs with a high level of sharpness and accuracy.« less

Support for stroke patients in resumption of driving: patient survey and driving simulator trial

PubMed Central

Hitosugi, Masahito; Takehara, Itaru; Watanabe, Shu; Hayashi, Yasufumi; Tokudome, Shogo

2011-01-01

Background: Encouragement of stroke patients to resume driving is important to promote their reintegration into the community. Limited rehabilitation has been performed in this regard, owing to lack of specific knowledge on the part of medical staff. To establish an effective support program for stroke patients who wish to resume driving, we propose comprehensive training by medical staff using a driving simulator. Methods: A survey of stroke patients admitted to the Tokyo Metropolitan Rehabilitation Hospital was first performed. A questionnaire was sent to 525 patients. Of 218 responses, the answers of 118 patients who had been driving before their stroke were analyzed. More than 80% of stroke patients did not obtain enough information about resuming driving during their hospital stay, and 38.1% of patients would have liked to have had driving training with a simulator. From these results, we set out to determine the effect of driving training using a realistic and technically advanced driving simulator. Twenty-four stroke patients and 20 healthy controls were included in the study. Results: Repeat training with the simulator resulted in an increased ability to perform braking and an improvement in driving ability. The majority of stroke patients who had the mental and physical ability to drive a car were likely to be assessed as being able to resume driving as a result of the training program. Conclusion: This study indicates that comprehensive support by medical staff and provision of adequate information about resumption of driving and the opportunity for training on a driving simulator are likely to aid resumption of driving by stroke patients, thus enhancing their rehabilitation and social reintegration. PMID:21475633

Remediation scenarios for attenuating peak flows and reducing sediment transport in Fountain Creek, Colorado, 2013

USGS Publications Warehouse

Kohn, Michael S.; Fulton, John W.; Williams, Cory A.; Stogner, Sr., Robert W.

2014-01-01

The U.S. Geological Survey (USGS) in cooperation with the Fountain Creek Watershed, Flood Control and Greenway District assessed remediation scenarios to attenuate peak flows and reduce sediment loads in the Fountain Creek watershed. To evaluate these strategies, the U.S. Army Corps of Engineers Hydrologic Engineering Center (HEC) hydrologic and hydraulic models were employed. The U.S. Army Corps of Engineers modeling system HEC-HMS (Hydrologic Modeling System) version 3.5 was used to simulate runoff in the Fountain Creek watershed, Colorado, associated with storms of varying magnitude and duration. Rain-gage precipitation data and radar-based precipitation data from the April 28–30, 1999, and September 14–15, 2011, storm events were used in the calibration process for the HEC-HMS model. The curve number and lag time for each subwatershed and Manning's roughness coefficients for each channel reach were adjusted within an acceptable range so that the simulated and measured streamflow hydrographs for each of the 12 USGS streamgages approximated each other. The U.S. Army Corps of Engineers modeling system HEC-RAS (River Analysis System) versions 4.1 and 4.2 were used to simulate streamflow and sediment transport, respectively, for the Fountain Creek watershed generated by a particular storm event. Data from 15 USGS streamgages were used for model calibration and 7 of those USGS streamgages were used for model validation. The calibration process consisted of comparing the simulated water-surface elevations and the cross-section-averaged velocities from the model with those surveyed in the field at the cross section at the corresponding 15 and 7 streamgages, respectively. The final Manning’s roughness coefficients were adjusted between –30 and 30 percent at the 15 calibration streamgages from the original left, right, and channel-averaged Manning's roughness coefficients upon completion of calibration. The U.S. Army Corps of Engineers modeling system HEC

Managing patient deterioration: assessing teamwork and individual performance.

PubMed

Cooper, Simon; Cant, Robyn; Porter, Jo; Missen, Karen; Sparkes, Louise; McConnell-Henry, Tracy; Endacott, Ruth

2013-05-01

To assess the ability of rural Australian nurse teams to manage deteriorating patients. This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure. Knowledge in relation to patient deterioration management varied (mean 63%, range 27-100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17-83%, SD 14.03) with significantly higher levels in younger participants (r=-0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001). Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.

Scenario planning.

PubMed

Enzmann, Dieter R; Beauchamp, Norman J; Norbash, Alexander

2011-03-01

In facing future developments in health care, scenario planning offers a complementary approach to traditional strategic planning. Whereas traditional strategic planning typically consists of predicting the future at a single point on a chosen time horizon and mapping the preferred plans to address such a future, scenario planning creates stories about multiple likely potential futures on a given time horizon and maps the preferred plans to address the multiple described potential futures. Each scenario is purposefully different and specifically not a consensus worst-case, average, or best-case forecast; nor is scenario planning a process in probabilistic prediction. Scenario planning focuses on high-impact, uncertain driving forces that in the authors' example affect the field of radiology. Uncertainty is the key concept as these forces are mapped onto axes of uncertainty, the poles of which have opposed effects on radiology. One chosen axis was "market focus," with poles of centralized health care (government control) vs a decentralized private market. Another axis was "radiology's business model," with one pole being a unified, single specialty vs a splintered, disaggregated subspecialty. The third axis was "technology and science," with one pole representing technology enabling to radiology vs technology threatening to radiology. Selected poles of these axes were then combined to create 3 scenarios. One scenario, termed "entrepreneurialism," consisted of a decentralized private market, a disaggregated business model, and threatening technology and science. A second scenario, termed "socialized medicine," had a centralized market focus, a unified specialty business model, and enabling technology and science. A third scenario, termed "freefall," had a centralized market focus, a disaggregated business model, and threatening technology and science. These scenarios provide a range of futures that ultimately allow the identification of defined "signposts" that can

Evaluation of surface water budget and assessment the global water cycle for the IPCC AR4 A1B scenario simulations

NASA Astrophysics Data System (ADS)

Baek, H.; Park, E.; Kwon, W.

2009-12-01

Water balance calculations are becoming increasingly important for earth-system studies, because humans require water for their survival. Especially, the relationship between climate change and freshwater resources is of primary concern to human society and also has implications for all living species. The goal of this study is to assess the closure and annual variations of the water cycles based on the multi-model ensemble approach. In this study, the projection results of the previous works focusing on global and six sub-regions are updated using sixteen atmosphere-ocean general circulation model (AOGCM) simulations based on the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES) A1B scenario. Before projecting future climate, model performances are evaluated on the simulation of the present-day climate. From the result, we construct and use mainly multi-model ensembles (MMEs), which is referred to as MME9, defined from nine selected AOGCMs of higher performance. Analyzed variables include annual and seasonal precipitation, evaporation, and runoff. The overall projection results from MME9 show that most regions will experience warmer and wetter climate at the end of 21st century. The evaporation shows a very similar trend to precipitation, but not in the runoff projection. The internal and inter-model variabilities are larger in the runoff than both precipitation and evaporation. Moreover, the runoff is notably reduced in Europe at the end of 21st century.

Design, revision, and application of ground-water flow models for simulation of selected water-management scenarios in the coastal area of Georgia and adjacent parts of South Carolina and Florida

USGS Publications Warehouse

Clarke, John S.; Krause, Richard E.

2000-01-01

Ground-water flow models of the Floridan aquifer system in the coastal area of Georgia and adjacent parts of South Carolina and Florida, were revised and updated to ensure consistency among the various models used, and to facilitate evaluation of the effects of pumping on the ground-water level near areas of saltwater contamination. The revised models, developed as part of regional and areal assessments of ground-water resources in coastal Georgia, are--the Regional Aquifer-System Analysis (RASA) model, the Glynn County area (Glynn) model, and the Savannah area (Savannah) model. Changes were made to hydraulic-property arrays of the RASA and Glynn models to ensure consistency among all of the models; results of theses changes are evidenced in revised water budgets and calibration statistics. Following revision, the three models were used to simulate 32 scenarios of hypothetical changes in pumpage that ranged from about 82 million gallons per day (Mgal/d) lower to about 438 Mgal/d higher, than the May 1985 pumping rate of 308 Mgal/d. The scenarios were developed by the Georgia Department of Natural Resources, Environmental Protection Division and the Chatham County-Savannah Metropolitan Planning Commission to evaluate water-management alternatives in coastal Georgia. Maps showing simulated ground-water-level decline and diagrams presenting changes in simulated flow rates are presented for each scenario. Scenarios were grouped on the basis of pumping location--entire 24-county area, central subarea, Glynn-Wayne-Camden County subarea, and Savannah-Hilton Head Island subarea. For those scenarios that simulated decreased pumpage, the water level at both Brunswick and Hilton Head Island rose, decreasing the hydraulic gradient and reducing the potential for saltwater contamination. Conversely, in response to scenarios of increased pumpage, the water level at both locations declined, increasing the hydraulic gradient and increasing the potential for saltwater contamination

Simulation of hydrothermal recoveries by adopting symbiotic urban scenario in the Japanese megalopolis

NASA Astrophysics Data System (ADS)

Nakayama, T.; Fujita, T.; Hashimoto, S.; Hamano, H.

2008-05-01

The heat island phenomenon in summer has become a serious environmental problem with the expansion of cities and industrial areas in Japan. The present research evaluated the positive cooling effect of new material pavement (water-holding blocks) in comparison with the passive cooling effect of lawn. We coupled the process- based NIES Integrated Catchment-based Eco-hydrology (NICE) model (Nakayama, 2008; Nakayama and Watanabe, 2004, 2006, 2007; Nakayama et al., 2006, 2007) to an urban canopy model (Nakayama and Fujita, 2008) and the Regional Atmospheric Modeling System (RAMS) in order to simulate the effect of this newly symbiotic pavement on the hydrologic budget and the regional climate at the Kawasaki eco-town in Japan, with a grid spacing of 200 m. The model simulated the water and heat budgets in various types of natural and artificial pavements (covered by lawn, concrete, steel plate, synthetic rubber sheet, infiltration and water-holding blocks), and to evaluate the role of water-holding blocks in promoting evaporation and cooling to counter the heat island phenomenon (2 degrees lower than that at the lawn), by comparing with the simplified empirical model. The heat budget analysis of observation data showed that the latent heat flux at the water-holding pavement has a strong impact on the cooling temperature, which could be reproduced well by the simulation. Because the water temperature in an aquifer is almost constant throughout the year, it is estimated that the use of groundwater as a heat sink would be very effective for tackling the urban heat island phenomenon, particularly during the summer (Ministry of Environment, 2003). We evaluated the relationship between the effect of groundwater use to ameliorate the heat island phenomenon and the effect of infiltration on the water cycle in the catchment. The procedure to integrate the model simulation with political scenario for the effective selection and use of ecosystem service sites in this study would

Decadal application of WRF/chem for regional air quality and climate modeling over the U.S. under the representative concentration pathways scenarios. Part 2: Current vs. future simulations

NASA Astrophysics Data System (ADS)

Yahya, Khairunnisa; Campbell, Patrick; Zhang, Yang

2017-03-01

Following a comprehensive model evaluation, this Part II paper presents projected changes in future (2046-2055) climate, air quality, and their interactions under the RCP4.5 and RCP8.5 scenarios using the Weather, Research and Forecasting model with Chemistry (WRF/Chem). In general, both WRF/Chem RCP4.5 and RCP8.5 simulations predict similar increases on average (∼2 °C) for 2-m temperature (T2) but different spatial distributions of the projected changes in T2, 2-m relative humidity, 10-m wind speed, precipitation, and planetary boundary layer height, due to differences in the spatial distributions of projected emissions, and their feedbacks into climate. Future O3 mixing ratios will decrease for most parts of the U.S. under the RCP4.5 scenario but increase for all areas under the RCP8.5 scenario due to higher projected temperature, greenhouse gas concentrations and biogenic volatile organic compounds (VOC) emissions, higher O3 values for boundary conditions, and disbenefit of NOx reduction and decreased NO titration over VOC-limited O3 chemistry regions. Future PM2.5 concentrations will decrease for both RCP4.5 and RCP8.5 scenarios with different trends in projected concentrations of individual PM species. Total cloud amounts decrease under both scenarios in the future due to decreases in PM and cloud droplet number concentration thus increased radiation. Those results illustrate the impacts of carbon policies with different degrees of emission reductions on future climate and air quality. The WRF/Chem and WRF simulations show different spatial patterns for projected changes in T2 for future decade, indicating different impacts of prognostic and prescribed gas/aerosol concentrations, respectively, on climate change.

Training Tomorrow's Doctors to Safeguard the Patients of Today: Using Medical Student Simulation Training to Explore Barriers to Recognition of Elder Abuse.

PubMed

Fisher, James M; Rudd, Matthew P; Walker, Richard W; Stewart, Jane

2016-01-01

In recognition of the fact that elder abuse is a global problem that doctors underrecognize and underreport, a simulation training session for undergraduate medical students was developed. The primary objective of this qualitative study was to examine barriers to and drivers of medical students making a diagnosis of elder abuse in simulated practice, with the goal of refining teaching methods and informing future teaching sessions for other clinical teachers. Third-year medical students (Newcastle University, United Kingdom) undertook a simulation scenario with a high-fidelity mannequin representing an elder abuse victim. After the simulation scenario, students underwent a semistructured debriefing. A tripartite approach to data collection was employed that included audio recordings of the simulation, data sheets capturing students' thoughts during the scenario, and postscenario debriefing. A different researcher analyzed each data set in isolation before discussions were held to triangulate findings from the data sets. Forty-six students undertook the scenario; none declined to participate. A number of barriers to students diagnosing elder abuse were identified. Students held a low index of suspicion for elder abuse and were overly optimistic regarding the etiology of the individual's injuries. Students lacked the confidence to raise concerns about possible elder abuse, believing that certainty was required before doing so. There was widespread confusion about nomenclature. These findings provide clinical teachers with important topic areas to address in future teaching sessions. Simulation, as a method to teach about elder abuse in a reproducible and immersive fashion, is recommended to clinical teachers. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients.

PubMed

Tates, Kiek; Antheunis, Marjolijn L; Kanters, Saskia; Nieboer, Theodoor E; Gerritse, Maria Be

2017-12-20

Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. This study aimed to examine (1) the impact of a consultation medium on doctors' and patients' communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors' and patients' communicative behavior on satisfaction with both types of consultation medium. Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients' attitude toward Web-based communication (b=-.249, P=.02 and patients' perceived time and attention (b=.271, P=.03) significantly predicted patients' perceived interpersonal relationship building. Patients' perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors

Piloting Augmented Reality Technology to Enhance Realism in Clinical Simulation.

PubMed

Vaughn, Jacqueline; Lister, Michael; Shaw, Ryan J

2016-09-01

We describe a pilot study that incorporated an innovative hybrid simulation designed to increase the perception of realism in a high-fidelity simulation. Prelicensure students (N = 12) cared for a manikin in a simulation lab scenario wearing Google Glass, a wearable head device that projected video into the students' field of vision. Students reported that the simulation gave them confidence that they were developing skills and knowledge to perform necessary tasks in a clinical setting and that they met the learning objectives of the simulation. The video combined visual images and cues seen in a real patient and created a sense of realism the manikin alone could not provide.

Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France.

PubMed

Atsou, Kokuvi; Crequit, Perrine; Chouaid, Christos; Hejblum, Gilles

2016-01-01

The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented. To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients. We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters. At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY). These results should provide a useful basis for COPD pulmonary rehabilitation programs.

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

Elective course in acute care using online learning and patient simulation.

PubMed

Seybert, Amy L; Kane-Gill, Sandra L

2011-04-11

To enhance students' knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions. Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient's physician, and completed a debriefing session with the facilitator. Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students' performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided. Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students' knowledge and critical-thinking skills in acute care.

Numerical optimization of actuator trajectories for ITER hybrid scenario profile evolution

NASA Astrophysics Data System (ADS)

van Dongen, J.; Felici, F.; Hogeweij, G. M. D.; Geelen, P.; Maljaars, E.

2014-12-01

Optimal actuator trajectories for an ITER hybrid scenario ramp-up are computed using a numerical optimization method. For both L-mode and H-mode scenarios, the time trajectory of plasma current, EC heating and current drive distribution is determined that minimizes a chosen cost function, while satisfying constraints. The cost function is formulated to reflect two desired properties of the plasma q profile at the end of the ramp-up. The first objective is to maximize the ITG turbulence threshold by maximizing the volume-averaged s/q ratio. The second objective is to achieve a stationary q profile by having a flat loop voltage profile. Actuator and physics-derived constraints are included, imposing limits on plasma current, ramp rates, internal inductance and q profile. This numerical method uses the fast control-oriented plasma profile evolution code RAPTOR, which is successfully benchmarked against more complete CRONOS simulations for L-mode and H-mode mode ITER hybrid scenarios. It is shown that the optimized trajectories computed using RAPTOR also result in an improved ramp-up scenario for CRONOS simulations using the same input trajectories. Furthermore, the optimal trajectories are shown to vary depending on the precise timing of the L-H transition.

The effect of compressor-administered defibrillation on peri-shock pauses in a simulated cardiac arrest scenario.

PubMed

Glick, Joshua; Lehman, Erik; Terndrup, Thomas

2014-03-01

Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43). Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits.

System Dynamics based Dengue modeling environment to simulate evolution of Dengue infection under different climate scenarios

NASA Astrophysics Data System (ADS)

Anwar, R.; Khan, R.; Usmani, M.; Colwell, R. R.; Jutla, A.

2017-12-01

Vector borne infectious diseases such as Dengue, Zika and Chikungunya remain a public health threat. An estimate of the World Health Organization (WHO) suggests that about 2.5 billion people, representing ca. 40% of human population,are at increased risk of dengue; with more than 100 million infection cases every year. Vector-borne infections cannot be eradicated since disease causing pathogens survive in the environment. Over the last few decades dengue infection has been reported in more than 100 countries and is expanding geographically. Female Ae. Aegypti mosquito, the daytime active and a major vector for dengue virus, is associated with urban population density and regional climatic processes. However, mathematical quantification of relationships on abundance of vectors and climatic processes remain a challenge, particularly in regions where such data are not routinely collected. Here, using system dynamics based feedback mechanism, an algorithm integrating knowledge from entomological, meteorological and epidemiological processes is developed that has potential to provide ensemble simulations on risk of occurrence of dengue infection in human population. Using dataset from satellite remote sensing, the algorithm was calibrated and validated using actual dengue case data of Iquitos, Peru. We will show results on model capabilities in capturing initiation and peak in the observed time series. In addition, results from several simulation scenarios under different climatic conditions will be discussed.

[Virtual Patients and Medical Teaching].

PubMed

Gómez-Restrepo, Carlos; Narváez, Yamile Reveiz

2012-01-01

Biomedical advancements have evolved to the point where teaching software may be implemented to represent real-life scenarios. Virtual Patients or VPs are software programs that simulate clinical scenarios allowing students to generate a diagnosis and make treatment decisions. In this article, advantages and disadvantages regarding the use of this state-of-the-art technology are discussed. VP is a useful technique for psychiatry students. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Hybrid integral-differential simulator of EM force interactions/scenario-assessment tool with pre-computed influence matrix in applications to ITER

NASA Astrophysics Data System (ADS)

Rozov, V.; Alekseev, A.

2015-08-01

A necessity to address a wide spectrum of engineering problems in ITER determined the need for efficient tools for modeling of the magnetic environment and force interactions between the main components of the magnet system. The assessment of the operating window for the machine, determined by the electro-magnetic (EM) forces, and the check of feasibility of particular scenarios play an important role for ensuring the safety of exploitation. Such analysis-powered prevention of damages forms an element of the Machine Operations and Investment Protection strategy. The corresponding analysis is a necessary step in preparation of the commissioning, which finalizes the construction phase. It shall be supported by the development of the efficient and robust simulators and multi-physics/multi-system integration of models. The developed numerical model of interactions in the ITER magnetic system, based on the use of pre-computed influence matrices, facilitated immediate and complete assessment and systematic specification of EM loads on magnets in all foreseen operating regimes, their maximum values, envelopes and the most critical scenarios. The common principles of interaction in typical bilateral configurations have been generalized for asymmetry conditions, inspired by the plasma and by the hardware, including asymmetric plasma event and magnetic system fault cases. The specification of loads is supported by the technology of functional approximation of nodal and distributed data by continuous patterns/analytical interpolants. The global model of interactions together with the mesh-independent analytical format of output provides the source of self-consistent and transferable data on the spatial distribution of the system of forces for assessments of structural performance of the components, assemblies and supporting structures. The numerical model used is fully parametrized, which makes it very suitable for multi-variant and sensitivity studies (positioning, off

Parallel particle filters for online identification of mechanistic mathematical models of physiology from monitoring data: performance and real-time scalability in simulation scenarios.

PubMed

Zenker, Sven

2010-08-01

Combining mechanistic mathematical models of physiology with quantitative observations using probabilistic inference may offer advantages over established approaches to computerized decision support in acute care medicine. Particle filters (PF) can perform such inference successively as data becomes available. The potential of PF for real-time state estimation (SE) for a model of cardiovascular physiology is explored using parallel computers and the ability to achieve joint state and parameter estimation (JSPE) given minimal prior knowledge tested. A parallelized sequential importance sampling/resampling algorithm was implemented and its scalability for the pure SE problem for a non-linear five-dimensional ODE model of the cardiovascular system evaluated on a Cray XT3 using up to 1,024 cores. JSPE was implemented using a state augmentation approach with artificial stochastic evolution of the parameters. Its performance when simultaneously estimating the 5 states and 18 unknown parameters when given observations only of arterial pressure, central venous pressure, heart rate, and, optionally, cardiac output, was evaluated in a simulated bleeding/resuscitation scenario. SE was successful and scaled up to 1,024 cores with appropriate algorithm parametrization, with real-time equivalent performance for up to 10 million particles. JSPE in the described underdetermined scenario achieved excellent reproduction of observables and qualitative tracking of enddiastolic ventricular volumes and sympathetic nervous activity. However, only a subset of the posterior distributions of parameters concentrated around the true values for parts of the estimated trajectories. Parallelized PF's performance makes their application to complex mathematical models of physiology for the purpose of clinical data interpretation, prediction, and therapy optimization appear promising. JSPE in the described extremely underdetermined scenario nevertheless extracted information of potential clinical

The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients

PubMed Central

Tates, Kiek; Kanters, Saskia; Nieboer, Theodoor E; Gerritse, Maria BE

2017-01-01

Background Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. Objective This study aimed to examine (1) the impact of a consultation medium on doctors’ and patients’ communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors’ and patients’ communicative behavior on satisfaction with both types of consultation medium. Methods Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. Results With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients’ attitude toward Web-based communication (b=−.249, P=.02 and patients’ perceived time and attention (b=.271, P=.03) significantly predicted patients’ perceived interpersonal relationship building. Patients’ perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between

Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

NASA Astrophysics Data System (ADS)

Fenz, Wolfgang; Dirnberger, Johannes

2015-03-01

Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

Dust Plume Modeling at Fort Bliss: Full Training Scenario

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chapman, Elaine G.; Rishel, Jeremy P.; Rutz, Frederick C.

2006-09-26

The potential for air quality impacts from heavy mechanized vehicles operating in the training ranges and on the unpaved main supply routes at Fort Bliss is being investigated. The investigation uses the atmospheric modeling system DUSTRAN to simulate fugitive dust emission and dispersion from typical activities occurring on the installation. This report conveys the results of DUSTRAN simulations conducted using a “Full Training” scenario developed by Fort Bliss personnel. he Full Training scenario includes simultaneous off-road activities of two full Heavy Brigade Combat Teams (HCBTs) and one HCBT battalion on three training ranges. Simulations were conducted for the six-day period,more » April 25-30, 2005, using previously archived meteorological records. Simulation results are presented in the form of 24-hour average PM10 plots and peak 1-hour PM10 concentration plots, where the concentrations represent contributions resulting from the specified military vehicular activities, not total ambient PM10 concentrations. Results indicate that the highest PM10 contribution concentrations occurred on April 30 when winds were light and variable. Under such conditions, lofted particulates generated by vehicular movement stay in the area of generation and are not readily dispersed. The effect of training duration was investigated by comparing simulations with vehicular activity extending over a ten hour period (0700 to 1700 MST) with simulations where vehicular activity was compressed into a one hour period (0700 to 0800 MST). Compressing all vehicular activity into one hour led to higher peak one-hour and 24-hour average concentration contributions, often substantially higher.« less

A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.

PubMed

Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

2006-01-01

Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.

Open Scenario Study: IDA Open Scenario Repository User’s Manual

DTIC Science & Technology

2010-01-01

Thomason, Study Co-Lead Zachary S. Rabold, Sub-Task Lead Ylli Bajraktari Rachel D. Dubin Mary Catherine Flythe Open Scenario Study: IDA Open Scenario... Bajraktari Rachel D. Dubin Mary Catherine Flythe Open Scenario Study: IDA Open Scenario Repository User’s Manual iii Preface This document reports the...vii Appendices A. Identifying Scenario Components...........................................................A-1 B . Acronyms

A patient safety course for preclinical medical students.

PubMed