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Sample records for simulated patients evaluation

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

    NASA Astrophysics Data System (ADS)

    Byrd, Kenneth A.; Yauger, Sunny

    2012-06-01

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

  2. 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.

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

    SciTech Connect

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

    2007-01-15

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

  4. Evaluation of various gentamicin dosage regimens in geriatric patients: a simulation study.

    PubMed

    Bourguignon, Laurent; Goutelle, Sylvain; De Saint-Martin, Julie Burdin; Maire, Pascal; Ducher, Michel

    2010-02-01

    The aim of this simulation study was to evaluate the ability of three regimens proposed in official French recommendations for gentamicin to hit defined pharmacokinetic (PK) and pharmacodynamic targets in a population of elderly patients. The first drug regimen tested consisted of a loading dose of 1 mg/kg and a maintenance dose weighted by creatininemia, every 8 h. The second regimen consisted of a fixed dose of 1 mg/kg at various intervals of time, calculated from creatinine clearance. The last regimen was a fixed dose of 3 mg/kg once a day. All regimens were for 5 days. We used a bicompartmental PK model and implemented a Monte Carlo simulation to generate a large sample of geriatric subjects. The analysis examined three ranges of creatinine clearance. Simulations showed that for the two regimens using multiple doses per day, neither was able to reach an efficacy level without significant toxicity after 5 days of treatment, regardless of the level of renal function. The use of creatininemia or creatinine clearance to adjust the drug dose did not alter these findings. The once-a-day dosing regimen gave better results both in efficacy and toxicity, except for patients with creatinine clearance lower than 60 mL/min, where the incidence of potential toxicity was above 25%. These results strongly suggest that official French recommendations about aminoglycoside dosage regimens in elderly patients with renal impairment should be updated, and that the frequent need for therapeutic drug monitoring and dosage individualization should be clearly stated.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Onovo, Grace N.

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  9. Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study

    PubMed Central

    Han, Jenny E.; Trammell, Antoine R.; Finklea, James D.; Udoji, Timothy N.; Dressler, Daniel D.; Honig, Eric G.; Abraham, Prasad; Ander, Douglas S.; Cotsonis, George A.; Martin, Greg S.; Schulman, David A.

    2014-01-01

    Background Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. Objective We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. Methods A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines. Results There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P  =  .70). There were no differences in primary outcome among groups in 147 actual inpatient codes. Conclusions This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms. PMID:25210581

  10. Simulation: improving patient outcomes.

    PubMed

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

    2013-06-01

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

  11. 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).

  12. Patient-specific surgical simulation.

    PubMed

    Soler, Luc; Marescaux, Jacques

    2008-02-01

    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  13. 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.

  14. Evaluations of lunar regolith simulants

    NASA Astrophysics Data System (ADS)

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

    2016-07-01

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

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

    ERIC Educational Resources Information Center

    Kiegaldie, Debra; White, Geoff

    2006-01-01

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

  16. Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers.

    PubMed

    Cooper, Jeffrey B; Singer, Sara J; Hayes, Jennifer; Sales, Michael; Vogt, Jay W; Raemer, Daniel; Meyer, Gregg S

    2011-08-01

    We developed a training program to introduce managers and informal leaders of healthcare organizations to key concepts of teamwork, safety leadership, and simulation to motivate them to act as leaders to improve safety within their sphere of influence. This report describes the simulation scenario and debriefing that are core elements of that program. Twelve teams of clinician and nonclinician managers were selected from a larger set of volunteers to participate in a 1-day, multielement training program. Two simulation exercises were developed: one for teams of nonclinicians and the other for clinicians or mixed groups. The scenarios represented two different clinical situations, each designed to engage participants in discussions of their safety leadership and teamwork issues immediately after the experience. In the scenarios for nonclinicians, participants conducted an anesthetic induction and then managed an ethical situation. The scenario for clinicians simulated a consulting visit to an emergency room that evolved into a problem-solving challenge. Participants in this scenario had a limited time to prepare advice for hospital leadership on how to improve observed safety and cultural deficiencies. Debriefings after both types of scenarios were conducted using principles of "debriefing with good judgment." We assessed the relevance and impact of the program by analyzing participant reactions to the simulation through transcript data and facilitator observations as well as a postcourse questionnaire. The teams generally reported positive perceptions of the relevance and quality of the simulation with varying types and degrees of impact on their leadership and teamwork behaviors. These kinds of clinical simulation exercises can be used to teach healthcare leaders and managers safety leadership and teamwork skills and behaviors.

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  18. Simulator scene display evaluation device

    NASA Technical Reports Server (NTRS)

    Haines, R. F. (Inventor)

    1986-01-01

    An apparatus for aligning and calibrating scene displays in an aircraft simulator has a base on which all of the instruments for the aligning and calibrating are mounted. Laser directs beam at double right prism which is attached to pivoting support on base. The pivot point of the prism is located at the design eye point (DEP) of simulator during the aligning and calibrating. The objective lens in the base is movable on a track to follow the laser beam at different angles within the field of vision at the DEP. An eyepiece and a precision diopter are movable into a position behind the prism during the scene evaluation. A photometer or illuminometer is pivotable about the pivot into and out of position behind the eyepiece.

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

    PubMed Central

    Wan, Xiaomin; Peng, Liubao; Li, Yuanjian

    2015-01-01

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

  20. CT Simulation to Evaluate of Pelvic Lymph Node Coverage in Conventional Radiotherapy Fields Based on Bone and Vessels Landmarks in Prostate Cancer Patients

    PubMed Central

    Yousefi Kashi, Amir Shahram; Khaledi, Samira; Houshyari, Mohammad

    2016-01-01

    Background Radiotherapy is the gold standard for treatment of prostrate cancer as it can cover an adequate area of tissues at risk for metastasis. Objectives We evaluated the Pelvic lymph node coverage of conventional radiotherapy fields based on bone and vessels landmarks using computed tomography (CT) simulation in patients with prostate cancer referred to Shohada-e-Tajrish hospital. Patients and Methods In this cross sectional study, 40 patients with prostate cancer at the Stage T1c to T3b were studied. Pelvic lymph nodes were contoured by using pelvic vessels as surrogate markers. The distances were measured at different points of anterior-posterior (AP) and lateral fields and distances > 5 mm or more between the contoured nodes and the field borders. Results Mean and standard deviation of the aortic bifurcation from the superior border was 4.73 ± 1.16 cm, the distance of common iliac bifurcation from the superior border was 1.11 ± 1.25 cm, the mean (SD) distance of right external iliac from the lateral border of AP field was 2.06 ± 0.48 cm and for left external iliac artery was 1.90 ± 0.56 cm. The distance of the external iliac artery from the anterior border of the lateral field was 2.30 ± 0.74 cm. The distance of the external iliac artery from pelvic rim was 0.59 ± 0.59 cm, distance of bifurcation of iliac from sacroiliac joint was 0.82 ± 1.01 cm, the size of the pelvic rim was 12.30 ± 0.64 cm, sacral width was 8.29 ± 1.01 cm, anterior promontory symphysis distance was 12.02 ± 0.92 cm and posterior promontory symphysis distance was 10.98 ± 0.73 cm. Conclusions We observed that conventional radiotherapy using CT simulation based on bone and vessels landmarks provided adequate coverage of pelvic lymph nodes in our patients with prostate cancer.

  1. Patient-specific simulation of tidal breathing

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  2. [Patient evaluation and outcome measures].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

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

  3. Simulators for corporate pilot training and evaluation

    NASA Technical Reports Server (NTRS)

    Treichel, Curt

    1992-01-01

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

  4. 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.

  5. Bedside Evaluation of Dizzy Patients

    PubMed Central

    Huh, Young-Eun

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Ehrlich, Lisa R.

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

  7. Aided targeting system simulation evaluation

    NASA Technical Reports Server (NTRS)

    Demaio, Joe; Becker, Curtis

    1994-01-01

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

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

    PubMed

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

    2016-11-01

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

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

    PubMed

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

    2016-11-01

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

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

    PubMed

    Wang, Yuanyuan; Day, Roger

    2010-01-01

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

  11. Making the Case for Simulation-Based Assessments to Overcome the Challenges in Evaluating Clinical Competency.

    PubMed

    Leigh, Gwen; Stueben, Frances; Harrington, Deedra; Hetherman, Stephen

    2016-05-13

    The use of simulation in nursing has increased substantially in the last few decades. Most schools of nursing have incorporated simulation into their curriculum but few are using simulation to evaluate clinical competency at the end of a semester or prior to graduation. Using simulation for such high stakes evaluation is somewhat novel to nursing. Educators are now being challenged to move simulation to the next level and use it as a tool for evaluating clinical competency. Can the use of simulation for high-stakes evaluation add to or improve our current evaluation methods? Using patient simulation for evaluation in contrast to a teaching modality has important differences that must be considered. This article discusses the difficulties of evaluating clinical competency, and makes the case for using simulation based assessment as a method of high stakes evaluation. Using simulation for high-stakes evaluation has the potential for significantly impacting nursing education.

  12. Enhanced vision simulator for human factors evaluations

    NASA Astrophysics Data System (ADS)

    Suiter, James M.

    1995-06-01

    A low-cost Operational Development and Evaluation System (ODES) was developed for evaluating and demonstrating Head Up Display (HUD) technology, including projected out the window graphics. This consisted of commercial workstations and PC's, a prototype autopilot control panel and an engineering F-15 HUD unit. Software utilized functional partitioning to provide maximum flexibility for modification, expansion and rehosting of software functions. For human factors evaluation of Enhanced Vision Systems (EVS), a real-time simulation was needed for subjects to respond to. Real-time simulated enhanced vision, such as that using millimeter wave radar, is not possible without supercomputers or oversimplification of the radar simulation. We solved this problem by defining operational scenarios for evaluation, generating the EVS radar simulation off-line, transferring simulation run results to a Silicon Graphics (SG) machine for B-scope to C-scope conversion and contrast enhancement and recording the SG images on an optical disk, a frame at a time. For real-time simulation, an ODES system was modified to control the playback of the optical disk recorder through the HUD raster subsystem in coordination with the aircraft model position as driven by the autopilot. The system was first put to use in a study of EVS raster obscuration issues.

  13. Using Simulated Patients to Teach Clinical Nutrition.

    ERIC Educational Resources Information Center

    Carroll, J. Gregory; And Others

    1983-01-01

    "Clinical Nutrition in an Interdisciplinary Setting" is a course designed to introduce basic nutrition knowledge and concepts of nutritional assessment, counseling, and intervention in the clinical care of patients. Provides a brief course overview and descriptions of its development, use, and preliminary evaluation of the patient simulation…

  14. Simulation method for evaluating progressive addition lenses.

    PubMed

    Qin, Linling; Qian, Lin; Yu, Jingchi

    2013-06-20

    Since progressive addition lenses (PALs) are currently state-of-the-art in multifocal correction for presbyopia, it is important to study the methods for evaluating PALs. A nonoptical simulation method used to accurately characterize PALs during the design and optimization process is proposed in this paper. It involves the direct calculation of each surface of the lens according to the lens heights of front and rear surfaces. The validity of this simulation method for the evaluation of PALs is verified by the good agreement with Rotlex method. In particular, the simulation with a "correction action" included into the design process is potentially a useful method with advantages of time-saving, convenience, and accuracy. Based on the eye-plus-lens model, which is established through an accurate ray tracing calculation along the gaze direction, the method can find an excellent application in actually evaluating the wearer performance for optimal design of more comfortable, satisfactory, and personalized PALs. PMID:23842170

  15. 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.

  16. Collision Avoidance for Airport Traffic Simulation Evaluation

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

  17. Simulated Patient Studies: An Ethical Analysis

    PubMed Central

    Rhodes, Karin V; Miller, Franklin G

    2012-01-01

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

  18. Runway Incursion Prevention System Simulation Evaluation

    NASA Technical Reports Server (NTRS)

    Jones, Denise R.

    2002-01-01

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

  19. Evaluating elicited anxiety in a simulated environment.

    PubMed

    Stredney, Don; Hittle, Brad; Sessanna, Dennis

    2008-01-01

    Simulated environments are increasingly being used to evaluate human behavior in a wide variety of situations. These virtual environments are particularly useful in the study of behavior involving dangerous conditions. Quantifying the impact of these environments on the subject is essential to validate the efficacy of the simulation as a virtualization of reality. We have developed a prototypical environment that simulates a common agricultural setting that provides the potential for acute injuries. We report on an exploratory study to evaluate the efficacy of our design to illicit a sense of realism and subsequently evoke a physiological response of anxiety in the subject. We present on the components that comprise the environment, our study design, and preliminary results.

  20. The Use of Patients as Student Evaluators.

    ERIC Educational Resources Information Center

    Henkin, Yaakov; And Others

    1991-01-01

    A comparison of patient (n=181) and tutor (n=31) evaluations of medical student (n=41) behavior in an internal medicine clerkship revealed difficulties with patient evaluation of students. The process is time consuming and introduces tension between students and patients, and patients are poor discriminators. (Author/MSE)

  1. Technology and simulation to improve patient safety.

    PubMed

    Ghobrial, George M; Hamade, Youssef J; Bendok, Bernard R; Harrop, James S

    2015-04-01

    Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.

  2. A Hierarchical Evaluation of Regional Climate Simulations

    SciTech Connect

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

    2013-08-20

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

  3. Walking simulator for evaluation of ophthalmic devices

    NASA Astrophysics Data System (ADS)

    Barabas, James; Woods, Russell L.; Peli, Eli

    2005-03-01

    Simulating mobility tasks in a virtual environment reduces risk for research subjects, and allows for improved experimental control and measurement. We are currently using a simulated shopping mall environment (where subjects walk on a treadmill in front of a large projected video display) to evaluate a number of ophthalmic devices developed at the Schepens Eye Research Institute for people with vision impairment, particularly visual field defects. We have conducted experiments to study subject's perception of "safe passing distance" when walking towards stationary obstacles. The subject's binary responses about potential collisions are analyzed by fitting a psychometric function, which gives an estimate of the subject's perceived safe passing distance, and the variability of subject responses. The system also enables simulations of visual field defects using head and eye tracking, enabling better understanding of the impact of visual field loss. Technical infrastructure for our simulated walking environment includes a custom eye and head tracking system, a gait feedback system to adjust treadmill speed, and a handheld 3-D pointing device. Images are generated by a graphics workstation, which contains a model with photographs of storefronts from an actual shopping mall, where concurrent validation experiments are being conducted.

  4. Digital autopilots: Design considerations and simulator evaluations

    NASA Technical Reports Server (NTRS)

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

    1971-01-01

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

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

    ERIC Educational Resources Information Center

    Ewy, Gordon A.; And Others

    1987-01-01

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

  6. Flow Simulation to Enable Patient Specific Virtual Surgical Planning

    NASA Astrophysics Data System (ADS)

    Jansen, Kenneth; Taylor, Charles; Mueller, Jens

    2003-11-01

    The current paradigm for interventional and surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We have proposed a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict differential changes in blood flow for alternative treatment plans for an individual patient. Ideally, these systems would provide an integrated set of image segmentation, geometric solid modeling, automatic finite element mesh generation, computational mechanics and scientific visualization tools accessible through an intuitive human-computer interface. In this talk we focus on the flow simulation aspects of this project. Error estimators for transient flow analyses have been developed and implemented to focus computational resources on the areas where they may have provide the greatest improvement. We will describe these error estimators and apply them to adaptive as well as uniform refinement simulations and compare the accuracy and performance to available experimental data in porcine bypass models that have been carried out specifically for this purpose.

  7. Evaluations of CMIP5 simulations over cropland

    SciTech Connect

    Hoffman, Forrest M

    2015-01-01

    Cropland is one of major sources of carbon lost to the atmosphere and directly contributes to the emissions of greenhouse gases. There is, however, large potential for cropland to reduce its carbon flux to the atmosphere and sequester soil carbon through conservative agriculture management including no-tillage, perennial and/or deep root crops, irrigation, and organic fertilization etc. But these estimations on carbon emissions and sequestrations over cropland under future climate changes and variability remain largest uncertain among all other terrestrial biomes. Global climate and earth system models are an effective tool to study the cropland responses and feedbacks to present and future climate, yet most models in the latest couple model intercomparsion project phase 5 (CMIP5), generally treat cropland similarly as grassland with tuned parameters and do not account for realistic crop phenology, physiology, and management. In this study, we will evaluate the limitations and deficiencies of the CMIP5 models without process-based crop growth models over cropland by comparing their simulations against FLUXNET observations at eight cropland sites. The results show that: (1) the observed and simulated annual cycles generally are not consistent in either phase or amplitude; (2) the MPI and IPSL model families have better skills in the annual cycles of gross primary product (GPP), net ecosystem production (NEP), and terrestrial ecosystem respiration (TER) than other models at the corn/soybean and cereal sites respectively; (3) none of the CMIP5 models successfully simulate the observed two-peak pattern in the annual cycles of sensible heat fluxes at the corn/soybean sites; (4) the simulated GPPs and NEPs of the CESM1, BCC model families and NorESM1-M are much smaller than the observations for entire year; (5) model members from same model family normally simulate similar annual cycles both in phase and magnitude, but the model members from the CESM1 model family with

  8. Scripting Scenarios for the Human Patient Simulator

    NASA Technical Reports Server (NTRS)

    Bacal, Kira; Miller, Robert; Doerr, Harold

    2004-01-01

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

  9. 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…

  10. Simulated paraphilias: a preliminary study of patients who imitate or exaggerate paraphilic symptoms and behaviors.

    PubMed

    Fedoroff, J P; Hanson, A; McGuire, M; Malin, H M; Berlin, F S

    1992-05-01

    In a consecutive series of admissions to the Johns Hopkins Sexual Disorders Unit, 4 out of 20 patients appeared to have simulated paraphilic symptoms that further assessment indicated were either exaggerated or not present. The paper presents case histories of these 4 patients. A descriptive comparison is made between these patients and control groups of patients who admitted having paraphilic symptoms and a group of patients accused of having paraphilic symptoms but who denied them. Patients who simulated paraphilias tended to be self-referred (75%) and without current legal charges (100%). None of these patients was referred or sought treatment for pedophilia, in contrast to the other two patient groups, in which pedophilia accounted for 75% of the referrals. Several possible explanations for why patients might simulate paraphilias and implications for therapists who evaluate or treat sex offenders are discussed.

  11. Evaluations of CMIP5 simulations over cropland

    NASA Astrophysics Data System (ADS)

    Xu, Min; Hoffman, Forrest

    2015-09-01

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

  12. JT15D simulated flight data evaluation

    NASA Technical Reports Server (NTRS)

    Holm, R. G.

    1984-01-01

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

  13. Presurgical Pulmonary Evaluation in Renal Transplant Patients

    PubMed Central

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

    2014-01-01

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

  14. Evaluating a Sexual Health Patient Education Resource

    PubMed Central

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

    2015-01-01

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

  15. Evaluating a Sexual Health Patient Education Resource.

    PubMed

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

    2015-01-01

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

  16. Assessment of Human Patient Simulation-Based Learning

    PubMed Central

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

    2011-01-01

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

  17. Critical Incident Nursing Management Using Human Patient Simulators.

    ERIC Educational Resources Information Center

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

    2002-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Shellman, Stephen M.; Turan, Kursad

    2006-01-01

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

  1. Debriefing with the OPT model of clinical reasoning during high fidelity patient simulation.

    PubMed

    Kuiper, RuthAnne; Heinrich, Carol; Matthias, April; Graham, Meki J; Bell-Kotwall, Lorna

    2008-01-01

    Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

  2. Spatial Evaluation and Verification of Earthquake Simulators

    NASA Astrophysics Data System (ADS)

    Wilson, John Max; Yoder, Mark R.; Rundle, John B.; Turcotte, Donald L.; Schultz, Kasey W.

    2016-09-01

    In this paper, we address the problem of verifying earthquake simulators with observed data. Earthquake simulators are a class of computational simulations which attempt to mirror the topological complexity of fault systems on which earthquakes occur. In addition, the physics of friction and elastic interactions between fault elements are included in these simulations. Simulation parameters are adjusted so that natural earthquake sequences are matched in their scaling properties. Physically based earthquake simulators can generate many thousands of years of simulated seismicity, allowing for a robust capture of the statistical properties of large, damaging earthquakes that have long recurrence time scales. Verification of simulations against current observed earthquake seismicity is necessary, and following past simulator and forecast model verification methods, we approach the challenges in spatial forecast verification to simulators; namely, that simulator outputs are confined to the modeled faults, while observed earthquake epicenters often occur off of known faults. We present two methods for addressing this discrepancy: a simplistic approach whereby observed earthquakes are shifted to the nearest fault element and a smoothing method based on the power laws of the epidemic-type aftershock (ETAS) model, which distributes the seismicity of each simulated earthquake over the entire test region at a decaying rate with epicentral distance. To test these methods, a receiver operating characteristic plot was produced by comparing the rate maps to observed m>6.0 earthquakes in California since 1980. We found that the nearest-neighbor mapping produced poor forecasts, while the ETAS power-law method produced rate maps that agreed reasonably well with observations.

  3. Large breast compressions: Observations and evaluation of simulations

    SciTech Connect

    Tanner, Christine; White, Mark; Guarino, Salvatore; Hall-Craggs, Margaret A.; Douek, Michael; Hawkes, David J.

    2011-02-15

    Purpose: Several methods have been proposed to simulate large breast compressions such as those occurring during x-ray mammography. However, the evaluation of these methods against real data is rare. The aim of this study is to learn more about the deformation behavior of breasts and to assess a simulation method. Methods: Magnetic resonance (MR) images of 11 breasts before and after applying a relatively large in vivo compression in the medial direction were acquired. Nonrigid registration was employed to study the deformation behavior. Optimal material properties for finite element modeling were determined and their prediction performance was assessed. The realism of simulated compressions was evaluated by comparing the breast shapes on simulated and real mammograms. Results: Following image registration, 19 breast compressions from 8 women were studied. An anisotropic deformation behavior, with a reduced elongation in the anterior-posterior direction and an increased stretch in the inferior-superior direction was observed. Using finite element simulations, the performance of isotropic and transverse isotropic material models to predict the displacement of internal landmarks was compared. Isotropic materials reduced the mean displacement error of the landmarks from 23.3 to 4.7 mm, on average, after optimizing material properties with respect to breast surface alignment and image similarity. Statistically significantly smaller errors were achieved with transverse isotropic materials (4.1 mm, P=0.0045). Homogeneous material models performed substantially worse (transverse isotropic: 5.5 mm; isotropic: 6.7 mm). Of the parameters varied, the amount of anisotropy had the greatest influence on the results. Optimal material properties varied less when grouped by patient rather than by compression magnitude (mean: 0.72 vs 1.44). Employing these optimal materials for simulating mammograms from ten MR breast images of a different cohort resulted in more realistic breast

  4. Field Evaluation of a General Purpose Simulator.

    ERIC Educational Resources Information Center

    Spangenberg, Ronald W.

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

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

    ERIC Educational Resources Information Center

    Shinnick, Mary Ann

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Jolly, Laura D.; Sisler, Grovalynn

    1988-01-01

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

  7. Evaluating Latent Variable Growth Models through Ex Post Simulation.

    ERIC Educational Resources Information Center

    Kaplan, David; George, Rani

    1998-01-01

    The use of ex post (historical) simulation statistics as means of evaluating latent growth models is considered, and a variety of simulation quality statistics are applied to such models. Results illustrate the importance of using these measures as adjuncts to more traditional forms of model evaluation. (SLD)

  8. Low vision aids (evaluation of 185 patients).

    PubMed

    Temel, A

    1989-07-01

    One hundred and eighty-five referred patients with various eye pathologies were evaluated retrospectively after they had undergone an examination and issued with a prescription for low vision. The majority of patients (77%) benefited from the prescribing of low vision aids (LVA). Spectacle-mounted magnifiers, high reading additions and telescopes were used as LVAs. Visual acuity, age and magnification are important factors in the assessment of an LVA.

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

    PubMed Central

    2016-01-01

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

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

    PubMed

    Green, Michael; Tariq, Rayhan; Green, Parmis

    2016-01-01

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

  11. Preoperative Evaluation of the Surgical Patient.

    PubMed

    O'Donnell, Frederick T

    2016-01-01

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

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

    PubMed

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

    2014-01-01

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

  13. Developing and Evaluating Patient Education Materials.

    ERIC Educational Resources Information Center

    Monsivais, Diane; Reynolds, Audree

    2003-01-01

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

  14. Developing and evaluating patient education materials.

    PubMed

    Monsivais, Diane; Reynolds, Audree

    2003-01-01

    Nurses should be involved in all aspects of patient education, including the development of print and web resources, but most nurses have not been educated in how to develop these resources. This article discusses the rationale for nurse involvement, describes guidelines for evaluating existing material for credibility and readability, and provides recommendations for rewriting material at an easier-to-read level.

  15. Allergic contact dermatitis: Patient diagnosis and evaluation.

    PubMed

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

    2016-06-01

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

  16. Evaluation of coupling approaches for thermomechanical simulations

    DOE PAGESBeta

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

    2015-08-10

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

  17. Evaluation of coupling approaches for thermomechanical simulations

    SciTech Connect

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

    2015-08-10

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

  18. Design, construction and evaluation of a simulated geothermal flow system

    SciTech Connect

    Mackanic, J.C.

    1980-07-28

    A system was designed and built to simulate the flow from a geothermal well. The simulated flow will be used to power a Lysholm engine, the performance of which will then be evaluated for different simulated geothermal flows. Two main subjects are covered: 1) the design, construction and evaluation of the behavior of the system that simulates the geothermal flow; included in that topic is a discussion of the probable behavior of the Lysholm engine when it is put into operation, and 2) the investigation of the use of dynamic modeling techniques to determine whether they can provide a suitable means for predicting the behavior of the system.

  19. Evaluation and psychotherapy of Indochinese refugee patients.

    PubMed

    Kinzie, J D

    1981-04-01

    Based on clinical experience with 70 Indochinese refugees, specific approaches to diagnosis and treatment of these patients were developed. The psychiatrist/patient relationship was supported and improved by well-trained, empathetic interpreters who assisted with the evaluation which stressed thorough history-taking and a mental status exam. Cultural differences and the psychiatrist's attitudes about refugees and the Indochinese war influenced the therapeutic process. Treatment consisted of appropriate medication, involvement with the social agencies when necessary, and the warmth, empathy, and support of the physician. In particular, it was helpful to understand the symptoms as the patient perceived them and to relate them to possible stresses in the past. Problem areas of therapy were the patient's concentration on physical symptoms, the horror stories, and taboo subjects difficult for the refugee to discuss. Case histories point out the conflict of values and cultural attitudes about mental illness among refugees due to their changed environment and life style. PMID:7258422

  20. Strengthening student communication through pediatric simulated patient encounters.

    PubMed

    Whitt, Ryan; Toussaint, Gregory; Bruce Binder, S; Borges, Nicole J

    2014-01-01

    As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP) encounters strengthen third-year medical students' communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios) were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students' self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n=215; response rate, 96%) analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students' perception of their confidence and abilities regarding their performance (P<0.05; Bonferroni correction, P<0.006). There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents. PMID:25112449

  1. Energy Navigation: Simulation Evaluation and Benefit Analysis

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  2. Simulations of Keratoconus Patient Vision with Optical Eye Modeling

    NASA Astrophysics Data System (ADS)

    Tan, Bo; Chen, Ying-Ling; Lewis, J. W. L.; Shi, Lei; Wang, Ming

    2007-11-01

    Keratoconus (KC) is an eye condition that involves progressive corneal thinning. Pushed by the intraocular pressure, the weakened cornea bulges outward and creates an irregular surface shape. The result is degraded vision that is difficult to correct with regular eye glasses or contact lens. In this study we use the optical lens design software, ZeMax, and patient data including cornea topography and refraction prescription to construct KC eye models. The variation of KC ``cone height'' on the cornea is used to simulate KC progression. The consequent patients' night vision and Snellen letter chart vision at 20 feet are simulated using these anatomically accurate 3-dimensional models. 100 million rays are traced for each image simulation. Animated results illustrate the change of KC visual acuity with the progression of disease. This simulation technique provides a comprehensive tool for medical training and patient consultation/education.

  3. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

    NASA Astrophysics Data System (ADS)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2014-03-01

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial

  4. Psychological Evaluation of Patients Seeking Rhinoplasty

    PubMed Central

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

    2016-01-01

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

  5. Evaluating a Cross-Continent EU Simulation

    ERIC Educational Resources Information Center

    Jones, Rebecca

    2008-01-01

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

  6. Using Simulation for Launch Team Training and Evaluation

    NASA Technical Reports Server (NTRS)

    Peaden, Cary J.

    2005-01-01

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

  7. Evaluation of atopy in patients with COPD*

    PubMed Central

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

    2013-01-01

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

  8. Simulation Environment for the Evaluation of 3D Coronary Tree Reconstruction Algorithms in Rotational Angiography

    PubMed Central

    Yang, Guanyu; Bousse, Alexandre; Toumoulin, Christine; Shu, Huazhong

    2007-01-01

    We present a preliminary version of a simulation environment to evaluate the 3D reconstruction algorithms of the coronary arteries in rotational angiography. It includes the construction of a 3D dynamic model of the coronary tree from patient data, the modeling of the rotational angiography acquisition system to simulate different acquisition and gating strategies and the calculation of radiographic projections of the 3D model of coronary tree throughout several cardiac cycles. PMID:18003001

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

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

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

    PubMed

    Escott, Sarah; Lucas, Beverley; Pearson, David

    2009-03-01

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

  11. Complex Equilibria Changing in Photochemical Reaction: Computerized Evaluation and Simulation.

    ERIC Educational Resources Information Center

    Horvath, Otto; Papp, Sandor

    1988-01-01

    States that if photochemical reactions can be followed spectrophotometrically, reactivities can be estimated by evaluating data from only one curve. Studies such a system using computerized evaluation and simulation. Uses chlorocuprate(II) complexes in acetonitrile solutions for the model systems. (MVL)

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  13. The evaluation of patients with urticaria.

    PubMed

    Guin, J D

    1985-01-01

    Not only is urticaria a condition of disparate cause, but it also may be produced through the action of one or more of a long list of chemical mediators. This article discusses some of the accepted procedures in the evaluation of patients with urticaria, which includes not only categorization but also a search for the sources of aggravation and laboratory testing to confirm the clinical diagnosis. An example of a printed history form is included, which comprises questions that hopefully will help to identify aggravating factors as well as potential causes. PMID:4092381

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

    PubMed

    Rosenbloom, Tova; Eldror, Ehud

    2014-02-01

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

  15. 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. PMID:24732536

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  2. The Effects of Horseback Riding Simulator Exercise on Postural Balance of Chronic Stroke Patients

    PubMed Central

    Park, Jungseo; Lee, Sangyong; Lee, Jiyeun; Lee, Daehee

    2013-01-01

    [Purpose] The aim of this study was to examine the effects of horseback riding simulator exercise on postural balance of chronic stroke patients. [Subjects] A total of 67 stroke patients were assigned either to a horseback riding simulator exercise group (HEG, n=34) or a mat exercise group (MEG, n=33). [Methods] The subjects exercised three times per week for 8 weeks. Static balance ability was determined by eyes open balance (EOB) and eyes closed balance (ECB), which was measured using a Kinesthetic Ability Trainer Balance system. Dynamic balance was evaluated using the Berg balance scale (BBS). [Results] EOB and ECB significantly decreased and BBS had significantly increased after the intervention in the HEG and the MEG, and ECB decreased and BBS increased significantly more in the HEG than in the MEG. [Conclusion] Horseback riding simulator exercise is more effective than mat exercise for improving the ECB and BBS of stroke patients. PMID:24259938

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

    PubMed Central

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Benhuri, Gloria

    2014-01-01

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

  5. Simulation laboratory for evaluating dynamic traffic management systems

    SciTech Connect

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

    1997-08-01

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

  6. Patient care simulations: role playing to enhance clinical understanding.

    PubMed

    Comer, Shirley K

    2005-01-01

    Role-play techniques can serve as an effective substitute for, and supplement to, simulation technology when teaching clinical nursing skills. They provide risk-free opportunities to practice clinical skills and develop clinical judgment. A two-phase patient care simulation, performed in real time, is described. Students are presented with a scenario and work cooperatively in role-playing appropriate care, with one student using a prepared script to assume the role of patient. The class functions as a resource for four students who assume the nursing role. Students reported increased understanding of course material as a result of participation in the clinical simulation scenario. Faculty observed a decreased failure rate on the corresponding course examination.

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

    ERIC Educational Resources Information Center

    Kinkade, Raenel E.; And Others

    1995-01-01

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

  8. Using simulation in out-patient queues: a case study.

    PubMed

    Huarng, F; Lee, M H

    1996-01-01

    Overwork and overcrowding in some periods was an important issue for the out-patient department of a local hospital in Chia-Yi in Taiwan. The hospital administrators wanted to manage the patient flow effectively. Describes a study which focused on the utilization of doctors and staff in the out-patient department, the time spent in the hospital by an out-patient, and the length of the out-patient queue. Explains how a computer simulation model was developed to study how changes in the appointment system, staffing policies and service units would affect the observed bottleneck. The results show that the waiting time was greatly reduced and the workload of the doctor was also reduced to a reasonable rate in the overwork and overcrowding periods.

  9. Towards patient-specific finite-element simulation of MitralClip procedure.

    PubMed

    Mansi, T; Voigt, I; Assoumou Mengue, E; Ionasec, R; Georgescu, B; Noack, T; Seeburger, J; Comaniciu, D

    2011-01-01

    MitralClip is a novel minimally invasive procedure to treat mitral valve (MV) regurgitation. It consists in clipping the mitral leaflets together to close the regurgitant hole. A careful preoperative planning is necessary to select respondent patients and to determine the clipping sites. Although preliminary indications criteria are established, they lack prediction power with respect to complications and effectiveness of the therapy in specific patients. We propose an integrated framework for personalized simulation of MV function and apply it to simulate MitralClip procedure. A patient-specific dynamic model of the MV apparatus is computed automatically from 4D TEE images. A biomechanical model of the MV, constrained by the observed motion of the mitral annulus and papillary muscles, is employed to simulate valve closure and MitralClip intervention. The proposed integrated framework enables, for the first time, to quantitatively evaluate an MV finite-element model in-vivo, on eleven patients, and to predict the outcome of MitralClip intervention in one of these patients. The simulations are compared to ground truth and to postoperative images, resulting in promising accuracy (average point-to-mesh distance: 1.47 +/- 0.24 mm). Our framework may constitute a tool for MV therapy planning and patient management.

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

    NASA Technical Reports Server (NTRS)

    Lee, J.-J.

    1976-01-01

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

  11. 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

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

    PubMed

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

    2006-01-01

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

  13. Knowledge-Driven Design of Virtual Patient Simulations

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-07-01

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

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

    PubMed

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

    2009-12-01

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

  16. Evaluation of Visual Computer Simulator for Computer Architecture Education

    ERIC Educational Resources Information Center

    Imai, Yoshiro; Imai, Masatoshi; Moritoh, Yoshio

    2013-01-01

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

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

    SciTech Connect

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

    2005-11-01

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

  18. Evaluating performance of container terminal operation using simulation

    NASA Astrophysics Data System (ADS)

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

    2015-05-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    Allaire, Joanna L

    2015-09-01

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

  1. Using geographic information systems to simulate patient access areas.

    PubMed

    Doi, Shunsuke; Inoue, Takashi; Ide, Hiroo; Nakamura, Toshihito; Fujita, Shinsuke; Suzuki, Takahiro; Takabayashi, Katsuhiko

    2014-01-01

    We constructed a simulation model with a geographic information system (GIS) to predict the future shortage of beds in the Tokyo Metropolitan Area. With a grid square method, we calculated patient numbers for every 500 square meters of the Tokyo Metropolitan Area until 2040 and estimated whether those in need could be admitted to hospitals within an hour's drive from their homes. The simulation demonstrates that after 2025 many patients may not be able to find hospitals within this time framework. The situation will be especially serious in the center of Tokyo and along the railway lines, where many senior citizens reside. We can now apply this innovative GIS method in many fields and especially for the precise estimation of future demands for and supply of medical assistance.

  2. Köppen bioclimatic evaluation of CMIP historical climate simulations

    NASA Astrophysics Data System (ADS)

    Phillips, Thomas J.; Bonfils, Céline J. W.

    2015-06-01

    Köppen bioclimatic classification relates generic vegetation types to characteristics of the interactive annual-cycles of continental temperature (T) and precipitation (P). In addition to predicting possible bioclimatic consequences of past or prospective climate change, a Köppen scheme can be used to pinpoint biases in model simulations of historical T and P. In this study a Köppen evaluation of Coupled Model Intercomparison Project (CMIP) simulations of historical climate is conducted for the period 1980-1999. Evaluation of an example CMIP5 model illustrates how errors in simulating Köppen vegetation types (relative to those derived from observational reference data) can be deconstructed and related to model-specific temperature and precipitation biases. Measures of CMIP model skill in simulating the reference Köppen vegetation types are also developed, allowing the bioclimatic performance of a CMIP5 simulation of T and P to be compared quantitatively with its CMIP3 antecedent. Although certain bioclimatic discrepancies persist across model generations, the CMIP5 models collectively display an improved rendering of historical T and P relative to their CMIP3 counterparts. In addition, the Köppen-based performance metrics are found to be quite insensitive to alternative choices of observational reference data or to differences in model horizontal resolution.

  3. Using simulation to evaluate clinical competence after impairment.

    PubMed

    Raborn, G W; Carter, R M

    1999-01-01

    It is important for individual dentists and the profession to have access to a process for evaluating the clinical competence of practitioners who are professionally impaired as a result of an accident or a medical disability. No common standards for such evaluations currently exist, however, as demand for this type of assessment is still rare. This article reviews the evaluative approach taken by a team of experienced dental educators in examining three dentists who suffered from medical disabilities. An attempt was made to standardize the evaluation process by using clinical simulation to create an environment that would be comfortable for the dentists and acceptable to the lawyers and the insurance companies. Following evaluation, recommendations on individual competence were made, contributing to a faster resolution of legal and insurance issues.

  4. Evaluation and Treatment of the Patient with Vertigo.

    ERIC Educational Resources Information Center

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

    1997-01-01

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

  5. Simulation of the effectiveness evaluation process of security systems

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

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

  6. A pilot study to evaluate gaze behavior in aircraft simulations.

    PubMed

    Russi-Vigoya, Maria Natalia; Patterson, Patrick

    2012-01-01

    Pilots encounter dynamic situations in which there are drastic changes in weather or where their primary equipment fails. The glass cockpit interface, a computerized system, is often used in today?s aircraft to integrate information about aircraft status onto a visual display. When adverse, life-threatening, situations occur, pilots have to make decisions, with or without their primary equipment. One of the most important tools that pilots have to prepare for adverse situations is simulation training. This study evaluated the link between situational awareness and eye behavior while using a flight simulator to present different adverse situations.

  7. Somatosensory evaluation in Dysfunctional Syndrome patients.

    PubMed

    Hilgenberg-Sydney, P B; Kowacs, P A; Conti, P C R

    2016-02-01

    Many chronic pain patients are refractory to treatment, which leads to the suspicion that somehow they are not fully effective and probably some mechanism of pain generation and/or maintenance is still unknown. The aim of this cross-sectional study was to provide evidence-based data on pain mechanisms in different types of chronic pain conditions. Eighty women, with 18-65 years old, were included, divided into four groups: myofascial pain of the masticatory muscles (n = 20), fibromyalgia (n = 20), chronic daily headache and healthy volunteers (n = 20). All patients were submitted to quantitative sensory tests: pressure pain threshold, mechanical detection threshold, mechanical pain threshold, ischaemic pain tolerance, cold pain sensitivity, aftersensation, wind-up ratio and conditioned pain modulation. Current perception threshold was also determined (Neurometer CPT/C - Neurotron). Three different zones were evaluated: trigeminal (masseter muscle), cervical and extratrigeminal (thenar eminence). Data were recorded and subjected to statistical analysis (anova, Tukey and Student's t-tests). Masticatory myofascial pain, fibromyalgia and chronic daily headache individuals presented lower pressure pain thresholds than healthy volunteers (P = 0.00). Chronic daily headache individuals had a significantly higher mechanical detection threshold than healthy volunteers (P = 0.01). Individuals of the symptomatic groups showed lower values for mechanical pain threshold and for ischaemic pain tolerance (P = 0.00) than healthy volunteers. The ability to activate the mechanism of endogenous modulation is impaired in women with fibromyalgia and myofascial pain (P = 0.00). These results reinforce evidence of central sensitisation and impaired endogenous modulation system in individuals with myofascial pain, fibromyalgia and chronic daily headache.

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

    SciTech Connect

    Sarathi, P.

    1991-04-01

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

  9. Performance evaluation of CESM in simulating the dust cycle

    NASA Astrophysics Data System (ADS)

    Parajuli, S. P.; Yang, Z. L.; Kocurek, G.; Lawrence, D. M.

    2014-12-01

    Mineral dust in the atmosphere has implications for Earth's radiation budget, biogeochemical cycles, hydrological cycles, human health and visibility. Mineral dust is injected into the atmosphere during dust storms when the surface winds are sufficiently strong and the land surface conditions are favorable. Dust storms are very common in specific regions of the world including the Middle East and North Africa (MENA) region, which contains more than 50% of the global dust sources. In this work, we present simulation of the dust cycle under the framework of CESM1.2.2 and evaluate how well the model captures the spatio-temporal characteristics of dust sources, transport and deposition at global scale, especially in dust source regions. We conducted our simulations using two existing erodibility maps (geomorphic and topographic) and a new erodibility map, which is based on the correlation between observed wind and dust. We compare the simulated results with MODIS satellite data, MACC reanalysis data, and AERONET station data. Comparison with MODIS satellite data and MACC reanalysis data shows that all three erodibility maps generally reproduce the spatio-temporal characteristics of dust optical depth globally. However, comparison with AERONET station data shows that the simulated dust optical depth is generally overestimated for all erodibility maps. Results vary greatly by region and scale of observational data. Our results also show that the simulations forced by reanalysis meteorology capture the overall dust cycle more realistically compared to the simulations done using online meteorology.

  10. Rheological evaluation of simulated neutralized current acid waste

    SciTech Connect

    Fow, C.L.; McCarthy, D.; Thornton, G.T.

    1986-06-01

    A byproduct of the Purex process is an aqueous waste stream that contains fission products. This waste stream, called current acid waste, is chemically neutralized and stored in double shell tanks on the Hanford Site. This neutralized current acid waste (NCAW) will be transported by pipe to B-Plant, a processing plant on the Hanford Site. Rheological and transport properties of NCAW slurry were evaluated. First, researchers conducted lab rheological evaluations of simulated NCAW. The results of these evaluations were then correlated with classical rheological models and scaled up to predict the performance that is likely to occur in the full-scale system. The NCAW in the tank will either be retrieved as is, i.e., no change in the concentration presently in the tank, or will be slightly concentrated before retrieval. Sluicing may be required to retrieve the solids. Three concentrations of simulated NCAW were evaluated that would simulate the different retrieval options: NCAW in the concentration that is presently in the tank; a slightly concentrated NCAW, called NCAW5.5; and equal parts of NCAW settled solids and water (simulating the sluicing stage), called NCAW1:1. The physical and rheological properties of three samples of each concentration at 25 and 100/sup 0/C were evaluated in the laboratory. The properties displayed by NCAW and NCAW5.5 at 25 and 100/sup 0/C allowed it to be classified as a pseudoplastic non-Newtonian fluid. NCAW1:1 at 25 and 100/sup 0/C displayed properties of a yield-pseudoplastic non-Newtonian fluid. The classical non-Newtonian models for pseudoplastic and yield-pseudoplastic fluids were used with the laboratory data to predict the full-scale pump-pipe network parameters.

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

    PubMed

    Clark, Paul Alexander

    2007-01-01

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

  12. Uses and Limitations of Simulated Patients in Psychiatric Education

    ERIC Educational Resources Information Center

    Brenner, Adam M.

    2009-01-01

    Objectives: The use of standardized patients (SPs) is becoming prominent as a learning and evaluation tool in both undergraduate and graduate medical education. As increasing attempts are made to extend this tool to psychiatric training and education, it has been suggested that SPs can be useful not only to expose students to the variety of…

  13. Quantitative surface evaluation by matching experimental and simulated ronchigram images

    NASA Astrophysics Data System (ADS)

    Kantún Montiel, Juana Rosaura; Cordero Dávila, Alberto; González García, Jorge

    2011-09-01

    To estimate qualitatively the surface errors with Ronchi test, the experimental and simulated ronchigrams are compared. Recently surface errors have been obtained quantitatively matching the intersection point coordinates of ronchigrama fringes with x-axis . In this case, gaussian fit must be done for each fringe, and interference orders are used in Malacara algorithm for the simulations. In order to evaluate surface errors, we added an error function in simulations, described with cubic splines, to the sagitta function of the ideal surface. We used the vectorial transversal aberration formula and a ruling with cosinusoidal transmittance, because these rulings reproduce better experimental ronchigram fringe profiles. Several error functions are tried until the whole experimental ronchigrama image is reproduced. The optimization process was done using genetic algorithms.

  14. Use of a computer simulation to evaluate a seminar on child abuse.

    PubMed

    Kost, S; Schwartz, W

    1989-09-01

    A computerized patient simulation was used to evaluate the effectiveness of a seminar on child abuse in changing students' behavior in assessing the problem and developing a treatment plan. The CAMPS system (DACIS Software) was selected because it allows students freedom to follow any pathway in selecting over 500 items of history, physical examination, laboratory, and treatments. In interacting with this simulation, students demonstrated how they integrate their knowledge into a clinical setting. The three-hour seminar covered the topics of physical and sexual abuse, patient neglect, and utilization of community resources for treatment. The control (n = 43) and experimental (n = 38) groups, enrolled in an introductory course in pediatrics, were given references to read about child abuse as part of the core curriculum, but they may or may not have had exposure to patients in their clinical work. Only the experimental group attended the seminar. As part of the course evaluation program, both groups interacted with eight computer simulations, two of which involved cases of child abuse. In the classic case of child abuse, the control and experimental groups had similar results. In the more difficult diagnostic problem (shaken baby), the groups differed significantly in total score, cost of the evaluation, and percentage of correct diagnosis.

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

    PubMed

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

    2016-05-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  17. The Evaluation of ERP Sandtable Simulation Based on AHP

    NASA Astrophysics Data System (ADS)

    Xu, Lan

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

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

    PubMed Central

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Dominguez, Nicolas; Reverdy, Frédéric

    2016-02-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

    Louloudiadis, Konstantinos; Tsiatsos, Thrasyvoulos-Konstantinos

    2013-01-01

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

  2. Virtual Patient Simulator for the Perfusion Resource Management Drill

    PubMed Central

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

    2009-01-01

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

  3. Evaluating the STORE Reputation System in Multi-Agent Simulations

    NASA Astrophysics Data System (ADS)

    Andrulis, Jonas; Haller, Jochen; Weinhardt, Christof; Karabulut, Yuecel

    In recent global business environments, collaborations among organisations raise an increased demand for swift establishment. Such collaborations are formed between organisations entering Virtual Organizations (VOs), crossing geographic borders and frequently without prior experience of the other partner’s previous performance. In VOs, every participant risks engaging with partners who may exhibit unexpected fraudulent or otherwise untrusted behaviour. In order to cope with this risk, the STochastic REputation system (STORE) was designed to provide swift, automated decision support for selecting partner organisations in the early stages of the VO’s formation. The contribution of this paper first consists of a multi-agent simulation framework design and implementation to evaluate the STORE reputation system. This framework is able to simulate dynamic agent behaviour, agents hereby representing organisations, and to capture the business context of different VO application scenarios. A configuration of agent classes is a powerful tool to obtain not only well or badly performing agents for simulation scenarios, but also agents which are specialized in particular VO application domains or even malicious agents, attacking the VO community. The second contribution comprises of STORE’s evaluation in two simulation scenarios, set in the VO application domains of Collaborative Engineering and Ad-hoc Service provisioning. Besides the ability to clearly distinguish between agents of different classes according to their reputation, the results prove STORE’s ability to take an agent’s dynamic behaviour into account. The simulation results show, that STORE solves the difficult task of selecting the most trustworthy partner for a particular VO application domain from a set of honest agents that are specialized in a wide spread of VO application domains.

  4. Evaluation of Intersection Traffic Control Measures through Simulation

    NASA Astrophysics Data System (ADS)

    Asaithambi, Gowri; Sivanandan, R.

    2015-12-01

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

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

    NASA Astrophysics Data System (ADS)

    Daftari, I.; Phillips, T. L.

    2003-06-01

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

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

    SciTech Connect

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

    1991-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-07-01

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

  9. Simulator evaluation of the final approach spacing tool

    NASA Technical Reports Server (NTRS)

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

    1990-01-01

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

  10. Evaluation of precipitation predictions in a regional climate simulation

    SciTech Connect

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

    1998-12-01

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

  11. Evaluation of color error and noise on simulated images

    NASA Astrophysics Data System (ADS)

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

    2010-01-01

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

  12. Physicians' evaluations of patients' decisions to refuse oncological treatment

    PubMed Central

    van Kleffens, T; van Leeuwen, E

    2005-01-01

    Objective: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. PMID:15738431

  13. Qualitative Evaluation of a Role Play Bullying Simulation

    PubMed Central

    Gillespie, Gordon L.; Brown, Kathryn; Grubb, Paula; Shay, Amy; Montoya, Karen

    2015-01-01

    Bullying against nurses is becoming a pervasive problem. In this article, a role play simulation designed for undergraduate nursing students is described. In addition, the evaluation findings from a subsample of students who participated in a role play simulation addressing bullying behaviors are reported. Focus group sessions were completed with a subset of eight students who participated in the intervention. Sessions were audiorecorded, transcribed verbatim, and analyzed using Colaizzi’s procedural steps for qualitative analysis. Themes derived from the data were “The Experience of Being Bullied”, “Implementation of the Program”, “Desired Outcome of the Program”, and “Context of Bullying in the Nursing Profession”. Role play simulation was an effective and active learning strategy to diffuse education on bullying in nursing practice. Bullying in nursing was identified as a problem worthy of incorporation into the undergraduate nursing curriculum. To further enhance the learning experience with role play simulation, adequate briefing instructions, opportunity to opt out of the role play, and comprehensive debriefing are essential. PMID:26504502

  14. Student Design and Evaluation of Written Patient Medication Information.

    ERIC Educational Resources Information Center

    Dolinsky, Donna; And Others

    1983-01-01

    A project is described that aims: (1) to give undergraduate pharmacy students an understanding of the complexities of communicating medication information to patients, and (2) to teach skills in the design, analysis, and evaluation of written patient medication information. Materials students developed were evaluated by fellow students (MSE)

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

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2016-02-01

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

  17. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.

    PubMed

    Sogg, Stephanie; Lauretti, Jennifer; West-Smith, Lisa

    2016-05-01

    Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.

  18. Evaluating abuse in the patient with dementia.

    PubMed

    Tronetti, Pamela

    2014-11-01

    For patients with dementia, abuse ranges from subtle scams to outright physical violence. As dementia progresses, abuse escalates. The stages of dementia--mild cognitive impairment, mild dementia, moderate dementia, and severe dementia--lend themselves to varied presentations of abuse. Knowing which types of abuse are more prominent at each stage aids the clinician in anticipating risk of abuse and patient and caregiver needs. Interviewing the victim is crucial in uncovering, documenting, and intervening in an abuse situation. A clinician who is skilled in drawing out the facts while remaining supportive of the patient is key in ending the victimization.

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

    PubMed

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

    2015-07-01

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

  20. Multiscale Hydrologic Evaluation of Radar Rainfall for Flow Simulations

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

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

    NASA Technical Reports Server (NTRS)

    Anderson, Molly; Curley, Su

    2005-01-01

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

  2. Using simulation to evaluate warhead monitoring system effectiveness

    SciTech Connect

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

    2015-07-12

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

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

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

    SciTech Connect

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

    1994-12-31

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

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

    NASA Astrophysics Data System (ADS)

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

    2009-08-01

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

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

    PubMed

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

    2000-01-01

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

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

    PubMed

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

    2000-01-01

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

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

    SciTech Connect

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

    1996-08-01

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

  9. Horizontal Borehole Flowmeter Evaluations in an Unconsolidated Aquifer Simulator

    NASA Astrophysics Data System (ADS)

    Bayless, E. R.

    2009-12-01

    Borehole flowmeters that measure horizontal flow velocity and direction of groundwater are being applied to a wide variety of environmental problems. This study was done to evaluate the measurement accuracy of several flowmeters. The flowmeters included a commercially available heat-pulse flowmeter, an acoustic Doppler flowmeter, a scanning colloidal borescope flowmeter, and a hydrophysical logging system. Measurements taken in an unconsolidated aquifer simulator tested flowmeter response to hydraulic gradient, aquifer properties and well-screen construction. Results of the study indicated that at least one flowmeter was capable of accurately measuring velocity and direction in most simulated conditions. Correction factors for differences between borehole and formation conditions were computed and generally fell within the theoretical ranges determined by previous investigations. The directional accuracy of all tested flowmeters improved with increasing hydraulic gradient. The accuracy of velocity measurements varied with well construction and simulator-velocity magnitude. The use of non-standard well construction methods and materials that maximize slot-opening area and control well-screen orientation may be preferred if flowmeter measurements are expected. The use of horizontal flowmeters in environmental studies appears promising but flowmeter applications may require more than one tool to measure the range of conditions encountered in the field.

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

    PubMed

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

    2016-07-01

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

  11. Evaluating techniques for metagenome annotation using simulated sequence data

    PubMed Central

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

    2016-01-01

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

  12. Evaluating the patient presenting with hyperhidrosis.

    PubMed

    Solish, Nowell; Wang, Rena; Murray, Christian A

    2008-05-01

    Hyperhidrosis is a debilitating condition that affects approximately 2.8% of the population. Patients experience reduced quality of life and face significantly impairment in social interactions and occupational activities. Primary focal hyperhidrosis stems from neurogenic overactivity involving normal eccrine glands, while secondary generalized hyperhidrosis is due to any one of a number of causes. Patient history, physical examination, and appropriate laboratory tests should rule out secondary causes of hyperhidrosis. For primary hyperhidrosis, rate and volume of sweat production and quality of life assessment can be determined.

  13. Evaluating the patient presenting with hyperhidrosis.

    PubMed

    Solish, Nowell; Wang, Rena; Murray, Christian A

    2008-05-01

    Hyperhidrosis is a debilitating condition that affects approximately 2.8% of the population. Patients experience reduced quality of life and face significantly impairment in social interactions and occupational activities. Primary focal hyperhidrosis stems from neurogenic overactivity involving normal eccrine glands, while secondary generalized hyperhidrosis is due to any one of a number of causes. Patient history, physical examination, and appropriate laboratory tests should rule out secondary causes of hyperhidrosis. For primary hyperhidrosis, rate and volume of sweat production and quality of life assessment can be determined. PMID:18557587

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

    PubMed Central

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

    2015-01-01

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

  15. Evaluating psychosocial function in elderly dental patients.

    PubMed

    Gironda, Melanie W

    2007-03-01

    Comprehensive dental care for older adults includes an understanding of, and sensitivity to, the psychosocial changes with age that can influence oral health care, including emotional functioning, anxiety, depression, cognitive functioning, alcohol and substance use, social support, and elder abuse and neglect. A case vignette highlights the contribution of an interdisciplinary psychosocial assessment to the oral health care of elderly patients.

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

    ERIC Educational Resources Information Center

    Deale, Deb; Pastore, Ray

    2014-01-01

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

  17. Evaluating the patient with low back pain.

    PubMed

    Shaikh, Maliha; Östör, Andrew J K

    2015-12-01

    In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain. Inflammatory back pain is often missed, particularly in the early stages when examination may be normal. The primary features are pain arising in patients under 40, thoracolumbar or sacroiliac pain and alternating buttock pain. Stiffness in the early morning and after rest is a hallmark of inflammatory back pain. There may also be peripheral joint involvement with evidence of inflammatory arthritis as well as extra-articular manifestations such as iritis, psoriasis and colitis. Sphincter disturbance leading to loss of bladder or bowel control should also be explored as it is a sign of spinal cord compression or cauda equina syndrome. Both of these are neurosurgical emergencies and need urgent referral for further investigation and possible intervention. The majority of patients with low back pain can be managed in primary care as the pain will usually be self-limiting. Patients with suspected inflammatory back pain should be referred to rheumatology as soon as possible in order to institute early management and prevent long-term deformity and disability. Patients with suspected serious spinal pathology should be referred urgently for further investigation. Red flag symptoms should raise concerns regarding a possible sinister cause such as malignancy and more than one red flag mandates urgent further investigation. PMID:26882775

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Harari, David Y; Macauley, Robert C

    2016-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2007-01-01

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

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

    PubMed

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

    2015-06-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

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

    PubMed

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

    2010-07-01

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

  4. Lunar Regolith Characterization for Simulant Design and Evaluation

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

  5. Simulation Modeling and Performance Evaluation of Space Networks

    NASA Technical Reports Server (NTRS)

    Jennings, Esther H.; Segui, John

    2006-01-01

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

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

    PubMed

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

    2005-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Abbott, Terence S.; Elliott, Dawn M.

    2001-01-01

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

  8. [Initial evaluation of febrile neutropenic patients: risk quantification].

    PubMed

    Vázquez, Lourdes; García, José Elías

    2005-12-01

    Infection in immunocompromised hosts represents a serious clinical situation due the high morbidity and mortality it produces and is one of the most frequent complications in patients with cancer. In patients treated with chemotherapy the risk of infection mainly depends on the duration and intensity of neutropenia. It is essential to evaluate which pathogens are involved so that the most appropriate treatment can be selected a priori, as well as to determine the patient's general clinical status so that more or less aggressive treatment can be provided from the beginning, bearing in mind that "low risk" patients can be managed in the home. These questions can be determined by evaluating the patient's clinical history, physical examination, laboratory investigations, and radiological tests. Prompt initiation of broad-spectrum antibiotic therapy adapted to the the patient's risk is crucial.

  9. Preoperative evaluation of patients with obesity and obstructive sleep apnea.

    PubMed

    Cartagena, Rafael

    2005-09-01

    Obesity and obstructive sleep apnea are conditions frequently encountered by the anesthesiologist and may have a significant impact on perioperative outcomes. This article discusses the preoperative evaluation of patients with one or both of these conditions. The goals of the preoperative assessment are to identify issues that can adversely affect the patient. This information is critical to forming an effective plan for the perioperative care of the patient.

  10. Systematic evaluation of bundled SPC water for biomolecular simulations.

    PubMed

    Gopal, Srinivasa M; Kuhn, Alexander B; Schäfer, Lars V

    2015-04-01

    molecules between the active site and the bulk. Our results form a basis for assessing the accuracy that can be expected from bundled SPC water models. At the same time, this study also highlights the importance of evaluating beforehand the effects of water bundling on the biomolecular system of interest for a particular multiscale simulation application.

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

    NASA Astrophysics Data System (ADS)

    Natsheh, E. M.; Albarbar, A.

    2012-05-01

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

  12. Evaluation of Patients Treated with Natalizumab for Progressive Multifocal Leukoencephalopathy

    PubMed Central

    Yousry, Tarek A.; Ryschkewitsch, Caroline; Fahle, Gary; Fischer, Steven; Hou, Jean; Curfman, Blanche; Miszkiel, Katherine; Mueller-Lenke, Nicole; Sanchez, Esther; Barkhof, Frederik; Radue, Ernst-Wilhelm; Jäger, Hans R.; Clifford, David B.

    2006-01-01

    Background Progressive multifocal leukoencephalopathy (PML) was reported to have developed in three patients treated with natalizumab. We conducted an evaluation to determine whether PML had developed in any other treated patients. Methods We invited patients who had participated in clinical trials in which they received recent or long-term treatment with natalizumab for multiple sclerosis, Crohn's disease, or rheumatoid arthritis to participate. The clinical history, physical examination, brain magnetic resonance imaging (MRI), and testing of cerebrospinal fluid for JC virus DNA were used by an expert panel to evaluate patients for PML. We estimated the risk of PML in patients who completed at least a clinical examination for PML or had an MRI. Results Of 3417 patients who had recently received natalizumab while participating in clinical trials, 3116 (91 percent) who were exposed to a mean of 17.9 monthly doses underwent evaluation for PML. Of these, 44 patients were referred to the expert panel because of clinical findings of possible PML, abnormalities on MRI, or a high plasma viral load of JC virus. No patient had detectable JC virus DNA in the cerebrospinal fluid. PML was ruled out in 43 of the 44 patients, but it could not be ruled out in one patient who had multiple sclerosis and progression of neurologic disease because data on cerebrospinal fluid testing and follow-up MRI were not available. Only the three previously reported cases of PML were confirmed (1.0 per 1000 treated patients; 95 percent confidence interval, 0.2 to 2.8 per 1000). Conclusions A detailed review of possible cases of PML in patients exposed to natalizumab found no new cases and suggested a risk of PML of roughly 1 in 1000 patients treated with natalizumab for a mean of 17.9 months. The risk associated with longer treatment is not known. PMID:16510746

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    PubMed

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

    2016-06-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

  16. The Psychiatric Evaluation and Psychotherapy of the Hispanic Bilingual Patient.

    ERIC Educational Resources Information Center

    Marcos, Luis R.; And Others

    1980-01-01

    This journal issue concerns research projects conducted at the Hispanic Research Center of Fordham University in New York City. In the first article, Luis R. Marcos discusses research on the psychiatric evaluation and psychotherapy of bilingual Hispanic patients, focusing primarily on linguistic factors which affect evaluation and treatment of the…

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

    PubMed Central

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

    1993-01-01

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

  18. Potential of using simulated patients to study the performance of general practitioners.

    PubMed Central

    Kinnersley, P; Pill, R

    1993-01-01

    A review of the literature on the use of simulated patients is presented. While simulated patients have become established for the education of medical undergraduates, international work suggests that they may also be of value for studying the performance of established general practitioners. A preliminary study is described in which simulated patients were used at practices in Cardiff. Roles were developed which would stimulate a discussion focusing on health risks. No particular practical problems were encountered but concerns were expressed about the validity of the data. Suggestions are made for the further development of the use of simulated patients. PMID:8398247

  19. Evaluation of the patient with asymptomatic microscopic hematuria.

    PubMed

    Ziemba, Justin; Guzzo, Thomas J; Ramchandani, Parvati

    2015-08-01

    Asymptomatic microscopic hematuria (AMH) is relatively common in clinical practice but the etiology remains unclear in the majority of patients; it is rarely related to genitourinary malignancies. The 2012 guidelines of the American Urological Association recommend an evaluation after a single positive urinalysis with mandatory upper tract evaluation in all patients, preferably with CT urography (CTU). The likelihood of detecting significant upper track abnormalities, particularly malignancies is low with CTU, while incidental extraurinary abnormalities are often found, the majority of which are not clinically significant. The workup for these incidental findings has significant financial and clinical implications. Primary care physicians, who are most apt to encounter patients with AMH, have a low rate of adherence to the AUA guidelines, possibly as a result of the broadening of criteria for AMH evaluation by the AUA, with resultant uncertainty amongst primary care physicians about the appropriate candidates for such evaluation. Selection of subgroups of patients with risk factors for GU malignancies who may benefit from a complete evaluation is essential, as opposed to evaluation of all patients classified as having AMH.

  20. Evaluation of the patient with asymptomatic microscopic hematuria.

    PubMed

    Ziemba, Justin; Guzzo, Thomas J; Ramchandani, Parvati

    2015-08-01

    Asymptomatic microscopic hematuria (AMH) is relatively common in clinical practice but the etiology remains unclear in the majority of patients; it is rarely related to genitourinary malignancies. The 2012 guidelines of the American Urological Association recommend an evaluation after a single positive urinalysis with mandatory upper tract evaluation in all patients, preferably with CT urography (CTU). The likelihood of detecting significant upper track abnormalities, particularly malignancies is low with CTU, while incidental extraurinary abnormalities are often found, the majority of which are not clinically significant. The workup for these incidental findings has significant financial and clinical implications. Primary care physicians, who are most apt to encounter patients with AMH, have a low rate of adherence to the AUA guidelines, possibly as a result of the broadening of criteria for AMH evaluation by the AUA, with resultant uncertainty amongst primary care physicians about the appropriate candidates for such evaluation. Selection of subgroups of patients with risk factors for GU malignancies who may benefit from a complete evaluation is essential, as opposed to evaluation of all patients classified as having AMH. PMID:26100195

  1. Evaluation of an antipsychotic information sheet for patients.

    PubMed

    Whiskey, Eromona; Taylor, David

    2005-01-01

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

  2. Evaluation of an antipsychotic information sheet for patients.

    PubMed

    Whiskey, Eromona; Taylor, David

    2005-01-01

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

  3. Psychiatric evaluation and psychotherapy in the patient's second language.

    PubMed

    Oquendo, M A

    1996-06-01

    Use of a patient's second language in psychiatric evaluation and treatment has a variety of effects. Patients frequently undergo psychiatric evaluation in their second language, yet competence in a second language varies depending on the phase of illness. Evaluation of bilingual patients should ideally be done in both their languages, preferably by a bilingual clinician or by a monolingual clinician with the help of an interpreter trained in mental health issues. Cultural nuances may be encoded in language in ways that are not readily conveyed in translation, even when the patient uses equivalent words in the second language. The monolingual clinician may clarify these nuances through consultation with a clinician who shares the patient's first language and culture or with an interpreter. In psychotherapy, patients may use a second language as a form of resistance, to avoid intense affect. Therapists may use language switching to overcome this resistance and to decrease emotional intensity, if necessary. Psychotherapy can also be affected by the attitudes toward speaking that are part of the patient's culture. Discussions with bilingual and bicultural consultants can elucidate these effects for the therapist who is unfamiliar with the patient's culture.

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

    PubMed

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

    2015-07-08

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

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

    PubMed

    Taylor, Janelle S

    2011-06-01

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

  6. Development and Evaluation of Simulation-Problem-Based Learning for Sex Education.

    PubMed

    Kim, Miok; Shin, Minho

    2016-01-01

    Nurses often encounter clients with sexual problems. A sexual problem is complicated and affects the quality of the client's life, and proper care requires the nurse to understand a variety of sex-related issues. Therefore, effective sex education for nursing students is necessary to prepare them for potential challenges from the client's sexual problems. In this study, we developed a simulation-problem-based sex education program for nursing students. The program immerses the students in a sex-related clinical situation to train them with nursing assessment, intervention skills, patient safety, patient privacy, and communication skills. To evaluate the effect of the program on the student's sexual knowledge and attitude, we provided the experimental group with simulation-problem-based sex education program along with traditional lectures, whereas the control group received only lectures. As a result, there were statistically significant differences in the improvement of knowledge (P < .05) and attitude (P < .05) of the two groups. The results show that the designed program effectively promotes nursing students' sexual knowledge and sexual attitude, and the simulation-problem-based learning is a practical and systematic approach to the sex education of nursing students.

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

    ERIC Educational Resources Information Center

    Pieper, William J.; And Others

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

  8. Deepening the theoretical foundations of patient simulation as social practice.

    PubMed

    Dieckmann, Peter; Gaba, David; Rall, Marcus

    2007-01-01

    Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffman's concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.

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

    PubMed Central

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-03-01

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

  12. Simulation Evaluation of Equivalent Vision Technologies for Aerospace Operations

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

  13. Simulation evaluation of equivalent vision technologies for aerospace operations

    NASA Astrophysics Data System (ADS)

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

    2009-05-01

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

  14. Evaluation of serum ceruloplasmin in aggressive and chronic periodontitis patients

    PubMed Central

    Harshavardhana, B.; Rath, S. K.; Mukherjee, Manish

    2013-01-01

    Background: Pro-inflammatory markers are seen to increase in inflammatory diseases like periodontitis. Detecting an increase in these markers is one of the diagnostic modality. One such marker, which can be detected, is the ceruloplasmin. Ceruloplasmin induces hypoxia and generates oxygen radicals at the site of aggressive periodontitis. It also causes a state of hypoferremia leading to increase in the natural resistance of the body. The aim of this study was to evaluate the serum levels of cerruloplasmin in both aggressive and chronic periodontitis patients. Materials and Methods: Blood samples were collected from aggressive periodontitis patients (n = 20), chronic periodontitis patients (n = 20) and periodontally healthy patients (n = 20). The serum was extracted from all the blood samples and ceruloplasmin levels were spectroscopically evaluated through a new kinetic method, which used a norfloxacin based reagent. Results: Serum ceruloplasmin levels were found to be significantly higher in aggressive periodontitis patients (P > 0.05) than in chronic periodontitis patients (P > 0.05) even though increase in the level of ceruloplasmin was found in chronic periodontitis. Periodontally healthy patients did not show increase in the levels of serum ceruloplasmin. The levels of serum ceruloplasmin also increased with the disease severity whose manifestations were increased bleeding on probing, increased pocket depth and increased attachment loss. Conclusion: Serum ceruloplasmin levels increased in both aggressive and chronic periodontitis patients, but more in aggressive periodontitis patients making it a potential marker for diagnosis of periodontitis. PMID:24049334

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-04-01

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

  18. Evaluation of 100 patients for living donor liver transplantation.

    PubMed

    Trotter, J F; Wachs, M; Trouillot, T; Steinberg, T; Bak, T; Everson, G T; Kam, I

    2000-05-01

    The initial success of living donor liver transplantation (LDLT) in the United States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of suitable donors. We report the outcome of our evaluation of the first 100 potential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO). All patients considered for LDLT had first been approved for conventional liver transplantation by the Liver Transplant Selection Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B. Once listed, those patients deemed suitable for LDLT were given the option to consider LDLT and approach potential donors. Donors were evaluated with a preliminary screening questionnaire, followed by formal evaluation. Of the 100 potential transplant recipients evaluated, 51 were initially rejected based on recipient characteristics that included imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psychosocial, or surgical problems (33 patients). Of the remaining 49 patients, considered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the remaining 25 potential transplant recipients. Eleven donors were rejected: 9 donors for medical reasons and 2 donors who refused donation after being medically approved. The remaining 15 donor-recipient pairs underwent LDLT. Using our criteria for the selection of recipients and donors for LDLT gave the following results: (1) 51 of 100 potential transplant recipients (51%) were rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor

  19. Simulator Evaluation of a New Cockpit Descent Procedure

    NASA Technical Reports Server (NTRS)

    Crane, Barry; Palmer, Everett; Smith, Nancy; Rosekind, Mark (Technical Monitor)

    1996-01-01

    An experiment was conducted to evaluate flight crew performance of the "Precision Descent," a new cockpit procedure designed to support the Descent Advisor (DA), one of the components in a new air traffic control advisory system called the "Center-TRACON Automation System" (CTAS). The DA predicts when aircraft will reach a specific waypoint on the arrival route, and presents controllers with clearance advisories designed to improve the sequencing of arriving aircraft. The effectiveness of the DA depends on the aircraft's descent trajectory: where it begins descent, what speed it maintains, how fast and at what altitude it crosses the bottom-of-descent waypoint. The Precision Descent allows controllers to assign these descent parameters to the flight crew. A Field Evaluation of the DA was conducted in Denver in 1995. Three separate clearances using standard ATC phraseology were used to support the cockpit descent procedure during this evaluation. The number and length of these clearances caused problems for both controllers and flight crews, causing readback errors, repeat requests and procedure misunderstandings. These observations led to a focus group meeting in which controller and pilot participants in the 1995 FE assisted in the redesign of the procedure. The Precision Descent eliminates one clearance used in the earlier study, and greatly reduces the length of the remaining clearances. This was accomplished by using non-standard clearance phraseology that relies on a published procedure chart for correct interpretation. Eight type-rated flight crews flew eight Precision Descents in a Boeing 747-400 simulator. No training was provided: crews received either a procedure chart or a procedure chart with a flight manual bulletin describing procedure techniques. Video and digital data were recorded for each descent. Preliminary results indicate that moving information from the verbal clearance to the chart was successful: the shorter clearances and the procedure

  20. Evaluation of autonomic functions in subclinical hypothyroid and hypothyroid patients

    PubMed Central

    Mahajan, Aarti S.; Lal, Ram; Dhanwal, Dinesh K.; Jain, Ajay K.; Chowdhury, Veena

    2013-01-01

    Background: Autonomic dysfunction may contribute to cardiovascular morbidity in subclinical hypothyroid patients. It is controversial whether the abnormality exists in sympathetic or the parasympathetic function. It is also not known whether the severity of autonomic dysfunction is related to the degree of thyroid deficiency. Design of Study: Prospective case control. Materials and Methods: Autonomic functions based on heart rate (HR) and blood pressure (BP) responses to various maneuvers were evaluated and scored in twenty two subclinical hypothyroid patients, 30-50 years and compared with twenty hypothyroid patients. Biochemical estimation of TSH, fT3, fT4, TPO antibody was done. Result: Sympathetic function abnormalities were seen in 82% subclinical hypothyroid patients and 85%hypothyroid patients when one test was abnormal. Parasympathetic dysfunction was also recorded in eight patients in both groups. When two abnormal tests were used as the selection criteria sympathetic function abnormality was observed in about 41% subclinical hypothyroid and 65% hypothyroid patients. There were no intergroup differences in autonomic functions, score and TPO levels. The TSH levels were not related to type or degree of autonomic dysfunction. Systolic BP in both groups and diastolic BP in hypothyroid patients were higher with lower thyroxine levels but the patients were normotensive. Conclusion: Autonomic dysfunction of comparable degree was seen in subclinical hypothyroid and hypothyroid patients. Sympathetic function abnormality was more common although decreased parasympathetic function reactivity was also present. These abnormalities were unrelated to TSH levels. PMID:23869303

  1. Virtual Patient Simulations for Medical Education: Increasing Clinical Reasoning Skills through Deliberate Practice

    ERIC Educational Resources Information Center

    McCoy, Lise

    2014-01-01

    Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement. Many studies indicate that VPS provide medical students with essential practice in clinical decision…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  3. A walking support/evaluation machine for patients with parkinsonism.

    PubMed

    Kai, Yoshihiro; Tanioka, Tetsuya; Inoue, Yoshio; Matsuda, Takuya; Sugawara, Kenichi; Takasaka, Youichiro; Nagamine, Isao

    2004-02-01

    Various walk supporting systems have been devised and developed. However, they have not been designed for supporting or evaluating the gait of parkinsonian patients, and not much consideration has been given to gait disturbances of parkinsonian patients. In this study: (a) We prepared a tentative model of walk supporting and monitoring system in consideration of typical symptoms of parkinsonism. (b) We conducted gait rehabilitation in a parkinsonian patient using the walk supporting and monitoring system and confirmed (i) the occurrence of frozen gait during walking, (ii) brachybasia, (iii) the absence of anterior tilting of the posture, pulsion symptom, and festination, and (iv) occurrence of hesitation to start walking. Therefore, typical symptoms of parkinsonism can be detected by the use of this system. (c) The medical staff can evaluate the state of recovery of patients on the basis of the data obtained from this system and use them for purposes such as guidance of rehabilitation.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2011-03-01

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

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

    PubMed

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

    2011-03-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  8. [Echocardiography for the evaluation of patients with heart failure].

    PubMed

    Mele, Donato

    2016-01-01

    Echocardiography is the most widely used technique for evaluating patients with heart failure owing to its widespread use, non-invasiveness and ability to provide diagnostic, functional, hemodynamic and prognostic information. However, echocardiography is not always used appropriately as regards both clinical indications to the examination and the information gathered in the course of the examination itself. This can lead to repeated, unnecessary or unhelpful echocardiographic evaluations, that is, non-optimal consumption of available resources. The purpose of this article is to describe how to use echocardiography appropriately for assessing patients with heart failure, and to highlight the advantages and limitations of this technique. PMID:26901256

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

    PubMed

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

    2015-08-01

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

  10. Endoscopic Evaluation and Management of the Postoperative Crohn's Disease Patient.

    PubMed

    Hashash, Jana G; Binion, David G

    2016-10-01

    Approximately 70% of patients with Crohn's disease (CD) undergo surgical resection for the treatment of medically refractory disease or its complications. The sickest cohort of CD patients experience rapid postoperative relapse at the anastomotic site. Over the past 2 decades, the types of surgical anastomoses used in CD reconstruction have changed; end-to-side and end-to-end anastomoses have been surpassed by the more rapidly created side-to-side anastomoses. This article provides a review of the timing and purpose of endoscopic evaluation in postoperative CD patients and pragmatic information regarding interpretation of endoscopic findings at the different types of surgical anastomoses after ileocecal resection. PMID:27633596

  11. 77 FR 50548 - Agency Information Collection: (PACT Qualitative Evaluation: Patient & Caregiver Interviews...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... needed to evaluate the universal Patient Aligned Care Teams (PACT) Systems Redesign, document patients... information on patient characteristics and their experiences with self-managing chronic conditions,...

  12. 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.

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

    PubMed

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

    2016-03-01

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

  14. [Medicinal plants in cancer patients: current practices and evaluation data].

    PubMed

    Huet, Matthieu

    2013-05-01

    Many complementary and alternatives medicines are offered to patients with cancer. Among them, herbal medicines have a substantial place. These plants are mainly used to reduce adverse effects of anticancer treatments and for specific anticancer properties. Our review shows that only few clinical data support medicinal plants effectiveness in cancer patients. Arguments rely mainly on usual indications and pharmacological data for minimization of treatments toxicity while for the anticancer properties, on epidemiological and preclinical data. To inform and counsel patients and people around, healthcare professionals need to evaluate benefit-risk balance on evidence-based information. Because the medical decision should be shared with the patient, his beliefs and preferences have to be considered. When no adverse effect or drug interaction is associated with herbal medicine, we state that their use is acceptable. This paper discuss of potential risk and benefit of the most used medicinal plants by cancer patients.

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

    PubMed

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

    2016-08-01

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

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

    PubMed

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

    2016-08-01

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

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

    PubMed

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

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

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

    PubMed

    Evans, Cecile B; Mixon, Diana K

    2015-12-01

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

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

    SciTech Connect

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

    1986-07-01

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

  20. Evaluating the Effectiveness of Information Retrieval Systems Using Simulated Queries.

    ERIC Educational Resources Information Center

    Gordon, Michael D.

    1990-01-01

    Describes a simulation method for estimating recall and fallout in a document retrieval system. Earlier research on simulating document retrieval systems is reviewed, examples are presented of the current method, a probabilistic justification of the method is given, theoretical concerns dealing with retrieval precision are discussed, and further…

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

    ERIC Educational Resources Information Center

    Garson, G. David

    2009-01-01

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

  2. Evaluating the care of patients with long term conditions

    PubMed Central

    Ahluwalia, Sanjiv

    2014-01-01

    Approaches to evaluating the care of patients with long-term conditions first need to be framed around defining outcomes that ‘matter to people’, rather than those that are focused on disease and easily measurable. Secondly, approaches to evaluating such care should be organised with the ability to ‘deliver what matters to people’ – such models of care must allow for the opportunity to maximise the impact of primary care. Finally, any approach to evaluation must also ‘enable the delivery of what matters to people’, including approaches to promote self-care, well-being and interprofessional workforce development organised around educational networks. PMID:25949734

  3. Initial Evaluation of the Patient with Suspected Epilepsy.

    PubMed

    Jetté, Nathalie; Wiebe, Samuel

    2016-05-01

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

  4. Evaluation and management of a patient with multiple drug allergies.

    PubMed

    Blumenthal, Kimberly G; Saff, Rebecca R; Banerji, Aleena

    2014-01-01

    Multiple drug allergy syndrome (MDAS) is a clinical diagnosis made in patients with adverse reactions to two or more structurally unrelated drugs with an underlying immune-mediated mechanism causing the reaction. The evaluation of a patient with MDAS begins with a comprehensive drug allergy history and consideration of the underlying immune mechanism for each reaction. Skin testing is a useful diagnostic tool; however, the only validated immediate hypersensitivity skin testing is for penicillin where the antigenic determinants have been identified. Skin testing to most other drugs, although not validated, can be considered using a nonirritating concentration (NIC). In general, skin test positivity using an NIC suggests that the drug should be avoided, but a negative result does not rule out an IgE-mediated allergy. A test dose, also called a drug provocation test, graded oral challenge, or incremental challenge, should be performed when there is a low likelihood of an IgE-mediated mechanism for the reaction. In patients with a recent IgE-mediated hypersensitivity reaction or positive skin testing with no reasonable alternative treatment options, desensitization protocols can be used to allow the patient to safely receive a necessary drug. The evaluation of patients with MDAS is both challenging and time-consuming for the practicing allergist, who must systematically evaluate each reaction to help determine which drugs can be safely used again in the future. The molecular mechanisms and risk factors for this condition remain poorly understood, but research to further understand this condition is ongoing.

  5. Simulation approach for the evaluation of tracking accuracy in radiotherapy: a preliminary study.

    PubMed

    Tanaka, Rie; Ichikawa, Katsuhiro; Mori, Shinichiro; Sanada, Sigeru

    2013-01-01

    Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). It is important to keep the patient dose as low as possible while maintaining tracking accuracy. A simulation approach would be helpful to optimize the imaging conditions. This study was performed to develop a computer simulation platform based on a noise property of the imaging system for the evaluation of tracking accuracy at any noise level. Flat-field images were obtained using a direct-type dynamic FPD, and noise power spectrum (NPS) analysis was performed. The relationship between incident quantum number and pixel value was addressed, and a conversion function was created. The pixel values were converted into a map of quantum number using the conversion function, and the map was then input into the random number generator to simulate image noise. Simulation images were provided at different noise levels by changing the incident quantum numbers. Subsequently, an implanted marker was tracked automatically and the maximum tracking errors were calculated at different noise levels. The results indicated that the maximum tracking error increased with decreasing incident quantum number in flat-field images with an implanted marker. In addition, the range of errors increased with decreasing incident quantum number. The present method could be used to determine the relationship between image noise and tracking accuracy. The results indicated that the simulation approach would aid in determining exposure dose conditions according to the necessary tracking accuracy. PMID:22843379

  6. Evaluating Functional Decline in Patients with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Rosenblum, Sara; Weiss, Patrice L.

    2010-01-01

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

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

    PubMed Central

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

    1998-01-01

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

  8. Evaluation of Ocular Movements in Patients with Dyslexia

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  11. Total mass attenuation coefficient evaluation of ten materials commonly used to simulate human tissue

    NASA Astrophysics Data System (ADS)

    Ferreira, C. C.; Ximenes, R. E.; Garcia, C. A. B.; Vieira, J. W.; Maia, A. F.

    2010-11-01

    To study the doses received by patient submitted to ionizing radiation, several materials are used to simulate the human tissue and organs. The total mass attenuation coefficient is a reasonable way for evaluating the usage in dosimetry of these materials. The total mass attenuation coefficient is determined by photon energy and constituent elements of the material. Currently, the human phantoms are composed by a unique material that presents characteristics similar to the mean proprieties of the different tissues within the region. Therefore, the phantoms are usually homogeneous and filled with a material similar to soft tissue. We studied ten materials used as soft tissue-simulating. These materials were named: bolus, nylon®, orange articulation wax, red articulation wax, PMMA, modelling clay, bee wax, paraffin 1, paraffin 2 and pitch. The objective of this study was to verify the best material to simulate the human cerebral tissue. We determined the elementary composition, mass density and, therefore, calculated the total mass attenuation coefficient of each material. The results were compared to the values established by the International Commission on Radiation Units and Measurements - ICRU, report n° 44, and by the International Commission on Radiation Protection - ICRP, report n° 89, to determine the best material for this energy interval. These results indicate that new head phantoms can be constructed with nylon®.

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    PubMed

    Dunnington, Renee M

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Abrams, Macy L.; And Others

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

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

    PubMed Central

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

    2011-01-01

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

  16. 3D Immersive Patient Simulators and Their Impact on Learning Success: A Thematic Review

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Morra, Linda G.

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

  18. [Preoperative evaluation, management and outcome in the elderly patient].

    PubMed

    Ueki, Masaaki; Maekawa, Nobuhiro

    2010-09-01

    Two principles should be kept in mind when performing preoperative evaluation of the elderly patient. First, we should suspect the disease processes commonly associated with aging. Second, we should assess the degree of functional reserve of specific, pertinent organ systems. Preoperative risk assessment is focused on detailed review from anamnesis and physical examination together with the assessment of functional status. Especially, it is important to examine the cardiovascular and respiratory functions in the elderly patient. Further, this also includes assessment of consumed drugs, physiological function, cognitive function, competency, availability of social support, and sign of depression. Surgical risk and outcome in the elderly patient depend primarily on four factors: age, the patient's physiological status and coexisting disease, whether the surgery is elective or urgent, and the type of procedures.

  19. Evaluation of patient wristbands and patient identification process in a training hospital in Turkey.

    PubMed

    Cengiz, Canan; Celik, Yusuf; Hikmet, Neset

    2016-10-10

    Purpose The purpose of this paper is to evaluate the utilisation of patient wristbands (PWs) and patient identification (PI) process in a training hospital in Ankara, Turkey. Design/methodology/approach This descriptive and cross-sectional study was conducted in a training hospital with 640 beds, accreditied by Joint Commission International. The views of 348 patients and 419 hospital personnel on the implementation of patient wristbands and identification process were evaluated. Findings The results indicated that lack of information among patients about the importance of PWs and the misknowledge among staff participants on when, where, and by whom PWs should be put on and verified were the weakest points in this hospital. Research limitations/implications PI process must be strictly implemented according to the standard procedures of patient safety. Both patients and hospital personnel should be trained continuously, and training sessions must be held to increase their awareness about the importance of PWs and identification process. Practical implications Finding new ways and using new methods for increasing knowledge about PI and PWs are necessary. Hospital management should prepare a written PI and PW policy and procedure documents by taking the views of patients and hospital personnel and share these with them. Originality/value This study incorporates the views and attitudes of patients and health care personnel in improving health care quality by increasing awareness about PI and wristbands. PMID:27671418

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

    PubMed

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

    2013-05-01

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

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

    PubMed

    Ayyildiz, Simel; Emir, Faruk; Sahin, Cem

    2015-01-01

    Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient's main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm(2), three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm(2)) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods. PMID:26587294

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

    PubMed Central

    Ayyildiz, Simel; Emir, Faruk; Sahin, Cem

    2015-01-01

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

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

    SciTech Connect

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

    2012-12-15

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

  4. Importance of realistic LVAD profiles for assisted aortic simulations: evaluation of optimal outflow anastomosis locations.

    PubMed

    Brown, Alistair Graham; Shi, Yubing; Arndt, Andreas; Müller, Jörg; Lawford, Patricia; Hose, David Rodney

    2012-01-01

    Left ventricular assist devices (LVADs) are carefully designed, but the significance of the implantation configuration and interaction with the vasculature is complex and not fully determined. The present study employs computational fluid dynamics to investigate the importance of applying a realistic LVAD profile when evaluating assisted aortic flow fields and subsequently compares a number of potential anastomosis locations in a patient-specific aortic geometry. The outflow profile of the Berlin Heart INCOR® device was provided by Berlin Heart GmbH (Berlin, Germany) and the cannula was attached at a number of locations on the aorta. Simulations were conducted to compare a flat profile against the real LVAD profile. The results illustrate the importance of applying an LVAD profile. It not only affects the magnitude and distribution of oscillatory shear index, but also the distribution of flow to the great arteries. The ascending aorta was identified as the optimal location for the anastomosis.

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

    PubMed Central

    Eftekharsadat, Bina; Habibzadeh, Afshin; Kolahi, Babak

    2015-01-01

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

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

    PubMed

    Hartl, Alexander; Yaniv, Ziv

    2009-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Humphries, W. R.

    1978-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

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

  9. Meeting the needs of new ostomists: a patient evaluation survey.

    PubMed

    Edis, Helena

    Nottingham University Hospitals (NUH) NHS Trust provides a care pathway for patients undergoing stoma formation surgery, with the stoma care nurse specialists providing ongoing support for patients, alongside the rest of the multidisciplinary team, from the preoperative consultation through to their community follow-up. In the past, the community service offered has not always been well-received and the whole pathway has not been evaluated in depth to date. This article reports on a patient evaluation survey of the stoma care pathway at NUH. The results showed that overall patients are very complimentary of the service offered to them by the stoma care team. They highly commend the stoma care nurse specialist. Two areas for amendment in the pathway have been identified: information provision and the length of time available for the stoma care nurse specialist to spend one-to-one with each patient. The results of this survey will aid the team in implementing positive changes to the stoma care pathway. PMID:26419818

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

    SciTech Connect

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

    2014-06-01

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

  11. Evaluation of renal function in patients with psoriasis using immunobiologicals*

    PubMed Central

    Melgaço, Sarah Suyanne Carvalho; da Silva, Geraldo Bezerra; Dantas, Amanda Maria Menezes; Vasconcelos, Ana Mirella Arcanjo; de Siqueira, Verônica Riquet; Vieira, Ana Patrícia Freitas; Daher, Elizabeth de Francesco

    2013-01-01

    The aim of this study was to evaluate renal function in patients with psoriasis using immunobiologicals. A prospective study was conducted with 15 patients with confirmed diagnosis of psoriasis who were starting to use immunobiologicals. The mean age was 41±11 years, with 60% females. The mean time of disease was 11±6.6 years. Significant changes in creatinine and creatinine clearance were not observed in the course of the study. There was an increase in transaminases and a decrease in magnesium levels. PMID:24068151

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  13. Evaluation of surgical training in the era of simulation

    PubMed Central

    Shaharan, Shazrinizam; Neary, Paul

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2014-01-01

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

  16. Economic evaluation of end stage renal disease patients undergoing hemodialysis

    PubMed Central

    Suja, A.; Anju, R.; Anju, V.; Neethu, J.; Peeyush, P.; Saraswathy, R.

    2012-01-01

    Background: In India the incidence of end stage renal disease (ESRD) is increasing day by day and the option for the treatment of ESRD is dialysis or transplantation. In the present scenario, due to the cost of treatment normal people can afford only hemodialysis rather than transplantation. Since the cost of hemodialysis differs across the country, research is needed to evaluate its exact cost. Aim: This study is to analyze the healthcare cost of hemodialysis in a private hospital of South India. Materials and Methods: This is a prospective, observational study carried out in a tertiary care hospital. Patients who are undergoing routine hemodialysis in this hospital were selected for the study. Patient data as well as cost details were collected for a period of six months. Thirty patients were selected for the study and a total of 2160 dialysis sessions were studied. Patient perspective was taken for the analysis of cost. Both direct and indirect costs were analyzed. This includes cost of dialysis, investigations, erythropoietin, food, transportation, lost wages etc. Socioeconomic status of the patient was also studied. Result: The total cost per session was found to be around Rs. 4500. Fifty six percent contributes direct medical cost whereas 20% contributes direct non medical cost. Twenty four percent cost was due to indirect costs. Since the patients are paying from their own pocket, only the upper or upper middle class patient can undergo hemodialysis regularly. Conclusion: These findings are important to find out the impact of cost of hemodialysis on patients suffering from ESRD. Further studies related to costs and outcome, otherwise known as pharmacoeconomic studies, are needed to analyze the pros and cons of renal replacement therapy and to improve the quality of life of ESRD patients. Thus pharmacoeconomical studies are needed to realize that government has to take initiative to provide insurance or reimbursement for the common people. PMID:22557920

  17. Characterization and Evaluation of Lunar Regolith and Simulants

    NASA Technical Reports Server (NTRS)

    Cross, William M.; Murphy, Gloria A.

    2010-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    McPherson, Christine J; Addington-Hall, Julia M

    2004-08-01

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

  20. Preoperative evaluation of the body contouring patient: the cornerstone of patient safety.

    PubMed

    Naghshineh, Nima; Rubin, J Peter

    2014-10-01

    The obesity pandemic has resulted in increasing cases of bariatric surgery and subsequent issues related to excess skin and laxity for patients. This patient population requires unique insight and consideration as part of the preoperative evaluation. Nutritional derangements are common, psychosocial issues are prevalent, and the sequelae of past and present medical conditions can all affect surgical planning and outcomes. This article familiarizes the plastic surgeon with the issues of the body contouring candidate and provides tools that may assist in surgical planning.

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

    ERIC Educational Resources Information Center

    Evens, Susan; Curtis, Peter

    1983-01-01

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

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

    EPA Science Inventory

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

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

    PubMed

    Vlahovic, Tracey C

    2016-07-01

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

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

    SciTech Connect

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

    2014-08-11

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

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

    ERIC Educational Resources Information Center

    McEneaney, John E.

    2016-01-01

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

  6. Radiological (scintigraphic) evaluation of patients with suspected pulmonar thromboembolism

    SciTech Connect

    Biello, D.R.

    1987-06-19

    The optimal strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism (PE) is subject of controversial and often conflicting opinions. If untreated, as many as 30% of patients with PE may die. Conversely, anticoagulant therapy significantly decreases mortality from PE, but bleeding complications occur. Underdiagnosis may result in a preventable death, and overdiagnosis may lead to significant hemorrhage from unnecessary anticoagulant therapy. This article outlines a practical guide for the use of pulmonary ventilation-perfusion (V-P) scintigraphy in patients with suspected PE. Perfusion imaging involves the intravenous injection of radiolabeled particles ranging from 10 to 60 ..mu..m in diameter (technetium Tc 99m macroaggregated albumin or technetium Tc 99m serum albumin microspheres); these particles are trapped in the capillaries and precapillary arterioles of the lung. The radiolabeled particles are distributed to the lungs in proportion to regional pulmonary blood flow. The correspondence of perfusion defects to bronchopulmonary segments is best appreciated in the posterior oblique views.

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

    SciTech Connect

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

    2014-05-15

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

  8. Evaluation of hearing deficit in patients with oral submucous fibrosis.

    PubMed

    Devi, Parvathi; Singh, Ipsa; Setru, Ravindra; Tyagi, Kuber; Singh, Dharamveer; Thiyam, Bellona

    2015-06-01

    Oral submucous fibrosis (OSMF) is a well recognized premalignant condition predominantly affecting the oral cavity, but sometimes extending to the pharynx, esophagus or even the larynx. OSMF may lead to stiffness of the oral cavity, resulting in trismus and inability to eat, difficulty with speech or swallowing, pain in the throat and ears, and a relative loss of auditory acuity. To evaluate the hearing deficit in patients with OSMF, we examined a study group comprising 40 patients, and also 10 age- and sex-matched healthy subjects as controls. All of the subjects were evaluated for hearing loss by pure tone audiometry. The OSMF group showed a significant degree of hearing loss relative to the control group. OSMF in advanced stages was significantly associated with mild conductive hearing loss (P < 0.01). The present study revealed a significant association between OSMF and hearing deficit. Involvement of the palatal muscles with OSMF may decrease the patency of the Eustachian tube, leading to conductive hearing loss. Therefore, all patients with OSMF should be evaluated for hearing deficit and advised about appropriate treatment. PMID:26062859

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

    PubMed

    Hardoff, D; Benita, S; Ziv, A

    2008-03-01

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

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

    PubMed

    Hardoff, D; Benita, S; Ziv, A

    2008-03-01

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

  11. Evaluation of tracheal cuff pressure variation in spontaneously breathing patients

    PubMed Central

    Plotnikow, Gustavo A; Roux, Nicolas; Feld, Viviana; Gogniat, Emiliano; Villalba, Dario; Ribero, Noelia Vairo; Sartore, Marisa; Bosso, Mauro; Quiroga, Corina; Leiva, Valeria; Scrigna, Mariana; Puchulu, Facundo; Distéfano, Eduardo; Scapellato, Jose Luis; Intile, Dante; Planells, Fernando; Noval, Diego; Buñirigo, Pablo; Jofré, Ricardo; Nielsen, Ernesto Díaz

    2013-01-01

    Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently. PMID:24459624

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

    ERIC Educational Resources Information Center

    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

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

  13. 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…

  14. Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities

    PubMed Central

    Schonder, Kristine S.; Pater, Karen S.; McGivney, Melissa S.; Meyer, Susan M.

    2016-01-01

    Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students. PMID:27667842

  15. Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities.

    PubMed

    Hall, Deanne L; Schonder, Kristine S; Pater, Karen S; McGivney, Melissa S; Meyer, Susan M

    2016-08-25

    Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students. PMID:27667842

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

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

    PubMed Central

    Martins, E N; Morse, L S

    2005-01-01

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

  18. Evaluation of an F100 multivariable control using a real-time engine simulation

    NASA Technical Reports Server (NTRS)

    Szuch, J. R.; Skira, C.; Soeder, J. F.

    1977-01-01

    A multivariable control design for the F100 turbofan engine was evaluated, as part of the F100 multivariable control synthesis (MVCS) program. The evaluation utilized a real-time, hybrid computer simulation of the engine and a digital computer implementation of the control. Significant results of the evaluation are presented and recommendations concerning future engine testing of the control are made.

  19. Evaluating the impact of a service fee on patient compliance.

    PubMed

    Wesch, D; Lutzker, J R; Frisch, L; Dillon, M M

    1987-02-01

    This paper addresses an evaluation of an administrative decision to change the manner in which services were paid for at a Student Health Center (SHC). The impact of the change in payment was observed through monitoring the number of scheduled appointments at the SHC which the patient failed to attend, reschedule, or cancel. The impact was assessed through a comparison of the weekly no-show rates from the year prior to the change in payment practices through the year following the change. A time-series statistical package was used to analyze the no-show data. Collateral measures on the number of students attending the university, staff opinions, and usage of the SHC by different student groups were collected. Evaluations of the impact of administrative decisions on health related behavior were discussed, in addition to a discussion of the usefulness of time-series models for this type of evaluation.

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

    PubMed

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

    2012-01-01

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

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

    SciTech Connect

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

    2015-04-24

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

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

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

  4. Patient Entry of Information: Evaluation of User Interfaces

    PubMed Central

    Johnson, Kevin B

    2004-01-01

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

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

    PubMed

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

    2016-04-01

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

  6. Motor Simulation during Action Word Processing in Neurosurgical Patients

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  7. Evaluation of nickel flash smelting through piloting and simulation

    SciTech Connect

    Varnas, S.R.; Koh, P.T.L.; Kemori, N.

    1998-12-01

    An extensive study of the nickel flash smelting process has been undertaken. It is aimed at the optimization of the burner design to improve the smelting performance and to increase the throughput of the rebuilt furnace. A design-based mathematical model was developed to simulate the operation of the four burners and the reaction shaft of the flash furnace at Western Mining Corporation Ltd.`s Kalgoorlie Nickel Smelter. A modified single burner version of the model was validated against data obtained from the pilot plant at the Pyrometallurgical Research Centre (PRC) of the Sumitomo Metal Mining Co.`s Toyo Smelter. The approach taken involved experimental measurements of key process parameters in the pilot plant and detailed numerical simulation of the fluid flow, heat transfer, and combustion in the entire burner-shaft complex. Several burner designs have been tested experimentally at the pilot plant and theoretically through computer simulation. The main outcome of the study was the development of an experimentally validated mathematical model of the flash smelter providing a new powerful design tool. The insight gained about the process from the application of this tool led to the design of a more efficient nickel flash smelting process.

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2006-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

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

    SciTech Connect

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

    2013-01-01

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

  12. Computer Technology Enables Georgetown U. Medical Students to Simulate Dialogue with Patients.

    ERIC Educational Resources Information Center

    Wilson, David L.

    1991-01-01

    A combination of computer, videodisk, and voice-recognition technology lets Georgetown University medical students ask questions of an electronic "patient" who appears on a television monitor and appears to respond. Students can order laboratory tests and study patient behavior inside and outside the hospital. Simulations use actors or actual…

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

    ERIC Educational Resources Information Center

    Hussin, Virginia

    2013-01-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Smith, Brian Daniel; Silk, Kami

    2011-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2008-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2004-08-01

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

  20. Simulation of synthetic aperture radar 3: Evaluation of prototype digital feature analysis data

    NASA Astrophysics Data System (ADS)

    Crane, Peter M.; Bell, Herbert H.

    1989-12-01

    This experiment evaluated the suitability of the Defense Mapping Agency (DMA) prototype Level 3c Digital Feature Analysis Data (DFAD) for the simulation of Synthetic Aperture Radar (SAR). The suitability of Prototype Level 3c DFAD was evaluated by comparing simulations generated from samples of Level 3c and from samples of DFAD previously demonstrated to be adequate for SAR simulation; these products, however, were unsuitable for production in the quantities required to meet Air Force needs. B-1B Offensive Systems Officers performed a navigation update task using simulated and actual SAR images. Crosshair placement accuracy, operator confidence in the placement, and ratings of acceptability for use in a Weapon System Trainer were recorded using both simulated and actual SAR images. The results indicated that SAR simulation can be supported as well by Level 3c DFAD as by the other products.

  1. Stimulation of a turbofan engine for evaluation of multivariable optimal control concepts. [(computerized simulation)

    NASA Technical Reports Server (NTRS)

    Seldner, K.

    1976-01-01

    The development of control systems for jet engines requires a real-time computer simulation. The simulation provides an effective tool for evaluating control concepts and problem areas prior to actual engine testing. The development and use of a real-time simulation of the Pratt and Whitney F100-PW100 turbofan engine is described. The simulation was used in a multi-variable optimal controls research program using linear quadratic regulator theory. The simulation is used to generate linear engine models at selected operating points and evaluate the control algorithm. To reduce the complexity of the design, it is desirable to reduce the order of the linear model. A technique to reduce the order of the model; is discussed. Selected results between high and low order models are compared. The LQR control algorithms can be programmed on digital computer. This computer will control the engine simulation over the desired flight envelope.

  2. Global Body Posture Evaluation in Patients with Temporomandibular Joint Disorder

    PubMed Central

    Saito, Eliza Tiemi; Akashi, Paula Marie Hanai; de Camargo Neves Sacco, Isabel

    2009-01-01

    AIM: To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified. INTRODUCTION: Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint. METHODS : Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview. RESULTS: Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups. CONCLUSION: Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder. PMID:19142549

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

    SciTech Connect

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

    2009-11-18

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

  4. Simulation and evaluation of latent heat thermal energy storage

    NASA Technical Reports Server (NTRS)

    Sigmon, T. W.

    1980-01-01

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

  5. The effect of unit-based simulation on nurses' identification of deteriorating patients.

    PubMed

    Disher, Jocelyn; Burgum, Angela; Desai, Anisha; Fallon, Cynthia; Hart, Patricia L; Aduddell, Kathie

    2014-01-01

    Patients are admitted to healthcare organizations with multiple, complex conditions that can lead to acute deterioration events. It is imperative that nurses are adequately trained to recognize and respond appropriately to these events to ensure positive patient outcomes. The purpose of this pilot research study was to examine the effects of a unit-based, high-fidelity simulation initiative on cardiovascular step-down unit registered nurses' identification and management of deteriorating patients.

  6. Short- and long-term transfer of urethral catheterization skills from simulation training to performance on patients

    PubMed Central

    2013-01-01

    Background Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC simulated skills training on performance on real patients and to examine whether watching a video of the procedure immediately before assessment enhanced clinical performance. Methods This was an experimental study of the effect of a UC simulation-based skills course on medical students’ short-term (after one week) and long-term (after six weeks) performance. The additional effect of video instruction before performance testing on real patients was studied in a randomized trial. Sixty-four students participated in the study, which was preceded by a pilot study investigating the validity aspects of a UC assessment form. Results The pilot study demonstrated sufficient inter-rater reliability, intra-class correlation coefficient 0.86, and a significant ability to discriminate between trainee performances when using the assessment form, p= 0.001. In the main study, more than 90% of students demonstrated an acceptable performance or better when tested on real patients. There was no significant difference in the total score between the one-week and the six-week groups when tested on real patients and no significant difference between the video and the control groups. Conclusions Medical students demonstrated good transfer of UC skills learned in the skills lab to real clinical situations up to six weeks after training. Simulated UC training should be the standard for all medical school curricula to reduce avoidable complications. However, this study did not demonstrate that an instructional video, as a supplement to simulated skills training, improved clinical UC performance. Trial registration Current Controlled Trials ISRCTN:ISRCTN90745002 PMID:23433258

  7. The history of invasive EEG evaluation in epilepsy patients.

    PubMed

    Reif, Philipp S; Strzelczyk, Adam; Rosenow, Felix

    2016-10-01

    Modern invasive EEG recording techniques are the result of an interdisciplinary research process between neurologists and neurosurgeons that began in the 19th century. In the beginning, stimulation studies were the basis of our understanding of cortical functions. After the introduction of EEG in humans by Hans Berger and its implementation in diagnostic procedures in epilepsy patients, a new era began when Forster and Altenburger performed the first invasive EEG recording five years later. The fruitful work of Wilder Penfield and Herbert Jasper was the basis of a new understanding of epilepsy and influenced the investigations of the next generation of researchers. The development of stereotactic devices advanced by Jean Talairach and Jean Bancaud was fundamental to the understanding of deep brain functions and pathophysiological processes in epilepsy patients. In subsequent decades, new recording techniques were established and long-term video-EEG-recordings became the gold standard in presurgical evaluation. The development of imaging techniques allowed a combination of structural and electrophysiological data and restricted the indications for invasive evaluations, but also led to new concepts in the diagnostic process, including the epileptogenic network and the pathophysiological understanding of epileptogenic tissue. The following article provides an overview of the history of invasive EEG evaluation in epilepsy from the 19th century until today. PMID:27131772

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

    PubMed

    Staniszewska, M A

    2002-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Mason, M. G.

    1975-01-01

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

  10. An Evaluation of the Bootstrap Hypothesis Using Computer Simulation.

    ERIC Educational Resources Information Center

    Tryon, Warren W.

    A normally distributed data set of 1,000 values--ranging from 50 to 150, with a mean of 50 and a standard deviation of 20--was created in order to evaluate the bootstrap method of repeated random sampling. Nine bootstrap samples of N=10 and nine more bootstrap samples of N=25 were randomly selected. One thousand random samples were selected from…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

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

    PubMed

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

    2012-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  15. Evaluation method of motorcycle fatigue strength using road simulator

    SciTech Connect

    Harashima, Shokichi

    1995-12-31

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

  16. Evaluation of Ceramic Foams and Simulated Reentry Environments

    NASA Technical Reports Server (NTRS)

    Stackpoole, Mairead

    2003-01-01

    NASA and Ames is conducting ongoing research in lower density reusable TPS material for future reentry vehicles. Ceramic foams from pre ceramic polymer routes have potential for use in both acreage TPS and as tile leading edges for reentry vehicles. One of the key factors to investigate, when developing new materials for reentry applications, is their oxidation behavior in the appropriate reentry environment whrch can be simulated using ground based arc jet (plasma jet) testing. Studies have shown that oxidation rates of materials will differ when exposed to either monatomatic or molecular oxygen and the amount of monoatomic oxygen depends on the conditions particular to a given test situation. Monoatomic oxygen is always present in reentry environment, therefore arc jet testing is required to provide the appropriate conditions (stagnation pressures, heat fluxes, enthalpies, heat loads and atmospheres) encountered during flight. This preliminary work looks at the response of ceramic foams (Si systems) exposed to simulated reentry environments and investigates the influence of microstructure and composition on the materials response.

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

    PubMed

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

    2013-06-01

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

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

    NASA Astrophysics Data System (ADS)

    Cassidy, Jeffrey; Betz, Vaughn; Lilge, Lothar

    2015-03-01

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

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

    PubMed Central

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

    2016-01-01

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

  20. Evaluation of Physical Symptoms in Patients on Peritoneal Dialysis

    PubMed Central

    Figueiredo, Ana Elizabeth; Goodlad, Cate; Clemenger, Michelle; Haddoub, San San; McGrory, Jacqueline; Pryde, Kim; Tonkins, Emma; Hisole, Nora; Brown, Edwina Anne

    2012-01-01

    Introduction. Little is known about physical symptoms in peritoneal dialysis (PD) Patients. This study aims to determine the prevalence of symptoms (general and abdominal) in PD patients. Methods. A cross-sectional study, with subsequent followup, using an author-designed 21 symptoms questionnaire (15 nonabdominal and 6 abdominal). Each symptom was assessed on a scale 0–3 for severity (none–severe) and frequency (never–every day). Results. We studied 41 patients, mean age 60 ± 15 years, 56% male, 19.5% diabetics, and 51.5% on APD. Mean number of symptoms was 9.5 ± 3.9 and total symptoms score was 28.5 ± 12 with abdominal scores of 6.4 ± 4.8. Most frequent symptoms were lack of energy, itching, cramps, poor sleep, and loss of appetite. A second evaluation in 20 patients disclosed no statistical difference between the first and second assessments, or between subgroups. Cramps were the only symptoms which decreased over time (P = 0.120). Lack of energy did not correlate with haemoglobin, neither did itching with phosphate level. Conclusions. Physical symptoms are frequent and troublesome; they relate to advanced kidney disease and not specifically to PD. Symptoms remain stable over time and do not appear to relate to dialysis parameter markers. PMID:23050149

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  3. Classification of postoperative cardiac patients: comparative evaluation of four algorithms.

    PubMed

    Artioli, E; Avanzolini, G; Barbini, P; Cevenini, G; Gnudi, G

    1991-12-01

    Four classification algorithms based on Bayes' rule for minimum error are compared by evaluating their ability to recognize high- and normal-risk cardio-surgical patients. These algorithms differ in the modelling of the probability density function (pdf) for each class and include: (a) two parametric algorithms based on the assumption of normal pdf; (b) two non-parametric algorithms using Parzen multidimensional approximation of pdf with normal kernels. In each case, classes with both equal and different covariance matrices were considered. A set of 200 patients in the 6 h immediately following cardiac surgery has been used to test the performance of the algorithms. For each patient the three measured variables most effective in representing the difference between the two classes were considered. We found that the two algorithms which explicitly incorporate the information on the different sample covariance between the physiological variables existing in the two classes generally provide better recognition of high- and normal-risk patients. Of these two algorithms the parametric one appears extremely attractive for practical applications, since it exhibits slightly better performance in spite of its great simplicity.

  4. Roentgenographic Evaluation of the Spine in Patients With Osteogenesis Imperfecta

    PubMed Central

    de Lima, Marcos Vaz; de Lima, Fabiana Vaz; Akkari, Miguel; de Resende, Vanessa Ribeiro; Santili, Claudio

    2015-01-01

    Abstract Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder that leads to bone weakness and deformities, especially in the spine, which can lead to poor outcomes. The aim of this study was to find patterns and risk factors in spinal deformities in patients with OI. In a retrospective study, 70 patients with OI were selected. Radiographs of the spine were evaluated. We observed the presence or absence of the following changes: biconcave vertebrae, chest and vertebral deformities, unilateral rib, and thoracolumbar kyphosis. The greater curve was considered the primary one, and the secondary curve considered compensatory. In the study sample, we observed that the patients’ ages ranged between 7 and 50 years, with a mean equal to 13 years, and 76% had scoliosis. In 68% of cases the main curve in the thoracic region was observed with the convexity to the right. The following was found in patients with OI: scoliosis, biconcave vertebrae, vertebral and chest deformity, unilateral rib, and thoracolumbar kyphosis. The thoracolumbar kyphosis is highly associated with thoracic hypokyphosis in patients with OI. PMID:26632680

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

    PubMed

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

    2005-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1981-01-01

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

  8. Rapid Evaluation of Particle Properties using Inverse SEM Simulations

    SciTech Connect

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

    2016-01-01

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

  9. The Evaluation of Postoperative Patients with Ulcerative Colitis.

    PubMed

    Shen, Bo

    2016-10-01

    Restorative proctocolectomy with ileal pouch-anal anastomosis has become the standard surgical treatment modality for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Normally staged pouch surgery is performed. Endoscopy plays an important role in postoperative monitoring of disease status and delivery of therapy, if necessary. Therefore, ileal pouch surgery significantly alters bowel anatomy, with new organ structures being created. Endoscopy of the altered bowel includes the evaluation of end ileostomy, Hartmann pouch or diverted rectum, loop ileostomy, diverted pouch, and pouchoscopy. Each segment of the bowel has unique landmarks. PMID:27633595

  10. Vascular growth and remodeling coupled with fluid simulation in patient specific geometry

    NASA Astrophysics Data System (ADS)

    Wu, Jiacheng; Shadden, Shawn C.

    2014-11-01

    In this talk, we propose a computational framework to couple vascular growth and remodeling (G&R) with fluid simulation in 3D patient specific geometry. Hyperelastic and anisotropic properties are considered for the vessel wall material. A constrained mixture model is used to represent multiple constituents in the vessel wall. The coupled simulation is divided into two time scales, the longer time scale for G&R and the shorter time scale for fluid dynamics simulation. G&R is simulated to determine the boundary of the fluid domain, the fluid simulation in turn generates wall shear stress and transmural pressure data that regulates G&R. To minimize required computation cost, fluid is only simulated when G&R causes significant vascular geometric change. This coupled model can be used to study the influence of the stress-mediated law parameters on the stability of the vascular tissue growth, and predict progression of vascular diseases such as aneurysm expansion.

  11. Survey of Australian schools of nursing use of human patient (mannequin) simulation.

    PubMed

    McGarry, Denise Elizabeth; Cashin, Andrew; Fowler, Cathrine

    2014-11-01

    Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.

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

    SciTech Connect

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

    2013-02-15

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

  13. Bringing skin assessments to life using human patient simulation: an emphasis on cancer prevention and early detection.

    PubMed

    Kuhrik, Marilee; Seckman, Christy; Kuhrik, Nancy; Ahearn, Tina; Ercole, Patrick

    2011-12-01

    Skin cancer is the most common cancer in the United States, with about 1,000,000 people developing the disease each year. The incidence of melanoma has rapidly increased in young white women between the ages of 15-34 over the last three decades. While melanoma accounts for approximately 3% of skin cancers, it causes more than 75% of skin cancer deaths. Thorough skin assessments and awareness of new or changing appearance of skin lesions are critical to early detection and treatment of skin cancer, as well as teaching sun-protective behaviors. Educators created a novel approach to "bring to life" skin cancer assessment skills to promote awareness of prevention and early detection of skin cancer using moulage in a human patient simulation lab. Through the use of moulage-like lesions, simulated patients were evaluated and taught skin cancer prevention and early detection principles by baccalaureate nursing students. The average age of study participants (n = 104) was 26.50 years. The majority of responders were female. At the end of the lab, students' average responses to an evaluation based on program goals were very positive. Anecdotal comments affirmed positive student perceptions of their simulation experience. Data analyses indicated item means were consistently higher for upper-division students. The age and gender of students who participated in this study align with the NCI statistics on age and gender of the population with increased incidence of melanoma.

  14. A unique control system simulator for the evaluation of pulsed plasma thrusters

    NASA Technical Reports Server (NTRS)

    Dahlgren, J. B.

    1973-01-01

    Because of the low thrust characteristics of solid-propellant pulsed plasma thrusters and their operational requirement to operate in a vacuum environment, unique and sensitive test techniques are required. A technique evolved for testing and evaluating pulsed plasma thrusters in an open- or closed-loop system mode employs a unique air bearing platform as a single-axis simulator on which the thruster is mounted. The simulator described was developed to evaluate pulsed plasma thrusters in the low micropound range; however, the simulator can be extended to cover the operational range of currently developed millipound thrusters.

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

    PubMed

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

    2010-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1981-01-01

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

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

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed Central

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

    2016-01-01

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

  20. Evaluation of regional climate model simulations of rainfall over the Upper Blue Nile basin

    NASA Astrophysics Data System (ADS)

    Alemseged, Tamiru Haile; Tom, Rientjes

    2015-07-01

    Climate change impact and adaptation studies can benefit from an enhanced understanding about the performance of individual as well as ensemble simulations of climate models. Studies that evaluate downscaled simulations of General Circulation Models (GCMs) by Regional Climate Models (RCMs) for African basins are noticeably missing. Recently, the Coordinated Regional Climate Downscaling Experiment (CORDEX) initiative has made multiple RCMs' outputs available for end users across the African continent. Before climate simulations receive applications in impact and adaptation studies, accuracy of the simulation results has to be evaluated. In this study, the rainfall accuracy of eight independent GCMs at a wide range of time scales over the Upper Blue Nile Basin (UBN) in Ethiopia is evaluated. The reference data for performance assessment was obtained from the rain gauge network of the National Meteorological Agency of Ethiopia (http://www.ethiomet.gov.et/)

  1. The evaluation of diabetic patients' use of a telehealth program.

    PubMed

    Lee, Ting-Ting; Huang, Tzu-Yi; Chang, Chi-Ping; Lin, Kuan-Chia; Tu, Hsiu-Mei; Fan, Ching-Jih; Mills, Mary Etta

    2014-12-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.

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

    ERIC Educational Resources Information Center

    Sarle, Ruth; And Others

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

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

    EPA Science Inventory

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

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

    PubMed Central

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

    2008-01-01

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

  5. Evaluation of normal tissue exposure in patients receiving radiotherapy for pancreatic cancer based on RTOG 0848

    PubMed Central

    Ling, Ted C.; Slater, Jerry M.; Mifflin, Rachel; Nookala, Prashanth; Grove, Roger; Ly, Anh M.; Patyal, Baldev; Slater, Jerry D.

    2015-01-01

    Background Pancreatic cancer is a highly aggressive malignancy. Chemoradiotherapy (CRT) is utilized in many cases to improve locoregional control; however, toxicities associated with radiation can be significant given the location of the pancreas. RTOG 0848 seeks to evaluate chemoradiation using either intensity-modulated radiation therapy (IMRT) or 3D conformal photon radiotherapy (3DCRT) modalities as an adjuvant treatment. The purpose of this study is to quantify the dosimetric changes seen when using IMRT or 3D CRT photon modalities, as well as proton radiotherapy, in patients receiving CRT for cancer of the pancreas treated per RTOG 0848 guidelines. Materials Ten patients with pancreatic head adenocarcinoma treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using IMRT and 3DCRT as well as proton radiotherapy were created for each patient. All planning volumes were created per RTOG 0848 protocol. Dose-volume histograms (DVH) were calculated and analyzed in order to compare plans between the three modalities. The organs at risk (OAR) evaluated in this study are the kidneys, liver, small bowel, and spinal cord. Results There was no difference between the IMRT and 3DCRT plans in dose delivered to the kidneys, liver, or bowel. The proton radiotherapy plans were found to deliver lower mean total kidney doses, mean liver doses, and liver D1/3 compared to the IMRT plans. The proton plans also gave less mean liver dose, liver D1/3, bowel V15, and bowel V50 in comparison to the 3DCRT. Conclusions For patients receiving radiotherapy per ongoing RTOG 0848 for pancreatic cancer, there was no significant difference in normal tissue sparing between IMRT and 3DCRT treatment planning. Therefore, the choice between the two modalities should not be a confounding factor in this study. The proton plans also demonstrated improved OAR sparing compared to both IMRT and 3DCRT treatment

  6. Evaluation of skeletal muscle DTI in patients with duchenne muscular dystrophy.

    PubMed

    Hooijmans, M T; Damon, B M; Froeling, M; Versluis, M J; Burakiewicz, J; Verschuuren, J J G M; Niks, E H; Webb, A G; Kan, H E

    2015-11-01

    Diffusion tensor imaging (DTI) is a popular method to assess differences in fiber organization in diseased and healthy muscle tissue. Previous work has shown that muscle DTI measurements depend on signal-to-noise ratio (SNR), %fat, and tissue T2. The goal of this study was to evaluate the potential biasing effects of these factors on skeletal muscle DTI data in patients with Duchenne Muscular Dystrophy (DMD). MR images were obtained of the right lower leg of 21 DMD patients and 12 healthy controls on a Philips 3T system. DTI measurements were combined with quantitative in-vivo measures of mean water T2, %fat and SNR to evaluate their effect on DTI parameter estimation. All outcome measures were determined within ROIs drawn for six lower leg muscles. Between group analysis, using all ROIs, revealed a significantly elevated FA in the GCL, SOL and PER muscles (p<0.05) and an increased mean diffusivity (p<0.05) and λ3 (p<0.05) in the TA muscle of DMD patients. In-vivo evaluation of the individual confounders showed behaviour in line with predictions from previous simulation work. To account for these confounders, subsequent analysis used only ROIs with SNR greater than 20. With this criterion we found significantly greater MD in the TA muscle of DMD patient (p<0.009) and λ3 in the TA and GCL muscles (p<0.001) of DMD patients, but no differences in FA. As both increased %fat and lower SNR are expected to reduce the apparent MD and λ3, these between-group differences are likely due to pathophysiology. However, the increased FA, observed when using all ROIs, likely reflects the effect of low SNR and %fat on the DTI parameter estimation. These findings suggest that measuring mean water T2, %fat and SNR is essential to ascribe changes in DTI measures to intrinsic diffusion changes or to confounding influences.

  7. Evaluation of an interactive case simulation system in dermatology and venereology for medical students

    PubMed Central

    Wahlgren, Carl-Fredrik; Edelbring, Samuel; Fors, Uno; Hindbeck, Hans; Ståhle, Mona

    2006-01-01

    Background Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. Methods Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination. Results The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. Conclusion We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting

  8. Evaluation of an integrated graphical display to promote acute change detection in ICU patients

    PubMed Central

    Anders, Shilo; Albert, Robert; Miller, Anne; Weinger, Matthew B.; Doig, Alexa K.; Behrens, Michael; Agutter, Jim

    2012-01-01

    Objective The purpose of this study was to evaluate ICU nurses’ ability to detect patient change using an integrated graphical information display (IGID) versus a conventional tabular ICU patient information display (i.e. electronic chart). Design Using participants from two different sites, we conducted a repeated measures simulator-based experiment to assess ICU nurses’ ability to detect abnormal patient variables using a novel IGID versus a conventional tabular information display. Patient scenarios and display presentations were fully counterbalanced. Measurements We measured percent correct detection of abnormal patient variables, nurses’ perceived workload (NASA-TLX), and display usability ratings. Results 32 ICU nurses (87% female, median age of 29 years, and median ICU experience of 2.5 years) using the IGID detected more abnormal variables compared to the tabular display [F (1,119)=13.0, p < 0.05]. There was a significant main effect of site [F (1, 119)=14.2], with development site participants doing better. There were no significant differences in nurses’ perceived workload. The IGID display was rated as more usable than the conventional display, [F (1, 60)=31.7]. Conclusion Overall, nurses reported more important physiological information with the novel IGID than tabular display. Moreover, the finding of site differences may reflect local influences in work practice and involvement in iterative display design methodology. Information displays developed using user-centered design should accommodate the full diversity of the intended user population across use sites. PMID:22534099

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    SciTech Connect

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

    2012-06-01

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

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

    PubMed

    Nordby, Halvor

    2016-09-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

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

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

    PubMed

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

    2006-12-01

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

  16. Simulation to enhance patient safety: why aren't we there yet?

    PubMed

    Aggarwal, Rajesh; Darzi, Ara

    2011-10-01

    The delivery of state-of-the-art medical care is complex, with large numbers of treatment strategies often available to individual patients. It is paramount to ensure that each patient receives optimal treatment in a safe, effective, and timely manner. Evidence suggests that an unacceptably high number of patients currently experience suboptimal care as the result of adverse events and medical error. Simulation-based training reduces medical error, enhances clinical outcomes, and reduces the cost of clinical care. It is surprising that medical simulation is not routinely integrated into the training curricula of all health-care professionals. Simulation enables doctors to practice and hone their technical, communication, decision making, and crisis management skills in a safe and educationally orientated environment. The process can foster the development of interprofessional working skills, leading to enhanced patient outcomes. Selection, credentialing, and revalidation of medical professionals are also possible in a simulation setting, enabling maintenance of standards of practice throughout a medical career. In order for simulation to become a part of the medical curriculum, collaborative efforts are required from academics, physicians, managers, and policy makers alike. Bringing these groups together, while a challenge, can lead to high-level outputs in medical care, which will benefit all.

  17. Computer simulation and capacity evaluation of Panama Canal alternatives

    SciTech Connect

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

    1994-12-31

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

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

    PubMed

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

    2009-12-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Shin, Hyunsook; Kim, Mi Ja

    2014-10-01

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

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

    PubMed

    Shin, Hyunsook; Kim, Mi Ja

    2014-10-01

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

  3. Objective fidelity evaluation in multisensory virtual environments: auditory cue fidelity in flight simulation.

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  5. An XML Standard for Virtual Patients: Exchanging Case-Based Simulations in Medical Education

    PubMed Central

    Triola, Marc M.; Campion, Ned; McGee, James B.; Albright, Susan; Greene, Peter; Smothers, Valerie; Ellaway, Rachel

    2007-01-01

    Virtual Patients are computer-based simulations of a clinical encounter where the user plays the role of a healthcare provider while receiving in-context instruction. This unique pedagogical approach enables active case-based learning for learners. Academic institutions around the world have developed high-quality virtual patients using many different authoring and playback technologies. However, sustainability and scalability have proved challenging due to the number of cases needed and production costs. In an effort to promote sharing of Virtual Patients and broader adoption into medical education at all levels, MedBiquitous organized an international working group to create an XML-based “MedBiquitous Virtual Patient Standard” (MVP) describing a common structure for virtual patient content and activities. The MVP enables virtual patient exchange across systems, modification, and display within conformant player software. PMID:18693935

  6. Axillary lymph nodes in breast cancer patients: sonographic evaluation.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  12. A clinical evaluation denture adhesives used by patients with xerostomia.

    PubMed

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

    2015-02-01

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

  13. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab

    PubMed Central

    Aira, Lazaro E.; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A.; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease. PMID:26466969

  14. Evaluating bone quality in patients with chronic kidney disease

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    1981-12-01

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

  16. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab.

    PubMed

    Aira, Lazaro E; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease.

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    ERIC Educational Resources Information Center

    Lewis, Carol Ann

    2013-01-01

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

  19. Equivalence evaluation of moisturizers in atopic dermatitis patients.

    PubMed

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

    2015-01-01

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

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

    SciTech Connect

    Imbus, H.R.

    1985-12-01

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

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

    PubMed

    Imbus, H R

    1985-12-01

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

  2. Evaluating the Use of the Wilbarger Intervention with Schizophrenic Patients

    PubMed Central

    Stout, Janet; Mogge, Neil L.; Nesland, Anita; David Allen, G.

    2005-01-01

    Individuals with schizophrenia have difficulty processing sensory information. The authors hypothesized that the Wilbarger intervention, an occupational therapy technique successfully used to treat children with sensory integration deficits, might prove beneficial if used with schizophrenic patients. Thirty inpatients diagnosed with schizophrenia or schizoaffective disorders voluntarily participated. Each was evaluated using the sensory integration subscale of the Neurological Evaluation Scale (NES) both pre- and post-intervention. The Wilbarger was scheduled to be administered five times per day for seven days per week for four weeks. Participants averaged 19.5 days (mean) in the study (median=27.5 days) and received 80.4 (mean) (106.5 median) interventions.Those receiving 90 or more interventions improved significantly on the graphesthesia subtest (t(28)=2.498; p<0.019), the right/left confusion subtest (t(28)=2.373; p<0.025) and the post-total score (t(28)=2.184; p<0.037). Sensory subscales of the NES statistically improved after use of the Wilbarger intervention. Further studies are planned to determine the duration and clinical significance of the noted changes. PMID:21179643

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  5. [Simulation training for better patient safety-learning from team work].

    PubMed

    Hoppu, Sanna; Niemi-Murola, Leila; Handolin, Lauri

    2014-01-01

    At work, healthcare personnel will encounter various emergency situations and patients who are in poor physical condition and require urgent care. A multidisciplinary team of experts must be able to carry out seamless collaboration, even when working together for the first time. Described in this review is how systematically arranged simulation rehearsals help form a united expert group from a group of individual experts.

  6. Weaving the tapestry of learning: simulation, standardized patients, and virtual communities.

    PubMed

    Holland, Brian; Landry, Karen; Mountain, Angela; Middlebrooks, Mary Alice; Heim, Deborah; Missildine, Kathy

    2013-01-01

    Using situated cognition learning theory, nursing faculty developed simulated clinical learning experiences integrating virtual communities and standardized patients. These learning experiences provide authenticity and realism not easily achieved using the individual techniques in isolation. The authors describe the process of weaving these strategies into a rich learning experience for students.

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Johnson-Frey, Scott H.

    2004-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    PubMed

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

    2014-10-01

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

  12. Human vision simulation for evaluation of enhanced and synthetic vision systems

    NASA Astrophysics Data System (ADS)

    Doll, Theodore J.; Home, Richard; Cooke, Kevin J.; Wasilewski, Anthony A.; Sheerin, David T.; Hetzler, Morris C.

    2003-09-01

    One of the key problems in developing Enhanced and Synthetic Vision Systems is evaluating their effectiveness in enhancing human visual performance. A validated simulation of human vision would provide a means of avoiding costly and time-consuming testing of human observers. We describe an image-based simulation of human visual search, detection, and identification, and efforts to further validate and refine this simulation. One of the advantages of an image-based simulation is that it can predict performance for exactly the same visual stimuli seen by human operators. This makes it possible to assess aspects of the imagery, such as particular types and amounts of background clutter and sensor distortions, that are not usually considered in non-image based models. We present two validation studies - one showing that the simulation accurately predicts human color discrimination, and a second showing that it produces probabilities of detection (Pd's) that closely match Blackwell-type human threshold data.

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

    NASA Technical Reports Server (NTRS)

    Galanter, E.; Popper, R.

    1980-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Tabary, J.; Glière, A.

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

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

    NASA Technical Reports Server (NTRS)

    Firestone, R. F.; Harada, Y.

    1979-01-01

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

  16. An Evaluation of a Computer Simulation in the Assessment of Physician Competence.

    ERIC Educational Resources Information Center

    Norcini, John J.; And Others

    1986-01-01

    This study compares physician performance on the Computer-Aided Simulation of the Clinical Encounter with peer ratings and performance on multiple choice questions and patient management problems. Results indicate that all formats are equally valid, although multiple choice is the most reliable method of assessment per unit of testing time.…

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

    ERIC Educational Resources Information Center

    Adamson, Katie Anne

    2011-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Le, Trung; Borazjani, Iman; Sotiropoulos, Fotis

    2009-11-01

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

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

    PubMed

    Philip, J H

    2015-12-01

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

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

    PubMed

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

    2015-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  2. Evaluation of coronary microvascular function in patients with vasospastic angina

    PubMed Central

    Teragawa, Hiroki; Mitsuba, Naoya; Ishibashi, Ken; Nishioka, Kenji; Kurisu, Satoshi; Kihara, Yasuki

    2013-01-01

    AIM: To investigate endothelium-dependent and -independent coronary microvascular functions in patients with vasospastic angina (VSA). METHODS: Thirty-six patients with VSA (30 men and 6 women; mean age, 58 years) were enrolled in this study. VSA was defined as ≥ 90% narrowing of the epicardial coronary arteries on angiography performed during a spasm provocation test, presence of chest pain, and/or ST-segment deviation on an electrocardiogram (ECG). Patients (n = 36) with negative spasm provocation test results and those matched for age and sex were enrolled as a control group (nonVSA group). Low-dose acetylcholine (ACh; 3 μg/min) was infused into the left coronary ostium for 2 min during the spasm provocation test. Following the spasm provocation test, nitroglycerin (0.2 mg) was administered intracoronally. Coronary blood flow (was calculated from quantitative angiography and Doppler flow velocity measurements, and the coronary flow reserve was calculated as the ratio of coronary flow velocity after injection of adenosine triphosphate (20 μg) to the baseline value. Changes in the coronary artery diameter in response to ACh and nitroglycerin infusion were expressed as percentage changes from baseline measurements. RESULTS: Body mass index was significantly lower in the VSA group than in the nonVSA group. The frequency of conventional coronary risk factors and the rate of statin use were similar between the 2 groups. The left ventricular ejection fraction as evaluated by echocardiography was similar between the 2 groups. The duration of angina was 9 ± 2 mo. The results of blood chemistry analysis were similar between the 2 groups. Low-dose ACh did not cause coronary spasms. The change in coronary artery diameter in response to ACh was lower in the VSA group (-1.4% ± 9.3%) than in the nonVSA group (3.1% ± 6.5%, P < 0.05), whereas nitroglycerin-induced coronary artery dilatation and coronary blood flow increase in response to ACh or coronary flow reserve did

  3. Patient Education Corner. Accessing and evaluating the Internet for patient and family education.

    PubMed

    Cutilli, Carolyn Crane

    2006-01-01

    In the last decade, the Internet has become a vast resource for healthcare information. Multiple Web sites, produced by the federal government, healthcare institutions, and individual healthcare providers, give Americans a wealth of useful information sources. Nurses recognize that more Americans than ever before are using the Internet and that nurses are in an excellent position to help patients learn how to search for healthcare topics and evaluate the information found. This article will focus on seeking information, judging the quality of the information, and listing specific Web sites. PMID:17035921

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

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2009-08-01

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

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

    PubMed

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

    2016-10-01

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

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

    PubMed

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

    2016-10-01

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

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

    PubMed

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

    2016-09-01

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

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

    PubMed

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

    2016-09-01

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

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

    PubMed

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

    2011-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  12. Development of three-dimensional patient face model that enables real-time collision detection and cutting operation for a dental simulator.

    PubMed

    Yamaguchi, Satoshi; Yamada, Yuya; Yoshida, Yoshinori; Noborio, Hiroshi; Imazato, Satoshi

    2012-01-01

    The virtual reality (VR) simulator is a useful tool to develop dental hand skill. However, VR simulations with reactions of patients have limited computational time to reproduce a face model. Our aim was to develop a patient face model that enables real-time collision detection and cutting operation by using stereolithography (STL) and deterministic finite automaton (DFA) data files. We evaluated dependence of computational cost and constructed the patient face model using the optimum condition for combining STL and DFA data files, and assessed the computational costs for operation in do-nothing, collision, cutting, and combination of collision and cutting. The face model was successfully constructed with low computational costs of 11.3, 18.3, 30.3, and 33.5 ms for do-nothing, collision, cutting, and collision and cutting, respectively. The patient face model could be useful for developing dental hand skill with VR. PMID:23207214

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  15. An EarthCARE/ATLID simulator to evaluate cloud description in climate models

    NASA Astrophysics Data System (ADS)

    Reverdy, M.; Chepfer, H.; Donovan, D.; Noel, V.; Cesana, G.; Hoareau, C.; Chiriaco, M.; Bastin, S.

    2015-11-01

    Clouds still remain the largest source of uncertainty in model-based predictions of future climate; thus, the description of the clouds in climate models needs to be evaluated. In particular, the cloud detailed vertical distribution that impacts directly the cloud radiative effect needs to be evaluated. Active satellite sensors directly measure the cloud vertical distribution with high accuracy; their observations should be used for model evaluation together with a satellite simulator in order to allow fair comparison between models and observations. The next cloud lidar in space, EarthCARE/ATmospheric LIDar (ATLID), is planned for launch in 2018, while the current spaceborne cloud lidar CALIPSO/CALIOP is expected to stop collecting data within the next coming years. Here we describe the characteristics of the ATLID on board the EarthCARE satellite (spatial resolution, signal-to-noise ratio, wavelength, field of view, pulse repetition frequency, orbit, and high-spectral resolution lidar) that need to be taken into account to build a Cloud Feedback Model Intercomparison Project Observation Simulator Package (COSP)/ATLID simulator. We then present the COSP/ATLID simulator, and the low-, middle-, high-level cloud covers it produces, as well as the zonal mean cloud fraction profiles and the height-intensity histograms that are simulated by COSP/ATLID when overflying an atmosphere predicted by LMDZ5 global circulation model. Finally, we compare the clouds simulated by COSP/ATLID with those simulated by COSP/CALIPSO when overflying the same atmosphere. As the main differences between ATLID and CALIOP are taken into account in the simulators, the differences between COSP/ATLID and COSP/CALIPSO cloud covers are less than 1% in nighttime conditions

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

    NASA Astrophysics Data System (ADS)

    Zimmer, Johannes; Stommel, Markus

    2013-12-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

  19. Evaluating clinical simulations for learning procedural skills: a theory-based approach.

    PubMed

    Kneebone, Roger

    2005-06-01

    Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.

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

    NASA Astrophysics Data System (ADS)

    Wang, Zhaohui; Ha, Seunghan; Kim, Kang

    2012-03-01

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

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

    SciTech Connect

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

    2012-06-27

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

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

    SciTech Connect

    Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John

    2009-10-15

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

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

    PubMed

    Zhang, Xuyang; Goh, Kean S

    2015-11-01

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

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

    PubMed

    Zhang, Xuyang; Goh, Kean S

    2015-11-01

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

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

    PubMed Central

    Kay, Gary G.; Feldman, Neil

    2013-01-01

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

  6. Preoperative evaluation of renal artery in patients with renal tumor

    PubMed Central

    Zhu, Liangsong; Wu, Guangyu; Wang, Jianfeng; Huang, Jiwei; Kong, Wen; Chen, Yonghui; Xue, Wei; Huang, Yiran; Zhang, Jin

    2016-01-01

    Abstract To investigate the feasibility of the noncontrast-enhanced magnetic resonance angiography (NCE-MRA) to evaluate renal arteries before partial nephrectomy (PN). Retrospective analyzed 479 patients who underwent renal surgery between January 2013 and December 2015 with NCE-MRA or computed tomographic angiography (CTA) renal artery image reconstruction preoperative in our department. The renal artery reconstruction score (RARS) was based on the level of artery visualization in a 4-class criterion, and the R.E.N.A.L nephrometry score (R.E.N.A.L), arterial based complexity (ABC) were also analyzed. Of the 479 patients, the overall-lever RARS was 3.62, and the average in 2 groups was no significant difference (NCE-MRA vs CTA, P = 0.072). The performance of NCE-MRA in PN group was similar with CTA. Further comparison demonstrated that the efficiency of NCE-MRA in moderate- or low-degree tumor according to the R.E.N.A.L and ABC complexity less than 3S was equal to CTA. However, high degree (P < 0.001), 3S (P = 0.027), or 3H (P < 0.001) would affect the imaging of renal artery. Intragroup analysis showed that tumor complexity such as max tumor size (r = −o.351, P < 0.001), R.E.N.A.L (r = −0.439, P < 0.001), and ABC (r = −0.619, P < 0.001) were closely correlated with the NCE-MRA performance. The images of 2 sides of the kidney were compared in single person as well, which was meaningful for NCE-MRA patients only (NCE-MRA, P < 0.001; CTA, P = 0.182). The renal artery reconstruction performed by NCE-MRA is feasible and has a similar achievement in the PN potential recipients, with a lower side effect, and meets the requirements for making surgical decision. It has a broad application prospect in clinical practice; however, it still needs to further improve the ability in more complex tumors. PMID:27759632

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

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

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

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

    NASA Technical Reports Server (NTRS)

    Blaisdell, Gregory A.

    1996-01-01

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

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

    SciTech Connect

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

    2014-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  11. Study on Applicability of Numerical Simulation to Evaluation of Gas Entrainment From Free Surface

    SciTech Connect

    Kei Ito; Takaaki Sakai; Hiroyuki Ohshima

    2006-07-01

    An onset condition of gas entrainment (GE) due to free surface vortex has been studied to establish a design of fast breeder reactor with higher coolant velocity than conventional designs, because the GE might cause the reactor operation instability and therefore should be avoided. The onset condition of the GE has been investigated experimentally and theoretically, however, dependency of the vortex type GE on local geometry configuration of each experimental system and local velocity distribution has prevented researchers from formulating the universal onset condition of the vortex type GE. A real scale test is considered as an accurate method to evaluate the occurrence of the vortex type GE, but the real scale test is generally expensive and not useful in the design study of large and complicated FBR systems, because frequent displacement of inner equipments accompanied by the design change is difficult in the real scale test. Numerical simulation seems to be promising method as an alternative to the real scale test. In this research, to evaluate the applicability of the numerical simulation to the design work, numerical simulations were conducted on the basic experimental system of the vortex type GE. This basic experiment consisted of rectangular flow channel and two important equipments for vortex type GE in the channel, i.e. vortex generation and suction equipments. Generated vortex grew rapidly interacting with the suction flow and the grown vortex formed a free surface dent (gas core). When the tip of the gas core or the bubbles detached from the tip of the gas core reached the suction mouth, the gas was entrained to the suction tube. The results of numerical simulation under the experimental conditions were compared to the experiment in terms of velocity distributions and free surface shape. As a result, the numerical simulation showed qualitatively good agreement with experimental data. The numerical simulation results were similar to the experimental

  12. In Vitro Validation of Patient-Specific Hemodynamic Simulations in Coronary Aneurysms Caused by Kawasaki Disease

    PubMed Central

    Kung, Ethan; Kahn, Andrew M.; Burns, Jane C.; Marsden, Alison

    2014-01-01

    To perform experimental validation of computational fluid dynamics (CFD) applied to patient specific coronary aneurysm anatomy of Kawasaki disease. We quantified hemodynamics in a patient-specific coronary artery aneurysm physical phantom under physiologic rest and exercise flow conditions. Using phase contrast MRI (PCMRI), we acquired 3-component flow velocity at two slice locations in the aneurysms. We then performed numerical simulations with the same geometry and inflow conditions, and performed qualitative and quantitative comparisons of velocities between experimental measurements and simulation results. We observed excellent qualitative agreement in flow pattern features. The quantitative spatially and temporally varying differences in velocity between PCMRI and CFD were proportional to the flow velocity. As a result, the percent discrepancy between simulation and experiment was relatively constant regardless of flow velocity variations. Through 1D and 2D quantitative comparisons, we found a 5–17% difference between measured and simulated velocities. Additional analysis assessed wall shear stress differences between deformable and rigid wall simulations. This study demonstrated that CFD produced good qualitative and quantitative predictions of velocities in a realistic coronary aneurysm anatomy under physiological flow conditions. The results provide insights on factors that may influence the level of agreement, and a set of in vitro experimental data that can be used by others to compare against CFD simulation results. The findings of this study increase confidence in the use of CFD for investigating hemodynamics in the specialized anatomy of coronary aneurysms. This provides a basis for future hemodynamics studies in patient-specific models of Kawasaki disease. PMID:25050140

  13. In Vitro Validation of Patient-Specific Hemodynamic Simulations in Coronary Aneurysms Caused by Kawasaki Disease.

    PubMed

    Kung, Ethan; Kahn, Andrew M; Burns, Jane C; Marsden, Alison

    2014-06-01

    To perform experimental validation of computational fluid dynamics (CFD) applied to patient specific coronary aneurysm anatomy of Kawasaki disease. We quantified hemodynamics in a patient-specific coronary artery aneurysm physical phantom under physiologic rest and exercise flow conditions. Using phase contrast MRI (PCMRI), we acquired 3-component flow velocity at two slice locations in the aneurysms. We then performed numerical simulations with the same geometry and inflow conditions, and performed qualitative and quantitative comparisons of velocities between experimental measurements and simulation results. We observed excellent qualitative agreement in flow pattern features. The quantitative spatially and temporally varying differences in velocity between PCMRI and CFD were proportional to the flow velocity. As a result, the percent discrepancy between simulation and experiment was relatively constant regardless of flow velocity variations. Through 1D and 2D quantitative comparisons, we found a 5-17% difference between measured and simulated velocities. Additional analysis assessed wall shear stress differences between deformable and rigid wall simulations. This study demonstrated that CFD produced good qualitative and quantitative predictions of velocities in a realistic coronary aneurysm anatomy under physiological flow conditions. The results provide insights on factors that may influence the level of agreement, and a set of in vitro experimental data that can be used by others to compare against CFD simulation results. The findings of this study increase confidence in the use of CFD for investigating hemodynamics in the specialized anatomy of coronary aneurysms. This provides a basis for future hemodynamics studies in patient-specific models of Kawasaki disease. PMID:25050140

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

  15. Airspace Concept Evaluation System (ACES), Concept Simulations using Communication, Navigation and Surveillance (CNS) System Models

    NASA Technical Reports Server (NTRS)

    Kubat, Greg; Vandrei, Don

    2006-01-01

    Project Objectives include: a) CNS Model Development; b Design/Integration of baseline set of CNS Models into ACES; c) Implement Enhanced Simulation Capabilities in ACES; d) Design and Integration of Enhanced (2nd set) CNS Models; and e) Continue with CNS Model Integration/Concept evaluations.

  16. The Utilization and Evaluation of a Simulation Game in Pre-Registration Nurse Education.

    ERIC Educational Resources Information Center

    Wildman, Stuart; Reeves, Maggie

    1996-01-01

    A management simulation game that trains student nurses for clinical practice was evaluated using 528 responses from 557 participants. The vast majority found it an enjoyable and appropriate way to learn skills in a safe environment. Teamwork and information sharing with peers were also valuable. (SK)

  17. Error-Based Simulation for Error-Awareness in Learning Mechanics: An Evaluation

    ERIC Educational Resources Information Center

    Horiguchi, Tomoya; Imai, Isao; Toumoto, Takahito; Hirashima, Tsukasa

    2014-01-01

    Error-based simulation (EBS) has been developed to generate phenomena by using students' erroneous ideas and also offers promise for promoting students' awareness of errors. In this paper, we report the evaluation of EBS used in learning "normal reaction" in a junior high school. An EBS class, where students learned the concept…

  18. The Interior Design Simulator. Courseware Evaluation for Vocational and Technical Education.

    ERIC Educational Resources Information Center

    Worts, Nancy; And Others

    This courseware evaluation rates the Interior Design Simulator program developed by Orange Juice Software Systems. (This program--not contained in this document--allows the user to design a room of any shape with maximum dimensions of 14 x 26 feet.) Part A describes the program in terms of subject area (furniture arrangement) and hardware…

  19. Evaluation of the Efficacy of Simulation Games in Traffic Safety Education of Kindergarten Children.

    ERIC Educational Resources Information Center

    Renaud, Lise; Suissa, Samy

    1989-01-01

    Uses a post-test-only control group study to evaluate the effect of three different types of simulation games used to teach traffic safety to kindergarten students. Results suggest that games including role-playing/group dynamics and modeling/training can change attitudes and modify behavior with this age group. (FMW)

  20. 3RIP Evaluation of the Performance of the Search System Using a Realtime Simulation Technique.

    ERIC Educational Resources Information Center

    Lofstrom, Mats

    This report describes a real-time simulation experiment to evaluate the performance of the search and editing system 3RIP, an interactive system written in the language BLISS on a DEC-10 computer. The test vehicle, preliminary test runs, and capacity test are detailed, and the following conclusions are reported: (1) 3RIP performs well up to the…

  1. EVALUATION OF CHROMOMYCIN A3 ASSAY IN HUMAN SPERM AFTER SIMULATED OVERNIGHT SHIPMENT

    EPA Science Inventory

    EVALUATION OF CHROMOMYCIN A3ASSAY IN HUMAN SPERM AFTER SIMULATED OVERNIGHT SHIPMENT.
    SC Jeffay1, R Morris Buus1, LF Strader1, AF Olshan2, DP Evenson3, SD Perreault1. 1US EPA/ORD, RTP, NC;2UNC-CH, Chapel Hill, NC;3SDSU, Brookings, SD.

    Semen collection kits that allow ...

  2. Coating Adhesion Evaluation by Nanoscratching Simulation Using the Molecular Dynamics Method

    NASA Astrophysics Data System (ADS)

    Akabane, Tomoaki; Sasajima, Yasushi; Onuki, Jin

    2007-05-01

    By using a molecular dynamics method, a computer simulation of a scratch test on bilayer thin films on a nanometer scale has been performed. In the present simulation, the substrate and thin-film material are TiN or SiO2 and Al or Cu, respectively. The indentor is assumed to be a perfect rigid body, and the Morse potential is utilized as the interaction between the indentor and a specimen atom. The extended Tersoff potential is assumed as the interaction between specimen atoms. Results indicate that the standard deviation of the friction constant becomes maximum when the scratching load is critical to spalling. The critical loads obtained by the present simulation and actual experiments do not match quantitatively. In contrast, the maximum standard deviation reproduces the spalling strength evaluated from actual experiments. On the basis of this finding, a new evaluation technique for adhesion strength using a nanoscratching test is proposed.

  3. Evaluation of thermochemical models for particle and continuum simulations of hypersonic flow

    NASA Technical Reports Server (NTRS)

    Boyd, Iain D.; Gokcen, Tahir

    1992-01-01

    Computations are presented for one-dimensional, strong shock waves that are typical of those that form in front of a reentering spacecraft. The fluid mechanics and thermochemistry are modeled using two different approaches. The first employs traditional continuum techniques in solving the Navier-Stokes equations. The second approach employs a particle simulation technique (the direct simulation Monte Carlo method, DSMC). The thermochemical models employed in these two techniques are quite different. The present investigation presents an evaluation of thermochemical models for nitrogen under hypersonic flow conditions. Four separate cases are considered that are dominated in turn by vibrational relaxation, weak dissociation, strong dissociation and weak ionization. In near-continuum, hypersonic flow, the nonequilibrium thermochemical models employed in continuum and particle simulations produce nearly identical solutions. Further, the two approaches are evaluated successfully against available experimental data for weakly and strongly dissociating flows.

  4. Evaluating simulant materials for understanding cranial backspatter from a ballistic projectile.

    PubMed

    Das, Raj; Collins, Alistair; Verma, Anurag; Fernandez, Justin; Taylor, Michael

    2015-05-01

    In cranial wounds resulting from a gunshot, the study of backspatter patterns can provide information about the actual incidents by linking material to surrounding objects. This study investigates the physics of backspatter from a high-speed projectile impact and evaluates a range of simulant materials using impact tests. Next, we evaluate a mesh-free method called smoothed particle hydrodynamics (SPH) to model the splashing mechanism during backspatter. The study has shown that a projectile impact causes fragmentation at the impact site, while transferring momentum to fragmented particles. The particles travel along the path of least resistance, leading to partial material movement in the reverse direction of the projectile motion causing backspatter. Medium-density fiberboard is a better simulant for a human skull than polycarbonate, and lorica leather is a better simulant for a human skin than natural rubber. SPH is an effective numerical method for modeling the high-speed impact fracture and fragmentations.

  5. Evaluating simulant materials for understanding cranial backspatter from a ballistic projectile.

    PubMed

    Das, Raj; Collins, Alistair; Verma, Anurag; Fernandez, Justin; Taylor, Michael

    2015-05-01

    In cranial wounds resulting from a gunshot, the study of backspatter patterns can provide information about the actual incidents by linking material to surrounding objects. This study investigates the physics of backspatter from a high-speed projectile impact and evaluates a range of simulant materials using impact tests. Next, we evaluate a mesh-free method called smoothed particle hydrodynamics (SPH) to model the splashing mechanism during backspatter. The study has shown that a projectile impact causes fragmentation at the impact site, while transferring momentum to fragmented particles. The particles travel along the path of least resistance, leading to partial material movement in the reverse direction of the projectile motion causing backspatter. Medium-density fiberboard is a better simulant for a human skull than polycarbonate, and lorica leather is a better simulant for a human skin than natural rubber. SPH is an effective numerical method for modeling the high-speed impact fracture and fragmentations. PMID:25739515

  6. Quantitative evaluation of ozone and selected climate parameters in a set of EMAC simulations

    NASA Astrophysics Data System (ADS)

    Righi, M.; Eyring, V.; Gottschaldt, K.-D.; Klinger, C.; Frank, F.; Jöckel, P.; Cionni, I.

    2014-10-01

    Four simulations with the ECHAM/MESSy Atmospheric Chemistry (EMAC) model have been evaluated with the Earth System Model Validation Tool (ESMValTool) to identify differences in simulated ozone and selected climate parameters that resulted from (i) different setups of the EMAC model (nudged vs. free-running) and (ii) different boundary conditions (emissions, sea surface temperatures (SSTs) and sea-ice concentrations (SICs)). To assess the relative performance of the simulations, quantitative performance metrics are calculated consistently for the climate parameters and ozone. This is important for the interpretation of the evaluation results since biases in climate can impact on biases in chemistry and vice versa. The observational datasets used for the evaluation include ozonesonde and aircraft data, meteorological reanalyses and satellite measurements. The results from a previous EMAC evaluation of a model simulation with weak nudging towards realistic meteorology in the troposphere have been compared to new simulations with different model setups and updated emission datasets in free-running timeslice and nudged Quasi Chemistry-Transport Model (QCTM) mode. The latter two configurations are particularly important for chemistry-climate projections and for the quantification of individual sources (e.g. transport sector) that lead to small chemical perturbations of the climate system, respectively. With the exception of some specific features which are detailed in this study, no large differences that could be related to the different setups of the EMAC simulations (nudged vs. free-running) were found, which offers the possibility to evaluate and improve the overall model with the help of shorter nudged simulations. The main differences between the two setups is a better representation of the tropospheric and stratospheric temperature in the nudged simulations, which also better reproduce stratospheric water vapour concentrations, due to the improved simulation of

  7. A brief neuropsychological testing battery for evaluating patients with schizophrenia.

    PubMed

    Savage, Robert M; Jackson, Warren T; Sourathathone, Choun M

    2003-06-01

    Current conceptualizations of schizophrenia include neurocognitive impairment, particularly in aspects of attention, memory, and executive functioning. Evaluation of these cognitive abilities typically involves use of comprehensive batteries which may take up to six hours to complete. The current study examined the effectiveness of a briefer battery to detect cognitive impairments usually seen in schizophrenia as established by previous studies using more lengthy and labor intensive protocols. The current study involved 61 outpatients with schizophrenia who were separated into three subgroups: paranoid type (n = 20), undifferentiated type (n = 21), and schizoaffective (n = 20). The majority of the patients were male (61%), African-American (52%), and of low socio-economic status. The mean age was 41.4 years (SD = 8.8), and the mean years of education was 11.7 (SD = 6.8). For the overall sample, results revealed mild to moderate impairments in memory, construction, concept formation, response set maintenance, psychomotor speed, and visual speed of information processing. Post-hoc analyses revealed significant differences between subgroups on Similarities and psychomotor speed, with the undifferentiated group performing more poorly than the paranoid or schizoaffective groups. In conclusion, the current brief battery minimized respondent burden in terms of both time demands and level of task complexity. However, it was also sensitive enough to capture many of the same cognitive weaknesses as those reported when using more labor-intensive neuropsychological test protocols.

  8. Using alternative methodologies for evaluating patient medication leaflets.

    PubMed

    Krass, Ines; Svarstad, Bonnie L; Bultman, Dara

    2002-05-01

    A variety of direct and indirect methods have been used to evaluate written medication information; however, no published research has validated assessment tools or presented direct consumer assessment of patient information leaflets (PILs) provided in US community pharmacy (CP). We report on two new instruments: the medication information design assessment scale (MIDAS), an indirect measure of design quality administered by the investigators, and the consumer information rating form (CIRF), a direct measure of comprehensibility, utility, and overall design quality applied by a consumer panel. These were used to assess two types of PILs: 36 CP-PILs obtained from community pharmacies and 3 Model-PILs incorporating recommended design characteristics. The validity of the MIDAS was demonstrated in two ways. First, as predicted, the Model-PILs were rated more positively by consumers. We also found a significant positive correlation between the number of design criteria incorporated in a CP-PIL (as measured by the MIDAS score) and the consumers rating of design quality (CIRF). In conclusion, we confirmed the importance of design characteristics in the production of written medication information and have also developed and validated two easy-to-use tools for the assessment of written medication information.

  9. Evaluation of ocular movements in patients with dyslexia.

    PubMed

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

    2015-04-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological examinations, and eye movement analysis, specifically, stability analysis on fixating a still target, tracking saccades, analysis of fixation pauses, speed reading, saccades, and regressions through the reading of a text. Stability analysis on fixating a still target showed a significant (p < 0.001) difference between the two groups showing an increased amount of loss of fixation among dyslexic subjects (5.36 ± 2.5 s and 0.82 ± 2.1, respectively). Tracking saccades (left and right horizontal axis) did not show a significant difference. When reading parameters were looked into (number of saccades, number of regressions, reading time through the reading of a text), a significant (p < 0.001) difference was found between the groups. This study supports the belief that the alteration of eye movement does not depend on oculo-motor dysfunction but is secondary to a defect in the visual processing of linguistic material. Inclusion of assessment of this defect might prove beneficial in determining the presence of dyslexia in young children at a younger age, and an earlier intervention could be initiated.

  10. Clinical Evaluation of Shilajatu Rasayana in patients with HIV Infection

    PubMed Central

    Gupta, G. D.; Sujatha, N.; Dhanik, Ajay; Rai, N. P.

    2010-01-01

    AIDS is one of the serious global health concerns caused by Human Immuno Deficiency(HIV) virus and is predominantly a sexually transmitted disease. Currently there is no vaccine or cure for AIDS still Anti Retroviral Therapy (ART) is successful. It reduces both the mortality and the morbidity of HIV infection, but is expensive and inaccessible in many countries. However intense the therapy may be, HIV virus is rarely eliminated, and drug resistance is a major setback during long-term therapy. The development of new drugs and strategies and exploring alternative systems of medicine for antiviral herbs or drugs is the need of the age to improve treatment outcomes. Ayurveda describes many diseases which incorporate HIV like illness e.g. Rajayakshma, Ojo Kshaya, Sannipata jwara etc. HIV infection affects multisystems, chiefly the Immune System which can be correlated to Ojo Kshaya. Rasayana Chikitsa is the frontline therapy employed to treat Ojus disorders. Therefore Shilajatu (Mineral pitch), Centella asiatica (Mandukaparni), Tinospora cordifolia (Guduchi) and Emblica officinalis (Amalaki), well known for their Immuno-modulator and antioxidant properties were selected to evaluate their role on immune system. The study was carried on 20 patients from OPD and IPD of Kayachikitsa, S.S.Hospital, IMS, BHU and was randomly allocated into Treated group (Shilajatu+ART) and Control group (ART). Treated Group responded better to ART both clinically and biochemically. The results show that Shilajatu decreases the recurrent resistance of HIV virus to ART and improves the outcome of the therapy PMID:22131681

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

    PubMed

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

    2015-10-01

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

  12. Evaluation of ocular movements in patients with dyslexia.

    PubMed

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

    2015-04-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological examinations, and eye movement analysis, specifically, stability analysis on fixating a still target, tracking saccades, analysis of fixation pauses, speed reading, saccades, and regressions through the reading of a text. Stability analysis on fixating a still target showed a significant (p < 0.001) difference between the two groups showing an increased amount of loss of fixation among dyslexic subjects (5.36 ± 2.5 s and 0.82 ± 2.1, respectively). Tracking saccades (left and right horizontal axis) did not show a significant difference. When reading parameters were looked into (number of saccades, number of regressions, reading time through the reading of a text), a significant (p < 0.001) difference was found between the groups. This study supports the belief that the alteration of eye movement does not depend on oculo-motor dysfunction but is secondary to a defect in the visual processing of linguistic material. Inclusion of assessment of this defect might prove beneficial in determining the presence of dyslexia in young children at a younger age, and an earlier intervention could be initiated. PMID:25804764

  13. Evaluation of the soft tissue treatment simulation module of a computerized cephalometric program

    PubMed Central

    Oz, Aslihan Zeynep; Akcan, Cenk Ahmet; El, Hakan; Ciger, Semra

    2014-01-01

    Objective: The purpose of this study is to compare the accuracy of the treatment simulation module of Quick Ceph Studio (QCS) program to the actual treatment results in Class II Division 1 patients. Design: Retrospective study. Materials and Methods: Twenty-six skeletal Class II patients treated with functional appliances were included. T0 and T1 lateral cephalograms were digitized using QCS. Before applying treatment simulation to the digitized cephalograms, the actual T0-T1 difference was calculated for the SNA, SNB, ANB angles, maxillary incisor inclination, and protrusion and mandibular incisor inclination and protrusion values. Next, using the treatment simulation module, the aforementioned values for the T0 cephalograms were manually entered to match the actual T1 values taking into account the T0-T1 differences. Paired sample t-test were applied to determine the difference between actual and treatment simulation measurements. Results: No significant differences were found for the anteroposterior location of the landmarks. Upper lip, soft tissue A point, soft tissue pogonion, and soft tissue B point measurements showed statistically significant difference between actual and treatment simulation in the vertical plane. Conclusion: Quick Ceph program was reliable in terms of reflecting the sagittal changes that would probably occur with treatment and growth. However, vertical positions of the upper lip, soft tissue pogonion, soft tissue A point, and soft tissue B point were statistically different from actual results. PMID:24966775

  14. Fast Monte Carlo simulation on a voxelized human phantom deformed to a patient

    PubMed Central

    Bueno, G.; Déniz, O.; Carrascosa, C. B.; Delgado, J. M.; Brualla, L.

    2009-01-01

    Purpose: A method for performing fast simulations of absorbed dose using a patient’s computerized tomography (CT) scan without explicitly relying on a calibration curve is presented. Methods: The method is based on geometrical deformations performed on a standard voxelized human phantom. This involves spatially transforming the human phantom to align it with the patient CT image. Since the chemical composition and density of each voxel are given in the phantom data, a calibration curve is not used in the proposed method. For this study, the Monte Carlo (MC) code PENELOPE has been used as the simulation of reference. The results obtained with PENELOPE simulations are compared to those obtained with PENFAST and with the collapsed cone convolution algorithm implemented in a commercial treatment planning system. Results: The comparisons of the absorbed doses calculated with the different algorithms on two patient CTs and the corresponding deformed phantoms show a maximum distance to agreement of 2 mm, and in general, the obtained absorbed dose distributions are compatible within the reached statistical uncertainty. The validity of the deformation method for a broad range of patients is shown using MC simulations in random density phantoms. A PENFAST simulation of a 6 MV photon beam impinging on a patient CT reaches 2% statistical uncertainty in the absorbed dose, in a 0.1 cm3 voxel along the central axis, in 10 min running on a single core of a 2.8 GHz CPU. Conclusions: The proposed method of the absorbed dose calculation in a deformed voxelized phantom allows for dosimetric studies in the geometry of a patient CT scan. This is due to the fact that the chemical composition and material density of the phantom are known. Furthermore, simulation using the phantom geometry can provide dosimetric information for each organ. The method can be used for quality assurance procedures. In relation to PENFAST, it is shown that a purely condensed-history algorithm (class I) can

  15. Difficulties in applying numerical simulations to an evaluation of occupational hazards caused by electromagnetic fields

    PubMed Central

    Zradziński, Patryk

    2015-01-01

    Due to the various physical mechanisms of interaction between a worker's body and the electromagnetic field at various frequencies, the principles of numerical simulations have been discussed for three areas of worker exposure: to low frequency magnetic field, to low and intermediate frequency electric field and to radiofrequency electromagnetic field. This paper presents the identified difficulties in applying numerical simulations to evaluate physical estimators of direct and indirect effects of exposure to electromagnetic fields at various frequencies. Exposure of workers operating a plastic sealer have been taken as an example scenario of electromagnetic field exposure at the workplace for discussion of those difficulties in applying numerical simulations. The following difficulties in reliable numerical simulations of workers’ exposure to the electromagnetic field have been considered: workers’ body models (posture, dimensions, shape and grounding conditions), working environment models (objects most influencing electromagnetic field distribution) and an analysis of parameters for which exposure limitations are specified in international guidelines and standards. PMID:26323781

  16. Identification and simulation evaluation of an AH-64 helicopter hover math model

    NASA Technical Reports Server (NTRS)

    Schroeder, J. A.; Watson, D. C.; Tischler, M. B.; Eshow, M. M.

    1991-01-01

    Frequency-domain parameter-identification techniques were used to develop a hover mathematical model of the AH-64 Apache helicopter from flight data. The unstable AH-64 bare-airframe characteristics without a stability-augmentation system were parameterized in the convectional stability-derivative form. To improve the model's vertical response, a simple transfer-function model approximating the effects of dynamic inflow was developed. Additional subcomponents of the vehicle were also modeled and simulated, such as a basic engine response for hover and the vehicle stick dynamic characteristics. The model, with and without stability augmentation, was then evaluated by AH-64 pilots in a moving-base simulation. It was the opinion of the pilots that the simulation was a satisfactory representation of the aircraft for the tasks of interest. The principal negative comment was that height control was more difficult in the simulation than in the aircraft.

  17. Teaching Workflow Analysis and Lean Thinking via Simulation: A Formative Evaluation

    PubMed Central

    Campbell, Robert James; Gantt, Laura; Congdon, Tamara

    2009-01-01

    This article presents the rationale for the design and development of a video simulation used to teach lean thinking and workflow analysis to health services and health information management students enrolled in a course on the management of health information. The discussion includes a description of the design process, a brief history of the use of simulation in healthcare, and an explanation of how video simulation can be used to generate experiential learning environments. Based on the results of a survey given to 75 students as part of a formative evaluation, the video simulation was judged effective because it allowed students to visualize a real-world process (concrete experience), contemplate the scenes depicted in the video along with the concepts presented in class in a risk-free environment (reflection), develop hypotheses about why problems occurred in the workflow process (abstract conceptualization), and develop solutions to redesign a selected process (active experimentation). PMID:19412533

  18. Written debriefing: Evaluating the impact of the addition of a written component when debriefing simulations.

    PubMed

    Reed, Shelly J

    2015-11-01

    Debriefing, the reflective period following a simulation, is said to be where the bulk of simulation learning takes place. Many expert opinions regarding debriefing exist, but evidence-based best practices have yet to be identified. Written debriefing is one of these practices; experts state learning can be extended through the addition of a written component to the debriefing process, but no evidence exists to support this. This study compares three debriefing types: discussion alone, and discussion followed by journaling or blogging. Undergraduate nursing students participating in a simulation were randomized as a simulation group to one of these three debriefing types. Following completion of debriefing activities, students completed a Debriefing Experience Scale, a tool designed to evaluate the student experience during debriefing. Data obtained from completed scales were analyzed with ANOVA followed by Fisher LSD post hoc testing. The results showed the students preferred their experience with discussion debriefing over discussion debriefing with a written component added.

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

    PubMed

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

    2015-01-01

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

  20. Fast Simulators for Satellite Cloud Optical Centroid Pressure Retrievals, 1. Evaluation of OMI Cloud Retrievals

    NASA Technical Reports Server (NTRS)

    Joiner, J.; Vasilkov, A. P.; Gupta, Pawan; Bhartia, P. K.; Veefkind, Pepijn; Sneep, Maarten; deHaan, Johan; Polonsky, Igor; Spurr, Robert

    2011-01-01

    We have developed a relatively simple scheme for simulating retrieved cloud optical centroid pressures (OCP) from satellite solar backscatter observations. We have compared simulator results with those from more detailed retrieval simulators that more fully account for the complex radiative transfer in a cloudy atmosphere. We used this fast simulator to conduct a comprehensive evaluation of cloud OCPs from the two OMI algorithms using collocated data from CloudSat and Aqua MODIS, a unique situation afforded by the A-train formation of satellites. We find that both OMI algorithms perform reasonably well and that the two algorithms agree better with each other than either does with the collocated CloudSat data. This indicates that patchy snow/ice, cloud 3D, and aerosol effects not simulated with the CloudSat data are affecting both algorithms similarly. We note that the collocation with CloudSat occurs mainly on the East side of OMI's swath. Therefore, we are not able to address cross-track biases in OMI cloud OCP retrievals. Our fast simulator may also be used to simulate cloud OCP from output generated by general circulation models (GCM) with appropriate account of cloud overlap. We have implemented such a scheme and plan to compare OMI data with GCM output in the near future.

  1. Evaluation of virtual simulation in a master's-level nurse education certificate program.

    PubMed

    Foronda, Cynthia; Lippincott, Christine; Gattamorta, Karina

    2014-11-01

    Master's-level, nurse education certificate students performed virtual clinical simulations as a portion of their clinical practicum. Virtual clinical simulation is an innovative pedagogy using avatars in Web-based platforms to provide simulated clinical experiences. The purpose of this mixed-methods study was to evaluate nurse educator students' experience with virtual simulation and the effect of virtual simulation on confidence in teaching ability. Aggregated quantitative results yielded no significant change in confidence in teaching ability. Individually, some students indicated change of either increased or decreased confidence, whereas others exhibited no change in confidence after engaging in virtual simulation. Qualitative findings revealed a process of precursors of anxiety and frustration with technical difficulties followed by outcomes of appreciation and learning. Instructor support was a mediating factor to decrease anxiety and technical difficulties. This study served as a starting point regarding the application of a virtual world to teach the art of instruction. As the movement toward online education continues, educators should further explore use of virtual simulation to prepare nurse educators.

  2. Evaluation of a global internal-tide resolving and submesoscale admitting ocean simulation

    NASA Astrophysics Data System (ADS)

    Ubelmann, C.; Menemenlis, D.; Fu, L. L.; Zhao, Z.

    2014-12-01

    We will present ongoing evaluation of a global ocean and sea ice configuration of the Massachusetts Institute of Technology general circulation model (MITgcm) that has 0.75 to 2.2 km horizontal grid spacing and 1-m thick vertical levels near the surface. Surface boundary conditions are from the 0.14-degree European Center for Medium-Range Weather Forecasts (ECMWF) atmospheric operational model analysis, starting in 2011, including atmospheric pressure forcing. The simulation also includes tidal forcing. A unique feature of this simulation is that we save hourly output of full 3-dimensional model prognostic variables, making it a remarkable tool for the study of ocean processes and for the simulation of satellite observations. Although this initial simulation was run without ocean data constraints, it already presents very interesting features and interactions between an exceptionally wide range of scales. The simulation resolves geostrophic eddies and internal tides and admits submesoscale variability and unbalanced dynamics such as internal waves at non-tidal frequencies.We will present some evaluation of these different components based on altimetry observations and moorings. As a first result, the internal tides for the major tidal components have overall realistic amplitudes and spatial patterns compared to independent analyses from altimetry, although some discrepancies arise in equatorial regions. Despite discrepancies with observations, this simulation already constitutes an extremely useful tool for ocean process studies and for satellite observation system experiments, for example, in preparation for the Surface Water and Ocean Topography (SWOT) mission. As a preliminary exercise, the simulation has been tested in the SWOT simulator developed at the Jet Propulsion Laboratory (Fu et al., in this session). Some illustrations of the challenges will be presented.

  3. Dynamic modeling and experimental simulation of active solar energy systems for the evaluation of control strategies

    NASA Astrophysics Data System (ADS)

    Schiller, S. R.; Warren, M. L.; Wahlig, M.

    1980-07-01

    Dynamic modeling and experimental simulation are used to evaluate control strategies for active solar energy systems. Performance of proportional and on/off collector loop controllers are evaluated and compared using a theoretical dynamic collector model. The effect of controls and control strategies on hydronic space heating system performance is discussed. Both the computer model and the test facility allow evaluation of control strategies using various flow rates, controller set points, insolation patterns, ambient temperature conditions, and collector types. The test facility also allows comparison of collector and load loop flow stragegies based on various system configurations and building load demands.

  4. An innovative strategy in evaluation: using a student engagement framework to evaluate a role-based simulation.

    PubMed

    Smith, Morgan; Warland, Jane; Smith, Colleen

    2012-03-01

    Online role-play has the potential to actively engage students in authentic learning experiences and help develop their clinical reasoning skills. However, evaluation of student learning for this kind of simulation focuses mainly on the content and outcome of learning, rather than on the process of learning through student engagement. This article reports on the use of a student engagement framework to evaluate an online role-play offered as part of a course in Bachelor of Nursing and Bachelor of Midwifery programs. Instruments that measure student engagement to date have targeted large numbers of students at program and institutional levels, rather than at the level of a specific learning activity. Although the framework produced some useful findings for evaluation purposes, further refinement of the questions is required to be certain that deep learning results from the engagement that occurs with course-level learning initiatives.

  5. Quantitative evaluation of ozone and selected climate parameters in a set of EMAC simulations

    NASA Astrophysics Data System (ADS)

    Righi, M.; Eyring, V.; Gottschaldt, K.-D.; Klinger, C.; Frank, F.; Jöckel, P.; Cionni, I.

    2015-03-01

    Four simulations with the ECHAM/MESSy Atmospheric Chemistry (EMAC) model have been evaluated with the Earth System Model Validation Tool (ESMValTool) to identify differences in simulated ozone and selected climate parameters that resulted from (i) different setups of the EMAC model (nudged vs. free-running) and (ii) different boundary conditions (emissions, sea surface temperatures (SSTs) and sea ice concentrations (SICs)). To assess the relative performance of the simulations, quantitative performance metrics are calculated consistently for the climate parameters and ozone. This is important for the interpretation of the evaluation results since biases in climate can impact on biases in chemistry and vice versa. The observational data sets used for the evaluation include ozonesonde and aircraft data, meteorological reanalyses and satellite measurements. The results from a previous EMAC evaluation of a model simulation with nudging towards realistic meteorology in the troposphere have been compared to new simulations with different model setups and updated emission data sets in free-running time slice and nudged quasi chemistry-transport model (QCTM) mode. The latter two configurations are particularly important for chemistry-climate projections and for the quantification of individual sources (e.g., the transport sector) that lead to small chemical perturbations of the climate system, respectively. With the exception of some specific features which are detailed in this study, no large differences that could be related to the different setups (nudged vs. free-running) of the EMAC simulations were found, which offers the possibility to evaluate and improve the overall model with the help of shorter nudged simulations. The main differences between the two setups is a better representation of the tropospheric and stratospheric temperature in the nudged simulations, which also better reproduce stratospheric water vapor concentrations, due to the improved simulation of

  6. Simulating physiological conditions to evaluate nanoparticles for magnetic fluid hyperthermia (MFH) therapy applications

    NASA Astrophysics Data System (ADS)

    Chen, Shihwei; Chiang, Chen-li; Hsieh, Shuchen

    2010-01-01

    Magnetite nanoparticles with high self-heating capacity and low toxicity characteristics are a promising candidate for cancer hyperthermia treatment. In order to achieve minimum dosage to a patient, magnetic nanoparticles with high heating capacity are needed. In addition, the influence of physiological factors on the heat capacity of a material should be investigated in order to determine the feasibility. In this study, magnetite nanoparticles coated with lauric acid were prepared by co-precipitation of Fe 3+:Fe 2+ in a ratio of 2:1, 5:3, 3:2, and 4:3, and the pH was controlled using NaOH. Structural and magnetization characterization by means of X-ray diffractometry (XRD) and a superconducting quantum interference device (SQUID) revealed that the main species was Fe 3O 4 and further showed that most of the nanoparticles exhibited superparamagnetic properties. All of the magnetic nanoparticles showed a specific absorption rate (SAR) increase that was linear with the magnetic field strength and frequency of the alternating magnetic field. Among all, the magnetic nanoparticles prepared in a 3:2 ratio showed the highest SAR. To further test the influence of physiological factors on the 3:2 ratio magnetic nanoparticles, we simulated the environment with protein (bovine serum albumin, BSA), blood sugar (dextrose), electrolytes (commercial norm-saline) and viscosity (glycerol) to examine the heating capacity under these conditions. Our results showed that the SAR value was unaffected by the protein and blood sugar environments. On the other hand, the SAR value was significantly reduced in the electrolyte environment, due to precipitation and aggregation with sodium ions. For the simulated viscous environment with glycerol, the result showed that the SAR values reduced with increasing glycerol concentration. We have further tested the heating capacity contribution from the Néel mechanism by trapping the magnetic nanoparticles in a solid form of polydimethylsiloxane

  7. Automation of the patient history--evaluation of ergonomic aspects.

    PubMed

    Quaak, M J; Van der Voort, P J; Westerman, R F; Hasman, A; van Bemmel, J H

    1987-11-01

    In this study it was investigated in quantitative terms how patient reactions were on automated history-taking. The study is part of a comprehensive project, in which also physicians participated in the validation of such computerized medical records. In total 99 patients, visiting the outpatient clinic of Internal Medicine for the first time, took part in this in-depth study, in which they could express themselves via an interactive and modified terminal and keyboard. The questionnaire that was used in the system contains 28 different screens. Patient complaints are entered together with data on frequency, severity, onset, and duration. The patient may indicate his physical complaints on a stylized picture of the human body. Of the 99 patients, 67 answered the full questionnaire, and another 16 the main part. On the average, 66 min were needed. Younger patients do complete the history in a significantly shorter time than older patients, resulting in relatively more completed histories for the younger group. Quick patients answered on the average 3.5 questions per minute, the slow patients only 2.5. This was strongly correlated with patient familiarization, that has also been investigated: patients who had a quick familiarization were able to finish within 50 min. Patients who needed no help at all in using the system had even answering rates of 3.9/min.

  8. Control of thermal barrier performance by optimized nanoparticle size and experimental evaluation using a solar simulator

    NASA Astrophysics Data System (ADS)

    Gonome, Hiroki; Baneshi, Mehdi; Okajima, Junnosuke; Komiya, Atsuki; Yamada, Noboru; Maruyama, Shigenao

    2014-12-01

    An experimental investigation to evaluate the radiative properties of a selectively transparent thin coating on a substrate of a different material has been performed in order to evaluate its thermal behavior for applications where a low temperature at the surface exposed to the sun is desired. Copper (II) oxide (CuO) micro-particles have been used to create a pigmented coating on a paper substrate. The particle volume fraction and size have been optimized by the theoretical methodology. The spectral reflectance was measured using spectroscopy in the visible (VIS) and near-infrared (NIR) regions. The spectral emissivity was evaluated from the reflectance in IR region. The temperatures of the designed coatings and typical black paints are measured in a solar simulator. The temperature measurement was simulated by numerical analysis. The temperature of CuO coating on standard white paper was 10 °C lower than the ones of typical black paint while keeping the desired dark tone.

  9. Patient-specific simulations of stenting procedures in coronary bifurcations: two clinical cases.

    PubMed

    Morlacchi, Stefano; Colleoni, Sebastian George; Cárdenes, Rubén; Chiastra, Claudio; Diez, Jose Luis; Larrabide, Ignacio; Migliavacca, Francesco

    2013-09-01

    Computational simulations of stenting procedures in idealized geometries can only provide general guidelines and their use in the patient-specific planning of percutaneous treatments is inadequate. Conversely, image-based patient-specific tools that are able to realistically simulate different interventional options might facilitate clinical decision-making and provide useful insights on the treatment for each individual patient. The aim of this work is the implementation of a patient-specific model that uses image-based reconstructions of coronary bifurcations and is able to replicate real stenting procedures following clinical indications. Two clinical cases are investigated focusing the attention on the open problems of coronary bifurcations and their main treatment, the provisional side branch approach. Image-based reconstructions are created combining the information from conventional coronary angiography and computed tomography angiography while structural finite element models are implemented to replicate the real procedure performed in the patients. First, numerical results show the biomechanical influence of stents deployment in the coronary bifurcations during and after the procedures. In particular, the straightening of the arterial wall and the influence of two overlapping stents on stress fields are investigated here. Results show that a sensible decrease of the vessel tortuosity occurs after stent implantation and that overlapping devices result in an increased stress state of both the artery and the stents. Lastly, the comparison between numerical and image-based post-stenting configurations proved the reliability of such models while replicating stent deployment in coronary arteries.

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

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

    PubMed Central

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

    2016-01-01

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

  12. Scattered radiation in flat-detector based cone-beam CT: analysis of voxelized patient simulations

    NASA Astrophysics Data System (ADS)

    Wiegert, Jens; Bertram, Matthias

    2006-03-01

    This paper presents a systematic assessment of scattered radiation in flat-detector based cone-beam CT. The analysis is based on simulated scatter projections of voxelized CT images of different body regions allowing to accurately quantify scattered radiation of realistic and clinically relevant patient geometries. Using analytically computed primary projection data of high spatial resolution in combination with Monte-Carlo simulated scattered radiation, practically noise-free reference data sets are computed with and without inclusion of scatter. The impact of scatter is studied both in the projection data and in the reconstructed volume for the head, thorax, and pelvis regions. Currently available anti-scatter grid geometries do not sufficiently compensate scatter induced cupping and streak artifacts, requiring additional software-based scatter correction. The required accuracy of scatter compensation approaches increases with increasing patient size.

  13. A Psychiatric Assessment-Treatment-Outcome Information System: Evaluation with Computer Simulation

    PubMed Central

    Angle, Hugh V.; Ellinwood, Everett H.

    1978-01-01

    The prediction of treatment outcome will require a clinically dedicated and comprehensive information system to gather a sizable data file on each individual, covering patient assessment, treatment and treatment outcome. The computer interview represents an information system capable of routinely gathering a large portion of this information. However, current methods of data analysis cannot adequately handle the information complexity associated with psychiatric treatment. Computer simulation is a method ideally suited to the investigation of complex subject matter and is proposed as a means to forecast the treatment outcome of actual patients under various conditions of treatment.

  14. The nature of reality represented in high fidelity human patient simulation: philosophical perspectives and implications for nursing education.

    PubMed

    Dunnington, Renee M

    2014-01-01

    Simulation technology is increasingly being used in nursing education. Previously used primarily for teaching procedural, instrumental, or critical incident types of skills, simulation is now being applied to training related to more dynamic, complex, and interpersonal human contexts. While high fidelity human patient simulators have significantly increased in authenticity, human responses have greater complexity and are qualitatively different than current technology represents. This paper examines the texture of representation by simulation. Through a tracing of historical and contemporary philosophical perspectives on simulation, the nature and limits of the reality of human health responses represented by high fidelity human patient simulation (HF-HPS) are explored. Issues concerning nursing education are raised around the nature of reality represented in HF-HPS. Drawing on Waks, a framework for guiding pedagogical considerations around simulation in nursing education is presented for the ultimate purpose of promoting an educative experience with simulation. PMID:24320978

  15. The nature of reality represented in high fidelity human patient simulation: philosophical perspectives and implications for nursing education.

    PubMed

    Dunnington, Renee M

    2014-01-01

    Simulation technology is increasingly being used in nursing education. Previously used primarily for teaching procedural, instrumental, or critical incident types of skills, simulation is now being applied to training related to more dynamic, complex, and interpersonal human contexts. While high fidelity human patient simulators have significantly increased in authenticity, human responses have greater complexity and are qualitatively different than current technology represents. This paper examines the texture of representation by simulation. Through a tracing of historical and contemporary philosophical perspectives on simulation, the nature and limits of the reality of human health responses represented by high fidelity human patient simulation (HF-HPS) are explored. Issues concerning nursing education are raised around the nature of reality represented in HF-HPS. Drawing on Waks, a framework for guiding pedagogical considerations around simulation in nursing education is presented for the ultimate purpose of promoting an educative experience with simulation.

  16. Evaluation of Global Observations-Based Evapotranspiration Datasets and IPCC AR4 Simulations

    NASA Technical Reports Server (NTRS)

    Mueller, B.; Seneviratne, S. I.; Jimenez, C.; Corti, T.; Hirschi, M.; Balsamo, G.; Ciais, P.; Dirmeyer, P.; Fisher, J. B.; Guo, Z.; Jung, M.; Maignan, F.; McCabe, M. F.; Reichle, R.; Reichstein, M.; Rodell, M.; Sheffield, J.; Teuling, A. J.; Wang, K.; Wood, E. F.; Zhang, Y.

    2011-01-01

    Quantification of global land evapotranspiration (ET) has long been associated with large uncertainties due to the lack of reference observations. Several recently developed products now provide the capacity to estimate ET at global scales. These products, partly based on observational data, include satellite ]based products, land surface model (LSM) simulations, atmospheric reanalysis output, estimates based on empirical upscaling of eddycovariance flux measurements, and atmospheric water balance datasets. The LandFlux-EVAL project aims to evaluate and compare these newly developed datasets. Additionally, an evaluation of IPCC AR4 global climate model (GCM) simulations is presented, providing an assessment of their capacity to reproduce flux behavior relative to the observations ]based products. Though differently constrained with observations, the analyzed reference datasets display similar large-scale ET patterns. ET from the IPCC AR4 simulations was significantly smaller than that from the other products for India (up to 1 mm/d) and parts of eastern South America, and larger in the western USA, Australia and China. The inter-product variance is lower across the IPCC AR4 simulations than across the reference datasets in several regions, which indicates that uncertainties may be underestimated in the IPCC AR4 models due to shared biases of these simulations.

  17. Evaluation of Cloud Microphysical Parameterizations in Cloud Resolving Model Simulations using the ARM observations

    NASA Astrophysics Data System (ADS)

    Liu, Z.; Muhlbauer, A.; Ackerman, T. P.

    2011-12-01

    Clouds modulate the distribution of energy and water within the atmosphere and regulate the hydrological cycle. Cloud microphysical parameterizations are critical for the representation of cloud microphysical properties in both cloud-resolving and climate models. In this study, we analyze the capabilities of a cloud-resolving model (CRM) with advanced bulk microphysics schemes to simulate the microphysical properties and evolution of convective clouds and anvil cirrus over the Southern Great Plains (SGP) site in the mid-latitudes and Kwajalein Atoll in the tropics. For evaluating simulated cloud properties, we use observations from the Atmospheric Radiation Measurement (ARM) Program 1997 summer Intensive Observations Period at the SGP site and the Kwajalein Experiment (KWAJEX) field campaign. The CRM simulations are evaluated with the ARM and KWAJEX observations, in particular using precipitation records, radiative fluxes, and radar reflectivity values observed by the ARM millimeter wavelength cloud radar (MMCR) and the Kwajalein precipitation radar. Preliminary analysis of the ARM SGP case shows that although the precipitation events during this period are well captured by the model, the outgoing longwave radiation (OLR) is considerably underestimated and the model generates too much high cloud, which is inconsistent with the MMCR observations. In our study we especially focus on the causes of the overproduction of ice and high clouds in the CRM simulations. Improvements of the ice microphysics scheme and resulting impacts on the simulation are presented.

  18. Using patient-specific phantoms to evaluate deformable image registration algorithms for adaptive radiation therapy.

    PubMed

    Stanley, Nick; Glide-Hurst, Carri; Kim, Jinkoo; Adams, Jeffrey; Li, Shunshan; Wen, Ning; Chetty, Indrin J; Zhong, Hualiang

    2013-11-04

    The quality of adaptive treatment planning depends on the accuracy of its underlying deformable image registration (DIR). The purpose of this study is to evaluate the performance of two DIR algorithms, B-spline-based deformable multipass (DMP) and deformable demons (Demons), implemented in a commercial software package. Evaluations were conducted using both computational and physical deformable phantoms. Based on a finite element method (FEM), a total of 11 computational models were developed from a set of CT images acquired from four lung and one prostate cancer patients. FEM generated displacement vector fields (DVF) were used to construct the lung and prostate image phantoms. Based on a fast-Fourier transform technique, image noise power spectrum was incorporated into the prostate image phantoms to create simulated CBCT images. The FEM-DVF served as a gold standard for verification of the two registration algorithms performed on these phantoms. The registration algorithms were also evaluated at the homologous points quantified in the CT images of a physical lung phantom. The results indicated that the mean errors of the DMP algorithm were in the range of 1.0 ~ 3.1 mm for the computational phantoms and 1.9 mm for the physical lung phantom. For the computational prostate phantoms, the corresponding mean error was 1.0-1.9 mm in the prostate, 1.9-2.4mm in the rectum, and 1.8-2.1 mm over the entire patient body. Sinusoidal errors induced by B-spline interpolations were observed in all the displacement profiles of the DMP registrations. Regions of large displacements were observed to have more registration errors. Patient-specific FEM models have been developed to evaluate the DIR algorithms implemented in the commercial software package. It has been found that the accuracy of these algorithms is patient dependent and related to various factors including tissue deformation magnitudes and image intensity gradients across the regions of interest. This may suggest that

  19. Effects of simulator motion and visual characteristics on rotorcraft handling qualities evaluations

    NASA Technical Reports Server (NTRS)

    Mitchell, David G.; Hart, Daniel C.

    1993-01-01

    The pilot's perceptions of aircraft handling qualities are influenced by a combination of the aircraft dynamics, the task, and the environment under which the evaluation is performed. When the evaluation is performed in a groundbased simulator, the characteristics of the simulation facility also come into play. Two studies were conducted on NASA Ames Research Center's Vertical Motion Simulator to determine the effects of simulator characteristics on perceived handling qualities. Most evaluations were conducted with a baseline set of rotorcraft dynamics, using a simple transfer-function model of an uncoupled helicopter, under different conditions of visual time delays and motion command washout filters. Differences in pilot opinion were found as the visual and motion parameters were changed, reflecting a change in the pilots' perceptions of handling qualities, rather than changes in the aircraft model itself. The results indicate a need for tailoring the motion washout dynamics to suit the task. Visual-delay data are inconclusive but suggest that it may be better to allow some time delay in the visual path to minimize the mismatch between visual and motion, rather than eliminate the visual delay entirely through lead compensation.

  20. Evaluating the Benefits of Collaboration in Simulation Games: The Case of Health Care

    PubMed Central

    2014-01-01

    Background Organizations have used simulation games for health promotion and communication. To evaluate how simulation games can foster collaboration among stakeholders, this paper develops two social network measures. Objective The paper aims to initiate two specific measures that facilitate organizations and researchers to evaluate the effectiveness of Web-based simulation games in fostering collaboration. Methods The two measures are: (1) network density and (2) network diversity. They measure the level of connectedness and communication evenness within social networks. To illustrate how these measures may be used, a hypothetical game about health policy is outlined. Results Web-based games can serve as an effective platform to engage stakeholders because interaction among them is quite convenient. Yet, systematic evaluation and planning are necessary to realize the benefits of these games. The paper suggests directions for testing how the social network dimension of Web-based games can augment individual-level benefits that stakeholders can obtain from playing simulation games. Conclusions While this paper focuses on measuring the structural properties of social networks in Web-based games, further research should focus more attention on the appropriateness of game contents. In addition, empirical research should cover different geographical areas, such as East Asian countries where video games are very popular. PMID:25658851