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Sample records for simulated patients evaluation

  1. Evaluation of Surgical Resident Applications Using Simulated Patients.

    ERIC Educational Resources Information Center

    Ramsey, Don; And Others

    1987-01-01

    This study examined the effects of a simulated patient examination administered to applicants for the General Surgical residency program at Southern Illinois University School of Medicine. Results obtained from 29 applicants showed no significant differences in faculty ratings between applicants provided practical exam results and those using…

  2. Evaluating the management of septic shock using patient simulation.

    PubMed

    Ottestad, Einar; Boulet, John R; Lighthall, Geoffrey K

    2007-03-01

    Develop a scoring system that can assess the management of septic shock by individuals and teams. Retrospective review of videotapes of critical care house staff managing a standardized simulation of septic shock. Academic medical center; videotapes were made in a recreated intensive care unit environment using a high-fidelity patient simulator. Residents in medicine, surgery, and anesthesiology who had participated in the intensive care unit rotation. The septic patient was managed by the intensive care unit team in a graded manner with interns present for the first 10 mins and more senior-level help arriving after 10 mins. The intern was graded separately for the first 10 mins, and the team was graded for the entire 35-min performance. Both technical and nontechnical scoring systems were developed to rate the management of septic shock. Technical scores are based on guidelines and principles of managing septic shock. Team leadership, communication, contingency planning, and resource utilization were addressed by the nontechnical rating. Technical scores were calculated for both interns and teams; nontechnical scores applied only to the team. Of 16 technical checklist items, interns completed a mean of 7 with a range of 1.5-11. Team technical ratings had a mean of 9.3 with a range of 3.3-13. Nontechnical scores showed similar intergroup variability with a mean of 26 and a range of 10-35. Technical and nontechnical scores showed a modest correlation (r = .40, p = .05). Interrater reliabilities for intern and team technical scores were both r = .96 and for nontechnical scores r = .88. Objective measures of both knowledge-based and behavioral skills pertinent to the management of septic shock were made. Scores identified both adequate and poor levels of performance. Such assessments can be used to benchmark clinical skills of individuals and groups over time and may allow the identification of interventions that improve clinical effectiveness in sepsis management.

  3. 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).

  4. Evaluating the Impact of Classroom Education on the Management of Septic Shock Using Human Patient Simulation.

    PubMed

    Lighthall, Geoffrey K; Bahmani, Dona; Gaba, David

    2016-02-01

    Classroom lectures are the mainstay of imparting knowledge in a structured manner and have the additional goals of stimulating critical thinking, lifelong learning, and improvements in patient care. The impact of lectures on patient care is difficult to examine in critical care because of the heterogeneity in patient conditions and personnel as well as confounders such as time pressure, interruptions, fatigue, and nonstandardized observation methods. The critical care environment was recreated in a simulation laboratory using a high-fidelity mannequin simulator, where a mannequin simulator with a standardized script for septic shock was presented to trainees. The reproducibility of this patient and associated conditions allowed the evaluation of "clinical performance" in the management of septic shock. In a previous study, we developed and validated tools for the quantitative analysis of house staff managing septic shock simulations. In the present analysis, we examined whether measures of clinical performance were improved in those cases where a lecture on the management of shock preceded a simulated exercise on the management of septic shock. The administration of the septic shock simulations allowed for performance measurements to be calculated for both medical interns and for subsequent management by a larger resident-led team. The analysis revealed that receiving a lecture on shock before managing a simulated patient with septic shock did not produce scores higher than for those who did not receive the previous lecture. This result was similar for both interns managing the patient and for subsequent management by a resident-led team. We failed to find an immediate impact on clinical performance in simulations of septic shock after a lecture on the management of this syndrome. Lectures are likely not a reliable sole method for improving clinical performance in the management of complex disease processes.

  5. Evaluating the practice of Iranian community pharmacists regarding oral contraceptive pills using simulated patients

    PubMed Central

    Foroutan, Nazanin; Dabaghzadeh, Fatemeh

    2016-01-01

    Background: As oral contraceptive pills are available over the counter in pharmacies, pharmacists are professionally responsible for checking and informing patients about every aspect of taking these drugs. Simulated patient method is a new and robust way to evaluate professional performance of pharmacists. Objective: The aim of the present study was to evaluate the pharmacy practice of Iranian pharmacists regarding over-the-counter use of oral contraceptive pills using simulated patient method. Methods: Simulated patients visited pharmacy with a prescription containing ciprofloxacin and asked for oral contraceptive pills. The pharmacist was expected to ask important questions for using these drugs and to inform the patient about them properly. Moreover, the Pharmacists should advise patients in regard to the possible interaction. Results: Ninety four pharmacists participated in this study. In 24 (25.3%) visits, the liable pharmacist was not present at the time of purchase. Furthermore, In 13 (18.57 %) visits by the simulated patients, the liable pharmacists did not pay any attention to the simulated patients even when they asked for consultation. Twenty nine (41.43%) pharmacists did not ask any question during dispensing. Nausea was the most frequent described side effect by pharmacists (27 (38.57%)). Yet important adverse effects of oral contraceptive pills were not mentioned by the pharmacists except for few ones. Only twelve (17.14%) pharmacists mentioned the possible interaction. There was a significant relation between the pharmacists’ gender and detection of possible interaction (p value= 0.048). Conclusion: The quality of the pharmacists’ consultations regarding the over the counter use of oral contraceptive pills was not satisfactory and required improvement. PMID:28042350

  6. Evaluating community pharmacy practice in Qatar using simulated patient method:acute gastroenteritis management

    PubMed Central

    Ibrahim, Mohamed I.; Palaian, Subish; Al-Sulaiti, Fatima; El-Shami, Somia

    2016-01-01

    Objective: To evaluate Qatari pharmacists’ prescribing, labeling, dispensing and counseling practices in response to acute community-acquired gastroenteritis. Methods: The simulated patient method was used in this study. Thirty pharmacies in Doha were randomly selected and further randomized into two groups: Face-to-Face (n=15) vs. Telephone-call (n=15) per simulated patient; 2 simulated patients were involved. Prescribing, labeling, dispensing and counseling practices were assessed. Data analysis was performed using Mann-Whitney and chi square tests at alpha=0.05. Results: Most pharmacists prescribed and dispensed medicines (96%), including antimicrobials (43.9%), antidiarrheals (36%), antiemetics (5.1%) and antipyretics (3%). Counseling practices were poor (62.1% in the face-to-face group vs 70% in the telephone-call group did not counsel simulated patients about the dispensed medicines; p-value=0.50). In more than one-third of the encounters, at least one labeling parameter was missing. The duration of each interaction in minutes was not significantly different between the groups [median (IQR); 3(4.25) in the face-to-face group versus 2(0.25) in the telephone-call group; p-value=0.77]. No significant differences in prescribing or dispensing behaviors were present between groups (p-value>0.05). Conclusion: Qatar community pharmacists’ labeling, dispensing, and counseling practices were below expectation, thus urging the need for continuous professional development. PMID:28042351

  7. A pilot study evaluating the perceptions of Certified Registered Nurse Anesthetists toward human patient simulation.

    PubMed

    Hawkins, Robert; Bendickson, Lee; Benson, Pretoria; Osborne, Lisa; McPherson, Jennifer; Todd, Larry; Snelson, Jennifer; Bruner, Sandra; Bohan, Kevin

    2014-10-01

    An evaluation was conducted of perceptions of practicing Certified Registered Nurse Anesthetists (CRNAs) toward use of simulation for initial certification, continuing education, and recertification. The hypothesis was that a 1-day simulation experience would improve their perceptions toward simulation use. The first phase developed content-valid questions to examine CRNAs' perceptions toward simulation. The second phase used these questions to survey practicing CRNAs in the District of Columbia, Maryland, and Virginia. During the third phase, 9 CRNAs were selected to complete a 1-day simulation experience and complete the perception questionnaire before and after the experience. Through content validity index calculations, 25 of 27 questions were retained for use in this study. A total of 378 CRNAs responded to the questionnaire. There was consensus that human patient simulation (HPS) is an important part of anesthesia provider training, and 85.7% strongly agreed, agreed, or somewhat agreed that HPS should be a required component for initial certification. Additionally, 52.9% of respondents agreed (somewhat agreed or strongly agreed) that continuing education units from HPS should be required for recertification. After the simulation, a significant (P < .05) positive change in level of agreement was noted for 13 of 25 questions, including questions related to initial training and recertification.

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

    PubMed

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

    2014-11-01

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

  9. Patient specific surgical simulator for the evaluation of the movability of bimanual robotic arms.

    PubMed

    Moglia, Andrea; Turini, Giuseppe; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

    2011-01-01

    This work presents a simulator based on patient specific data for bimanual surgical robots. Given a bimanual robot with a particular geometry and kinematics, and a patient specific virtual anatomy, the aim of this simulator was to evaluate if a dexterous movability was obtainable to avoid collisions with the surrounding virtual anatomy in order to prevent potential damages to the tissues during the real surgical procedure. In addition, it could help surgeons to find the optimal positioning of the robot before entering the operative room. This application was tested using a haptic device to reproduce the interactions of the robot with deformable organs. The results showed good performances in terms of frame rate for the graphic, haptic, and dynamic processes.

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

    PubMed

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

    2015-01-01

    Structured simulations have become a critical part of health professions education at every level, particularly for high-risk, low-incidence scenarios. This article describes the implementation and evaluation of a hybrid simulation of emergency birth situations in a graduate midwifery program. In the fall of 2011 and spring of 2012, nurse-midwifery students twice participated in 2 simulated emergencies-shoulder dystocia and postpartum hemorrhage-using hybrid simulation (a standardized patient paired with a birth task trainer). Students found the simulations to be realistic. The use of best practices (ie, repetitive practice, team learning, small group debriefing, and large group debriefing) enhanced the quality of the simulation experience and the learners' reflection about their professional skills, strengths, weaknesses, and confidence in managing these 2 obstetric emergencies. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

  11. Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient

    PubMed Central

    Kern, Donna H.; Shrader, Sarah P.

    2016-01-01

    Objective. To evaluate the impact of an Interprofessional Communication Skills Workshop on pharmacy student confidence and proficiency in disclosing medical errors to patients. Pharmacy student behavior was also compared to that of other health professions’ students on the team. Design. Students from up to four different health professions participated in a simulation as part of an interprofessional team. Teams were evaluated with a validated rubric postsimulation on how well they handled the disclosure of an error to the patient. Individually, each student provided anonymous feedback and self-reflected on their abilities via a Likert-scale evaluation tool. A comparison of pharmacy students who completed the workshop (active group) vs all others who did not (control group) was completed and analyzed. Assessment. The majority of students felt they had adequate training related to communication issues that cause medication errors. However, fewer students believed that they knew how to report such an error to a patient or within a health system. Pharmacy students who completed the workshop were significantly more comfortable explicitly stating the error disclosure to a patient and/or caregiver and were more likely to apologize and respond to questions forthrightly (p<0.05). Conclusions. This data affirms the need to devote more time to training students on communicating with patients about the occurrence of medical errors and how to report these errors. Educators should be encouraged to incorporate such training within interprofessional education curricula. PMID:27899834

  12. Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

    PubMed

    Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; de Oliveira Baldoni, André; 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

    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. To evaluate the COC dispensing practices of CPs in a developing country. 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. 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. 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.

  13. 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

  14. A medical hand tool physical interaction evaluation approach for prototype testing using patient care simulators.

    PubMed

    Browne, Aleksandra; O'Sullivan, Leonard

    2012-05-01

    The purpose of this study was to develop and test a physical ergonomics assessment approach for medical device handles. The method assesses wrist posture and force of exertion simultaneously by task element. Electrogoniometers and EMG sensors were connected through a data acquisition module for synchronization with video recordings of trials. Task analysis of video recordings were performed offline with Observer XT software. Average posture and force data across several repetitions of individual task elements were calculated and presented in a format suitable for informing product designers of specific issues during a test trial. A handle comfort questionnaire is proposed to survey subjective responses. The evaluation approach was applied to an endoscope needle in sampling a biopsy from the stomach wall using a gastrointestinal track simulator with ten physician surrogates. The results showed that for all task elements the wrist was in extension (33(°)-45(°)). Peak muscle forces ranged from 28% to 68% MVC across the three muscles studied. Muscle peak forces were above ACGIH HAL maximum threshold limits for four of the seven task elements, and above the action limit for all seven task elements for two muscles. The handle comfort questionnaire data also supported the high muscle force findings, and also on force distribution on the handle due to contact stresses. This combined approach could be used to collect and report detailed early stage ergonomics data from user trials on patient care simulators. The approach is proposed for use by medical device designers at the design stage of new products using prototypes, but it could also be used on existing products with real patients.

  15. 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…

  16. 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…

  17. 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

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

    PubMed

    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

    2014-09-01

    Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. 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. 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. 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.

  19. Evaluation of fluoroquinolone reduced dosage regimens in elderly patients by using pharmacokinetic modelling and Monte Carlo simulations.

    PubMed

    Leroy, Bertrand; Uhart, Mathieu; Maire, Pascal; Bourguignon, Laurent

    2012-09-01

    Fluoroquinolones are widely used in geriatric patients, but elderly patients are known to be at increased risk of decline in renal function. As fluoroquinolones usually exhibit a dominant renal elimination pathway, reduced dosage regimens are often used in geriatric patients. Our objective was to assess the capability to reach a pharmacokinetic-pharmacodynamic target of efficacy with such reduced dosage regimens of ofloxacin, levofloxacin and ciprofloxacin in elderly patients. Using Monte Carlo simulations, 1000 simulated elderly patients were created, based on published pharmacokinetic and pharmacodynamic data, and measured demographic data. Three usually proposed drug regimens taking renal function into account were evaluated using compartmental models. The probability of reaching an fAUC/MIC >100 was calculated for each regimen. For MICs <1 mg/L, all simulated patients reach the efficacy target. However, with higher values of MIC, the proposed regimens were inefficient for patients with moderate or severe renal impairment: 3.4% and 30.2% of patients with moderate renal impairment reached the efficacy target for ciprofloxacin and ofloxacin, respectively, for an MIC of 2 mg/L. For ciprofloxacin, more than 80% of patients with severe renal impairment were unable to reach the target fAUC/MIC with an MIC as low as 1 mg/L, whereas for levofloxacin, all simulated patients reached the efficacy target until an MIC of 4 mg/L. This suggests that the proposed dosage reduction does not allow the same exposure to be achieved in elderly patients with renal impairment, eventually leading to treatment failure or development of resistant strains.

  20. Evaluation Training: Simulation Exercises.

    ERIC Educational Resources Information Center

    Smith, Carl B.; Farr, Roger

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

  1. Evaluation of a Patient-Specific Finite-Element Model to Simulate Conservative Treatment in Adolescent Idiopathic Scoliosis.

    PubMed

    Vergari, Claudio; Ribes, Gwenael; Aubert, Benjamin; Adam, Clayton; Miladi, Lotfi; Ilharreborde, Brice; Abelin-Genevois, Kariman; Rouch, Philippe; Skalli, Wafa

    2015-01-01

    Retrospective validation study. To propose a method to evaluate, from a clinical standpoint, the ability of a finite-element model (FEM) of the trunk to simulate orthotic correction of spinal deformity and to apply it to validate a previously described FEM. Several FEMs of the scoliotic spine have been described in the literature. These models can prove useful in understanding the mechanisms of scoliosis progression and in optimizing its treatment, but their validation has often been lacking or incomplete. Three-dimensional (3D) geometries of 10 patients before and during conservative treatment were reconstructed from biplanar radiographs. The effect of bracing was simulated by modeling displacements induced by the brace pads. Simulated clinical indices (Cobb angle, T1-T12 and T4-T12 kyphosis, L1-L5 lordosis, apical vertebral rotation, torsion, rib hump) and vertebral orientations and positions were compared to those measured in the patients' 3D geometries. Errors in clinical indices were of the same order of magnitude as the uncertainties due to 3D reconstruction; for instance, Cobb angle was simulated with a root mean square error of 5.7°, and rib hump error was 5.6°. Vertebral orientation was simulated with a root mean square error of 4.8° and vertebral position with an error of 2.5 mm. The methodology proposed here allowed in-depth evaluation of subject-specific simulations, confirming that FEMs of the trunk have the potential to accurately simulate brace action. These promising results provide a basis for ongoing 3D model development, toward the design of more efficient orthoses. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  2. EPS: An Epidemiologic Patient Simulator

    PubMed Central

    Lewis, James Scott

    1981-01-01

    EPS is an automated patient case simulator which presents the user (student) with a mock patient that he may interview, as in a standard medical history; examine, as in a physical examination; evaluate, through XRAY and other laboratory studies; and finally, diagnose. The foundation of the system is a mathematical description of the relevant epidemiological data for each disease simulated. This is referred to as the DISEASE MODEL.

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

    PubMed Central

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

    2006-01-01

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

  4. Human patient simulation evaluation rubrics for nursing education: measuring the Essentials of Baccalaureate Education for Professional Nursing Practice.

    PubMed

    Davis, Alison H; Kimble, Laura P

    2011-11-01

    With the call for curriculum that meets the educational needs of nurses in the 21st century, the American Association of Colleges of Nursing provided nine essentials for baccalaureate nursing education in The Essentials of Baccalaureate Education for Professional Nursing Practice, which serves as a critical guide to inform and shape baccalaureate nursing program curricula. Nursing programs must demonstrate program outcomes that reflect all of the essentials. Human patient simulation was specifically acknowledged as an appropriate educational tool for meeting these needs. This article identifies and assesses six rubrics purported to measure outcomes of human patient simulation and evaluates how these rubrics measure outcomes reflecting the baccalaureate essentials. Psychometric data were limited for the majority of the rubrics, especially validity data. The rubrics consistently failed to measure Essentials V and VII. Suggestions for how these Essentials might be integrated into the existing rubrics are provided. Copyright 2011, SLACK Incorporated.

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

    NASA Astrophysics Data System (ADS)

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

    2008-02-01

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

  6. Evaluating amikacin dosage regimens in intensive care unit patients: a pharmacokinetic/pharmacodynamic analysis using Monte Carlo simulation.

    PubMed

    Zazo, Hinojal; Martín-Suárez, Ana; Lanao, José M

    2013-08-01

    The objectives of this study were to conduct a comparative pharmacokinetic/pharmacodynamic (PK/PD) evaluation using Monte Carlo simulation of conventional versus high-dose extended-interval dosage (HDED) regimens of amikacin (AMK) in intensive care unit (ICU) patients for an Acinetobacter baumannii infection model. The simulation was performed in five populations (a control population and four subpopulations of ICU patients). Using a specific AMK PK/PD model and Monte Carlo simulation, the following were generated: simulated AMK steady-state plasma level curves; PK/PD efficacy indexes [time during which the serum drug concentration remains above the minimum inhibitory concentration (MIC) for a dosing period (%T>MIC) and ratio of peak serum concentration to MIC (Cmax/MIC)]; evolution of bacterial growth curves; and adaptive resistance to treatment. A higher probability of bacterial resistance was observed with the HDED regimen compared with the conventional dosage regimen. A statistically significant increase in Cmax/MIC and a statistically significant reduction in %T>MIC with the HDED regimen were obtained. A multiple linear relationship between CFU values at 24h with Cmax/MIC and %T>MIC was obtained. In conclusion, with the infection model tested, the likelihood of resistance to treatment may be higher against pathogens with a high MIC with the HDED regimen, considering that in many ICU patients the %T>MIC may be limited. If a sufficient value of %T>MIC (≥60%) is not reached, even though the Cmax/MIC is high, the therapeutic efficacy of the treatment may not be guaranteed. This study indicates that different AMK dosing strategies could directly influence the efficacy results in ICU patients.

  7. An Advanced Objective Structured Clinical Examination Using Patient Simulators to Evaluate Pharmacy Students’ Skills in Physical Assessment

    PubMed Central

    Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Utsumi, Miho; Kourogi, Yasuyuki; Osaki, Takashi; Ozaki, Mineo; Sato, Keizo; Arimori, Kazuhiko

    2014-01-01

    Objective. To implement an advanced objective structured clinical examination (OSCE) in the curriculum and to evaluate Japanese pharmacy students’ skills in physical assessment such as measuring pulse and blood pressure, and assessing heart, lung, and intestinal sounds. Design. An advanced OSCE was implemented in a hospital pharmacy seminar as a compulsory subject. We programmed patient simulators with 21 different patient cases in which normal and abnormal physiological conditions were produced. The virtual patients were then used to evaluate the physical assessment skills of fifth-year pharmacy students. Assessment. Significant differences were observed between the average of all the detailed evaluations and the mean results for the following skills: pulse measurement, blood pressure measurement, deflating the cuff at a rate of 2-3 mmHg/sec, listening to heart sounds, and listening to lung sounds. Conclusion. Administering an advanced OSCE using virtual patients was an effective way of assessing pharmacy students’ skills in a realistic setting. Several areas in which pharmacy students require further training were identified. PMID:25657371

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

    PubMed Central

    Schwartz, Brian; Palma, Anton

    2015-01-01

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

  9. Evaluation of deformation accuracy of a virtual pneumoperitoneum method based on clinical trials for patient-specific laparoscopic surgery simulator

    NASA Astrophysics Data System (ADS)

    Oda, Masahiro; Qu, Jia Di; Nimura, Yukitaka; Kitasaka, Takayuki; Misawa, Kazunari; Mori, Kensaku

    2012-02-01

    This paper evaluates deformation accuracy of a virtual pneumoperitoneum method by utilizing measurement data of real deformations of patient bodies. Laparoscopic surgery is an option of surgical operations that is less invasive technique as compared with traditional surgical operations. In laparoscopic surgery, the pneumoperitoneum process is performed to create a viewing and working space. Although a virtual pneumoperitoneum method based on 3D CT image deformation has been proposed for patient-specific laparoscopy simulators, quantitative evaluation based on measurements obtained in real surgery has not been performed. In this paper, we evaluate deformation accuracy of the virtual pneumoperitoneum method based on real deformation data of the abdominal wall measured in operating rooms (ORs.) The evaluation results are used to find optimal deformation parameters of the virtual pneumoperitoneum method. We measure landmark positions on the abdominal wall on a 3D CT image taken before performing a pneumoperitoneum process. The landmark positions are defined based on anatomical structure of a patient body. We also measure the landmark positions on a 3D CT image deformed by the virtual pneumoperitoneum method. To measure real deformations of the abdominal wall, we measure the landmark positions on the abdominal wall of a patient before and after the pneumoperitoneum process in the OR. We transform the landmark positions measured in the OR from the tracker coordinate system to the CT coordinate system. A positional error of the virtual pneumoperitoneum method is calculated based on positional differences between the landmark positions on the 3D CT image and the transformed landmark positions. Experimental results based on eight cases of surgeries showed that the minimal positional error was 13.8 mm. The positional error can be decreased from the previous method by calculating optimal deformation parameters of the virtual pneumoperitoneum method from the experimental

  10. Design of appointment systems for preanesthesia evaluation clinics to minimize patient waiting times: a review of computer simulation and patient survey studies.

    PubMed

    Dexter, F

    1999-10-01

    Anesthesiologists can use the science of clinic scheduling to design appointment systems for preanesthesia evaluation clinics. The principal reasons reported for inappropriately [or arguably unethically] long patient waiting times are provider tardiness, lack of patient punctuality, patient no-shows, and improperly designed appointment systems. However, the fundamental reason why anesthesia clinics have such long patient waiting times is because of their relatively long mean (and consequently standard deviation) of consultation times. If commonly applied valuations of provider idle time to patient waiting time are used in anesthesia clinics, appointment intervals will be sufficiently brief that the mean patient waiting time will be at least the mean consultation time or half an hour. Patients will be dissatisfied with this level of service. Therefore, efforts to decrease the mean patient waiting time in anesthesia clinics should focus foremost on minimizing the mean consultation time and its variability, which can most likely be achieved by assuring that providers have rapid access to relevant clinical information, including external medical records, surgical dictations, etc. Anesthesiologists managing anesthesia clinics may find it valuable to apply other interventions to decrease patient waiting times. Scheduling of preanesthesia evaluation and surgical clinics should be coordinated to assure patient punctuality. Providers should be on time for the start of their sessions. If an add-on patient cannot be seen during a scheduled clinic session, because all appointment times have been assigned to other patients, the add-on patient should be seen by a different provider or at the end of the regularly scheduled clinic session. Mean consultation times should be measured accurately for each provider. Substantial provider idle time should be expected. Appropriate values for breaks, appointment intervals, and percentage no-shows should be determined by computer simulation

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

    PubMed

    McGarry, Denise; Cashin, Andrew; Fowler, Cathrine

    2014-08-01

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

  12. Evaluation of Initial and Steady-State Gatifloxacin Pharmacokinetics and Dose in Pulmonary Tuberculosis Patients by Using Monte Carlo Simulations

    PubMed Central

    Smythe, Wynand; Merle, Corinne S.; Rustomjee, Roxana; Gninafon, Martin; Lo, Mame Bocar; Bah-Sow, Oumou; Olliaro, Piero L.; Lienhardt, Christian; Horton, John; Smith, Peter; Simonsson, Ulrika S. H.

    2013-01-01

    A 4-month regimen of gatifloxacin with rifampin, isoniazid, and pyrazinamide is being evaluated for the treatment of tuberculosis in a phase 3 randomized controlled trial (OFLOTUB). A prior single-dose study found that gatifloxacin exposure increased by 14% in the combination. The aims of the study are to evaluate the initial and steady-state pharmacokinetics of gatifloxacin when daily doses are given to patients with newly diagnosed drug-sensitive pulmonary tuberculosis as part of a combination regimen and to evaluate the gatifloxacin dose with respect to the probability of attaining a pharmacokinetic/pharmacodynamic target. We describe the population pharmacokinetics of gatifloxacin from the first dose to a median of 28 days in 169 adults enrolled in the OFLOTUB trial in Benin, Guinea, Senegal, and South Africa. The probability of achieving a ratio of ≥125 for the area under the concentration time curve to infinity (AUC0–∞) for the free fraction of gatifloxacin over the MIC (fAUC/MIC) was investigated using Monte Carlo simulations. The median AUC0–∞ of 41.2 μg · h/ml decreased on average by 14.3% (90% confidence interval [CI], −90.5% to +61.5%) following multiple 400-mg daily doses. At steady state, 90% of patients achieved an fAUC/MIC of ≥125 only when the MIC was <0.125 μg/ml. We conclude that systemic exposure to gatifloxacin declines with repeated daily 400-mg doses when used together with rifampin, isoniazid, and pyrazinamide, thus compensating for any initial increase in gatifloxacin levels due to a drug interaction. (The OFLOTUB study has been registered at ClinicalTrials.gov under registration no. NCT00216385.) PMID:23774436

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

    PubMed

    Schiavenato, Martin

    2009-07-01

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

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

    PubMed

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

    2013-11-01

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

  15. 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).

  16. Simulator Test and Evaluation

    DTIC Science & Technology

    2009-01-13

    control system (AFCS) ON and OFF. Flight control axes which include a trim system will be tested with both TRIM ON and OFF and stability augmentation system (SAS...Flight Test Manual HQ Handling Qualities M&S Modeling and Simulation SAS Stability Augmentation System SCAS Stability and Control

  17. Training simulated patients: evaluation of a training approach using self-assessment and peer/tutor feedback to improve performance

    PubMed Central

    Perera, Jennifer; Perera, Joachim; Abdullah, Juriah; Lee, Nagarajah

    2009-01-01

    Background Most medical schools use simulated patients (SPs) for teaching. In this context the authenticity of role play and quality of feedback provided by SPs is of paramount importance. The available literature on SP training mostly addresses instructor led training where the SPs are given direction on their roles. This study focuses on the use of peer and self evaluation as a tool to train SPs. Methods SPs at the medical school participated in a staff development and training programme which included a) self-assessment of their performance while observing video-tapes of their role play using a structured guide and b) peer group assessment of their performance under tutor guidance. The pre and post training performance in relation to authenticity of role play and quality of feedback was blindly assessed by students and tutors using a validated instrument and the scores were compared. A focus group discussion and a questionnaire assessed acceptability of the training programme by the SPs. Results The post-training performance assessment scores were significantly higher (p < 0.05) than the pre-training scores. The degree of improvement in the quality of feedback provided to students was more when compared to the improvement of role play. The acceptability of the training by the SPs was very satisfactory scoring an average of 7.6 out of 10. The majority of the SPs requested the new method of training to be included in their current training programme as a regular feature. Conclusion Use of structured self-reflective and peer-interactive, practice based methods of SP training is recommended to improve SP performance. More studies on these methods of training may further refine SP training and lead to improvement of SP performance which in turn may positively impact medical education. PMID:19563621

  18. Evaluation of the Target Inhalation Mode (TIM) Breathing Maneuver in Simulated Nebulizer Therapy in Patients with Cystic Fibrosis

    PubMed Central

    Prince, Ivan; Dixon, Emma; Agent, Penny; Pryor, Jennifer; Hodson, Margaret

    2010-01-01

    Abstract Background Adaptive Aerosol Delivery (AAD) systems provide efficient drug delivery and improved lung deposition over conventional nebulizers by combining real-time analyses of patient breathing patterns and precisely timed aerosol delivery. Delivery and deposition are further enhanced by breathing techniques involving slow, deep inhalations. Methods This exploratory study assessed the acceptability of slow, deep inhalations in 20 patients with cystic fibrosis (CF) during up to eight simulated nebulizer treatments with the I-neb AAD System. The breathing maneuver, Target Inhalation Mode (TIM) breathing, involved the lengthening of the patient's inhalation time over successive breaths with guidance from auditory and tactile (vibratory) feedback from the device. Results At the end of the first treatment, most patients felt that the instructions were easy to understand (90%) and that the vibratory feedback was pleasant (65%). Half of the patients found the procedure to be comfortable. At the end of the final treatment, most patients felt that the breathing maneuver was easy to understand (90%) and use (80%), but that the duration of the breath was too long (100%). Logged data revealed that 90% of patients were able to comply with the breathing maneuver. The two patients unable to comply had a forced vital capacity of <1.75 L. The average treatment time decreased from 288.4 to 141.6 sec during the first and final treatments, respectively. Conclusions This study provides preliminary evidence of the acceptability of the TIM breathing maneuver in patients with CF and their ability to perform repeated TIM breathing during simulated nebulizer therapy with the I-neb AAD System. PMID:20373907

  19. Simulated patients in audiology education: student reports.

    PubMed

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

    2013-09-01

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

  20. [Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

    PubMed

    Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

    2013-08-01

    Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

  1. 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.

  2. Simulation-Based Evaluation of PK/PD Indices for Meropenem Across Patient Groups and Experimental Designs.

    PubMed

    Kristoffersson, Anders N; David-Pierson, Pascale; Parrott, Neil J; Kuhlmann, Olaf; Lave, Thierry; Friberg, Lena E; Nielsen, Elisabet I

    2016-05-01

    Antibiotic dose predictions based on PK/PD indices rely on that the index type and magnitude is insensitive to the pharmacokinetics (PK), the dosing regimen, and bacterial susceptibility. In this work we perform simulations to challenge these assumptions for meropenem and Pseudomonas aeruginosa. A published murine dose fractionation study was replicated in silico. The sensitivity of the PK/PD index towards experimental design, drug susceptibility, uncertainty in MIC and different PK profiles was evaluated. The previous murine study data were well replicated with fT > MIC selected as the best predictor. However, for increased dosing frequencies fAUC/MIC was found to be more predictive and the magnitude of the index was sensitive to drug susceptibility. With human PK fT > MIC and fAUC/MIC had similar predictive capacities with preference for fT > MIC when short t1/2 and fAUC/MIC when long t1/2. A longitudinal PKPD model based on in vitro data successfully predicted a previous in vivo study of meropenem. The type and magnitude of the PK/PD index were sensitive to the experimental design, the MIC and the PK. Therefore, it may be preferable to perform simulations for dose selection based on an integrated PK-PKPD model rather than using a fixed PK/PD index target.

  3. 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.

  4. Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways.

    PubMed

    Cook, T M; Green, C; McGrath, J; Srivastava, R

    2007-07-01

    We evaluated the performance of four manikins: Airsim(trade mark), Bill 1, Airway Management Trainer and Airway Trainer, as simulators for insertion of single-use laryngeal mask airways and the reusable LMA Classic. Sixteen volunteer anaesthetists inserted each laryngeal mask airway into each manikin twice. Insertions were scored for ease of insertion, clinical and fibreoptic position, and lung ventilation (maximum score 10). Scores < 7 were classified 'poor' and < 5 'failure'. We analysed manikin and laryngeal mask airway performance. Poor insertion rate was 15% (range 9-21%) and was lowest for the VBM manikin (p = 0.02). Insertion failure rate was 2.6% and did not differ significantly between manikins (p = 0.2). Overall manikin performance was significantly different (p < 0.0001). The VBM manikin scored best, with all other manikins equivalent. The VBM manikin performed significantly better for three individual laryngeal mask airways. Overall performance differences of laryngeal mask airways were statistically significant (p < 0.001) but individual comparisons were not. Silicone devices performed better than PVC devices (p < 0.05) Devices with and without grilles performed similarly. All manikins were adequate. The VBM manikin performed best overall and for several individual laryngeal mask airways. The methodology is useful for future evaluations of devices, both manikins and supraglottic airways. Further human clinical research is required.

  5. Cultural competence and simulated patients.

    PubMed

    Paroz, Sophie; Daele, Amaury; Viret, Francine; Vadot, Sara; Bonvin, Raphaël; Bodenmann, Patrick

    2016-10-01

    Cultural competence education is central in addressing the socio-cultural factors that affect health care; however, there is little agreement over the best teaching approach. Although simulated patients are widely used in medical education, little is known about their application to cultural competence education. At the Department of Ambulatory Care and Community Medicine, University of Lausanne, the content of a cultural competence education module for resident doctors was recently restructured, with a final session emphasising previous principles through a simulated patient-doctor encounter. We tested the feasibility of cultural competence training with simulated patients. We created two complementary case scenarios based on real clinical practice and focused on specific clinical skills. An interdisciplinary team trained two simulated patients, and a 90-minute pilot session took place. General satisfaction was high and the increased opportunity for interaction was greatly appreciated. According to the learners, the simulated case setting was relevant for improving self-reflection and cultural sensitivity: applying skills in the session enhanced perceived impact for 'real-world' practice. We tested the feasibility of cultural competence training with simulated patients The use of patient-centred simulated clinical practice as a teaching approach seems to be advantageous in increasing providers' self-reflection about cultural competence and intensifying the impact of cultural competence education in clinical practice, and hopefully will improve the quality of care for every patient. Case scenarios based on a diversity of socio-cultural factors and oriented towards a broad skills set would seem preferable to avoid cultural drift and to enhance the learning of cultural approaches that are adaptable to every patient. © 2016 John Wiley & Sons Ltd.

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

    SciTech Connect

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

    2008-01-15

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

  7. 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.

  8. 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.

  9. Motion sensor evaluation using simulation

    NASA Astrophysics Data System (ADS)

    Schmutz, J. D.; McNerney, G. M.; Workhoven, R. M.

    Thorough evaluation testing of interior motion sensors which requires repeated testing under a variety of environmental conditions is outlined. Although the sensors are intended primarily for interior installations, many of the buildings where protection may be required are warehouses or bunkers without environmental control. To evaluate sensors for such installations, it is important to collect data on coverage or sensitivity at room temperature and at environmental extremes. A system designed and built to provide repeatability in environmental testing is described. The system is dubbed sandia intruder motion simulator (SIMS). This system is used to acquire much of the data now collected on sensors in the laboratory and a duplicate system has been delivered to the Belvoir R and D center so that the laboratory can now run similar tests.

  10. "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…

  11. "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…

  12. Challenging conversations with simulated patients.

    PubMed

    Dennis, Diane; Furness, Anne; Parry, Sharon

    2017-02-28

    Simulation-based learning (SBL) activities in the health sciences provide students with opportunities to interact with realistic patients and environments. This study aimed to develop and then implement a novel activity using simulation for a large group of mostly millennial physiotherapy students, to enhance their ability to communicate with a challenging patient and to assess their motivation to learn. Students enrolled in a second-year communication unit were invited to participate in a non-compulsory unique SBL activity in groups of four for 40 minutes, undertaking two 5-minute simulation scenarios and two debriefing sessions. On completion of the activity, 140 students scored their motivation to learn during the activity using the Instructional Materials Motivation Scale (IMMS) questionnaire. Of the physiotherapy students enrolled in the unit, 83 per cent took part in the SBL and 100 per cent of the participants completed the follow-up survey. Mean scores for each subscale ranged from 3.8 to 4.0, reflecting that students agreed more than moderately with the statements made in the scale. The median total IMMS score for all students was 149, well above the published median total score of the scale (108). Simulation-based learning activities provide students with opportunities to interact with realistic patients and environments DISCUSSION: The SBL activity model was successfully implemented and received positively by the students in terms of their motivation to learn. It gained the attention of participants by providing an opportunity to practise the non-technical skill of 'communicating with patients', previously learned in the classroom, in a simulated realistic environment and by using a design that seemed to consider the needs of the millennial generation. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  13. Pharmacokinetic evaluation of doxorubicin plasma levels in normal and overweight patients with breast cancer and simulation of dose adjustment by different indexes of body mass.

    PubMed

    Barpe, Deise Raquel; Rosa, Daniela Dornelles; Froehlich, Pedro Eduardo

    2010-11-20

    Although being used for decades in the treatment of several types of cancer, either alone or in association, only a few data about the pharmacokinetics of doxorubicin (DOX) in humans are available. DOX is frequently used in association with other anticancer drugs in the management of breast cancer. Pharmacokinetic data available in the literature show that after i.v. administration DOX follows a two-compartment open model, with a fast distribution phase followed by a very slow elimination phase. The objective of this work is to perform a pilot study in order to verify if the usual dose adjustment based on body surface area (BSA) would be producing the same plasma concentration-time profiles in patients with normal (<25) and above normal (>25) body mass index (BMI). In order to assess the pharmacokinetics of DOX after a short-term i.v. infusion of 60mg/m(2) of BSA, an experimental design using only five plasma samples of each patient was applied. Samples were collected at 0.00, 0.66 (right after the end of infusion), 1.66, 8.66, and 24.66h. DOX pharmacokinetic profiles were evaluated after quantification of DOX using a new HPLC method developed and validated. Pharmacokinetic parameters (AUC(0-24.66) and C(max)) were analyzed by non-compartmental and compartmental approaches. Significant differences (α=0.05) between overweight and normal weight groups were found with respect to AUC and C(max). After adjustment of dose by weight and by BMI, the compartmental model was used to simulate plasma concentrations and new values for C(max) and AUC(0-24.66) were calculated. The new values obtained using both body weight (BW) and BMI were closer to the normal group than those obtained with BSA. According to the simulation, the differences of AUC and C(max) between the overweight group and the group of patients with normal weight were lower when the dose was adjusted by BW and BMI. These results suggest that more studies must be conducted, with more patients, in order to

  14. 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

  15. A review and comparison of methods for recreating individual patient data from published Kaplan-Meier survival curves for economic evaluations: a simulation study.

    PubMed

    Wan, Xiaomin; Peng, Liubao; Li, Yuanjian

    2015-01-01

    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. 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. 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. 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.

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

    PubMed

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

    2013-08-01

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

  17. 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.

  18. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

    PubMed Central

    Austin, Zubin; Gregory, Paul; Tabak, Diana

    2006-01-01

    Objectives To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies. Design The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Assessment Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Conclusions Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs. PMID:17149448

  19. 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…

  20. 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…

  1. Psychophysiological evaluation of simulator sickness evoked by a graphic simulator.

    PubMed

    Min, Byung-Chan; Chung, Soon-Cheol; Min, Yoon-Ki; Sakamoto, Kazuyoshi

    2004-11-01

    The present study investigated the effects of simulator sickness, as an important bias factor on evaluation of emotional changes under the controlled condition of driving a car for 60 min at a constant speed (60 km/h) in a graphic simulator. Simulator sickness was measured and analyzed every 5 min using both subjective evaluation and physiological signals. Results of the subjective evaluation showed there was a significant difference between the rest and the driving conditions 10 min after the main experiment started and that the level of difference increased linearly with time. Analysis of the central and the autonomic nervous systems showed the significant differences in delta, theta, alpha and beta bands of an electroencephalogram (EEG), skin temperature, and the R-R interval between the rest and the driving conditions after about 5 min from the start of driving. In particular, there was the highest correlation between parameter of theta and subjective evaluation, and thus theta was considered an effective physiological parameter for numerically evaluating simulator sickness. The results indicate that physiological changes due to simulator sickness can be a bias factor in evaluation of human sensibility.

  2. Lightning Simulation Test Technique Evaluation

    DTIC Science & Technology

    1988-10-01

    Example Resistive Response Measurement 94 43 Example dI/dt Response Measurement 95 44 Statistical Distribution of Swept CW Extrapolated Values - Nose...Aircraft 2 2 Prior Research and Development Tests on Full-Scale Air Vehicles 10 3 Summary of Simulation Technique Capabilities 14 4 Test Bed Resistance ...second L Inductance henrys R Resistance ohms V Potential difference volts STANDARD UNITS A amperes dB, dBm decibels Hz hertz kA kiloamps kV kilovolts

  3. 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.

  4. Full scale computer simulators in anesthesia training and evaluation.

    PubMed

    Wong, Anne K

    2004-05-01

    With the advent of competency-based curriculum, technology such as full scale computer simulators have acquired an increasingly important role in anesthesia both in training and evaluation. This article reviews the current role of full scale computer simulators in teaching and evaluation in anesthesia. This review draws from existing anesthesia and medical education literature in order to examine and assess the current role of full scale computer simulators in anesthesia education today. The last decade has witnessed a major increase in the use of full scale computer simulators in anesthesia. Many applications have been found for these simulators including teaching and training, evaluation and research. Despite the increasing use and application of full scale computers in anesthesia in the area of teaching and training, definitive studies evaluating its cost effectiveness, its efficacy compared to traditional training methods or its impact on patient outcome are still pending. Although there is some preliminary evidence of reliability and validity in using the simulator to evaluate clinical competence, development in this area has not progressed enough to justify its use in formal, summative evaluation of competence in anesthesia at this time. As technology acquires an increasingly important role in medical education, full scale computer simulators represent an exciting potential in anesthesia. However, the full potential and role of simulators in anesthesia is still in development and will require a dovetailing of clinical theory and practice with current research in medical education.

  5. Effect of Repeated Simulations by Standardized Patients on Intercase Reliability.

    ERIC Educational Resources Information Center

    Colliver, Jerry A.; And Others

    1991-01-01

    A study using five Southern Illinois University senior medical school classes (n=350 students) investigated whether having a standardized patient simulate a case repeatedly in postclerkship medical student evaluation affects the measure's reliability. Results suggest that repeated simulation had little or no effect on intercase reliability of…

  6. 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.

  7. An interprofessional course using human patient simulation to teach patient safety and teamwork skills.

    PubMed

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

    2012-05-10

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

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

    PubMed Central

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

    2012-01-01

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

  9. Interpersonal styles of nurse practitioner students during simulated patient encounters.

    PubMed

    Miller, A M; Wilbur, J; Dedhiya, S; Talashek, M L; Mrtek, R

    1998-05-01

    Evaluation methods are needed to assess nurse practitioners' (NPs') interpersonal skills and provide students with systematic, qualitative feedback. The purpose of this study was to identify characteristics and styles of students' interpersonal behavior from patients' perspectives during simulated encounters. The 29-item Clinical Encounter Q-Set for NPs was generated pertaining to patients' perceptions of their interactions with NP students. Using Q-methodology, simulated patients (SPs) sorted the items immediately after each of their encounters with 45 NP students. Items were rank-ordered along a continuum, ranging from "most like my feelings regarding the encounter" to "least like my feelings." Three interpersonal styles were identified. "Nonjudgmental professionalism" characterized student behavior during the simulation portraying a patient with a sexually transmitted disease. "Competence/confidence" and "empathy/respect" were predominant styles exhibited during the hypertension simulation. The potential value of this method for teaching and evaluation is discussed.

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

    PubMed

    Cox, Tiffany; Seymour, Neal; Stefanidis, Dimitrios

    2015-08-01

    This review investigates the available literature that addresses the impact simulator training has on patient outcomes. The authors conducted a comprehensive literature search of studies reporting outcomes of simulation training and categorized studies based on the Kirkpatrick model of training evaluation. Kirkpatrick level 4 studies reporting patient outcomes were identified and included in this review. Existing evidence is promising, demonstrating patient benefits as a result of simulation training for central line placement, obstetric emergencies, cataract surgery, laparoscopic inguinal hernia repair, and team training. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. 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.

  12. Nuclear power plant simulation facility evaluation methodology

    SciTech Connect

    Haas, P.M.; Carter, R.J.; Laughery, K.R. Jr.

    1985-01-01

    A methodology for evaluation of nuclear power plant simulation facilities with regard to their acceptability for use in the US Nuclear Regulatory Commission (NRC) operator licensing exam is described. The evaluation is based primarily on simulator fidelity, but incorporates some aspects of direct operator/trainee performance measurement. The panel presentation and paper discuss data requirements, data collection, data analysis and criteria for conclusions regarding the fidelity evaluation, and summarize the proposed use of direct performance measurment. While field testing and refinement of the methodology are recommended, this initial effort provides a firm basis for NRC to fully develop the necessary methodology.

  13. Pharmacy students' preferences for various types of simulated patients.

    PubMed

    Gallimore, Casey; George, Angela K; Brown, Michael C

    2008-02-15

    To evaluate pharmacy students' preferences for various types of simulated patients. Second-professional year (P2) pharmacy students participated in 7 learning activities that used simulated patients including community volunteers, College administrative staff, course instructors, and student peers. Students ranked each simulated patient type according to believability, skill development, and preference using a 5-point Likert scale. One-hundred seven of 155 students (69%) completed the survey instrument. Students preferred community volunteers as simulated patients (mean rank 1.39), followed by peers (2.22), instructors (2.63), and staff members (2.81) (p < 0.001). Greater than 89% agreed or strongly agreed that their work with simulated patients prepared them for actual patients, with community volunteers receiving the highest ratings (p < 0.03). Although pharmacy students found value in interactions will all types of simulated patients, they preferred community volunteers over staff members and their peers. Future scholarship should explore the relationship among simulated patient types and student learning outcomes.

  14. Evaluation of Patient Welfare

    PubMed Central

    Piedmont, Eugene B.; Dornblaser, Bright M.

    1970-01-01

    A multifaceted attempt is made to measure patients' well-being quantitatively in a complex interdisciplinary research and experimental construction project. Parallel studies were conducted in adjoining traditionally shaped and spoke-design hospital buildings. Major innovations were made, in both plants, in the organization of nursing staffs and in communications and logistical support. Smaller nursing staffs achieved significant increases in time spent in direct patient (“bedside”) care, without negative effects on patient welfare, in both buildings; but these effects were maximized in the spoke-design building. PMID:5494267

  15. 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

  16. Evaluation of decadal hindcasts using satellite simulators

    NASA Astrophysics Data System (ADS)

    Spangehl, Thomas; Mazurkiewicz, Alex; Schröder, Marc

    2013-04-01

    The evaluation of dynamical ensemble forecast systems requires a solid validation of basic processes such as the global atmospheric water and energy cycle. The value of any validation approach strongly depends on the quality of the observational data records used. Current approaches utilize in situ measurements, remote sensing data and reanalyses. Related data records are subject to a number of uncertainties and limitations such as representativeness, spatial and temporal resolution and homogeneity. However, recently several climate data records with known and sufficient quality became available. In particular, the satellite data records offer the opportunity to obtain reference information on global scales including the oceans. Here we consider the simulation of satellite radiances from the climate model output enabling an evaluation in the instrument's parameter space to avoid uncertainties stemming from the application of retrieval schemes in order to minimise uncertainties on the reference side. Utilizing the CFMIP Observation Simulator Package (COSP) we develop satellite simulators for the Tropical Rainfall Measuring Mission precipitation radar (TRMM PR) and the Infrared Atmospheric Sounding Interferometer (IASI). The simulators are applied within the MiKlip project funded by BMBF (German Federal Ministry of Education and Research) to evaluate decadal climate predictions performed with the MPI-ESM developed at the Max Planck Institute for Meteorology. While TRMM PR enables the evaluation of the vertical structure of precipitation over tropical and sub-tropical areas, IASI is used to support the global evaluation of clouds and radiation. In a first step the reliability of the developed simulators needs to be explored. The simulation of radiances in the instrument space requires the generation of sub-grid scale variability from the climate model output. Furthermore, assumptions are made to simulate radiances such as, for example, the distribution of different

  17. Quantitative Evaluation for Uncertainty of Information About Patients' Injury Severity in a Hospital Disaster: A Simulation Study Using Shannon's Information Theory.

    PubMed

    Ajimi, Yasuhiko; Saaki, Masaru; Uchida, Yasuyuki; Gakumazawa, Masayasu; Sasaki, Katsunori; Fujita, Takashi; Sakamoto, Tetsuya

    2015-08-01

    calculated as 0.4, 1.0, and 2.0 bits, respectively. These amounts of information indicate a reduction in uncertainty regarding the probability of the triage levels arising. It was possible to quantify uncertainty of information about the extent of disability in patients at a triage location and to evaluate reduction of the uncertainty by using entropy based on Shannon's Information Theory.

  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. An evaluation of dental operative simulation materials.

    PubMed

    He, Li-Hong; Foster Page, Lyndie; Purton, David

    2012-01-01

    The study was to evaluate the performance of different materials used in dental operative simulation and compare them with those of natural teeth. Three typical phantom teeth materials were compared with extracted permanent teeth by a nanoindentation system and evaluated by students and registered dentists on the drilling sensation of the materials. Moreover, the tool life (machinability) of new cylindrical diamond burs on cutting the sample materials was tested and the burs were observed. Although student and dentist evaluations were scattered and inconclusive, it was found that elastic modulus (E) and hardness (H) were not the main factors in determining the drilling sensation of the materials. The sensation of drilling is a reflection of cutting force and power consumption.An ideal material for dental simulation should be able to generate similar drilling resistance to that of natural tooth, which is the machinability of the material.

  20. [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). Copyright © 2014 Elsevier España, S.L. All rights reserved.

  1. Physical evaluation of the patient.

    PubMed

    Sykes, P; Lipp, M; Malamed, S F; Kubota, Y; Matsuura, H

    1992-01-01

    The physical evaluation of the patient before and during anesthesia and sedation is assuming an ever greater importance with the advent of sophisticated and reliable monitoring devices. This paper reviews the possible methods of evaluation and describes the types of mechanical monitors most suited to the dental office.

  2. Effectiveness of patient simulation in nursing education: meta-analysis.

    PubMed

    Shin, Sujin; Park, Jin-Hwa; Kim, Jung-Hee

    2015-01-01

    The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms. To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis. This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis. We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity. These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as "CRM simulator study IB").

    PubMed

    Kim, John; Neilipovitz, David; Cardinal, Pierre; Chiu, Michelle

    2009-01-01

    Crisis resource management (CRM) skills are a set of nonmedical skills required to manage medical emergencies. There is currently no gold standard for evaluation of CRM performance. A prior study examined the use of a global rating scale (GRS) to evaluate CRM performance. This current study compared the use of a GRS and a checklist as formal rating instruments to evaluate CRM performance during simulated emergencies. First-year and third-year residents participated in two simulator scenarios each. Three raters then evaluated resident performance in CRM using edited video recordings using both a GRS and a checklist. The Ottawa GRS provides a seven-point anchored ordinal scale for performance in five categories of CRM, and an overall performance score. The Ottawa CRM checklist provides 12 items in the five categories of CRM, with a maximum cumulative score of 30 points. Construct validity was measured on the basis of content validity, response process, internal structure, and response to other variables. T-test analysis of Ottawa GRS scores was conducted to examine response to the variable of level of training. Intraclass correlation coefficient (ICC) scores were used to measure inter-rater reliability for both scenarios. Thirty-two first-year and 28 third-year residents participated in the study. Third-year residents produced higher mean scores for overall CRM performance than first-year residents (P < 0.05), and in all individual categories within the Ottawa GRS (P < 0.05) and the Ottawa CRM checklist (P < 0.05). This difference was noted for both scenarios and for each individual rater (P < 0.05). No statistically significant difference in resident scores was observed between scenarios for both instruments. ICC scores of 0.59 and 0.61 were obtained for Scenarios 1 and 2 with the Ottawa GRS, whereas ICC scores of 0.63 and 0.55 were obtained with the Ottawa CRM checklist. Users indicated a strong preference for the Ottawa GRS given ease of scoring, presence of an

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

    PubMed

    Radetzky, Arne; Nürnberger, Andreas

    2002-11-01

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

  5. Evaluating the patient with fibromyalgia.

    PubMed

    Culpepper, Larry

    2010-09-01

    Once the physician has identified fibromyalgia as a potential diagnosis, further evaluation is warranted, both to understand the full dimensions of fibromyalgia and to evaluate other potential causes of the patient's symptoms. For example, mood disorders, sleep disorders, and daytime fatigue are often present in patients with fibromyalgia and often are closely related to pain. In addition, a number of physical conditions can mimic fibromyalgia and must be considered in the patient's evaluation. These include endocrine conditions, neurologic disorders, musculoskeletal diseases, and medication-related side effects. Taking a complete medical history and performing a thorough physical examination, including a complete laboratory assessment, can be very helpful in confirming the diagnosis or establishing an alternate diagnosis. © Copyright 2010 Physicians Postgraduate Press, Inc.

  6. Developing integrated patient pathways using hybrid simulation

    NASA Astrophysics Data System (ADS)

    Zulkepli, Jafri; Eldabi, Tillal

    2016-10-01

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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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…

  13. Hospital simulated patient programme: a guide.

    PubMed

    Barrett, Jenny; Hodgson, Jan

    2011-12-01

    Many university courses employ simulated patients to work with students in the development of communication skills. Our challenge was to build a sustainable programme that could be adapted for medical, nursing and allied health staff, and groups of students, on our hospital campus. In recognition of the need to provide practice opportunities for junior medical staff to hone their capacity to communicate effectively with parents, we employed professional actors who are also qualified teachers. Junior doctors have multiple opportunities over their training time to work one-to-one with an actor-tutor in the role of simulated parent. The simulated parents are skilled in helping the trainees reflect on the conversation, and the trainees are given a recording of their sessions for further reflection and feedback from a colleague. This model has been adapted to meet the 'topic' needs and scheduling requirements of other staff and hospital-based student groups. In adapting the original medical staff programme, we came to appreciate not only the logistical but also the ethical considerations inherent in a simulated parent/patient programme. Our guide highlights the importance of safeguarding the educational integrity of the design, maintaining the fidelity of the simulations and ensuring the safety of all involved. © Blackwell Publishing Ltd 2011.

  14. Clinical Simulation: A Protocol for Evaluation of Mobile Technology.

    PubMed

    Mather, Carey; Jensen, Sanne; Cummings, Elizabeth

    2017-01-01

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

  15. Interprofessional Education Among Student Health Professionals Using Human Patient Simulation

    PubMed Central

    Chmil, Joyce V.

    2014-01-01

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

  16. Using simulation for prescribing: an evaluation.

    PubMed

    Woodfield, Georgia; O'Sullivan, Marie; Haddington, Nicholas; Stanton, Andrew

    2014-02-01

    Drug errors are a major cause of patient morbidity. The UK General Medical Council has highlighted that prescribing teaching should be prioritised. How should medical teachers best teach the practical aspects of prescribing? We piloted a set of eight prescribing simulation tutorials for 35 final-year undergraduate medical students in Great Western Hospital, Swindon, UK. Students completed baseline questionnaires addressing confidence levels in prescribing. They then prescribed independently for simulated cases of common medical emergencies within tutor-led tutorials (n = 17) or self-directed prescribing tutorials (n = 18). Confidence scores and numbers of drug errors were documented at baseline and following four tutorials. Drug errors were categorised according to potential harm. Students then swapped to receive the alternative tutorial type. Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors: from 57 to three in the tutor-led group (p = 0.003) and from 60 to 14 in the self-directed learning group (p = 0.001). Both tutorial types led to statistically significant increases in confidence scores for global prescribing, prescribing in medical emergencies and managing medical emergencies (with a median increase of one point on a modified Likert scale). Confidence using the British National Formulary improved, but reached statistical significance for the self-directed group only. Simulating cases and using real drug charts is an effective method for improving students' prescribing ability and confidence in common medical emergencies. Tutorials like these, whether tutor-led or self-directed, could be incorporated into medical curricula. This could help prevent drug errors in practice, thereby improving patient care and safety. © 2014 John Wiley & Sons Ltd.

  17. Atmospheric Model Evaluation Tool for meteorological and air quality simulations

    EPA Pesticide Factsheets

    The Atmospheric Model Evaluation Tool compares model predictions to observed data from various meteorological and air quality observation networks to help evaluate meteorological and air quality simulations.

  18. 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

  19. Accessing primary care: a simulated patient study

    PubMed Central

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

    2013-01-01

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

  20. Evaluating markers for selecting a patient's treatment.

    PubMed

    Song, Xiao; Pepe, Margaret Sullivan

    2004-12-01

    Selecting the best treatment for a patient's disease may be facilitated by evaluating clinical characteristics or biomarker measurements at diagnosis. We consider how to evaluate the potential impact of such measurements on treatment selection algorithms. For example, magnetic resonance neurographic imaging is potentially useful for deciding whether a patient should be treated surgically for Carpal Tunnel Syndrome or should receive less-invasive conservative therapy. We propose a graphical display, the selection impact (SI) curve that shows the population response rate as a function of treatment selection criteria based on the marker. The curve can be useful for choosing a treatment policy that incorporates information on the patient's marker value exceeding a threshold. The SI curve can be estimated using data from a comparative randomized trial conducted in the population as long as treatment assignment in the trial is independent of the predictive marker. Estimating the SI curve is therefore part of a post hoc analysis to determine whether the marker identifies patients that are more likely to benefit from one treatment over another. Nonparametric and parametric estimates of the SI curve are proposed in this article. Asymptotic distribution theory is used to evaluate the relative efficiencies of the estimators. Simulation studies show that inference is straightforward with realistic sample sizes. We illustrate the SI curve and statistical inference for it with data motivated by an ongoing trial of surgery versus conservative therapy for Carpal Tunnel Syndrome.

  1. Using simulations and standardized patients in intervention research.

    PubMed

    Gates, D M; Fitzwater, E; Telintelo, S

    2001-11-01

    Caregiving is both an art and a science; both knowledge and skills are necessary to improve the quality of care that professionals provide. Researchers are often limited in their assessment of skill performance due to inadequate and unrealistic measurement options. Simulation using standardized patients offers researchers an objective method to evaluate skill performance. This article describes the use of simulations by researchers in their quest to measure changes in violence prevention skills after an intervention program given to nurse assistants working in long-term care facilities.

  2. Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers.

    PubMed

    Schebesta, Karl; Hüpfl, Michael; Rössler, Bernhard; Ringl, Helmut; Müller, Michael P; Kimberger, Oliver

    2012-06-01

    Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized "patients" to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter. Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed. The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements). The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.

  3. 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.

  4. 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.

  5. Multiple Integrated Laser Engagement Simulation (MILES) Training and Evaluation Test (TET) Evaluator Guidebook

    DTIC Science & Technology

    1979-09-01

    7:,LEVEVEL$ Research Product 79-11 Multiple Integrated Laser Engagement Simulation -~ (MILES) Training and Evaluation Test (T ET) be Evaluator...COVEREO Multiple Integrated Laser Engagement Simulation (MILES) Training and Evaluation Test (TET) Evaluator Guidebook . 6. PERFORMING ORG. REPORT NUMBER...KEY WORDS (Continue on reverse side If neceaswry and identify by block nwmbsr) Unit Evaluation Engagement Simulation Unit Training Diagnosis

  6. U.S. Army Research, Development, And Engineering Command (RDECOM), Independent Test And Evaluation Of The Stand Alone Patient Simulator (SAPS), Under The DoD Challenge Program

    DTIC Science & Technology

    2009-01-15

    community (van Meurs, et al, 1997, DeVita , et al, 2004, Bradley, 2006). While several studies have been conducted for training efficacy as a measure...Anatomy Of Full-Scale patient Simulators”, Journal of Clinical Monitoring 1997; 00: 1-8. M.A. Devita , J Schaefer, J. Lutz, H. Wang, and T. Dongilli

  7. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Simulation in an undergraduate nursing curriculum: implementation and impact evaluation.

    PubMed

    Schlairet, Maura C

    2011-10-01

    Although endorsed by nursing professional bodies and incorporated into undergraduate nursing curricula, high-fidelity simulation has undergone little evaluation at the program or curriculum levels. A comprehensive program evaluation of a Simulation Demonstration Project was undertaken to explore the influence of simulation across an undergraduate curriculum in a college of nursing. The focus of the evaluation was on program activities accomplished (implementation evaluation) and the extent to which program objectives and outcomes were met (impact evaluation). The Nursing Education Simulation Framework (NESF) was used to arrange multiple variables to be explored and to support the use of diverse simulation-related data sources. The framework was helpful in both guiding the evaluation and interpreting the results at the curriculum level from implementation and impact perspectives. Although continued use and testing of the NESF is warranted, findings from the study supported the utility of the NESF in program evaluation of simulation at the curriculum level. Copyright 2011, SLACK Incorporated.

  9. 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)

  10. 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)

  11. 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…

  12. Using computer simulation for optimal staffing: A case for the patient registration process of a hospital.

    PubMed

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

    2017-01-01

    Some healthcare managers use computer simulation to assist with staffing. As staffing actions are usually slow to evolve and long term in nature, computer simulation can provide the opportunity to evaluate different alternatives at substantially lower costs with fewer risks. Using computer simulation, this paper seeks to determine the optimal number and allocation of clerks involved in the patient registration process of a hospital. This paper is based on a case study conducted in a hospital and uses historical data provided by the hospital in simulating the patient registration process. The simulation results indicate that computer simulation can be an effective decision supporting tool in modeling the patient registration process and evaluating the effects of changes in the number and allocation of clerks in the process. Based upon a case study applying real-world data, the results of this paper would be beneficial to those who consider utilizing computer simulation for staffing decisions.

  13. 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.

  14. 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.

    2017-06-01

    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.

  15. 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.

  16. Embedding a Virtual Patient Simulator in an Interactive Surgical lecture.

    PubMed

    Kleinert, Robert; Plum, Patrick; Heiermann, Nadine; Wahba, Roger; Chang, De-Huan; Hölscher, Arnulf H; Stippel, Dirk L

    2016-01-01

    Lectures are traditionally used for teaching declarative knowledge. One established tool for clinical education is the demonstration of a real patient. The use of real patients in the daily clinical environment is increasingly difficult. The use of a virtual patient simulator (VPS) can potentially circumvent these problems. Unlimited availability and the opportunity of an electronic feedback system could possibly enrich traditional lectures by enabling more interactivity that meets the expectations of the current student generation. As students face the consequences of their own decisions they take a more active role in the lecture. VPS links declarative knowledge with visual perception that is known to influence students' motivation. Until now, there have been no reports covering the usage and validation of interactive VPS for supporting traditional lectures. In this study, we (1) described the development of a custom-made three-dimensional (3D) VPS for supporting the traditional lecture and (2) performed a feasibility study including an initial assessment of this novel educational concept. Conceptualization included definition of curricular content, technical realization and validation. A custom-made simulator was validated with 68 students. The degree of student acceptance was evaluated. Furthermore, the effect on knowledge gain was determined by testing prelecture and postlecture performance. A custom-made simulator prototype that displays a 3D virtual clinic environment was developed and linked to a PowerPoint presentation. Students were able to connect to the simulator via electronic devices (smartphones and tablets) and to control the simulator via majority vote. The simulator was used in 6 lectures and validated in 2 lectures with 68 students each. Student acceptance and their opinion about effectiveness and applicability were determined. Students showed a high level of motivation when using the simulator as most of them had fun using it. Effect on

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

    PubMed

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

    2015-06-01

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

  18. Criterion Standards for Evaluating Computer Simulation Courseware.

    ERIC Educational Resources Information Center

    Wholeben, Brent Edward

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

  19. Criterion Standards for Evaluating Computer Simulation Courseware.

    ERIC Educational Resources Information Center

    Wholeben, Brent Edward

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

  20. 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…

  1. 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.

  2. 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

  3. 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…

  4. 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…

  5. Evaluating uncertainty in stochastic simulation models

    SciTech Connect

    McKay, M.D.

    1998-02-01

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

  6. Training inter-physician communication using the Dynamic Patient Simulator.

    PubMed

    Sijstermans, R; Jaspers, M W M; Bloemendaal, P M; Schoonderwaldt, E M

    2007-01-01

    Clear and adequate communication between physicians is essential in modern medicine. Nevertheless, the medical curricula in The Netherlands lack an identifiable part in their education concerning inter-physician communication training. To train medical students in inter-physician communication skills using the Dynamic Patient Simulator (DPS), the Academic Medical Center at the University of Amsterdam and the Leiden University Medical Center joined in a 2-year project sponsored by the Dutch government. DPS is an educational computer program to create and simulate virtual patients with a wide variety of medical conditions in different clinical settings and over different time frames. To evaluate whether DPS is a suitable method for training medical students in inter-physician communication, we assessed if medical students felt that they had improved their inter-collegial communication skills after the pilot with DPS. Besides, we inquired students on DPS' usability and their satisfaction with DPS. We first developed and implemented 20 patient simulations in DPS to be practiced upon by two students asynchronously during a week. These students were situated in different medical institutions, geographically spread over The Netherlands and had to treat the virtual patient as a team supported by DPS. The students had to report their findings and treatment plan in the electronic referral form of DPS. A total of 134 students participated in the pilot. To evaluate inter-physician communication training using DPS we conducted a survey amongst these students who were entering their internships. The evaluation focused on self-assessment of their communication skills, usability of the DPS program, and their satisfaction with DPS as educational format, using multiple questionnaires. The outcome of the evaluation showed significant progression in students' feeling of improvement of their skills in different aspects concerning the referral of a patient after participating in the

  7. 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…

  8. 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…

  9. 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)

  10. Using and Evaluating Resampling Simulations in SPSS and Excel.

    ERIC Educational Resources Information Center

    Smith, Brad

    2003-01-01

    Describes and evaluates three computer-assisted simulations used with Statistical Package for the Social Sciences (SPSS) and Microsoft Excel. Designed the simulations to reinforce and enhance student understanding of sampling distributions, confidence intervals, and significance tests. Reports evaluations revealed improved student comprehension of…

  11. Piloted evaluation of an integrated propulsion and flight control simulator

    NASA Technical Reports Server (NTRS)

    Bright, Michelle M.; Simon, Donald L.

    1992-01-01

    This paper describes a piloted evaluation of the integrated flight and propulsion control simulator at NASA Lewis Research Center. The purpose of this evaluation is to demonstrate the suitability and effectiveness of this fixed based simulator for advanced integrated propulsion and airframe control design. The evaluation will cover control effector gains and deadbands, control effectiveness and control authority, and heads up display functionality. For this evaluation the flight simulator is configured for transition flight using an advanced Short Take-Off and vertical Landing fighter aircraft model, a simplified high-bypass turbofan engine model, fighter cockpit, displays, and pilot effectors. The paper describes the piloted tasks used for rating displays and control effector gains. Pilot comments and simulation results confirm that the display symbology and control gains are very adequate for the transition flight task. Additionally, it is demonstrated that this small-scale, fixed base flight simulator facility can adequately perform a real time, piloted control evaluation.

  12. 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

  13. Assessment of human patient simulation-based learning.

    PubMed

    Bray, Brenda S; Schwartz, Catrina R; Odegard, Peggy Soule; Hammer, Dana P; Seybert, Amy L

    2011-12-15

    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.

  14. [Innovation in healthcare processes and patient safety using clinical simulation].

    PubMed

    Rojo, E; Maestre, J M; Díaz-Mendi, A R; Ansorena, L; Del Moral, I

    2016-01-01

    Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Exploring Simulation Utilization and Simulation Evaluation Practices and Approaches in Undergraduate Nursing Education

    ERIC Educational Resources Information Center

    Zitzelsberger, Hilde; Coffey, Sue; Graham, Leslie; Papaconstantinou, Efrosini; Anyinam, Charles

    2017-01-01

    Simulation-based learning (SBL) is rapidly becoming one of the most significant teaching-learning-evaluation strategies available in undergraduate nursing education. While there is indication within the literature and anecdotally about the benefits of simulation, abundant and strong evidence that supports the effectiveness of simulation for…

  16. Evaluation of the dry mouth patient.

    PubMed

    Zunt, Susan

    2007-01-01

    This paper examines the questions "who is the dry mouth patient and how is the dry mouth patient evaluated"? It reviews the clinical features of dry mouth. It presents current treatment options for dry mouth care.

  17. Evaluation of coupling approaches for thermomechanical simulations

    DOE PAGES

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

    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

  18. 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.

  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.

  20. 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.

  1. Simulating Radar Signals for Detection Performance Evaluation.

    DTIC Science & Technology

    1981-02-01

    continuous and batch processing has a dra- mat ic off, ct on thk, t-chniquets used to simulated clutter signals, so much si. that the techniques and...if linear inter- fr > 1 3dB pilation is used (8, Eq. 8.611. Now we can use (103) and write h > 10 f 3dB/fr; hkowever, if thi!. ratio is greater than

  2. Evaluation of Simulated RADARSAT-2 Polarimetry Products

    DTIC Science & Technology

    2007-09-01

    software, and the RADARSAT-2 Simulator (RSAT2SIMU) software. The MARSIE trial was implemented as a TTCP SEN AG-7 activity with Gary Geling (DRDC...Canada – Ottawa, 2006. [4] Liu, C., P.W. Vachon and G.W. Geling ; Improved ship detection using polarimetric SAR data; Canadian Journal of Remote...DRDC Ottawa TM 2007-189 LIST PART 1: Internal Distribution by Centre: Library DRDC Ottawa 4 English, Ryan 1 Geling , Gary 1 Liu, Chen 2

  3. The ergonomics simulation and evaluation architecture for the automobile

    NASA Astrophysics Data System (ADS)

    Wu, Jianfeng; Yang, Ying; Sun, Shouqian; Liu, Tao

    2005-12-01

    The architecture of ergonomics simulation and evaluation for the automobile was described. Ergonomics analysis and evaluation is one of the most important processes in product design at present. This ergonomics simulation system based on the elements of ergonomics analysis and evaluation can provide an excellent solution to take human element into account earlier in the design phase and make proactive choices in automobile design than those traditional methods. Thinking of the characteristics of the automobile industry, this system adopted the anatomy-based and parameterized human model for Chinese, the simulation technique using motion editing and the mathematical models of ergonomics to solve real ergonomic design problems in the design phases.

  4. Follow-on Simulator Comparative Evaluation.

    DTIC Science & Technology

    1979-05-01

    systems afforded the clari ty and resolution necessary to recognize and identify objects at norma l slant ranges. (3) Norma l techniques and...lacked norma l atnios phc ’r ic d i f f u s i o n of li ght. Also , al l l ight points were of s i m i l a r s ize and intensit y and did not vary...This permits simul taneous program modifications during norma l system operation . A high-speed paper tape punch and r eader setup is used to input or

  5. Elective course in acute care using online learning and patient simulation.

    PubMed

    Seybert, Amy L; Kane-Gill, Sandra L

    2011-04-11

    To enhance students' knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions. Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient's physician, and completed a debriefing session with the facilitator. Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students' performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided. Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students' knowledge and critical-thinking skills in acute care.

  6. Evaluation of the patient with incontinence.

    PubMed

    Gormley, E Ann

    2007-12-01

    The incontinent patient is evaluated in order to make a presumptive diagnosis so that treatment can be offered. The evaluation begins with a history and a physical examination. The history focuses on the description of the patient's incontinence. Assessing the patient's bother and determining their expectations of treatment may further guide how aggressive one needs to be both with the evaluation and the presentation of treatment options. The important parts of the physical exam are an examination of the abdomen and pelvis including a provocative stress test. A urinalysis and a post-void residual (PVR) should be performed in all incontinent patients. Incontinence questionnaires, voiding diaries, and pad weight tests can provide more objective data than the history alone. Upper tract imaging is indicated in the patient with a history of hematuria and in patients with suspected hydroureteronephrosis. Other imaging may be useful to further evaluate other suspected pelvic pathology. Urodynamics are performed to determine if the incontinence is due to bladder or urethral dysfunction or both, to assess if the patient has a storage or emptying problem and lastly in an effort to identify patients whose upper tracts are at risk due to high bladder storage pressures. Cystoscopy is indicated in the work up of some incontinent patients. The evaluation of the incontinent patient consists of a history, a physical, urinalysis and a post-void residual. Optional evaluative tests consist of a variety of urodynamic tests, imaging studies and cystoscopy.

  7. Using Simulation for Launch Team Training and Evaluation

    NASA Technical Reports Server (NTRS)

    Peaden, Cary J.

    2005-01-01

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

  8. Piloted evaluation of an integrated propulsion and flight control simulator

    NASA Technical Reports Server (NTRS)

    Bright, Michelle M.; Simon, Donald L.

    1992-01-01

    A piloted evaluation of the integrated flight and propulsion control simulator for advanced integrated propulsion and airframe control design is described. The evaluation will cover control effector gains and deadbands, control effectiveness and control authority, and heads up display functionality. For this evaluation the flight simulator is configured for transition flight using an advanced Short Take-Off and Vertical Landing fighter aircraft model, a simplified high-bypass turbofan engine model, fighter cockpit displays, and pilot effectors. The piloted tasks used for rating displays and control effector gains are described. Pilot comments and simulation results confirm that the display symbology and control gains are very adequate for the transition flight task. Additionally, it is demonstrated that this small-scale, fixed base flight simulator facility can adequately perform a real time, piloted control evaluation.

  9. Furniture rough mill costs evaluated by computer simulation

    Treesearch

    R. Bruce Anderson

    1983-01-01

    A crosscut-first furniture rough mill was simulated to evaluate processing and raw material costs on an individual part basis. Distributions representing the real-world characteristics of lumber, equipment feed speeds, and processing requirements are programed into the simulation. Costs of parts from a specific cutting bill are given, and effects of lumber input costs...

  10. Evaluation of wearable simulation interface for military training.

    PubMed

    Taylor, Grant S; Barnett, John S

    2013-06-01

    This research evaluated the training effectiveness of a novel simulation interface, a wearable computer integrated into a soldier's load-bearing equipment. Military teams often use game-based simulators on desktop computers to train squad-level procedures. A wearable computer interface that mimics the soldier's equipment was expected to provide better training through increased realism and immersion. A heuristic usability evaluation and two experiments were conducted. Eight evaluators interacted with both wearable and desktop interfaces and completed a usability survey. The first experiment compared the training retention of the wearable interface with a desktop simulator and interactive training video. The second experiment compared the training transfer of the wearable and desktop simulators with a live training environment. Results indicated the wearable interface was more difficult to use and elicited stronger symptoms of simulator sickness. There was no significant difference in training retention between the wearable, desktop, or interactive video training methods. The live training used in the second experiment provided superior training transfer than the simulator conditions, with no difference between the desktop and wearable. The wearable simulator interface did not provide better training than the desktop computer interface. It also had poorer usability and caused worse simulator sickness. Therefore, it was a less effective training tool. This research illustrates the importance of conducting empirical evaluations of novel training technologies. New and innovative technologies are always coveted by users, but new does not always guarantee improvement.

  11. Wavefront error simulator for evaluating optical testing instrumentation

    NASA Technical Reports Server (NTRS)

    Golden, L. J.

    1975-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Miner, Paul S.

    1991-01-01

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

  13. Helicopter Night Vision System Simulation Evaluation

    DTIC Science & Technology

    1981-12-01

    mision safety. The enroute evaluation indicates a con- sistent preference for the 4HMD-PMD configuration. The copilot felt that the virtual HUD...pilot but never allowed Cho copilot to slow in a hover. In edsencer the night cranpore mision appears wo be a two pilot task with a t consant verbal

  14. 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…

  15. SIMULATION AND EVALUATION OF LOGISTICS SYSTEMS,

    DTIC Science & Technology

    A description of PLANET (Planned Logistics Analysis and Evaluation Technique), designed to increase the possibility of discovering flaws in a weapon...equipment, and spare parts. Even though PLANET cannot optimize the hardware configuration, it permits examination of different configurations. It

  16. Intensive care unit nurses' evaluation of simulation used for team training.

    PubMed

    Ballangrud, Randi; Hall-Lord, Marie Louise; Hedelin, Birgitta; Persenius, Mona

    2014-07-01

    To implement a simulation-based team training programme and to investigate intensive care nurses' evaluations of simulation used for team training. Simulation-based training is recommended to make health care professionals aware of and understand the importance of teamwork related to patient safety. The study was based on a questionnaire evaluation design. A total of 63 registered nurses were recruited: 53 from seven intensive care units in four hospitals in one hospital trust and 10 from an intensive care postgraduate education programme. After conducting a simulation-based team training programme with two scenarios related to emergency situations in the intensive care, the participants evaluated each simulation activity with regard to: (i) outcome of satisfaction and self-confidence in learning, (ii) implementation of educational practice and (iii) simulation design/development. Intensive care nurses were highly satisfied with their simulation-based learning, and they were mostly in agreement with the statements about self-confidence in learning. They were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Significant differences were found with regard to scenario roles, prior simulation experience and area of intensive care practice. The study indicates a positive reception of a simulation-based programme with regard to team training in emergency situations in an intensive care unit. The findings may motivate and facilitate the use of simulation for team training to promote patient safety in intensive care and provide educators with support to develop and improve simulation-based training programmes. © 2013 British Association of Critical Care Nurses.

  17. Construction of the real patient simulator system.

    PubMed

    Chan, Richard; Sun, C T

    2012-05-01

    Simulation for perfusion education has been used for at least the past 25 years. The earlier models were either electronic (computer games) or fluid dynamic models and provided invaluable adjuncts to perfusion training and education. In 2009, the *North Shore-LIJ Health System at Great Neck, New York, opened an innovative "Bioskill Center" dedicated to simulated virtual reality advanced hands-on surgical training as well as perfusion simulation. Professional cardiac surgical organizations now show great interest in using simulation for training and recertification. Simulation will continue to be the direction for future perfusion training and education. This manuscript introduces a cost-effective system developed from discarded perfusion products and it is not intended to detail the actual lengthy process of its construction.

  18. 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

  19. Using the Clark Simulation Evaluation Rubric with associate degree and baccalaureate nursing students.

    PubMed

    Gantt, Laura T

    2010-01-01

    As simulation becomes a common teaching strategy in nursing education, faculty struggle with methods for measuring student performance in summative, or evaluative, scenarios. While skills checklists have been shown to be a valid way to quantify performance on many of the technical components of a patient care scenario, nurse educators have also begun to utilize simulation grading rubrics to capture more contextual and critical thinking components. The article describes a pilot study using the Clark Simulation Evaluation Rubric with undergraduate nursing students of different levels from two types of programs. Sixty-nine associate degree and 109 baccalaureate degree students were evaluated and scored in simulation performance using the rubric. The rubric was found to be a practical tool that could potentially be used with or without skills checklists. Future work will involve refining use of the rubric and establishing interrater reliability among faculty who routinely evaluate students using this rubric.

  20. Evaluation methods of a middleware for networked surgical simulations.

    PubMed

    Cai, Qingbo; Liberatore, Vincenzo; Cavuşoğlu, M Cenk; Yoo, Youngjin

    2006-01-01

    Distributed surgical virtual environments are desirable since they substantially extend the accessibility of computational resources by network communication. However, network conditions critically affects the quality of a networked surgical simulation in terms of bandwidth limit, delays, and packet losses, etc. A solution to this problem is to introduce a middleware between the simulation application and the network so that it can take actions to enhance the user-perceived simulation performance. To comprehensively assess the effectiveness of such a middleware, we propose several evaluation methods in this paper, i.e., semi-automatic evaluation, middleware overhead measurement, and usability test.

  1. 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.

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

    NASA Technical Reports Server (NTRS)

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

    1986-01-01

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

  3. The Use and Evaluation of Interest Inventories and Simulations.

    ERIC Educational Resources Information Center

    Holland, John L.

    This paper provides a general perspective for evaluating interest inventories and simulations and outlines some activities to stimulate the development of more useful inventories. Previous evaluations have been primarily instrument-specific; have relied generally on opinion rather than evidence; and have focused only on possible sex, age, race, or…

  4. 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)

  5. 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)

  6. 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.

  7. 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

  8. 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

  9. 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…

  10. 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…

  11. Evaluation of regional climate simulations for air quality modelling purposes

    NASA Astrophysics Data System (ADS)

    Menut, Laurent; Tripathi, Om P.; Colette, Augustin; Vautard, Robert; Flaounas, Emmanouil; Bessagnet, Bertrand

    2013-05-01

    In order to evaluate the future potential benefits of emission regulation on regional air quality, while taking into account the effects of climate change, off-line air quality projection simulations are driven using weather forcing taken from regional climate models. These regional models are themselves driven by simulations carried out using global climate models (GCM) and economical scenarios. Uncertainties and biases in climate models introduce an additional "climate modeling" source of uncertainty that is to be added to all other types of uncertainties in air quality modeling for policy evaluation. In this article we evaluate the changes in air quality-related weather variables induced by replacing reanalyses-forced by GCM-forced regional climate simulations. As an example we use GCM simulations carried out in the framework of the ERA-interim programme and of the CMIP5 project using the Institut Pierre-Simon Laplace climate model (IPSLcm), driving regional simulations performed in the framework of the EURO-CORDEX programme. In summer, we found compensating deficiencies acting on photochemistry: an overestimation by GCM-driven weather due to a positive bias in short-wave radiation, a negative bias in wind speed, too many stagnant episodes, and a negative temperature bias. In winter, air quality is mostly driven by dispersion, and we could not identify significant differences in either wind or planetary boundary layer height statistics between GCM-driven and reanalyses-driven regional simulations. However, precipitation appears largely overestimated in GCM-driven simulations, which could significantly affect the simulation of aerosol concentrations. The identification of these biases will help interpreting results of future air quality simulations using these data. Despite these, we conclude that the identified differences should not lead to major difficulties in using GCM-driven regional climate simulations for air quality projections.

  12. Pharmacy Student Response to Patient-Simulation Mannequins to Teach Performance-based Pharmacotherapeutics

    PubMed Central

    Seybert, Amy L.; Laughlin, Karen K.; Benedict, Neal J.; Barton, Christine M.; Rea, Rhonda S.

    2006-01-01

    Objective To design and implement a simulated patient-case assessment using a mannequin for critical care pharmacotherapeutic education of doctor of pharmacy students and to evaluate student satisfaction with the simulation. Design During the second year of the doctor of pharmacy program, all students were required to complete Introduction to Critical Care. This course consisted of didactic education, written patient-case sessions, and an interactive patient simulation session. Information on the patient case was distributed to students after completing the didactic portion of the course. Patient information was programmed into a simulation mannequin, which demonstrated characteristics of a critically ill human. Students were surveyed post-simulation to determine the effectiveness of the learning experience. Assessment The majority of students (88%) were extremely satisfied with the experience. The facilitator was considered to be extremely useful in 75% of responses. Conclusion By simulating a patient case, the facilitator was able to control students' learning environment, adapt the simulation to the level of the students' performance, and debrief students immediately. Ultimately, by involving students in actual patient cases early in the pharmacy curriculum, this type of education could produce pharmacists with a high level of expertise and confidence. PMID:17136169

  13. Using gaming simulation to evaluate bioterrorism and emergency readiness training.

    PubMed

    Olson, Debra K; Scheller, Amy; Wey, Andrew

    2014-01-01

    The University of Minnesota: Simulations, Exercises and Effective Education: Preparedness and Emergency Response Learning Center uses simulations, which allow trainees to participate in realistic scenarios, to develop and evaluate competency. In a previous study, participants in Disaster in Franklin County: A Public Health Simulation demonstrated that prior bioterrorism and emergency readiness training (BT/ER) is significantly associated with better performance in a simulated emergency. We conducted a second analysis with a larger data set, remapping simulation questions to the Public Health Preparedness and Response Core Competency Model, Version 1.0. We performed an outcome evaluation of the impact of public health preparedness training. In particular, we compared individuals with significant BT/ER training to individuals without training on the basis of performance in a simulated emergency. We grouped participants as group 1 (≥45 hours of BT/ER training) and group 2 (<45 hours). Dependent variables included effectiveness of chosen responses within the gaming simulation, which was measured as the proportion of questions answered correctly for each participant. The relationship of effectiveness with significant BT/ER training was estimated using either multiple linear or logistic regression. For overall effectiveness, group 1 had 2% more correct decisions, on average, than group 2 (P < .001). Group 1 performed significantly better, on average, than group 2 for competency 1.1 (P = .001) and competency 2.3 (P < .001). However, group 1 was significantly worse on competency 1.2 than group 2. Results indicate that prior training is significantly associated with better performance in a simulated emergency using gaming technology. Effectiveness differed by competency, indicating that more training may be needed in certain competency areas. Next steps to enhancing the usefulness of simulations in training should go beyond questioning if the learner learned and included

  14. Sensory Evaluation of Ride on Railway Vehicle Using Motion Simulator

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Daisuke; Takehara, Shoichiro; Sasaki, Koichi; Suda, Yoshihiro; Koga, Takaaki

    Sensory evaluation of ride on a railway vehicle is performed based on international standards such as ISO2631. However, it is expected that this evaluation would be insufficient because of the development of technologies of a railway vehicle. The evaluation for view and sound from the viewpoint of ergonomic and psychological perspectives might be needed as well as traditional evaluations in the future. Authors focused on the relation between view and motion of the railway vehicle. The experiment in sensory evaluation of ride on a railway vehicle using a motion simulator was performed. In this paper, the way and results of the experiment and the environmental psychological analysis are described.

  15. Technology evaluation, assessment, modeling, and simulation: the TEAMS capability

    NASA Astrophysics Data System (ADS)

    Holland, Orgal T.; Stiegler, Robert L.

    1998-08-01

    The United States Marine Corps' Technology Evaluation, Assessment, Modeling and Simulation (TEAMS) capability, located at the Naval Surface Warfare Center in Dahlgren Virginia, provides an environment for detailed test, evaluation, and assessment of live and simulated sensor and sensor-to-shooter systems for the joint warfare community. Frequent use of modeling and simulation allows for cost effective testing, bench-marking, and evaluation of various levels of sensors and sensor-to-shooter engagements. Interconnectivity to live, instrumented equipment operating in real battle space environments and to remote modeling and simulation facilities participating in advanced distributed simulations (ADS) exercises is available to support a wide- range of situational assessment requirements. TEAMS provides a valuable resource for a variety of users. Engineers, analysts, and other technology developers can use TEAMS to evaluate, assess and analyze tactical relevant phenomenological data on tactical situations. Expeditionary warfare and USMC concept developers can use the facility to support and execute advanced warfighting experiments (AWE) to better assess operational maneuver from the sea (OMFTS) concepts, doctrines, and technology developments. Developers can use the facility to support sensor system hardware, software and algorithm development as well as combat development, acquisition, and engineering processes. Test and evaluation specialists can use the facility to plan, assess, and augment their processes. This paper presents an overview of the TEAMS capability and focuses specifically on the technical challenges associated with the integration of live sensor hardware into a synthetic environment and how those challenges are being met. Existing sensors, recent experiments and facility specifications are featured.

  16. 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.

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

    PubMed

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

    2006-01-01

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

  18. Improving prospective memory performance with future event simulation in traumatic brain injury patients.

    PubMed

    Mioni, Giovanna; Bertucci, Erica; Rosato, Antonella; Terrett, Gill; Rendell, Peter G; Zamuner, Massimo; Stablum, Franca

    2017-06-01

    Previous studies have shown that traumatic brain injury (TBI) patients have difficulties with prospective memory (PM). Considering that PM is closely linked to independent living it is of primary interest to develop strategies that can improve PM performance in TBI patients. This study employed Virtual Week task as a measure of PM, and we included future event simulation to boost PM performance. Study 1 evaluated the efficacy of the strategy and investigated possible practice effects. Twenty-four healthy participants performed Virtual Week in a no strategy condition, and 24 healthy participants performed it in a mixed condition (no strategy - future event simulation). In Study 2, 18 TBI patients completed the mixed condition of Virtual Week and were compared with the 24 healthy controls who undertook the mixed condition of Virtual Week in Study 1. All participants also completed a neuropsychological evaluation to characterize the groups on level of cognitive functioning. Study 1 showed that participants in the future event simulation condition outperformed participants in the no strategy condition, and these results were not attributable to practice effects. Results of Study 2 showed that TBI patients performed PM tasks less accurately than controls, but that future event simulation can substantially reduce TBI-related deficits in PM performance. The future event simulation strategy also improved the controls' PM performance. These studies showed the value of future event simulation strategy in improving PM performance in healthy participants as well as in TBI patients. TBI patients performed PM tasks less accurately than controls, confirming prospective memory impairment in these patients. Participants in the future event simulation condition out-performed participants in the no strategy condition. Future event simulation can substantially reduce TBI-related deficits in PM performance. Future event simulation strategy also improved the controls' PM performance.

  19. Simulation to Standardize Patient Care and Maintain Procedural Competency.

    PubMed

    Butler-O'Hara, Meggan; Marasco, Margaret; Dadiz, Rita

    2015-01-01

    Simulation-based training is a means to teach procedural skills and to help advanced practice providers maintain procedural competency and credentialing. There is growing recognition of the importance of requiring providers to demonstrate competency of invasive procedures in a simulated environment prior to performing these high-risk procedures on patients. This article describes the development and implementation of the simulation procedural program at the University of Rochester Medical Center. In addition to contributing to the education of our providers, such a program can lead to improved patient quality, safety, and outcomes through the standardization of patient care. The innovative use of simulation can lead to effective heath care education and improvement in patient safety.

  20. 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

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

    PubMed

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

    2010-10-01

    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.

  2. Evaluation Of Fault-Tolerant Policies Using Simulation

    SciTech Connect

    Tikotekar, Anand A; Vallee, Geoffroy R; Naughton, III, Thomas J; Scott, Stephen L

    2007-01-01

    Various mechanisms for fault-tolerance (FT) are used today in order to reduce the impact of failures on application execution. In the case of system failure, standard FT mechanisms are checkpoint/restart (for reactive FT) and migration (for pro-active FT). However, each of these mechanisms create an overhead on application execution, overhead that for instance becomes critical on large-scale systems where previous studies have shown that applications may spend more time checkpointing state than performing useful work. In order to decrease this overhead, researchers try to both optimize existing FT mechanisms and implement new FT policies. For instance, combining reactive and pro-active approaches in order to decrease the number of checkpoints that must be performed during the application 's execution. However, currently no solutions exist which enable the evaluation of these FT approaches through simulation, instead experimentations must be done using real platforms. This increases complexity and limits experimentation into alternate solutions. This paper presents a simulation framework that evaluates different FT mechanisms and policies. The framework uses system failure logs for the simulation with a default behavior based on logs taken from the ASCI White at Lawrence Livermore National Laboratory. We evaluate the accuracy of our simulator comparing simulated results with those taken from experiments done on a 32-node compute cluster. Therefore such a simulator can be used to develop new FT policies and/or to tune existing policies.

  3. Using gaming simulation to evaluate bioterrorism and emergency readiness education.

    PubMed

    Olson, Debra K; Scheller, Amy; Larson, Susan; Lindeke, Linda; Edwardson, Sandra

    2010-01-01

    We performed an outcome evaluation of the impact of public health preparedness training as a group comparison posttest design to determine the differences in the way individuals who had participated in training performed in a simulated emergency. The Experimental Group 1 included students who had graduated from or were currently enrolled in the bioterrorism and emergency readiness (BT/ER) curriculum at the University of Minnesota School of Public Health. The comparison groups included individuals who had access to the Internet and were aware of the 2006 online simulation Disaster in Franklin County: A Public Health Simulation. The evaluation process employed surveys and the gaming simulation as sources for primary data. Participants in the BT/ER curriculum (p=0.0001) and other participants completing at least 45 hours of training in the past year (p=0.0001) demonstrated higher effectiveness scores (accuracy of chosen responses within the simulation) than participants who did not report significant amounts of training. This evaluation research demonstrated that training is significantly associated with better performance in a simulated emergency using gaming technology.

  4. Evaluation of the patient with recurrent vertigo.

    PubMed

    Kaylie, David; Garrison, Douglas; Tucci, Debara L

    2012-06-01

    The evaluation of the patient with recurrent vertigo requires knowledge of vestibular anatomy and physiology. The patient's medical history and physical examination provide the majority of the information necessary for diagnosis. Many diagnostic tests are available to the clinician to aid in the diagnosis. Videonystagmography is useful for the evaluation of peripheral vestibular function and provides some information about central processes as well. Rotary chair testing provides excellent information about central processes and can aid in diagnosing peripheral vestibular impairment. Vestibular-evoked myogenic potential testing is sensitive for testing inferior vestibular nerve and saccule function. Many different medical and surgical options are available for the patient with recurrent vertigo.

  5. Accuracy evaluation of a numerical simulation model of nasal airflow.

    PubMed

    Lu, Jiuxing; Han, Demin; Zhang, Luo

    2014-05-01

    Our numerical simulation model provides an accurate reflection of nasal airflow, and the results were validated by clinical measurements. To evaluate the accuracy of a numerical simulation model of nasal airflow. Ten volunteers with normal nasal cavities underwent CT, acoustic rhinometry, and rhinomanometry. CT data were uploaded into Mimics, ICEM-CFD, Fluent, and CFD-Post software for three-dimensional modeling, finite element grid division, transient calculations, and analysis, respectively. Velocity and pressure data of airflow were obtained during the normal respiratory cycle. The accuracy of the simulation was evaluated by two methods: acoustic rhinometry measurements were used to evaluate the accuracy of the anatomic model, and rhinomanometry measurements were used to evaluate the accuracy of the nasal resistance values obtained by numerical simulation. There were no significant differences between the values describing the model and the acoustic rhinometry measurements, the nasal resistance values obtained by numerical simulation. The airflow through the nasal cavity was mainly laminar. The maximum velocities were measured at the nasal valve, the amplitudes of all velocity curves at locations beyond the nasal valve were reduced. The amplitudes of the pressure curves increased from the front to the back of the airway.

  6. Neuroimaging evaluation of patients with headaches.

    PubMed

    Diamond, S

    1984-11-01

    As discussed in the introduction, the rote laboratory and neuroimaging evaluation of a patient with headache but without other neurologic symptoms or signs is often unrewarding. Such evaluations are dictated by the clinical history and examination, hence rely on the diagnostic acumen of the physician. In the case of patients during their initial visit, it is frequently useful to proceed with skull radiographs and, if the symptoms warrant, contrast-enhanced CT scanning. In the future, as NMR imaging becomes more widely available, it may prove useful for these initial clinical evaluations. More invasive procedures, such as angiography, are undertaken only if specific indications, such as those summarized in Table 1, are present.

  7. Practice Skill Development Through the Use of Human Patient Simulation

    PubMed Central

    2011-01-01

    Human patient simulation (HPS) is used in health care education to enhance the transition from classroom learning to competent performance. It has been used frequently in nursing and medical schools and less often in pharmacy and other allied health professions. HPS is used to improve the development of pharmacy practice skills such as physical assessment, pharmacotherapy plan development, and monitoring plans. Engaging multiple health care disciplines in simulations enables participants to practice teamwork and communication skills that are essential in preventing errors and events of harm to patients. This article reviews current literature and use of simulation in pharmacy curricula for the development, enhancement, and assessment of pharmacy practice skills. PMID:22171116

  8. Practice skill development through the use of human patient simulation.

    PubMed

    Crea, Kathryn A

    2011-11-10

    Human patient simulation (HPS) is used in health care education to enhance the transition from classroom learning to competent performance. It has been used frequently in nursing and medical schools and less often in pharmacy and other allied health professions. HPS is used to improve the development of pharmacy practice skills such as physical assessment, pharmacotherapy plan development, and monitoring plans. Engaging multiple health care disciplines in simulations enables participants to practice teamwork and communication skills that are essential in preventing errors and events of harm to patients. This article reviews current literature and use of simulation in pharmacy curricula for the development, enhancement, and assessment of pharmacy practice skills.

  9. Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

    PubMed

    Pereira, D; Gomes, P; Faria, S; Cruz-Correia, R; Coimbra, M

    2016-08-01

    Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

  10. Evaluation of kidney transplantation programmes using system simulation.

    PubMed

    Devi, S Prasanna; Kumar, S Saravana; Rao, K Suryaprakasa

    2012-06-01

    In the case of kidney transplantations, there is always a serious imbalance between the number of kidneys donated for transplantation and the number of persons wishing to receive a transplant. This not only affects the quality of life of those unable to obtain a transplant, but it also has important repercussions on the treatment of End Stage Renal Disease (ESRD) by transplantation and dialysis. Also there are a number of ways in which the kidney transplantation can be achieved, such as the cadaveric kidney transplantation, live donor kidney transplantation, kidney paired donation and list exchange. A simulation study of all the referred programmes is performed using simulation models developed for each programme to obtain the better estimate of the average waiting time of a patient per year. With the estimates given by the simulation models, the best serving programme for each blood type patient is selected, declared and recommended.

  11. 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…

  12. 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…

  13. 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.

  14. Endoscopic evaluation of neurological dysphagic patients.

    PubMed

    Coscarelli, S; Verrecchia, L; Coscarelli, A

    2007-12-01

    Dysphagia is a frequent finding in neurological patients and is a symptom related to the severity of the clinical picture. The swallowing impairments, in these patients, increase the risk of aspiration pneumonia, that leads to death, in at least 6% of patients, within the first year. Therefore, evaluation of the swallowing status is essential in patients with dysphagia and videofluoroscopic study of swallowing (VFSS) is the method of choice. It cannot be performed in all patients on account of the complexity of the procedure and since they must be brought to the Radiology Unit. In the 1980, a new bedside method was introduced, namely: fiber-optic endoscopic study of swallow (FESS) which is easy, low-cost, well-tolerated and repeatable. We use this bedside technique to assess swallowing function in patients with dysphagia admitted to acute care units, neurological and internal medicine units. The evaluation aims to indicate the safer nutritional method (oral intake, feeding tube or percutaneous gastrostomy) and, consequently, reducing the risk of aspiration pneumonia during hospitalization. We found that more than 50% of the dysphagic patients present cerebrovascular injuries and in 2% of the population, the first diagnostic hypothesis of Myasthenia Gravis can be made with the FESS technique. In 60%, we indicate a change in nutritional method: in 20% we indicate percutaneous endoscopic gastrostomy (PEG). With these indications, none of those patients had aspiration pneumonia. Our protocol for the bedside fiberoptic study of neurological patients with dysphagia has demonstrated its efectiveness by eliminating the incidence of aspiration pneumonia.

  15. A virtual reality simulator for teaching and evaluating dental procedures.

    PubMed

    Rhienmora, P; Haddawy, P; Khanal, P; Suebnukarn, S; Dailey, M N

    2010-01-01

    We present a dental training system with a haptic interface that allows dental students or experts to practice dental procedures in a virtual environment. The simulator is able to monitor and classify the performance of an operator into novice or expert categories. The intelligent training module allows a student to simultaneously and proactively follow the correct dental procedures demonstrated by an intelligent tutor. The virtual reality (VR) simulator simulates the tooth preparation procedure both graphically and haptically, using a video display and haptic device. We evaluated the performance of users using hidden Markov models (HMMs) incorporating various data collected by the simulator. We implemented an intelligent training module which is able to record and replay the procedure that was performed by an expert and allows students to follow the correct steps and apply force proactively by themselves while reproducing the procedure. We find that the level of graphics and haptics fidelity is acceptable as evaluated by dentists. The accuracy of the objective performance assessment using HMMs is encouraging with 100 percent accuracy. The simulator can simulate realistic tooth surface exploration and cutting. The accuracy of automatic performance assessment system using HMMs is also acceptable on relatively small data sets. The intelligent training allows skill transfer in a proactive manner which is an advantage over the passive method in a traditional training. We will soon conduct experiments with more participants and implement a variety of training strategies.

  16. Evaluation of articulation simulation system using artificial maxillectomy models.

    PubMed

    Elbashti, M E; Hattori, M; Sumita, Y I; Taniguchi, H

    2015-09-01

    Acoustic evaluation is valuable for guiding the treatment of maxillofacial defects and determining the effectiveness of rehabilitation with an obturator prosthesis. Model simulations are important in terms of pre-surgical planning and pre- and post-operative speech function. This study aimed to evaluate the acoustic characteristics of voice generated by an articulation simulation system using a vocal tract model with or without artificial maxillectomy defects. More specifically, we aimed to establish a speech simulation system for maxillectomy defect models that both surgeons and maxillofacial prosthodontists can use in guiding treatment planning. Artificially simulated maxillectomy defects were prepared according to Aramany's classification (Classes I-VI) in a three-dimensional vocal tract plaster model of a subject uttering the vowel /a/. Formant and nasalance acoustic data were analysed using Computerized Speech Lab and the Nasometer, respectively. Formants and nasalance of simulated /a/ sounds were successfully detected and analysed. Values of Formants 1 and 2 for the non-defect model were 675.43 and 976.64 Hz, respectively. Median values of Formants 1 and 2 for the defect models were 634.36 and 1026.84 Hz, respectively. Nasalance was 11% in the non-defect model, whereas median nasalance was 28% in the defect models. The results suggest that an articulation simulation system can be used to help surgeons and maxillofacial prosthodontists to plan post-surgical defects that will be facilitate maxillofacial rehabilitation.

  17. 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.

  18. Neuropsychiatric evaluation of patients with brucellosis.

    PubMed

    Shehata, Ghaydaa A; Abdel-Baky, Laila; Rashed, Heba; Elamin, Hussein

    2010-02-01

    Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Neurobrucellosis is one of the complications. The objective of this study was to determine neuropsychiatric manifestations among patients with brucellosis. Twenty-seven consecutive patients with brucellosis (14 patients with manifest neurological manifestation and 13 patients without apparent neurological manifestation) were recruited from Assiut University hospital and compared with 50 healthy controls matched with respect to age, sex, and social economic and educational levels. They were subjected to systemic, meticulous neuropsychiatric evaluations, laboratory, radiological, neurophysiology, and psychometric assessment with Mini-Mental State Examination, Wechsler Memory Scale-Revised. and Hamilton Depression Rating. Overt or apparent neurological manifestation was recorded in 14 patients (51.85%) and 13 patients (48.15%) with brucellosis without apparent neuropsychiatric involvement. Central nervous system (CNS) involvement (vascular stroke, meningeoencephalitis, and dementia) was recorded in 9 patients (33.3%) and 6 patients (22.2%) had peripheral nervous sytem (PNS) involvement (polyneuropathy, radiculoapathy, and polyradiculoneuropathy). Depression was recorded in 7 (29.2%) patients; 3 patients (21.4%) of the neurobrucellosis group and 4 patients (30.8%) with brucellosis without neurological manifestations. Patients with brucellosis (neurobrucellosis and patients without neurological manifestations) reported highly significant impairment in some cognitive function measures (mental control, logical memory, visual reproduction) and higher scores on depressive symptoms compared with controls. Patients with a Brucella infection usually manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas, should consider the likelihood of neurobrucellosis in patients with unexplained

  19. 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.

  20. 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.

  1. A Field Test of the TIME Patient Simulation Model.

    ERIC Educational Resources Information Center

    Harless, William G.; And Others

    1990-01-01

    The Technological Innovations in Medical Education (TIME) model, designed to be controlled by a professor in the classroom, incorporates voice recognition technology and video dramatization to create a believable patient encounter. A field test finding was that the students became committed to the care and management of the simulated patient.…

  2. A Field Test of the TIME Patient Simulation Model.

    ERIC Educational Resources Information Center

    Harless, William G.; And Others

    1990-01-01

    The Technological Innovations in Medical Education (TIME) model, designed to be controlled by a professor in the classroom, incorporates voice recognition technology and video dramatization to create a believable patient encounter. A field test finding was that the students became committed to the care and management of the simulated patient.…

  3. Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial.

    PubMed

    Liaw, Sok Ying; Chan, Sally Wai-Chi; Chen, Fun-Gee; Hooi, Shing Chuan; Siau, Chiang

    2014-09-17

    Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients. The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students' performances in assessing and managing patients with clinical deterioration. A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants' clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation. Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively. A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated

  4. 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.

  5. 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.

  6. Qualitative Evaluation of a Role Play Bullying Simulation.

    PubMed

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

    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.

  7. Evaluation of a Game-Based Simulation During Distributed Exercises

    DTIC Science & Technology

    2010-09-01

    U.S. Army Research Institute for the Behavioral and Social Sciences Research Report 1931 Evaluation of a Game-Based...Simulation During Distributed Exercises Michael J. Singer and Bruce W. Knerr U. S. Army Research Institute September 2010...Approved for public release; distribution is unlimited. U.S. Army Research Institute for the Behavioral and Social Sciences Department of

  8. 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…

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

    PubMed

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

    2017-03-29

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

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

    PubMed Central

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

    2017-01-01

    Objectives The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student’s behaviour, attitudes, and performance during simulated patient treatment. Methods Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Results Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude ‘handling errors’ improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. Conclusions This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student’s non-technical skills. In a next step, to improve student’s handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum. PMID:28355594

  11. Aesthetic evaluation of lipoabdominoplasty in overweight patients.

    PubMed

    Saldanha, Osvaldo R; Salles, Alessandra G; Ferreira, Marcus C; Llaverias, Francis; Morelli, Luis H U; Saldanha Filho, Osvaldo R; Saldanha, Cristianna B

    2013-11-01

    The aim of this study was to evaluate the aesthetic results of lipoabdominoplasty in overweight patients (body mass index, 25 to 29.9) compared with normal weight patients (body mass index, 18.5 to 24.9). The authors performed a retrospective and comparative analysis of late follow-up results after lipoabdominoplasty performed from 2000 to 2009 in two groups of 30 patients, one with a body mass index of 25 to 29.9 and one with a body mass index of 18 to 24.9. Aesthetic results were evaluated using a scale with five objective parameters, developed in the Faculty of Medicine, University of São Paulo. There were seven evaluators: three plastic surgeons, three nondoctors, and the surgeon performing the procedure. For all evaluators, the postoperative average grade was significantly higher than before surgery for the entire group of patients (n=60) and in each subgroup. The average grades for the normal weight group were consistently significantly higher than for the overweight group, both preoperatively and postoperatively, for all evaluators. However, the mean difference between the preoperative and postoperative grades, which measures the aesthetic improvement provided by the operation, was higher in the overweight group. Postoperatively, the average grade of the surgeon was significantly higher than for all other evaluator groups. The normal weight group showed superior grades, both before and after lipoabdominoplasty, for all evaluators. However, the gain between preoperative and postoperative grades was higher in the overweight patient group, indicating that lipoabdominoplasty was beneficial even in these cases. Therapeutic, III.

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

    NASA Astrophysics Data System (ADS)

    Zhou, Jin

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

  13. Systematic review of the use of computer simulation modeling of patient flow in surgical care.

    PubMed

    Sobolev, Boris G; Sanchez, Victor; Vasilakis, Christos

    2011-02-01

    Computer simulation has been employed to evaluate proposed changes in the delivery of health care. However, little is known about the utility of simulation approaches for analysis of changes in the delivery of surgical care. We searched eight bibliographic databases for this comprehensive review of the literature published over the past five decades, and found 34 publications that reported on simulation models for the flow of surgical patients. The majority of these publications presented a description of the simulation approach: 91% outlined the underlying assumptions for modeling, 88% presented the system requirements, and 91% described the input and output data. However, only half of the publications reported that models were constructed to address the needs of policy-makers, and only 26% reported some involvement of health system managers and policy-makers in the simulation study. In addition, we found a wide variation in the presentation of assumptions, system requirements, input and output data, and results of simulation-based policy analysis.

  14. Koppen bioclimatic evaluation of CMIP historical climate simulations

    DOE PAGES

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

    2015-06-05

    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 tomore » 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. Additionally, 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.« less

  15. 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.

  16. Evaluation of chemical simulations from EMEP4ASIA

    NASA Astrophysics Data System (ADS)

    Pommier, M.; Gauss, M.; Fagerli, H.; Benedictow, A.; Nyiri, A.; Valdebenito, Á.; Wind, P.

    2016-12-01

    The EMEP/MSC-W chemistry transport model (CTM) has been used for decades to simulate concentrations of surface air pollutants over Europe and to calculate source-receptor relationships between European countries. Within the framework of the operational air pollution forecasts for East Asia, being offered by the EU project PANDA, this study aims to evaluate the EMEP/MSC-W CTM in simulating high pollution events over Asian cities. This work is the first attempt to use this CTM with a fine horizontal resolution (0.1°×0.1°) over Asia and to simulate the pollution over urban regions. The main part of the work has been to focus on the evaluation of the EMEP/MSC-W CTM with measurements from different platforms (satellite, ground-based, in situ) and to identify the biases or the errors in the simulation. This evaluation is important in order to establish the capabilities of the model to identify air pollution sources. Regional distributions and temporal variation of main pollutants are thus discussed. For example, the daily variation in Ox is well captured while the NOx is under-predicted and the O3 is overestimated, especially in winter. The CTM performs also very well on day-to-day variation in PM25 or on the regional distribution in CO total column as over Beijing.

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

    PubMed Central

    Meyer, Susan M.

    2014-01-01

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

  18. Simulation evaluation of helicopter Terrain Following/Terrain Avoidance concepts

    NASA Technical Reports Server (NTRS)

    Swenson, Herry N.; Hardy, Gordon H.; Morris, Pat M.

    1988-01-01

    A helicopter Terrain-Following/Terrain-Avoidance (TF/TA) system was developed and evaluated using a real-time piloted simulation. The TF/TA system included a guidance algorithm based upon dynamic programming and a head-up display (HUD) concept which incorporates a pathway in the sky, a phantom aircraft, and flightpath vector/predictor symbology. The simulation was conducted at the NASA Ames Research Center Interchangeable Cab (ICAB) Laboratory using NASA test pilots. The pilots performed the TF/TA task by manually tracking the HUD symbology. The pilots were able to satisfactorily perform the TF/TA tasks with an acceptable level of pilot workload.

  19. 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.

  20. Evaluation of pediatric patients with hepatitis A.

    PubMed

    Çetinkaya, Bilge; Tezer, Hasan; Özkaya Parlakay, Aslinur; Revide Sayli, Tulin

    2014-03-13

    Hepatitis A is the most common form of acute viral hepatitis worldwide, especially in children. The clinical severity of the hepatitis A virus (HAV) infection varies from an asymptomatic infection to a fulminant disease. In this study, we aimed to evaluate characteristics of pediatric patients diagnosed with HAV infection. Patients younger than 18 years of age admitted between January 1, 2006 and January 1, 2011 to our hospital, an important reference center located in the middle part of Turkey, diagnosed as having hepatitis A were evaluated. Of 427 patients, 49.4% were female and 50.6% were male. Hospitalization rate of the patients was 28.3%. The reason for hospitalization was vomitting in 58.7% of the patients and abdominal pain in 28%. The mean time of hospitalization was 5.2 ± 4.5 (1-40) days. There was no significant difference in hospitalization time by age. Vomiting and abdominal pain were significantly more common, and PT and aPTT levels were significantly elevated in patients with elevated AST and ALT levels over 1000 IU/L (p < 0.001). PT elevation was present in 15.2% of the patients, aPTT elevation in 11.9%, leukopenia in 16.6%, and thrombocytopenia in 2.6%. In terms of atypical course, four patients (0.9%) had cholestatic hepatitis, one had recurrent hepatitis, and one had fulminant hepatitis, yet no mortality was observed. Atypical courses of hepatitis A were more scarce in pediatric patients, but careful follow-up of patients with AST and ALT levels > 1000 IU/L is necessary.

  1. Numerical simulation of cerebrospinal fluid hydrodynamics in the healing process of hydrocephalus patients

    NASA Astrophysics Data System (ADS)

    Gholampour, S.; Fatouraee, N.; Seddighi, A. S.; Seddighi, A.

    2017-05-01

    Three-dimensional computational models of the cerebrospinal fluid (CSF) flow and brain tissue are presented for evaluation of their hydrodynamic conditions before and after shunting for seven patients with non-communicating hydrocephalus. One healthy subject is also modeled to compare deviated patients data to normal conditions. The fluid-solid interaction simulation shows the CSF mean pressure and pressure amplitude (the superior index for evaluation of non-communicating hydrocephalus) in patients at a greater point than those in the healthy subject by 5.3 and 2 times, respectively.

  2. Successful techniques for using human patient simulation in nursing education.

    PubMed

    Brewer, Evelyn P

    2011-09-01

    The purpose of this paper was to explore techniques used successfully for human simulation exercises in nursing education. An integrated review of current literature was completed using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text and PubMed databases to identify studies that used simulation successfully in nursing curriculum. Human patient simulation can be used successfully as an instructional method in nursing education. While no single process was proven to be superior, there are techniques which have been used effectively. Nursing educators are challenged with discovering ways to facilitate the education of their students. Human patient simulation can be a valuable tool. More research is needed to fully develop this promising educational avenue. © 2011 Sigma Theta Tau International.

  3. Summative assessment in medicine: the promise of simulation for high-stakes evaluation.

    PubMed

    Boulet, John R

    2008-11-01

    Throughout their careers, physicians are exposed to a wide array of assessments, including those aimed at evaluating knowledge, clinical skills, and clinical decision-making. While many of these assessments are used as part of formative evaluation activities, others are employed to establish competence and, as a byproduct, to promote patient safety. In the past 10 years, simulations have been successfully incorporated in a number of high-stakes physician certification and licensure exams. In developing these simulation-based assessments, testing organizations were able to promote novel test administration protocols, build enhanced assessment rubrics, advance sophisticated scoring and equating algorithms, and promote innovative standard-setting methods. Moreover, numerous studies have been conducted to identify potential threats to the validity of test score interpretations. As simulation technology expands and new simulators are invented, this groundbreaking work can serve as a basis for organizations to build or expand their summative assessment activities. Although there will continue to be logistical and psychometric problems, many of which will be specialty- or simulator-specific, past experience with performance-based assessments suggests that most challenges can be addressed through focused research. Simulation, whether it involves standardized patients (SPs), computerized case management scenarios, part-task trainers, electromechanical mannequins, or a combination of these methods, holds great promise for high-stakes assessment.

  4. Live or computerized simulation of clinical encounters: do clinicians work up patient cases differently?

    PubMed

    Nendaz, Mathieu R; Ponte, Belen; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Junod, Alain F; Vu, Nu V

    2006-03-01

    Computer simulation of clinical encounters is increasingly used in clinical settings to train patient work-up. The aim of this prospective, controlled study was to compare the characteristics of data collection and diagnostic exploration of physicians working up cases with a standardized patient and in a computerized simulation. Six clinicians of different clinical experience in internal medicine worked up three cases with a standardized patient and through a computer simulation allowing free inquiry. After each encounter, we asked the subjects to justify the information collected and to comment on their working diagnoses. The characteristics of data collected and working diagnoses generated were assessed and compared, according to the simulation method used. In the computer simulation, physicians limited their data collection and focused earlier and more specifically on information and working diagnoses with high levels of relevance. They reached a similar diagnostic accuracy and made decisions of a similar relevance. Computer simulation with a free-inquiry approach reproduces the data collection and the diagnostic exploration observed in a standardized-patient simulation and promotes an early collection of relevant data. Its contribution to extend the competence of learners in clinical settings should be further evaluated.

  5. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

    PubMed Central

    Alsaad, Ali A; Davuluri, Swetha; Bhide, Vandana Y; Lannen, Amy M; Maniaci, Michael J

    2017-01-01

    Background Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM) residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs) as compared to mannequin. Methods Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis). Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score). Results Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01). When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002). Conclusions Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. PMID:28765717

  6. 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)

  7. 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.

  8. 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)

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

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2003-09-01

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

  10. A field test of the TIME patient simulation model.

    PubMed

    Harless, W G; Duncan, R C; Zier, M A; Ayers, W R; Berman, J R; Pohl, H S

    1990-05-01

    The Technological Innovations in Medical Education (TIME) Project has created an interactive videodisc patient-simulation model that provides faculty with a new method for patient-centered teaching in the medical school classroom. The TIME model is designed to be controlled by a professor in the classroom setting, and incorporates voice recognition technology and video dramatization to create a believable patient encounter. Under the auspices of the Lister Hill National Center for Biomedical Communications, National Library of Medicine, where the Project originated in 1983, three medical schools participated in a field test of this "high-tech" model. Six faculty members made ten classroom presentations of two TIME simulations to 306 second-year medical students. The principal finding was that, in a group setting, a large majority of the students at all three schools became individually committed to the care and management of the simulated patient. They acted as if the patient's problems were real and left the session feeling as though they had interacted with an actual person. Therefore, in terms of simulating a real patient, the TIME patient-simulation model was validated, providing the basis for the development of new patient-centered methods to teach and test medical students in the classroom setting. The Project has been at the Georgetown University School of Medicine, where the model is being introduced into the existing curriculum, since 1988. It is currently being used as a part of the final examination for second-year students and in discussion-group settings for fourth-year students in the internal medicine clerkship. A field test is also under way using the TIME model to assess the clinical performance of third-year students.

  11. 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.

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

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2012-01-01

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

  14. Patient simulation software to augment an advanced pharmaceutics course.

    PubMed

    Benedict, Neal; Schonder, Kristine

    2011-03-10

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

  15. Endoscopic evaluation of neurological dysphagic patients

    PubMed Central

    Coscarelli, S; Verrecchia, L; Coscarelli, A

    2007-01-01

    Summary Dysphagia is a frequent finding in neurological patients and is a symptom related to the severity of the clinical picture. The swallowing impairments, in these patients, increase the risk of aspiration pneumonia, that leads to death, in at least 6% of patients, within the first year. Therefore, evaluation of the swallowing status is essential in patients with dysphagia and videofluoroscopic study of swallowing (VFSS) is the method of choice. It cannot be performed in all patients on account of the complexity of the procedure and since they must be brought to the Radiology Unit. In the 1980, a new bedside method was introduced, namely: fiber-optic endoscopic study of swallow (FESS) which is easy, low-cost, well-tolerated and repeatable. We use this bedside technique to assess swallowing function in patients with dysphagia admitted to acute care units, neurological and internal medicine units. The evaluation aims to indicate the safer nutritional method (oral intake, feeding tube or percutaneous gastrostomy) and, consequently, reducing the risk of aspiration pneumonia during hospitalization. We found that more than 50% of the dysphagic patients present cerebrovascular injuries and in 2% of the population, the first diagnostic hypothesis of Myasthenia Gravis can be made with the FESS technique. In 60%, we indicate a change in nutritional method: in 20% we indicate percutaneous endoscopic gastrostomy (PEG). With these indications, none of those patients had aspiration pneumonia. Our protocol for the bedside fiberoptic study of neurological patients with dysphagia has demonstrated its efectiveness by eliminating the incidence of aspiration pneumonia. PMID:18320832

  16. Planning acetabular fracture reduction using patient-specific multibody simulation of the hip

    NASA Astrophysics Data System (ADS)

    Oliveri, Hadrien; Boudissa, Mehdi; Tonetti, Jerome; Chabanas, Matthieu

    2017-03-01

    Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.

  17. 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.

  18. Cray XT4: An Early Evaluation for Petascale Scientific Simulation

    SciTech Connect

    Alam, Sadaf R; Barrett, Richard F; Fahey, Mark R; Kuehn, Jeffery A; Sankaran, Ramanan; Worley, Patrick H; Larkin, Jeffrey M

    2007-01-01

    The scientific simulation capabilities of next generation high-end computing technology will depend on striking a balance among memory, processor, I/O, and local and global network performance across the breadth of the scientific simulation space. The Cray XT4 combines commodity AMD dual core Opteron processor technology with the second generation of Cray's custom communication accelerator in a system design whose balance is claimed to be driven by the demands of scientific simulation. This paper presents an evaluation of the Cray XT4 using microbenchmarks to develop a controlled understanding of individual system components, providing the context for analyzing and comprehending the performance of several petascale-ready applications. Results gathered from several strategic application domains are compared with observations on the previous generation Cray XT3 and other high-end computing systems, demonstrating performance improvements across a wide variety of application benchmark problems.

  19. 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.

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

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2001-08-01

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

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

    PubMed

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

    2012-10-01

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

  2. Transferability Studies - Evaluating and Improving Simulated Precipitation During CEOP

    NASA Astrophysics Data System (ADS)

    Meinke, I.; Roads, J.; Kanamitsu, M.

    2007-05-01

    Transferability studies are a useful methodology for evaluating the capability of regional climate models to simulate different climates. We are participating in the Coordinated Enhanced Observing Period (CEOP) Inter- Continental Transferability Study (ICTS) with the Experimental Climate Prediction Center's (ECPC's) Regional Spectral Model (RSM). We are evaluating the capability of the RSM to simulate energy and water budget components on seven different regional domains. Numerical simulations were conducted for regional climates in tropical, subtropical, mid-latitude and polar-regions. In particular, regional simulations were carried out for small- scale convective systems and various large-scale circulation regimes including: monsoons, the ITCZ, and mid- latitude storms. Sensitivity tests with four different convection schemes showed that either the Kain Fritsch (KF) convection scheme or the Simplified Arakawa Schubert Scheme (SAS) provided the best precipitation simulations for most domains. In those regions where the SAS convection scheme provided the best results, the KF scheme had poor results. On the other hand, in those regions where the KF scheme had the best result, the precipitation simulation using the SAS scheme was only slightly worse. On the basis of these findings we decided to rerun our original long term ICTS runs (July 1999 to December 2004) with the SAS convection scheme. These new long- term runs are now being compared to the previous long-term runs, which used the Relaxed Arakawa Schubert (RAS) convection scheme. Major improvements have been identified over the LBA domain. Also, the annual cycles over the LBA and the AMMA domains were improved in the long-term runs. Further comparisons with other water and energy budget components will be presented at the conference.

  3. Composite system reliability evaluation using sequential Monte Carlo simulation

    NASA Astrophysics Data System (ADS)

    Jonnavithula, Annapoorani

    Monte Carlo simulation methods can be effectively used to assess the adequacy of composite power system networks. The sequential simulation approach is the most fundamental technique available and can be used to provide a wide range of indices. It can also be used to provide estimates which can serve as benchmarks against which other approximate techniques can be compared. The focus of this research work is on the reliability evaluation of composite generation and transmission systems with special reference to frequency and duration related indices and estimated power interruption costs at each load bus. One of the main objectives is to use the sequential simulation method to create a comprehensive technique for composite system adequacy evaluation. This thesis recognizes the need for an accurate representation of the load model at the load buses which depends on the mix of customer sectors at each bus. Chronological hourly load curves are developed in this thesis, recognizing the individual load profiles of the customers at each load bus. Reliability worth considerations are playing an ever increasing role in power system planning and operation. Different methods for bus outage cost evaluation are proposed in this thesis. It may not be computationally feasible to use the sequential simulation method with time varying loads at each bus in large electric power system networks. Time varying load data may also not be available at each bus. This research work uses the sequential methodology as a fundamental technique to calibrate other non sequential methods such as the state sampling and state transition sampling techniques. Variance reduction techniques that improve the efficiency of the sequential simulation procedure are investigated as a part of this research work. Pertinent features that influence reliability worth assessment are also incorporated. All the proposed methods in this thesis are illustrated by application to two reliability test systems. In addition

  4. 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.

  5. 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.

  6. 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

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

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

  8. 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.

  9. [Effects of Training Students through a Program Simulating Medication Administration and Patient Instructions in Pre-training for Practical Training].

    PubMed

    Kikuchi, Chigusa; Matsunaga, Tamihide; Suzuki, Tadashi

    2015-01-01

    Pharmacy school students were trained in a program simulating medication administration and giving adherence instructions. Following the training, the educational effects were evaluated. Students were separated into two groups. One group of students played the role of pharmacists and instructed simulated patients on medication adherence. Another group of students played the role of patients receiving simulated drug therapy; they were instructed on medication adherence by the students playing the role of pharmacists. The educational effects were evaluated using a questionnaire. The scores for "recognition of factors that influence medication adherence" tended to increase after the simulation, and they increased significantly after practical training. The scores for "self-evaluation of technique for instructing patients on medication adherence" increased significantly after the simulation, and they increased even more after practical training. The students' understanding of the effects on patients who were being instructed also increased significantly after the simulation, and these changes were maintained after practical training. In particular, students became more aware of the influence of pharmacists' attitudes. In practical training, the simulation training was helpful for bedside practice at hospital pharmacies and over-the-counter service at community pharmacies. Thus, the use of role play and simulated patients was an effective method for training pharmacy students to instruct patients on medication adherence.

  10. 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

  11. 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.

  12. Dynamic Evaluation of Two Decades of CMAQ Simulations ...

    EPA Pesticide Factsheets

    This presentation focuses on the dynamic evaluation of the CMAQ model over the continental United States using multi-decadal simulations for the period from 1990 to 2010 to examine how well the changes in observed ozone air quality induced by variations in meteorology and/or emissions are simulated by the model. We applied spectral decomposition of the ozone time-series using the KZ filter to assess the variations in the strengths of synoptic (weather-induced variations) and baseline (long-term variation) forcings, embedded in the simulated and observed concentrations. The results reveal that CMAQ captured the year-to-year variability (more so in the later years than the earlier years) and the synoptic forcing in accordance with what the observations are showing. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

  13. Psychological Evaluation of Patients Seeking Rhinoplasty.

    PubMed

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

    2016-06-01

    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. 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. 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). 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.

  14. Evaluation of internet derived patient information.

    PubMed

    Ward, J B M; Leach, P

    2012-07-01

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

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

    PubMed

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

    2012-04-01

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

  16. High-fidelity patient simulation mannequins to facilitate aerodigestive endoscopy training.

    PubMed

    Deutsch, Ellen S

    2008-06-01

    To evaluate the perceived value of aerodigestive endoscopy training using high-fidelity simulation. Self-reported survey. Pediatric tertiary care hospital. Consecutive sample of otolaryngology residents and 1 fellow during the 2006-2007 academic year. Foreign body aspiration and ingestion were simulated in a high-fidelity, computer-assisted infant simulation mannequin. Avoidance of complications and successful removal required teamwork and responsiveness to the mannequin's physiologic characteristics in addition to dexterity with instruments. Postcourse 5-point Likert scale and subjective evaluation of perceived realism reported by participants. Participant response was generally positive. Ratings were highest for training cognitive and psychomotor endoscopy skills, preventing and managing complications, and facilitating team process. Overall realism and appropriate "feel" showed opportunity for improvement. Pediatric otolaryngology trainees perceive that high-fidelity patient simulation facilitates acquisition of aerodigestive endoscopy skills, especially in training cognitive and psychomotor endoscopy skills, preventing and managing complications, and facilitating team process.

  17. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department.

    PubMed

    Patterson, Mary D; Geis, Gary L; LeMaster, Thomas; Wears, Robert L

    2013-05-01

    Cincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error. To improve patient safety in a paediatric ED by implementing a multidisciplinary, simulation-based curriculum emphasising teamwork and communication. Subjects included all healthcare providers in the ED. Multidisciplinary teams participated in simulation-based training focused on teamwork and communication behaviours in critical clinical scenarios. The Safety Attitudes Questionnaire, tests of knowledge and evaluations of critical simulations and actual performance in the ED resuscitation bay were assessed. Methods to sustain improvements included mandatory participation of all new staff in simulation-based training and the introduction of routine in situ simulations. 289 participants attended the initial training. 151 participants attended the re-evaluation at a mean of 10.2 months later. Sustained improvements in knowledge and attitudes were demonstrated. Knowledge tests at baseline, postintervention and re-evaluation had scores of 86%, 96% and 93%, respectively. Friedman's test analysis of SAQ scores at baseline, postintervention and re-evaluation indicated significant attitude changes. The ED with a preintervention baseline of 2-3 patient safety events per year has now sustained more than 1000 days without a patient safety event. This improvement occurred even though the time required in initial simulation training has been condensed from 12 to 4 h. Simulation training is an effective tool to modify safety attitudes and teamwork behaviours in an ED. Sustaining cultural and behavioural changes requires repeated practice opportunities.

  18. Managing Deteriorating Patients: Registered Nurses’ Performance in a Simulated Setting

    PubMed Central

    Cooper, Simon; McConnell-Henry, Tracy; Cant, Robyn; Porter, Jo; Missen, Karen; Kinsman, Leigh; Endacott, Ruth; Scholes, Julie

    2011-01-01

    Aim: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance. PMID:22216077

  19. Virtual patient simulation at US and Canadian medical schools.

    PubMed

    Huang, Grace; Reynolds, Robby; Candler, Chris

    2007-05-01

    "Virtual patients" are computer-based simulations designed to complement clinical training. These applications possess numerous educational benefits but are costly to develop. Few medical schools can afford to create them. The purpose of this inventory was to gather information regarding in-house virtual patient development at U.S. and Canadian medical schools to promote the sharing of existing cases and future collaboration. From February to September 2005, the authors contacted 142 U.S. and Canadian medical schools and requested that they report on virtual patient simulation activities at their respective institutions. The inventory elicited information regarding the pedagogic and technical characteristics of each virtual patient application. The schools were also asked to report on their willingness to share virtual patients. Twenty-six out of 108 responding schools reported that they were producing virtual patients. Twelve schools provided additional data on 103 cases and 111 virtual patients. The vast majority of virtual patients were media rich and were associated with significant production costs and time. The reported virtual patient cases tended to focus on primary care disciplines and did not as a whole exhibit racial or ethnic diversity. Funding sources, production costs, and production duration influenced the extent of schools' willingness to share. Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training.

  20. Use of simulated patients for assessment of communication skills in undergraduate medical education in obstetrics and gynaecology.

    PubMed

    Jabeen, Darakhshan

    2013-01-01

    To compare the effectiveness of simulated patients with real patients through undergraduate students' results of Mini-Cex encounters and their opinions. Mixed method (combined qualitative and quantitative). Shifa College of Medicine / Shifa International Hospital, Islamabad, during the year 2010. The study included all 94 students of 4th year MBBS at Shifa College of Medicine. Their communication skills in history taking and counselling were assessed using first real patients and then simulated patients. The quantitative data was gathered from results (scores obtained) of the two encounters and was analyzed using SPSS version 10. It was interpreted as mean and standard deviation, and independent sample T-test was used to statistically determine the difference between the two results. The qualitative data was obtained from student interviews. The two forms of data was collected and analyzed for triangulation contributing towards validation of the results and to have deeper insight into the relevant phenomena. The results of history taking with real patients and simulated patients showed no significant difference (p = 0.158). Likewise, results of counselling with real and simulated patients did not show a significant difference (p = 0.306). The results of student interviews showed that 92/94 students (97.9%) were in favour of using simulated patients for the assessment of communication skills. Sixty-one (64.9%) were of the view that there was no difference between real patients and simulated patients. Ninety-one students (96.8%) agreed that simulated patients provided motivation and 62 (66%) indicated that simulated patient encounter was not difficult. Undergraduate students were more in favour of using simulated patients encounters for evaluation of communication skills. There were no significant difference between students performance on real and simulated patients.

  1. Evaluating Walking in Patients with Multiple Sclerosis

    PubMed Central

    Bennett, Susan

    2011-01-01

    Walking limitations are among the most visible manifestations of multiple sclerosis (MS). Regular walking assessments should be a component of patient management and require instruments that are appropriate from the clinician's and the patient's perspectives. This article reviews frequently used instruments to assess walking in patients with MS, with emphasis on their validity, reliability, and practicality in the clinical setting. Relevant articles were identified based on PubMed searches using the following terms: “multiple sclerosis AND (walking OR gait OR mobility OR physical activity) AND (disability evaluation)”; references of relevant articles were also searched. Although many clinician- and patient-driven instruments are available, not all have been validated in MS, and some are not sensitive enough to detect small but clinically important changes. Choosing among these depends on what needs to be measured, psychometric properties, the clinical relevance of results, and practicality with respect to space, time, and patient burden. Of the instruments available, the clinician-observed Timed 25-Foot Walk and patient self-report 12-Item Multiple Sclerosis Walking Scale have properties that make them suitable for routine evaluation of walking performance. The Dynamic Gait Index and the Timed Up and Go test involve other aspects of mobility, including balance. Tests of endurance, such as the 2- or 6-Minute Walk, may provide information on motor fatigue not captured by other tests. Quantitative measurement of gait kinetics and kinematics, and recordings of mobility in the patient's environment via accelerometry or Global Positioning System odometry, are currently not routinely used in the clinical setting. PMID:24453700

  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. Evaluation of stress patterns during simulated laparoscopy in residency.

    PubMed

    Ghazali, Daniel A; Faure, Jean P; Breque, Cyril; Oriot, Denis

    2016-08-01

    Laparoscopy simulation offers realistic complexity of tasks and required skills, and helps to develop competencies. However the relationship of stress to the experience has not been comprehensively explored. Objectives were: 1) to evaluate stress level before and during laparoscopy in surgery interns (PGY-1) and surgery residents (PGY-2); 2) to evaluate performance in simulated laparoscopy in both groups; 3) to study the correlation between stress pathways themselves and to study which factors mediate the relationship between stress and performance. Seven PGY-1 (didactic course plus 2-hour hands-on session) and 6 PGY-2 who usually operate by laparoscopy were included. Performance assessment used the MISTELS scale. Salivary cortisol (SC) was measured the day prior (T0) to simulation, and immediately before (T1), and after the session (T2). Electrophysiological indicators of stress were assessed by Holter: heart rate (HR) and its variability (pNN50) at the same time. Perceived stress was determined at T1. All parameters were similar at T0. Regarding the whole study population, simulation induced stress. However response varied by subgroups. For PGY-1, levels of SC, HR and pNN50 were similar between T0 and T1. Afterwards, SC and HR significantly increased with a parallel decrease in pNN50 at T2. For PGY-2, a significant increase in HR and decrease in pNN50 were observed from T0 to T1, and remained stable at T2. No change in SC level or perceived stress was noted. Performance score was significantly higher in PGY-2. Stress patterns were not correlated between each other but a correlation was found between electrophysiological parameters and performance. Two stress patterns were identified: PGY-1 exhibited an increase in stress level during the procedure, whereas in PGY-2 it occurred prior to the procedure. This suggests that the impact of simulation on stress parameters might be different according to the experience of the learners.

  4. 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.

  5. 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.

  6. 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…

  7. 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…

  8. Experience with the Simulated Patient-Physician Encounter

    ERIC Educational Resources Information Center

    Friedman, Richard B.; And Others

    1978-01-01

    Computer-based simulations of the patient-physician encounter have been used at the University of Wisconsin Medical School for five years. They have been used to permit students to gain clinical experience, as part of a series of structured teaching conferences, and in a medical testing program. Student and faculty response is favorable.…

  9. 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.

  10. 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.

  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. Evaluating and managing the patient with nosebleeds.

    PubMed

    Manes, R Peter

    2010-09-01

    Epistaxis is a common clinical problem often seen by primary care physicians. This can be caused by multiple factors, each of which should be explored to treat the epistaxis and prevent recurrences. In this article, etiologies and methods of evaluation for the patient with epistaxis are discussed. Treatment strategies are outlined in a stepwise fashion, as are recommendations for situations requiring referral to an otolaryngologist.

  13. 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

  14. 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.

  15. 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

  16. 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…

  17. 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…

  18. Maintenance personnel performance simulation (MAPPS) model: overview and evaluation efforts

    SciTech Connect

    Knee, H.E.; Haas, P.M.; Siegel, A.I.; Bartter, W.D.; Wolf, J.J.; Ryan, T.G.

    1984-01-01

    The development of the MAPPS model has been completed and the model is currently undergoing evaluation. These efforts are addressing a number of identified issues concerning practicality, acceptability, usefulness, and validity. Preliminary analysis of the evaluation data that has been collected indicates that MAPPS will provide comprehensive and reliable data for PRA purposes and for a number of other applications. The MAPPS computer simulation model provides the user with a sophisticated tool for gaining insights into tasks performed by NPP maintenance personnel. Its wide variety of input parameters and output data makes it extremely flexible for application to a number of diverse applications. With the demonstration of favorable model evaluation results, the MAPPS model will represent a valuable source of NPP maintainer reliability data and provide PRA studies with a source of data on maintainers that has previously not existed.

  19. 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.

  20. 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.

  1. [Hysteroscopic evaluation in patients with infertility].

    PubMed

    Lasmar, Ricardo Bassil; Barrozo, Paulo Roberto Mussel; Parente, Raphael Câmara Medeiros; Lasmar, Bernardo Portugal; da Rosa, Daniela Baltar; Penna, Ivan Araujo; Dias, Rogério

    2010-08-01

    to describe hysteroscopy findings in infertile patients. this was a retrospective series of 953 patients with diagnosis of infertility evaluated by hysteroscopy. A total of 957 patients investigated for infertility were subjected to hysteroscopy, preferentially during the first phase of the menstrual cycle. When necessary, directed biopsies (under direct visualization during the exam) or guided biopsies were obtained using a Novak curette after defining the site to be biopsied during the hysteroscopic examination. Outcome frequencies were determined as percentages, and the χ2 test was used for the correlations. The statistical software EpiInfo 2000 (CDC) was used for data analysis. a normal uterine cavity was detected in 436 cases (45.8%). This was the most frequent diagnosis for women with primary infertility and for women with one or no abortion (p<0.05). Abnormal findings were obtained in 517 of 953 cases (54.2%), including intrauterine synechiae in 185 patients (19.4%), endometrial polyps in 115 (12.1%), endocervical polyps in 66 (6.0%), submucosal myomas in 47 (4.9%), endometrial hyperplasia in 39 (4.1%), adenomyosis in five (0.5%), endometritis (with histopathological confirmation) in four (0.4%), endometrial bone metaplasia in two (0.4%), and cancer of the endometrium in one case (0.1%). Morphological and functional changes of the uterus were detected in 5.6% of the cases, including uterine malformations in 32 (3.4%) and isthmus-cervical incompetence in 21 (2.2%). intrauterine synechiae were the most frequent abnormal findings in patients evaluated for infertility. Patients with a history of abortion and infertility should be submitted to hysteroscopy in order to rule out intrauterine synechiae as a possible cause of infertility.

  2. 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.

  3. 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.

  4. 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

  5. Evaluation of global and regional climate simulations over Africa

    NASA Astrophysics Data System (ADS)

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

    2013-04-01

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

  6. Simulation in mental health nurse education: The development, implementation and evaluation of an educational innovation.

    PubMed

    Felton, Anne; Wright, Nicola

    2017-09-01

    Simulation is an important learning approach for the development of skills for healthcare practice. However, it remains under used in the education of mental health practitioners. This article examines the development, implementation and evaluation of a simulated learning experience for final year undergraduate BSc mental health nursing students in the UK. Scenarios involving managing care in an acute in patient ward and community older persons' team were designed to enable students to develop their complex decision making skills. An evaluation of the simulation experience was undertaken. This was informed by the principles of improvement science methodology and data was collected from the student participants using questionnaires. The findings indicated that simulation provided a realistic environment in which students were able to develop skills and manage clinical situations autonomously without fear of being assessed or making mistakes. Reflecting Dieckmann et al.'s (2007) position that simulation is a social situation in itself, the learning approach enabled mental health students to both experience the safety of the Higher Education setting and also the reality of clinical practice. Simulation may therefore provide an important tool to prepare students for the responsibilities of a qualified nurse. Copyright © 2017. Published by Elsevier Ltd.

  7. Performance evaluation of (18) F radioluminescence microscopy using computational simulation.

    PubMed

    Wang, Qian; Sengupta, Debanti; Kim, Tae Jin; Pratx, Guillem

    2017-05-01

    Radioluminescence microscopy can visualize the distribution of beta-emitting radiotracers in live single cells with high resolution. Here, we perform a computational simulation of (18) F positron imaging using this modality to better understand how radioluminescence signals are formed and to assist in optimizing the experimental setup and image processing. First, the transport of charged particles through the cell and scintillator and the resulting scintillation is modeled using the GEANT4 Monte-Carlo simulation. Then, the propagation of the scintillation light through the microscope is modeled by a convolution with a depth-dependent point-spread function, which models the microscope response. Finally, the physical measurement of the scintillation light using an electron-multiplying charge-coupled device (EMCCD) camera is modeled using a stochastic numerical photosensor model, which accounts for various sources of noise. The simulated output of the EMCCD camera is further processed using our ORBIT image reconstruction methodology to evaluate the endpoint images. The EMCCD camera model was validated against experimentally acquired images and the simulated noise, as measured by the standard deviation of a blank image, was found to be accurate within 2% of the actual detection. Furthermore, point source simulations found that a reconstructed spatial resolution of 18.5 μm can be achieved near the scintillator. As the source is moved away from the scintillator, spatial resolution degrades at a rate of 3.5 μm per μm distance. These results agree well with the experimentally measured spatial resolution of 30-40 μm (live cells). The simulation also shows that the system sensitivity is 26.5%, which is also consistent with our previous experiments. Finally, an image of a simulated sparse set of single cells is visually similar to the measured cell image. Our simulation methodology agrees with experimental measurements taken with radioluminescence microscopy. This in

  8. Cloud evaluation using satellite simulators and cloud changes for global nonhydrostatic simulations with NICAM

    NASA Astrophysics Data System (ADS)

    Satoh, M.; Noda, A. T.; Kodama, C.; Yamada, Y.; Hashino, T.

    2012-12-01

    Global cloud distributions and properties simulated by the global nonhydrostatic model, NICAM (Nonhydrostatic Icosahedral Atmospheric Model), are evaluated and their future changes are discussed. First, we evaluated the simulated cloud properties produced by a case study of the 3.5km mesh experiment of NICAM using the satellite simulator package (the Joint-simulator) with cloud microphysics oriented approach (Hashino et al. 2012). Then, we analyzed future cloud changes using various sets of simulations under the present and the future global warming conditions. The results show that the zonal averaged ice water path (IWP) generally decreases or marginally unchanged in the tropics, while IWP in the extra-tropics increases. The upper cloud fraction increases both in the tropics and in the extra-tropics in general. We further analyzed contributions of cloud systems such as cloud clusters, tropical cyclones (TCs), and storm-tracks to these changes. Probability distribution of the larger cloud clusters decreases, while that of the smaller ones increases, consistent with the decrease in the number of tropical cyclones in the future climate. Average liquid water path (LWP) and IWP associated with each tropical cyclone are diagnosed, and it is found that both the associated LWP and IWP increase under the warmer condition. Even though, since the number of the intensive cloud systems decrease, the average IWP decreases. It should be remarked that the change in TC tracks largely contribute to the change in the horizontal distribution of clouds. The NICAM simulations also show that the storm-tracks shift poleward, and the storms become less frequent and stronger in the extra-tropics, similar to the results of other general circulation models. Both LWP and IWP associated with the storms also increase in the warmer climate in the NICAM simulations. This results in increase in the upper clouds under the warmer climate condition, as described by Miura et al. (2005). References

  9. 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

  10. Importance of preclinical evaluation of wear in hip implant designs using simulator machines.

    PubMed

    Trommer, Rafael Mello; Maru, Márcia Marie

    2017-01-01

    Total hip arthroplasty (THA) is a surgical procedure that involves the replacement of the damaged joint of the hip by an artificial device. Despite the recognized clinical success of hip implants, wear of the articulating surfaces remains as one of the critical issues influencing performance. Common material combinations used in hip designs comprise metal-on-polymer (MoP), ceramic-on-polymer (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). However, when the design of the hip implant is concerned besides the materials used, several parameters can influence its wear performance. In this scenario, where the safety and efficacy for the patient are the main issues, it is fundamental to evaluate and predict the wear rate of the hip implant design before its use in THA. This is one of the issues that should be taken into account in the preclinical evaluation step of the product, in which simulated laboratory tests are necessary. However, it is fundamental that the applied motions and loads can reproduce the wear mechanisms physiologically observed in the patient. To replicate the in vivo angular displacements and loadings, special machines known as joint simulators are employed. This article focuses on the main characteristics related to the wear simulation of hip implants using mechanical simulators, giving information to surgeons, researchers, regulatory bodies, etc., about the importance of preclinical wear evaluation. A critical analysis is performed on the differences in the principles of operation of simulators and their effects on the final results, and about future trends in wear simulation.

  11. Method for patient-specific finite element modeling and simulation of deep brain stimulation.

    PubMed

    Aström, Mattias; Zrinzo, Ludvic U; Tisch, Stephen; Tripoliti, Elina; Hariz, Marwan I; Wårdell, Karin

    2009-01-01

    Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Success of DBS is highly dependent on electrode location and electrical parameter settings. The aim of this study was to develop a general method for setting up patient-specific 3D computer models of DBS, based on magnetic resonance images, and to demonstrate the use of such models for assessing the position of the electrode contacts and the distribution of the electric field in relation to individual patient anatomy. A software tool was developed for creating finite element DBS-models. The electric field generated by DBS was simulated in one patient and the result was visualized with isolevels and glyphs. The result was evaluated and it corresponded well with reported effects and side effects of stimulation. It was demonstrated that patient-specific finite element models and simulations of DBS can be useful for increasing the understanding of the clinical outcome of DBS.

  12. 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

  13. 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.; hide

    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.

  14. Analysis and evaluation of channel models: simulations of alamethicin.

    PubMed

    Tieleman, D Peter; Hess, Berk; Sansom, Mark S P

    2002-11-01

    Alamethicin is an antimicrobial peptide that forms stable channels with well-defined conductance levels. We have used extended molecular dynamics simulations of alamethicin bundles consisting of 4, 5, 6, 7, and 8 helices in a palmitoyl-oleolyl-phosphatidylcholine bilayer to evaluate and analyze channel models and to link the models to the experimentally measured conductance levels. Our results suggest that four helices do not form a stable water-filled channel and might not even form a stable intermediate. The lowest measurable conductance level is likely to correspond to the pentamer. At higher aggregation numbers the bundles become less symmetrical. Water properties inside the different-sized bundles are similar. The hexamer is the most stable model with a stability comparable with simulations based on crystal structures. The simulation was extended from 4 to 20 ns or several times the mean passage time of an ion. Essential dynamics analyses were used to test the hypothesis that correlated motions of the helical bundles account for high-frequency noise observed in open channel measurements. In a 20-ns simulation of a hexameric alamethicin bundle, the main motions are those of individual helices, not of the bundle as a whole. A detailed comparison of simulations using different methods to treat long-range electrostatic interactions (a twin range cutoff, Particle Mesh Ewald, and a twin range cutoff combined with a reaction field correction) shows that water orientation inside the alamethicin channels is sensitive to the algorithms used. In all cases, water ordering due to the protein structure is strong, although the exact profile changes somewhat. Adding an extra 4-nm layer of water only changes the water ordering slightly in the case of particle mesh Ewald, suggesting that periodicity artifacts for this system are not serious.

  15. Analysis and evaluation of channel models: simulations of alamethicin.

    PubMed Central

    Tieleman, D Peter; Hess, Berk; Sansom, Mark S P

    2002-01-01

    Alamethicin is an antimicrobial peptide that forms stable channels with well-defined conductance levels. We have used extended molecular dynamics simulations of alamethicin bundles consisting of 4, 5, 6, 7, and 8 helices in a palmitoyl-oleolyl-phosphatidylcholine bilayer to evaluate and analyze channel models and to link the models to the experimentally measured conductance levels. Our results suggest that four helices do not form a stable water-filled channel and might not even form a stable intermediate. The lowest measurable conductance level is likely to correspond to the pentamer. At higher aggregation numbers the bundles become less symmetrical. Water properties inside the different-sized bundles are similar. The hexamer is the most stable model with a stability comparable with simulations based on crystal structures. The simulation was extended from 4 to 20 ns or several times the mean passage time of an ion. Essential dynamics analyses were used to test the hypothesis that correlated motions of the helical bundles account for high-frequency noise observed in open channel measurements. In a 20-ns simulation of a hexameric alamethicin bundle, the main motions are those of individual helices, not of the bundle as a whole. A detailed comparison of simulations using different methods to treat long-range electrostatic interactions (a twin range cutoff, Particle Mesh Ewald, and a twin range cutoff combined with a reaction field correction) shows that water orientation inside the alamethicin channels is sensitive to the algorithms used. In all cases, water ordering due to the protein structure is strong, although the exact profile changes somewhat. Adding an extra 4-nm layer of water only changes the water ordering slightly in the case of particle mesh Ewald, suggesting that periodicity artifacts for this system are not serious. PMID:12414676

  16. Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices.

    PubMed

    Henneman, Elizabeth A; Cunningham, Helene; Fisher, Donald L; Plotkin, Karen; Nathanson, Brian H; Roche, Joan P; Marquard, Jenna L; Reilly, Cheryl A; Henneman, Philip L

    2014-01-01

    Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

  17. 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.

  18. 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.

  19. Simulator evaluation of takeoff performance monitoring system displays

    NASA Technical Reports Server (NTRS)

    Middleton, David B.; Person, Lee H., Jr.; Srivatsan, Raghavachari

    1988-01-01

    The development of head-up and head-down cockpit displays to convey symbolic status and advisory information to the pilot to aid him in his decision to continue or abort takeoff is described. It also describes a pilot-in-the-loop evaluation of the displays using the NASA Langley transport systems research vehicle fixed-base simulator. It was found that the head-up display was monitored with little effort and did not obstruct or distract from the runway scene.

  20. Simulator evaluation of takeoff performance monitoring system displays

    NASA Technical Reports Server (NTRS)

    Middleton, David B.; Person, Lee H., Jr.; Srivatsan, Raghavachari

    1988-01-01

    The development of head-up and head-down cockpit displays to convey symbolic status and advisory information to the pilot to aid him in his decision to continue or abort takeoff is described. It also describes a pilot-in-the-loop evaluation of the displays using the NASA Langley transport systems research vehicle fixed-base simulator. It was found that the head-up display was monitored with little effort and did not obstruct or distract from the runway scene.

  1. Laboratory evaluation of 10 heat and moisture exchangers using simulated aeromedical evacuation conditions.

    PubMed

    Suliman, Huda S; Fecura, Stephen E; Baskin, Jonathan; Kalns, John E

    2011-06-01

    Heat and moisture exchangers (HMEs) are used for airway humidification in mechanically ventilated patients and have been evaluated only under hospital conditions. U.S. Air Force aeromedical evacuation transports are performed under rugged conditions further complicated by the cold and dry environment in military aircrafts, and HMEs are used to provide airway humidification for patients. This study evaluated 10 commercial HMEs using a test system that simulated aeromedical evacuation conditions. Although the American National Standards Institute recommends inspired air to be at an absolute humidity value of > or = 30 mg/L for mechanically ventilated patients, the highest absolute humidity by any HME was approximately 20 mg/L. Although none of the HMEs were able to maintain a temperature high enough to achieve the humidity standard of the American National Standards Institute, the clinical significance of this standard may be less important than the relative humidity maintained in the respired air, especially on evacuation flights of short duration.

  2. Implementation and Evaluation of a Team Simulation Training Program.

    PubMed

    Rice, Yvonne; DeLetter, Mary; Fryman, Lisa; Parrish, Evelyn; Velotta, Cathie; Talley, Cynthia

    2016-01-01

    Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

  3. CT-based patient-specific simulation software for pedicle screw insertion.

    PubMed

    Klein, Shawn; Whyne, Cari M; Rush, Raphael; Ginsberg, Howard J

    2009-10-01

    Development of a 3-dimensional, patient-specific simulator for pedicle screw insertion. To allow the user to practice the insertion of pedicle screws into a 3-dimensional model of a patient-specific spine, and have both visual and quantitative feedback provided to the user. The goal is to better prepare surgeons to perform pedicle screw insertion surgery and help reduce the risk of pedicle screw misplacement. Pedicle screw insertion is particularly challenging to carry out on patients with abnormal spine morphology. Currently, preoperative planning for pedicle screw insertion is carried out using patient computed tomography and magnetic resonance imaging scans. In addition, once screws are inserted, there are no quantitative metrics against which to measure the results. The simulator was developed in the TCL scripting language as a graphical plug-in for the commercial visualization software AmiraDev 3.11. Surgical simulation uses a 3-dimensional model of patient's spine developed from the patient's computed tomography scan. Pedicle screw insertion can be practiced using pedicle screws of various sizes and analyzed in both 2-dimension and 3-dimension. Quantitative feedback is provided to the user in the form of anatomic lengths and angles, relative purchase of inserted screws, and a screw placement grading system. The software allows the user to adjust the translucency of a patient's spine to develop a better sense of the trajectories and depths involved with performing pedicle screw insertion on a patient. The simulator offers many helpful features to the surgeon with respect to complex cases and to the surgical trainee learning the basic technique of pedicle screw insertion. A study is currently underway to evaluate the efficacy of the simulator as a teaching tool for surgical trainees in placing pedicle screws. Future work will focus on the transfer of the software to a stand-alone platform.

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

    PubMed Central

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

    2014-01-01

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

  5. Simulation of ethane steam cracking with severity evaluation

    NASA Astrophysics Data System (ADS)

    Rosli, M. N.; Aziz, N.

    2016-11-01

    Understanding the influence of operating parameters towards cracking severity is paramount in ensuring optimum operation of an ethylene plant. However, changing the parameters in an actual plant for data collection can be dangerous. Thus, a simulation model for ethane steam cracking furnace is developed using ASPEN Plus for the assessment. The process performance is evaluated with cracking severity factors and main product yields. Three severity factors are used for evaluation due to their ease of measurement, which are methane yield (Ymet), Ethylene-Ethane Ratio (EER) and Propylene-Ethylene Ratio (PER). The result shows that cracking severity is primarily influenced by reactor temperature. Operating the furnace with coil outlet temperature ranging between 850°C to 950°C and steam-to-hydrocarbon ratio of 0.3 to 0.5 has led to optimum main product yield.

  6. An evaluation of anesthesia patient satisfaction instruments.

    PubMed

    Bell, Donald M; Halliburton, James R; Preston, John C

    2004-06-01

    The purpose of this study was to systematically review the instruments used to obtain anesthesia-specific patient satisfaction data and to determine the degree to which each instrument controlled for measurement error bias, such as poor survey design. By using an assessment and evaluation tool developed for the present study that held proven internal reliability and construct validity, we analyzed and scored each instrument according to the presence or absence of measurement error in survey design. We found that a paucity of anesthesia-specific patient satisfaction studies exists and that patient satisfaction studies dealing with anesthesia care were erratically defined, nonstandardized, and imprecise regarding intent and method. Moreover, the simple rating forms used in most of the reviewed studies were inadequate to achieve the goal of measuring the quality of anesthesia care. One instrument, the Iowa Satisfaction With Anesthesia Scale (ISAS), developed by Dexter et al (1997), was the first found to inculcate scientifically accepted psychometric item construction algorithms, an indicator of measurement reliability. Although the ISAS holds substantial potential for future application in this realm, we recommend that it be refined further and that the search for a superlative instrument to obtain anesthesia-specific patient satisfaction continue.

  7. Patient exposure levels in radiotherapy CT simulations in Finland.

    PubMed

    Toroi, P; Kaijaluoto, S; Bly, R

    2015-12-01

    Computed tomography (CT)-based simulation is an essential part of the radiotherapy treatment process. Patient exposure levels in CT simulations were collected from 15 CT systems from all 13 Finnish radiation therapy centres. A large standard deviation up to 56 % in dose levels between CT systems was noticed. Average volumetric CT dose indexes (in body phantom) were 24, 18 and 29 mGy for prostate, resection breast and head and neck treatment targets, respectively, and 70 mGy (in head phantom) for whole brain. These average dose indexes were much higher than those in corresponding diagnostic imaging in Finland. Dose levels in simulations with some devices were even over 3-fold higher than the diagnostic reference level for the same area of interest. Moreover, large variations in other exposure parameters, such as pitch and slice thickness, were seen. The results were discussed nationally, and general guidance to optimise dose levels was shared.

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

    NASA Astrophysics Data System (ADS)

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

    2004-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2005-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2007-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2006-05-01

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

  12. Patient-specific endovascular simulation influences interventionalists performing carotid artery stenting procedures.

    PubMed

    Willaert, W I M; Aggarwal, R; Van Herzeele, I; O'Donoghue, K; Gaines, P A; Darzi, A W; Vermassen, F E; Cheshire, N J

    2011-04-01

    The ability to perform patient-specific simulated rehearsal of complex endovascular interventions is a technological advance with potential benefits to patient outcomes. This study aimed to evaluate whether patient-specific rehearsal of a carotid artery stenting (CAS) procedure has an influence on tool selection and the use of fluoroscopy. Following case note and computed tomography (CT) angiographic review of a real patient case, subjects performed the CAS procedure on a virtual reality simulator. Endovascular tool requirements and fluoroscopic angles were evaluated with a pre- and post-case questionnaire. Participants also rated the simulation from 1 (poor) to 5 (excellent). Thirty-three endovascular physicians with varying degrees of CAS experience were recruited: inexperienced (5-20 CAS procedures) n = 11, moderately (21-50 CAS procedures) n = 7 or highly experienced (>50 CAS procedures) n = 15. For all participants, 96 of a possible 363 changes (26%) were observed from pre- to post-case questionnaires. This was most notable for optimal fluoroscopy C-arm position 15/33 (46%), choice of selective catheter 13/33 (39%), choice of sheath or guiding catheter 11/33 (33%) and balloon dilatation strategy 10/33 (30%). Experience with the CAS procedure did not influence the degree of change significantly (p > 0.05), and all groups exhibited a considerable modification in tool and fluoroscopy preference. The model was considered realistic and useful as a tool to practice a real case (median score 4/5). Patient-specific simulated rehearsal of a complex endovascular procedure strongly influences tool selection and fluoroscopy preferences for the real case. Further research has to evaluate how this technology may transfer from in vitro to in vivo and if it can reduce the radiation dose and the number of endovascular tools used and improve outcomes for patients in the clinical setting. Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All

  13. Improving bariatric patient transport and care with simulation.

    PubMed

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

    2014-03-01

    Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics' knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence

  14. Simulation Technique for Evaluating Containers (SIMTEC) Version 2.2. User’s Guide

    DTIC Science & Technology

    1988-04-26

    cycle cost and sensitivities. Procedure. The Simulation Technique for Evaluating Containers (SIMTEC), a computer simulation model, was developed to...Simulation Technique for Evaluating Containers (SIMTEC) is a computer program (model) developed to compare different types of packaging in terms of...and industrial organizations; environments involving conflict, such as military strategies and competi- tive market Ptrategies. Simulation provides a

  15. Evaluation of butaclamol in chronic schizophrenic patients.

    PubMed

    Clark, M L; Paredes, A; Costiloe, J P; Wood, F

    1977-01-01

    In a double-blind, placebo-controlled study, an attempt was made to evaluate butaclamol in chronic schizophrenic patients using chlorpromazine (CPZ) as the standard comparative drug. With doses up to 50 mg/day, butaclamol was shown to have significant antipsychotic activity comparable to CPZ but with a much higher incidence of extrapyramidal signs. A more reasonable maintenance dose may be in the range of 5 to 20 mg/day. Rebound insomnia was noted again with butaclamol, which warrants further study.

  16. Evaluation of an infant simulator intervention for teen pregnancy prevention.

    PubMed

    Herrman, Judith W; Waterhouse, Julie K; Chiquoine, Julie

    2011-01-01

    To evaluate the effectiveness of simulation as a strategy to influence teens' perceptions of pregnancy and parenting. This pilot study was a preexperimental, one group pre/posttest design. The school-based wellness center of a high school was the setting for the weekly sessions and the pre/posttest administration. Sample members participated in 6 weekly Baby Think it Over (BTIO) classes and an infant simulator experience. The final sample included 79 teens age 14 to 18 years who attended one of eight BTIO sessions. We used the Thoughts on Teen Parenting Survey (TTPS) to assess the perceptions of teens with regard to the costs and rewards associated with teen parenting. The TTPS yields a composite score of the teen attitudes toward the teen parenting experience and eight subscale scores that assess different areas of teen life. No significant differences were found in the mean pre/posttest scores or in correlations of the demographic data and mean scores. Two significant differences in pre/posttest subscale scores were in the areas of friends and personal characteristics. The results of this study suggest that the effectiveness of using infant simulators to influence the perceptions of teens about the reality of teen parenting is minimal. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  17. 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.

  18. 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.

  19. 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.

  20. Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.

    PubMed

    Gamble, Andree S

    2017-03-01

    Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Evaluation of Residential Hot Water Distribution Ssytems by Numeric Simulation

    SciTech Connect

    Wendt, ROBERT

    2005-08-17

    The objective of this project was to evaluate the performance and economics of various domestic hot water distribution systems in representative California residences. While the greatest opportunities for improved efficiency occur in new construction, significant improvements can also be made in some existing distribution systems. Specific objectives of the project tasks were: (1) Simulate potential energy savings of, perform cost-benefit analyses of, and identify market barriers to alternative new systems. (2) Simulate potential energy savings of, perform cost-benefit analyses of, and identify market barriers to maintenance, repair, and retrofit modifications of existing systems. (3) Evaluate potential impact of adopting alternative hot water distribution systems and report project findings. The outcome of this project is to provide homeowners, homebuilders, systems suppliers, municipal code officials and utility providers (both electric and water/sewer) with a neutral, independent, third party, cost-benefit analysis of alternative hot water distribution systems for use in California. The results will enable these stakeholders to make informed decisions regarding which system is most appropriate for use.

  2. 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

  3. Comparing the standardized live trauma patient and the mechanical simulator models in the ATLS initial assessment station.

    PubMed

    Ali, Jameel; Dunn, Julie; Eason, Martin; Drumm, Jacob

    2010-07-01

    Mechanical simulators may be an acceptable substitute for the live patient model in trauma skills teaching and assessment. We compare these models in the initial assessment station of the Advanced Trauma Life Support (ATLS) course. After a pilot project utilizing both models in a provider ATLS course it appeared that the mechanical model would be satisfactory for ATLS teaching and assessment. Instructors (n = 32) and ATLS Students (n = 64) were randomly selected from our database and completed a questionnaire evaluating the patient model and the simulator after viewing a video in which the simulator replaced the patient model. The evaluators indicated whether the patient and simulator models were satisfactory and then compared them by indicating whether there was any difference between the models, indicating which was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. Comments were also written in the evaluation form. All 32 instructors and 64 students indicated that both the patient and simulator models were satisfactory for teaching and testing ATLS resuscitation skills. At least 62 of the 64 students rated the simulator higher in all categories. Two students rated the patient model as more realistic and two noted no difference in terms of being more interesting. All 32 instructors indicated that the simulator was more challenging, interesting, dynamic, and better overall. Two of the 32 instructors indicated that the patient model was more enjoyable and two indicated that there was no difference as far as the models being realistic. Comments included inability to hear breath sounds that were changing in the patient model as opposed to the simulator model, and the simulator was more interesting and dynamic because the hemodynamic and physiologic parameters could be witnessed without being prompted by the instructor. One main concern expressed by the participants was the more costly simulator, and two instructors indicated that the

  4. Evaluation of a simulation-based curriculum for implementing a new clinical protocol.

    PubMed

    Marzano, David; Smith, Roger; Mhyre, Jill M; Seagull, F Jacob; Curran, Diana; Behrmann, Sydney; Priessnitz, Kristina; Hammoud, Maya

    2016-12-01

    To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team training. A prospective observational study was performed at the obstetrics unit of Von Voightlander Women's Hospital, Michigan, USA, between October 1, 2012 to April 30, 2013. All members of the labor and delivery team were eligible for participation. Traditional education methods and in-situ multi-disciplinary simulations were used to educate labor and delivery staff. Following each simulation, participants responded to a survey regarding their experience. To evaluate the effect of the interventions, paging content was analyzed for mandated elements and adherence to operating room entry-time tracking was examined. In total, 51 unique individuals participated in 12 simulations during a 6-month period. Simulation was perceived as a valuable activity and paging content improved. Following the intervention, the inclusion of a goal time for reaching the operation room increased from 7% to 61% of pages and the proportion of patients entering to operating room within 10 minutes of the stated goal increased from 67% to 85%. The training program was well received, and the accuracy of the communication and the goal set for reaching the operating room improved. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Use of clinical simulation centers in health professions schools for patient-centered research.

    PubMed

    Nickman, Nancy A; Haak, Sandra W; Kim, Jaewhan

    2010-10-01

    Professional practice assessment research performed in clinical simulation centers is a research method that also creates opportunity for multidisciplinary investigator collaboration. Nursing and pharmacy school clinical simulation laboratories at the University of Utah were used to conduct time-and-motion (TM) studies of medication dispensing and administration. Time data were then used to determine personnel and supply costs associated with different medication dosage forms and delivery methods. A case study from a completed research project describes the use of TM and activity-based costing analyses to assess medication preparation and administration time and cost differences related to three proton pump inhibitor dosage forms. Standardized doses were prepared by pharmacists or technicians and subsequently administered by nurses to a mannequin in the simulation center by seven different administration scenarios. Simulation scenarios were developed in a manner that held the independent variables constant, so that time and cost differences between dosage forms and administrations methods could be quantified. A detailed example of one approach to use of simulation centers for TM studies and activity-based costing analyses is provided. The advantages of isolating processes of interest from the day-to-day complexity of patient care are shown. Results illustrate how simulations based on professional school simulation centers may be used to assess health care processes at the microlevel with potential for projection to the macrolevel. Studies based on health professional schools simulation centers may offer a novel method of evaluating health care processes at the microlevel.

  6. 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…

  7. 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…

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    Fang, Mengqi; Tao, Yuan; Wang, Youqing

    2014-02-01

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

  10. Learning outcomes associated with patient simulation method in pharmacotherapy education: an integrative review.

    PubMed

    Aura, Suvi M; Sormunen, Marjorita S T; Jordan, Sue E; Tossavainen, Kerttu A; Turunen, Hannele E

    2015-06-01

    The aims of this systematic integrative review were to identify evidence for the use of patient simulation teaching methods in pharmacotherapy education and to explore related learning outcomes. A systematic literature search was conducted using 6 databases as follows: CINAHL, PubMed, SCOPUS, ERIC, MEDIC, and the Cochrane Library, using the key words relating to patient simulation and pharmacotherapy. The methodological quality of each study was evaluated. Eighteen articles met the inclusion criteria. The earliest article was published in 2005. The selected research articles were subjected to qualitative content analysis. Patient simulation has been used in pharmacotherapy education for preregistration nursing, dental, medical, and pharmacy students and for the continuing education of nurses. Learning outcomes reported were summarized as follows: (1) commitment to pharmacotherapy learning, (2) development of pharmacotherapy evaluation skills, (3) improvement in pharmacotherapy application skills, and (4) knowledge and understanding of pharmacotherapy. To develop effective teaching methods and ensure health care professionals' competence in medication management, further research is needed to determine the educational and clinical effectiveness of simulation teaching methods.

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

    NASA Astrophysics Data System (ADS)

    Cultura, Ambrosio B., II

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

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

    PubMed

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

    2009-11-01

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

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

    NASA Astrophysics Data System (ADS)

    Shepherd, Seth D.

    2002-07-01

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

  14. Simulation of the AUC Changes after Generic Substitution in Patients

    PubMed Central

    2009-01-01

    To address the debate on the safety of generic substitution quantitatively, the author compared the change in AUC in virtual patients who were simulated for several different scenarios of generic substitution. In four scenarios of original (branded) to generic and generic to generic substitution, 5,000 virtual patients were simulated per scenario using the programming software R. The mean population AUC of generics ranged from 90-110% (scenarios A and B) and 80-123.5% (scenarios C and D) of the AUC of the original. Those patients who had an AUC change (ratio) as a result of drug substitution of less than 0.67 or greater than 1.5 were considered to be in potential danger due to the substitution. We found that less than 6% of patients fell outside of the cutoff range of 0.67-1.5 as a result of original to generic substitution. However, in the case of generic to generic substitution, the proportion was as high as 9-12%. This alerts us to the potential danger of generic substitution, especially for drugs with narrow therapeutic indices. PMID:19270806

  15. Learning outcomes evaluation of a simulation-based introductory course to anaesthesia.

    PubMed

    Rábago, J L; López-Doueil, M; Sancho, R; Hernández-Pinto, P; Neira, N; Capa, E; Larraz, E; Redondo-Figuero, C G; Maestre, J M

    2017-10-01

    An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Standardized patients and mechanical simulators in teaching and assessment at colleges of osteopathic medicine.

    PubMed

    Gimpel, John R; Weidner, Angela C; Boulet, John R; Wilson, Crystal; Errichetti, Anthony M

    2007-12-01

    A 2001 survey of 19 colleges of osteopathic medicine (COMs) revealed that standardized patient programs (SPPs) are increasingly used in osteopathic medical education. However, no new data have been published since. To evaluate current SPP and mechanical simulator use at COMs compared with previous survey results. In 2005, an electronic survey regarding the use of SPPs (eg, staffing, facilities) and mechanical simulators in the teaching and assessment of students' clinical skills was sent to the deans of the 23 fully accredited COMs and branch campuses. Responses were received from all 23 COMs for a 100% response rate. According to survey results, 19 COMs (87%) had active SPPs, 2 COMs (9%) reported that SPPs were in development, and the remaining 2 COMs (9%) used students as patients. In comparison, only 12 COMs (63%) in 2001 had active SPPs. Results indicated an increased use of standardized patients for assessment, particularly in physician-patient communication, osteopathic manipulative medicine, and osteopathic manipulative treatment. In addition, 12 COMs (52%) reported using mechanical simulators in the teaching or assessment of clinical skills. From 2001 to 2005, the use of SPPs and mechanical simulators at COMs increased substantially.

  17. Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

    PubMed

    Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

    2016-11-24

    (1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

  18. 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

  19. 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

  20. Healing by Creating: Patient Evaluations of Art-Making Program

    ERIC Educational Resources Information Center

    Heiney, Sue P.; Darr-Hope, Heidi; Meriwether, Marian P.; Adams, Swann Arp

    2017-01-01

    The benefits of using art in health care, especially with cancer patients, have been described anecdotally. However, few manuscripts include a conceptual framework to describe the evaluation of patient programs. This paper describes patients' evaluation of a healing arts program developed within a hospital for cancer patients that used art-making,…

  1. 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. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  2. 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.

  3. Pavement nondestructive evaluation using finite-element dynamic simulation

    NASA Astrophysics Data System (ADS)

    Uddin, W.; Hackett, R. M.

    1996-11-01

    This paper describes the nondestructive evaluation devices, visual distress survey and coring used to investigate jointed concrete pavement performance in northern Mississippi. 3D finite-element models were developed to simulate in-service conditions and to characterize in-situ material properties. Reasonable good agreement is found between in-situ moduli backcalculated from the dynamic analysis of falling weight deflectometer (FWD) deflections measured on selected pavements and laboratory moduli. Effects of load pulse shape, cracking, and discontinuities on the surface deflection response of pavements subjected to FWD load wee also investigated. It is shown that 3D analysis of temperature distribution and resulting thermal stresses play a significant role int he performance of concrete pavements. The study results demonstrated the extensive usefulness of the finite-element dynamic analysis and limitations of the static multilayered analysis and other pavement analysis programs which do not allow for crack modeling and dynamic analysis.

  4. 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.

  5. AQMEII3 evaluation of regional NA/EU simulations and ...

    EPA Pesticide Factsheets

    Through the comparison of several regional-scale chemistry transport modelling systems that simulate meteorology and air quality over the European and American continents, this study aims at i) apportioning the error to the responsible processes using time-scale analysis, ii) helping to detect causes of models error, and iii) identifying the processes and scales most urgently requiring dedicated investigations. The analysis is conducted within the framework of the third phase of the Air Quality Model Evaluation International Initiative (AQMEII) and tackles model performance gauging through measurement-to-model comparison, error decomposition and time series analysis of the models biases for several fields (ozone, CO, SO2, NO, NO2, PM10, PM2.5, wind speed, and temperature). The operational metrics (magnitude of the error, sign of the bias, associativity) provide an overall sense of model strengths and deficiencies, while apportioning the error to its constituent parts (bias, variance and covariance) can help to assess the nature and quality of the error. Each of the error components is analysed independently and apportioned to specific processes based on the corresponding timescale (long scale, synoptic, diurnal, and intra-day) using the error apportionment technique devised in the former phases of AQMEII. The application of the error apportionment method to the AQMEII Phase 3 simulations provides several key insights. In addition to reaffirming the strong impac

  6. Parameters affecting genome simulation for evaluating genomic selection method.

    PubMed

    Nishio, Motohide; Satoh, Masahiro

    2014-10-01

    The present study investigated the parameter settings for obtaining a simulated genome at steady state of allele frequency (mutation-drift equilibrium) and linkage disequilibrium (LD), and evaluated the impact of whether or not the simulated genome reached steady state of allele frequency and LD on the accuracy of genomic estimated breeding values (GEBVs). After 500 to 50,000 historical generations, the base population and subsequent seven generations were generated as recent populations. The allele frequency distribution of the last generations of the historical population and LD in the base population were calculated when varying the values of five parameters: initial minor allele frequency, mutation rate, effective population size, number of markers and chromosome length. The accuracies of GEBVs in the last generation of the recent population were calculated by genomic best linear unbiased prediction. The number of historical generations required to reach mutation-drift equilibrium depended on the initial allele frequency and mutation rate. Regardless of the parameters, LD reached a steady state before allele frequency distribution reached mutation-drift equilibrium. The accuracies of GEBVs largely reflect the extent of linkage disequilibrium with the exception of varying chromosome length, although there were no associations between the accuracies of GEBVs and allele frequency distribution. © 2014 Japanese Society of Animal Science.

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

    PubMed

    Wang, Chen; Stamatiadis, Nikiforos

    2014-10-01

    The development of surrogate safety measures is essential due to the problems of availability and quality of historical crash data. The Aggregate Conflict Propensity Metric (ACPM) is a surrogate metric recently proposed and it is based on conflict studies and traffic simulations. ACPM is expected to be capable of assessing the relative safety levels of traffic facilities and/or treatments in order to help traffic engineers to select appropriate treatments based on traffic safety estimates. This paper presents three experimental tests conducted to evaluate the reliability of ACPM. In each test, ACPM is compared to a traditional conflict indicator in terms of identifying and ranking safety of traffic conditions under various traffic volumes based on traffic simulations. ACPM shows its strength and reliability in all three tests, as it provides results highly consistent with the Highway Safety Manual. The experimental tests indicate that ACPM is a promising surrogate safety measure that can appropriately identify relative safety among traffic treatments and/or facilities and provide traffic engineers with useful information on potential safety impact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Evaluations of sparse source imaging and minimum norm estimate methods in both simulation and clinical MEG data.

    PubMed

    Zhu, Min; Zhang, Wenbo; Dickens, Deanna; Ding, Lei

    2012-01-01

    The aim of the present study is to evaluate the capability of a recently proposed l(1)-norm based regularization method, named as variation-based sparse cortical current density (VB-SCCD) algorithm, in estimating location and spatial coverage of extensive brain sources. Its performance was compared to the conventional minimum norm estimate (MNE) using both simulations and clinical interictal spike MEG data from epilepsy patients. Four metrics were adopted to evaluate two regularization methods for EEG/MEG inverse problems from different aspects in simulation study. Both methods were further compared in reconstructing epileptic sources and validated using results from clinical diagnosis. Both simulation and experimental results suggest VB-SCCD has better performance in localization and estimation of source extents, as well as less spurious sources than MNE, which makes it a promising noninvasive tool to assist presurgical evaluation for surgical treatment in epilepsy patients.

  9. Use of Harvey® the Cardiopulmonary Patient Simulator in Physician Assistant Training.

    PubMed

    Loftin, Camille; Garner, Kristen; Eames, Jennifer; West, Holly

    2016-03-01

    The purpose of this study was to evaluate physician assistant students' confidence levels in detection of heart murmurs following instruction with Harvey(R) the Cardiopulmonary Patient Simulator compared with a classroom heart sounds activity. Cohort 1 (n = 33) participated in the classroom heart sounds activity and then participated in the Harvey simulation exercise. Cohort 2 (n = 34) first participated in the Harvey simulation activity and then in the classroom heart sounds activity. All students completed preintervention and postintervention surveys to assess confidence in detecting heart sounds. A multiple-choice quiz was distributed to each group after participation in the first heart sounds activity. Sixty-seven students completed all surveys. Before either activity, 6% of students in Cohort 1 and 3% in Cohort 2 reported confidence in detecting abnormal heart sounds. After completing the first activity, 85% of the classroom heart sounds activity group (Cohort 1) and 53% of the Harvey simulation group (Cohort 2) reported confidence in detecting abnormal heart sounds. The mean score on the multiple-choice quiz was 62% in Cohort 1 and 24% in Cohort 2. Both cohorts reported confidence in learning abnormal heart sounds after participation in the Harvey simulation compared with baseline confidence. Students who participated in the classroom heart sounds activity before the Harvey simulation activity performed higher on the murmur identification multiple-choice quiz. The University of Texas Medical Branch PA faculty should consider continued use of both the classroom heart sounds activity and Harvey simulation.

  10. [Functional evaluation in patients with kidney calculi].

    PubMed

    Stojimirović, B

    1998-01-01

    crystallographic analysis, includes serum urea, creatinine, uric acid, sodium, calcium, phosphorus and protein levels, urinary pH and volume, urine samples for culture and urinary calcium, uric acid, oxalate and citrate. Extensive metabolic evaluation includes simple protocol, determination of serum levels of alkaline phosphatase, parathyroid hormone, thyroxin, magnesium. A 24-h collection of urine specimen is analysed for urea, creatinine, uric acid, calcium, phosphate, sodium, magnesium, oxalate and citrate. Extensive protocol includes specialized evaluation tests [5]. Urinary acidification test is important for detecting distal renal tubular acidosis. Two 24-h urine specimens are collected while the patient is on the regular diet. The patient is then placed on a restricted diet (400 mg of calcium and 100 mEq of sodium) for a week, and another 24-h urine sample is collected. After that fasting and calcium load tests are performed (Sheme 1). Fasting urinary calcium is used to detect renal calcium leak, and calciuric response to oral calcium load provides an indirect measure of intestinal calcium absorption. Diagnostic criteria for major forms of stone disease [8] are presented in Table 1. There are some still unsolved questions: does time after passage of stones or urological intervention influence the frequency of urine abnormalities that can be detected; are there differences in 24-h urine composition between weekdays and weekends: what is the prevalence of the most important urinary risk factors of recurrent idiopathic calcium nephrolithiasis: do male patients differ from females with respect to urinary risk factors or recurrent idiopathic calcium nephrolithiasis? [7].

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

    ERIC Educational Resources Information Center

    Re, Antonio

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Re, Antonio

    2011-01-01

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

  13. Evaluating obstetrical residency programs using patient outcomes.

    PubMed

    Asch, David A; Nicholson, Sean; Srinivas, Sindhu; Herrin, Jeph; Epstein, Andrew J

    2009-09-23

    Patient outcomes have been used to assess the performance of hospitals and physicians; in contrast, residency programs have been compared based on nonclinical measures. To assess whether obstetrics and gynecology residency programs can be evaluated by the quality of care their alumni deliver. A retrospective analysis of all Florida and New York obstetrical hospital discharges between 1992 and 2007, representing 4 906 169 deliveries performed by 4124 obstetricians from 107 US residency programs. Nine measures of maternal complications from vaginal and cesarean births reflecting laceration, hemorrhage, and all other complications after vaginal delivery; hemorrhage, infection, and all other complications after cesarean delivery; and composites for vaginal and cesarean deliveries and for all deliveries regardless of mode. Obstetricians' residency program was associated with substantial variation in maternal complication rates. Women treated by obstetricians trained in residency programs in the bottom quintile for risk-standardized major maternal complication rates had an adjusted complication rate of 13.6%, approximately one-third higher than the 10.3% adjusted rate for women treated by obstetricians from programs in the top quintile (absolute difference, 3.3%; 95% confidence interval, 2.8%-3.8%). The rankings of residency programs based on each of the 9 measures were similar. Adjustment for medical licensure examination scores did not substantially alter the program ranking. Obstetrics and gynecology training programs can be ranked by the maternal complication rates of their graduates' patients. These rankings are stable across individual types of complications and are not associated with residents' licensing examination scores.

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

    PubMed

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

    2015-04-07

    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.

  15. Clinical evaluation of the overweight patient.

    PubMed

    Bray, G A; Ryan, D H

    2000-10-01

    Evaluation of an overweight patient is the first step in any therapeutic program. The syndromes of obesity can be classified in several ways. The first is an anatomic classification based on the size, number, and distribution of fat cells and fat tissue. The second is an etiologic classification based on identification of specific diseases and settings that produce obesity. Hypothalamic injury and endocrine disease such as Cushing's disease and the polycystic ovary syndrome are three identifiable causes of obesity. In this medicated society drugs are always candidates to produce weight gain. The most common causes, however, are stopping smoking, overconsumption of high-fat foods, a decrease in the level of activity, and aging. The natural history of obesity provides a useful framework in which to view both preventive and therapeutic strategies. Some individuals will never become overweight, but of those who do, about one-third will do so during the first two decades, and the remaining two-thirds will become overweight after age 20. A number of epidemiological and metabolic factors can serve as a guide to those individuals who are at high risk. Having overweight parents tops the list, but multiple births, cessation of smoking, and a sedentary lifestyle are additional factors. Therapeutic decisions should be based on risk-benefit decisions. The risk can be assessed from the body mass index, the distribution of fat in upper or lower body obesity, the rate of weight gain, and the degree of physical inactivity. After assessing risk, the therapeutic choices can be selected from the age category of the patient. With any therapeutic activity, involvement of the patient in a realistic approach to the treatment process is essential.

  16. 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.

  17. Patient-Centered Appointment Scheduling Using Agent-Based Simulation

    PubMed Central

    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

  18. Stability of latanoprost in generic formulations using controlled degradation and patient usage simulation studies.

    PubMed

    Velpandian, Thirumurthy; Kotnala, Ankita; Halder, Nabanita; Ravi, Alok Kumar; Archunan, Vikneshwari; Sihota, Ramanjit

    2015-05-01

    To evaluate the stability of latanoprost in generic formulations by using controlled degradation and patient usage simulation studies Standard latanoprost was subjected to controlled degradation studies. Latanoprost content was assessed by using MRM, and generated Degradation Products (DP) were analysed by using the Information Dependent Acquisition (IDA) protocol of positive ESI-LC-MS/MS. Latanoprost content and formation of DP were assessed in generic formulations and were compared with Xalatan(®) in a controlled patient usage simulation studies. The last few drops of latanoprost, present in containers used by patients were also evaluated. Extreme pH conditions, oxidation, light and heat were found to be the significant factors for high degree of latanoprost degradation. Systematic analysis of 7 selected generics revealed that the latanoprost content varied from 90-330%. Concentration of the latanoprost in Xalatan was found to be 97% of the label claim. Degradation studies showed the formation of 3 novel and 3 already known impurities. Upon simulated patient usage, 2 of the generic formulations showed significant degradation of latanoprost. Generic formulations having thermally sealed gas tight packing showed good stability during patient usage. Overage of latanoprost was observed in generics with other than thermal sealing. Latanoprost bottles used by patients showed concentrations ranging from 20 to 250% of label claim (144% median). This study revealed the presence of overage of latanoprost in some generic formulations and formation of degradation products. Packaging with gas tight containers may be one of the important factors for latanoprost stability, along with its storage at low temperature during patient usage.

  19. Environmental simulation evaluation of SSiC brazed optical mirrors

    NASA Astrophysics Data System (ADS)

    Liu, Yan; Ma, Zhen; Chen, Jian; Chen, Zhongming; Liu, Xuejian; Huang, Zhengren

    2014-09-01

    Sintered silicon carbide (SSiC) is becoming one of the most important materials for the optical mirrors due to its excellent specific stiffness (E/ρ) and demission stability (λ/α). However, it is difficult to fabricate the monolithic structure SSiC optical mirror with demission of larger than Φ1.5m because of process limitation. Joining of SSiC segments (brazing) provide a good solution to prepare large size mirror optics. However, compared with the uniform properties of the monolithic structure SSiC optical mirror, the brazed mirror is composed of two materials (SSiC segments and brazing material), so the performance of optical grinding and reliability of brazed optical mirrors become the focus. In this paper, the Φ300mm and Φ600mm brazed optical mirrors was used to evaluate the reliability of different conditions. Three kinds of environmental simulation tests, including thermal stability, thermal circle and random vibration were carried out. The evaluation results show that the temperature and vibration has no obvious effects on the surface figure (RMS) of the brazed optical mirrors.

  20. 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.

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

    NASA Technical Reports Server (NTRS)

    Banks, Bruce A.; Rutledge, Sharon K.

    1989-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Banks, Bruce A.; Rutledge, Sharon K.

    1989-01-01

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

  3. Use of High-Fidelity Simulation to Enhance Interdisciplinary Collaboration and Reduce Patient Falls.

    PubMed

    Bursiek, April A; Hopkins, Matthew R; Breitkopf, Daniel M; Grubbs, Pamela L; Joswiak, Mary Ellen; Klipfel, Janee M; Johnson, Kristine M

    2017-03-07

    This pilot study aimed to determine the effect of nurse/physician interdisciplinary team training on patient falls. Specifically, we evaluated team training in a simulation center as a method for targeting and minimizing breakdowns in perceptions of respect, collaboration, communication, and role misunderstanding behaviors between care disciplines. Registered nurses (RNs) were randomly assigned to participate. Residents were divided into groups and assigned based on their availability and clinical responsibility. All participants completed a demographic form, the Professional Practice Environment Assessment Scale (PPEAS), and the Mayo High Performance Teamwork Scale (MHPTS) after consenting and before participation in simulation training. The PPEAS and the MHPTS were readministered at 2 and 6 months after the simulation experience. Differences in MHPTS and PPEAS scores between the baseline and 2- and 6-month assessments were analyzed; fall rates over time were evaluated using Cochran-Armitage trend tests. After the team training exercises, teamwork as measured by the MHPTS improved significantly at both 2 and 6 months (P = 0.01; P < 0.001) compared with baseline measurement. Practice environment subscores, with the exception of positive organizational characteristics, also increased when measured 6 months after training. The primary outcome, reduction in anticipated patient falls, improved significantly (P = 0.02) over the course of the study. Results of this pilot study show that team training exercises result in improvement in both patient safety (anticipated patient falls) and team member perception of their work environment. If validated by other studies, improvement in this patient safety metric would represent an important benefit of simulation and team training.

  4. 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.

  5. 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

  6. 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.

  7. The information-giving skills of resident physicians: relationships with confidence and simulated patient satisfaction.

    PubMed

    Ishikawa, Hirono; Son, Daisuke; Eto, Masato; Kitamura, Kiyoshi; Kiuchi, Takahiro

    2017-02-08

    Sharing information is crucial for discussion of problems and treatment decision making by patients and physicians. However, the focus of communication skills training in undergraduate medical education has been on building the relationship and gathering information; thus, resident physicians tend to be less confident about sharing information and planning treatment. This study evaluated the medical interviews conducted by resident physicians with a focus on information giving, and investigated its relationships with their confidence in communication and simulated patient (SP) satisfaction. Among 137 junior resident physicians at a university hospital in Japan who participated in a survey of communication skills, 25 volunteered to conduct simulated medical interviews. The medical interviews were video-recorded and analyzed using the Roter Interaction Analysis System, together with additional coding to explore specific features of information giving. The SPs evaluated their satisfaction with the medical interview. Resident physicians who were more confident in their communication skills provided more information to the patients, while SP satisfaction was associated only with patient-prompted information giving. SPs were more satisfied when the physicians explained the rationales for their opinions and recommendations. Our findings underscore the importance of providing relevant information in response to the patient requests, and explaining the rationales for the opinions and recommendations. Further investigation is needed to clinically confirm our findings and develop an appropriate communication skills training program.

  8. Principal considerations for the contemporary high-fidelity endovascular simulator design used in training and evaluation.

    PubMed

    Eslahpazir, Benjamin A; Goldstone, Jerry; Allemang, Matthew T; Wang, John C; Kashyap, Vikram S

    2014-04-01

    The simulation and rehearsal of virtual endovascular procedures are anticipated to improve the outcomes of actual procedures. Contemporary, high-fidelity simulation is based on feedback systems that combine concepts of mechanical, electrical, computer, and control systems engineering to reproduce an interactive endovascular case. These sophisticated devices also include psychometric instruments for objective surgical skill assessment. The goal of this report is to identify the design characteristics of commercially available simulators for endovascular procedures and to provide a cross-section comparison across all devices to aid in the simulator selection process. Data were obtained (1) by a standard questionnaire issued to four simulator companies prompting for relevant design details of each model for the expressed purpose of publication, (2) from each manufacturer's respective website including appended sales brochures and specification sheets, and (3) by an evaluation of peer-reviewed literature. Focus topics include haptic technology, vessel segmentation, physiologic feedback, performance feedback, and physical logistics (ie, weight, dimensions, and portability). All data sources were surveyed between January 1, 2012, and June 30, 2013. All of the commercially available, high-fidelity endovascular simulators use interactive virtual environments with preprogrammed physics and physiology models for accurate reproduction of surgical reality. The principal differences between devices are the number of access sites and haptic devices, the ability to reconstruct patient-specific anatomy for preprocedural rehearsal, and the available peripheral training modalities. Hardware and software options can also vary within the same device in comparing patient-specific with generic cases. Despite our limited knowledge about the potential of high-fidelity simulation within the endovascular world, today's currently available simulators successfully provide high

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

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

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

  10. A Conceptual Model for Evaluation of Patient Education for Cancer.

    ERIC Educational Resources Information Center

    Newby, Larry G.; And Others

    Procedures for the evaluation of patient education programs have been slow to evolve; the majority of programs, in fact, remain unevaluated. Patient education efforts, particularly with cancer patients, are effective in enhancing recovery, alleviating anxiety, and facilitating compliance. Patient education should minimize patient dependence on…

  11. 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…

  12. Evaluating multisite multiprofessional simulation training for a hyperacute stroke service using the Behaviour Change Wheel.

    PubMed

    Ross, A J; Reedy, G B; Roots, A; Jaye, P; Birns, J

    2015-09-02

    Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London. This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment. The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty. Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5-6.33]; pre-course median 5 [IQ range 4.67-5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated 'debrief' was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity. Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.

  13. Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement.

    PubMed

    Jagneaux, Tonya; Caffery, Terrell S; Musso, Mandi Wilkes; Long, Ann C; Zatarain, Lauren; Stopa, Erik; Freeman, Nathan; Quin, Cara Cantelli; Jones, Glenn N

    2017-10-04

    We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.

  14. 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

  15. Pediatric and Adolescent Gynecology Education through Simulation (PAGES): Development and Evaluation of a Simulation Curriculum.

    PubMed

    Damle, Lauren F; Tefera, Eshetu; McAfee, Julie; Loyd, Mary K; Jackson, Allison M; Auguste, Tamika C; Gomez-Lobo, Veronica

    2015-06-01

    Develop a Pediatric and Adolescent Gynecology (PAG) curriculum, appropriate pelvic model for teaching examination skills, and an objective structured clinical examination (OSCE) for evaluation. Compare OSCE performance between residents with clinical training in PAG vs those that completed the curriculum vs those without either experience. Prospective cohort study. Obstetrics and Gynecology (Ob/Gyn) residency program in an urban academic center. Senior Ob/Gyn residents. A simulation-based teaching curriculum was created to teach PAG skills. A pediatric mannequin with anatomic pre-pubertal genitalia was developed for teaching and assessment of skills. Performance on a PAG-based OSCE as assessed by 2 observers using a 40 point checklist. 17 residents participated in the OSCE; 5 completed the curriculum, 6 completed a clinical rotation, and 6 were controls. The teaching curriculum group had the highest median composite OSCE score (75.0%) compared to the clinical group (73.1%) and control group (55.3%). There was no statistical difference between the scores of the teaching and clinical groups, but the teaching group scored statistically higher than controls (P = .0331). Scores for each OSCE component were compared. The teaching and clinical groups outperformed controls on assessment and procedures. There was no difference in scores on history taking or physical examination. An interactive teaching curriculum incorporating simulation and a realistic pediatric pelvic model can be used to teach PAG clinical skills. Using an OSCE to evaluate skills shows that residents completing the curriculum perform as well as those with clinical experience and better than controls. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  16. Using simulation to teach patient safety behaviors in undergraduate nursing education.

    PubMed

    Gantt, Laura T; Webb-Corbett, Robin

    2010-01-01

    The purpose of this article is to describe how our college of nursing began to integrate patient safety instruction into simulation experiences for undergraduate nursing students. A system for evaluating and grading students was developed. Data on student safety behaviors were collected before and after implementation of instruction designed to improve adherence to hand washing and patient identification procedures. In the first semester in which data were collected, students did not demonstrate satisfactory performance of either hand hygiene or patient identification 61% of the time. After instruction, students still did not perform these procedures consistently 38% of the time. Lessons learned and future plans for addressing these problems with basic patient safety behaviors are discussed. Copyright 2010, SLACK Incorporated.

  17. 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

  18. Surface-Attack Mission Simulation: Preliminary Scenario Evaluation.

    DTIC Science & Technology

    1983-11-01

    on reverse side if necessary and udengty by block number) Advanced Simulator for Pilot Training ( ASPT ) flight training air to surface mission planning...number) A part-task deep/strike interdiction scenario was developed for flight simulation application on the Advanced Simulator for Pilot Training ( ASPT ...briefing. information and the second after four trails in the ASPT /F- 16. Thus, each pilot flew eight trials in the simulated combat environment. The

  19. Preoperative vascular access evaluation for haemodialysis patients.

    PubMed

    Kosa, Sarah D; Al-Jaishi, Ahmed A; Moist, Louise; Lok, Charmaine E

    2015-09-30

    Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of vascular access, provides superior long-term patency, requires few interventions, has low thrombosis and infection rates and cost. However, it has been estimated that between 20% and 60% of fistulas never mature sufficiently to enable haemodialysis treatment. Mapping blood vessels using imaging technologies before surgery may identify vessels that are most suitable for fistula creation. We compared the effect of conducting routine radiological imaging evaluation for vascular access creation preoperatively with standard care without routine preoperative vessel imaging on fistula creation and use. We searched Cochrane Kidney and Transplant's Specialised Register to 14 April 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We included randomised controlled trials (RCTs) that enrolled adult participants (aged ≥ 18 years) with chronic or end-stage kidney disease (ESKD) who needed fistulas (both before dialysis and after dialysis initiation) that compared fistula maturation rates relating to use of imaging technologies to map blood vessels before fistula surgery with standard care (no imaging). Two authors assessed study quality and extracted data. Dichotomous outcomes, including fistula creation, maturation and need for catheters at dialysis initiation, were expressed as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes, such as numbers of interventions required to maintain patency, were expressed as mean differences (MD). We used the random-effects model to measure mean effects. Four studies enrolling 450 participants met our inclusion criteria. Overall risk of bias was judged to be low in one study, unclear in two, and high in one.There was no significant differences in the number of fistulas that were successfully created (4

  20. Simulating Hemodynamics of the Fontan Y-Graft Based on Patient-Specific In Vivo Connections

    PubMed Central

    Haggerty, Christopher M.; Kanter, Kirk R.; Restrepo, Maria; de Zélicourt, Diane A.; Parks, W. James; Rossignac, Jarek; Fogel, Mark A.; Yoganathan, Ajit P.

    2012-01-01

    Background Using a bifurcated Y-graft as the Fontan baffle is hypothesized to be a means to streamline and improve flow dynamics through the total cavopulmonary connection (TCPC). This study conducted numerical simulations to evaluate this hypothesis using post-operative data from five patients. Methods Patients were imaged with cardiac magnetic resonance or computed tomography after receiving a bifurcated aorto-iliac Y-graft as their Fontan conduit. Numerical simulations were performed using in vivo flow rates, as well as two levels of simulated exercise. Two TCPC models were virtually created for each patient to serve as the basis for hemodynamic comparison. Comparative metrics included connection flow resistance and inferior vena caval flow distribution. Results Results demonstrate good hemodynamic outcomes for the Y-graft options. The consistency of inferior vena caval flow distribution was improved over TCPC controls, while the connection resistances were generally no different from the TCPC values, except for one case in which there was a marked improvement under both resting and exercise conditions. Examination of the connection hemodynamics as they relate to surgical Y-graft implementation identified critical strategies and modifications that are needed to potentially realize the theoretical efficiency of such bifurcated connection designs. Conclusions Five consecutive patients received a Y-graft connection to complete their Fontan procedure with positive hemodynamic results. Refining the surgical technique for implementation should result in further energetic improvements that may help improve long-term outcomes. PMID:22560957

  1. Simulated and standardized patients in OSCEs: achievements and challenges 1992-2003.

    PubMed

    Adamo, Graceanne

    2003-05-01

    International interest in the teaching and assessment of clinical skills across the professional continuum has fueled extensive use of simulated parents in multiple station events by medical schools and professional organizations devoted to assessment. The author discuss achievements and challenges in the use of the objective structured clinical examination (OSCE) and simulated patient (SP) for medical education and assessment. The author revisits and expands subject put forth as 'technical issues related to logistics' that summarize group discussions of conference attendees in 1992 by Anderson and Kassebaum, editors of the Proceedings of the Association of American Medical Colleges' Consensus Conference on the Use of Standardised Patients in the Teaching and Evaluation of Clinical Skills. The author describes and discusses current terminology; evolving conceptual and practical applications of the OSCE that utilize simulated patients in medical education and high-stakes assessment for licensure and certification; standards of practice in SP case materials development, recruitment, training and quality assurance; operational and research questions for the future in the use of SPs, centralized SP programs and staffing; faculty development in the use of the SP and OSCE; program costs, event space, test and web-based video access and security issues; document and data management of SP programs; development of web-based and online resources and the founding of the Association of Standardized Patient Educators(ASPE), a specialist professional organization.

  2. 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)

  3. 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)

  4. Evaluation of a Rapid Anisotropic Model for ECG Simulation.

    PubMed

    Pezzuto, Simone; Kal'avský, Peter; Potse, Mark; Prinzen, Frits W; Auricchio, Angelo; Krause, Rolf

    2017-01-01

    State-of-the-art cardiac electrophysiology models that are able to deliver physiologically motivated activation maps and electrocardiograms (ECGs) can only be solved on high-performance computing architectures. This makes it nearly impossible to adopt such models in clinical practice. ECG imaging tools typically rely on simplified models, but these neglect the anisotropic electric conductivity of the tissue in the forward problem. Moreover, their results are often confined to the heart-torso interface. We propose a forward model that fully accounts for the anisotropic tissue conductivity and produces the standard 12-lead ECG in a few seconds. The activation sequence is approximated with an eikonal model in the 3d myocardium, while the ECG is computed with the lead-field approach. Both solvers were implemented on graphics processing units and massively parallelized. We studied the numerical convergence and scalability of the approach. We also compared the method to the bidomain model in terms of ECGs and activation maps, using a simplified but physiologically motivated geometry and 6 patient-specific anatomies. The proposed methods provided a good approximation of activation maps and ECGs computed with a bidomain model, in only a few seconds. Both solvers scaled very well to high-end hardware. These methods are suitable for use in ECG imaging methods, and may soon become fast enough for use in interactive simulation tools.

  5. Evaluation of a Rapid Anisotropic Model for ECG Simulation

    PubMed Central

    Pezzuto, Simone; Kal'avský, Peter; Potse, Mark; Prinzen, Frits W.; Auricchio, Angelo; Krause, Rolf

    2017-01-01

    State-of-the-art cardiac electrophysiology models that are able to deliver physiologically motivated activation maps and electrocardiograms (ECGs) can only be solved on high-performance computing architectures. This makes it nearly impossible to adopt such models in clinical practice. ECG imaging tools typically rely on simplified models, but these neglect the anisotropic electric conductivity of the tissue in the forward problem. Moreover, their results are often confined to the heart-torso interface. We propose a forward model that fully accounts for the anisotropic tissue conductivity and produces the standard 12-lead ECG in a few seconds. The activation sequence is approximated with an eikonal model in the 3d myocardium, while the ECG is computed with the lead-field approach. Both solvers were implemented on graphics processing units and massively parallelized. We studied the numerical convergence and scalability of the approach. We also compared the method to the bidomain model in terms of ECGs and activation maps, using a simplified but physiologically motivated geometry and 6 patient-specific anatomies. The proposed methods provided a good approximation of activation maps and ECGs computed with a bidomain model, in only a few seconds. Both solvers scaled very well to high-end hardware. These methods are suitable for use in ECG imaging methods, and may soon become fast enough for use in interactive simulation tools. PMID:28512434

  6. Evaluating clinical decision support tools for medication administration safety in a simulated environment.

    PubMed

    Moss, Jacqueline; Berner, Eta S

    2015-05-01

    The specific aims of this study were to develop a methodology and tools for the design of clinical decision support systems to decrease the incidence of medication administration errors. A mixed-methods design was utilized in this study. First, observations of medication administration practice were used to inform the design of a simulated information system with a variety of decision support tools. Then, nurses were observed administering medications in a simulated environment using the simulated system. Finally, the nurses participated in focus groups to provide input into system tools design. Observations of nurses' use of the decision support tools as well as semi-structured focus groups were used to evaluate nurses' use and perceptions of the utility of the system decision support tools. Nurses' evaluation of the medication administration decision support tools as well as their actual performance revealed a tendency to underestimate their need for support. Their preferences were for decision support that was short, color coded, and easily accessed. Observations of medication administration showed that nurses exhibit a variety of work processes to prepare and administer medications to patients and access system decision support tools at a variety of points in this process. System design should allow flexibility of multiple points and types of information delivery to accommodate variations in workflow to minimize the tendency for system workarounds. This study was performed in one hospital and results may not generalize beyond this setting. However, this method used to design and test decision support could be transferred to other settings. Using simulation in this study provided a method for testing new information system design, related to a potentially dangerous procedure, in a manner that eliminated the hazards of potential unintended consequences for patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Fuzzy control for closed-loop, patient-specific hypnosis in intraoperative patients: a simulation study.

    PubMed

    Moore, Brett L; Pyeatt, Larry D; Doufas, Anthony G

    2009-01-01

    Research has demonstrated the efficacy of closed-loop control of anesthesia using bispectral index (BIS) as the controlled variable, and the recent development of model-based, patient-adaptive systems has considerably improved anesthetic control. To further explore the use of model-based control in anesthesia, we investigated the application of fuzzy control in the delivery of patient-specific propofol-induced hypnosis. In simulated intraoperative patients, the fuzzy controller demonstrated clinically acceptable performance, suggesting that further study is warranted.

  8. 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.

  9. 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

  10. 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

  11. Creep evaluation of (orthotic) cast materials during simulated clubfoot correction.

    PubMed

    Cohen, Tamara L; Altiok, Haluk; Tarima, Sergey; Smith, Peter A; Harris, Gerald F

    2012-01-01

    The Ponseti method is a widely accepted and highly successful conservative treatment of pediatric clubfoot that relies on weekly manipulations and cast applications. However, the material behavior of the cast in the Ponseti technique has not been investigated. The current study sought to characterize the ability of two standard casting materials to maintain the Ponseti corrected foot position by evaluating creep response. A dynamic cast testing device (DCTD) was built to simulate a typical pediatric clubfoot. Semi-rigid fiberglass and rigid fiberglass casting materials were applied to the device, and the rotational creep was measured at various constant torques. The movement was measured using a 3D motion capture system. A 2-way ANOVA was performed on the creep displacement data at a significance level of 0.05. Among cast materials, the rotational creep displacement was found to be significantly different (p-values ≪ 0.001). The most creep displacement occurs in the semi-rigid fiberglass (approximately 1.0 degrees), then the rigid fiberglass (approximately 0.4 degrees). There was no effect of torque magnitude on the creep displacement. All materials maintained the corrected position with minimal change in position over time.

  12. A system for automatic evaluation of simulation software

    NASA Technical Reports Server (NTRS)

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

    1976-01-01

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

  13. 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.

  14. Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis.

    PubMed

    Pritchard, Shane A; Blackstock, Felicity C; Nestel, Debra; Keating, Jenny L

    2016-09-01

    Traditional models of physical therapy clinical education are experiencing unprecedented pressures. Simulation-based education with simulated (standardized) patients (SPs) is one alternative that has significant potential value, and implementation is increasing globally. However, no review evaluating the effects of SPs on professional (entry-level) physical therapy education is available. The purpose of this study was to synthesize and critically appraise the findings of empirical studies evaluating the contribution of SPs to entry-level physical therapy education, compared with no SP interaction or an alternative education strategy, on any outcome relevant to learning. A systematic search was conducted of Ovid MEDLINE, PubMed, AMED, ERIC, and CINAHL Plus databases and reference lists of included articles, relevant reviews, and gray literature up to May 2015. Articles reporting quantitative or qualitative data evaluating the contribution of SPs to entry-level physical therapy education were included. Two reviewers independently extracted study characteristics, intervention details, and quantitative and qualitative evaluation data from the 14 articles that met the eligibility criteria. Pooled random-effects meta-analysis indicated that replacing up to 25% of authentic patient-based physical therapist practice with SP-based education results in comparable competency (mean difference=1.55/100; 95% confidence interval=-1.08, 4.18; P=.25). Thematic analysis of qualitative data indicated that students value learning with SPs. Assumptions were made to enable pooling of data, and the search strategy was limited to English. Simulated patients appear to have an effect comparable to that of alternative educational strategies on development of physical therapy clinical practice competencies and serve a valuable role in entry-level physical therapy education. However, available research lacks the rigor required for confidence in findings. Given the potential advantages for

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

    PubMed

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

    2016-06-01

    In paediatric radiography, according to the as low as reasonably achievable (ALARA) principle, the imaging task should be performed with the lowest possible radiation dose. This paper describes a Monte-Carlo simulation framework for dose optimisation of imaging parameters in digital paediatric radiography. Patient models with high spatial resolution and organ segmentation enable the simultaneous evaluation of image quality and patient dose on the same simulated radiographic examination. The accuracy of the image simulation is analysed by comparing simulated and acquired images of technical phantoms. As a first application example, the framework is applied to optimise tube voltage and pre-filtration in newborn chest radiography. At equal patient dose, the highest CNR is obtained with low-kV settings in combination with copper filtration. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Experimental Evaluation of Rocket Exhaust Diffusers for Altitude Simulation

    NASA Technical Reports Server (NTRS)

    Sivo, Joseph N.; Meyer, Carl L.; Peters, Daniel J.

    1960-01-01

    An experimental investigation of exhaust diffusers has been conducted to evaluate various methods of minimizing the overall pressure ratio (from chamber to ambient pressure) required to establish and maintain full expansion of the nozzle flow (altitude simulation). Exhaust-diffuser configurations investigated were (1) cylindrical diffusers, (2) diffusers with contraction, and (3) diffusers including a right-angle turn. Cylindrical diffusers were evaluated with primary nozzles of various area ratios and types, as well as two clustered configurations; the other diffusers were evaluated with individual nozzles of constant area ratio and varied type. Air was the working fluid, except for two check points obtained with JP-4 fuel and liquid-oxygen rocket engines and cylindrical diffusers. The minimum length-diameter ratio of cylindrical diffusers was about 6 for minimum pressure-ratio requirements. With cylindrical diffusers of adequate length, the pressure-ratio requirements were primarily a function of the ratio of diffuser to nozzle-throat areas and were essentially independent of primary-nozzle type (including two clustered configurations) or area ratio. The two check points obtained with rocket engines indicated the pressure-ratio requirements at given ratios of diffuser to nozzle-throat areas were lowered, as compared with the requirements with air, as a result of the reduced ratio of specific heats. The minimum length-diameter ratio of the contraction throat of convergent-divergent diffusers was also about 6 for minimum pressure-ratio requirements. With adequate contraction-throat length, the pressure-ratio requirements of such diffusers were appreciably below those of comparable cylindrical diffusers when used with conical and cutoff-isentropic nozzles, but not when used with a bell nozzle. Minimum pressure-ratio requirements of a diffuser including a simple long-radius right-angle turn at maximum diffuser area, obtained with the center of radius of the turn a

  17. 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

  18. Faculty as simulated patients (FSPs) in assessing medical students' clinical reasoning skills.

    PubMed

    Abdelkhalek, Nahed M; Hussein, Amal M; Sulaiman, Nabil; Hamdy, Hossam

    2009-12-01

    At the University of Sharjah College of Medicine in the United Arab Emirates, clinical faculty are used as simulated patients (FSP) to assess students' communication, history taking and reasoning skills on summative Objective Structured Clinical Examinations (OSCEs). The aim of this study is to evaluate student and faculty perceptions of using a faculty member simultaneously as both the simulated patient and the assessor in OSCEs. Two structured questionnaires were developed. The questionnaires measured, on a five-point Likert scale, the students' and faculty's agreement with statements related to the ability of the FSPs to convince students that they were real patients, to respond to students' questions, and to evaluate students' skills in questioning, communication and clinical reasoning. Responses to items were collapsed into three-point scales (3=Agree/Strongly Agree, 2=Neutral/Uncertain, 1=Disagree/Strongly Disagree). Students' and faculty's responses to the questionnaires' items were summarized and presented in frequencies, percentages and mean scores. A total of 412 students and 28 FSPs responded to the questionnaires with response rates of 98% and 93%, respectively. The encounter with a FSP was generally found not to be stressful by students and faculty. Students were able to think of the FSP as a real patient and faculty generally felt they were able to assess the students' reasoning processes, communication skills and history taking. The percentage of students who agreed or strongly agreed with the various positively-worded questionnaire items ranged from a lowest of 52% (mean = 2.32) to a highest of 78% (mean = 2.66) and among faculty ranged from a lowest of 61% (mean = 2.54) to a highest of 100% (mean=3.0). Student and faculty perceptions about the simultaneous use of faculty as simulated patients and assessors were generally positive. The results of this study encouraged the program to continue using FSPs on formative and summative OSCE assessments

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

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  20. Using Satellite- and Ground-Based Simulators to Evaluate the US DOE Climate Model (ACME) Simulated Clouds

    NASA Astrophysics Data System (ADS)

    Zhang, Y.; Xie, S.; Lin, W.; Klein, S. A.; Branstetter, M. L.; Evans, K. J.; Marchand, R.; Kollias, P.; Clothiaux, E. E.

    2016-12-01

    It has been challenging to compare cloud measurements with climate model output because of limitations or features of the observing process. The simulator mimics the instrument view of a narrow atmospheric column by accounting for observational limitations of the instruments, so will facilitate direct comparison of modeled clouds with cloud observations. In this study, we implement the CFMIP (the Cloud-Feedback Model Intercomparison Project) Observation Simulator Package (COSP) and the Atmospheric Radiation Measurement (ARM) radar simulator in the US DOE Accelerated Climate Modeling for Energy (ACME) model and evaluate its simulated clouds. The poster shows preliminary results on using the COSP simulator package to evaluate clouds simulated by ACME at 1 degree and 0.25 degree resolutions in its AMIP runs, as well as using the ARM radar simulator to evaluate clouds in ACME day 2 hindcasts at the ARM Southern Great Plains site. Technical issues with developing the ARM radar simulator are discussed. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

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

    PubMed

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

    2008-12-01

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

  2. 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

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

    PubMed

    Fischer, G

    1991-09-01

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

  4. Auditorium acoustics evaluation based on simulated impulse response

    NASA Astrophysics Data System (ADS)

    Wu, Shuoxian; Wang, Hongwei; Zhao, Yuezhe

    2001-05-01

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

  5. The development of a quantitative evaluation tool for simulations in nursing education.

    PubMed

    Todd, Martha; Manz, Julie A; Hawkins, Kim S; Parsons, Mary E; Hercinger, Maribeth

    2008-01-01

    In a complex healthcare environment, educating nursing students to safely care for clients is a challenging endeavor. As the use of high fidelity simulations increases, the ability to evaluate students is essential. A review of the literature identified a lack of tested simulation evaluation instruments to accurately measure student performance. A simulation evaluation tool was developed and tested with senior nursing students. Content validity was established from the literature and from the review of the tool by an expert panel. Reliability was established using sixteen simulation sessions, with two trained evaluators at each session. Percent agreement by evaluators ranged from 84.4% to 89.1%. Additional research needs to verify these results with different evaluators, varying levels of students, and additional scenarios. A valid, reliable tool to evaluate simulation experiences improves student assessment skills and ultimately clinical performance.

  6. Patient simulation: a literary synthesis of assessment tools in anesthesiology.

    PubMed

    Edler, Alice A; Fanning, Ruth G; Chen, Michael I; Claure, Rebecca; Almazan, Dondee; Struyk, Brain; Seiden, Samuel C

    2009-12-20

    High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.

  7. Connectionist Modeling as the Basis for Multimedia Clinical Patient Simulations with Diagnostic Capabilities.

    ERIC Educational Resources Information Center

    Bergeron, Bryan P.; And Others

    1995-01-01

    Presents a connectionist approach to modeling that relies on neural networks to control conventional simulations of multimedia clinical patient simulations. These neural networks simplify the medical expert's task of validating and maintaining patient simulations with diagnostic capabilities and serves as the basis of clinical decision support…

  8. Connectionist Modeling as the Basis for Multimedia Clinical Patient Simulations with Diagnostic Capabilities.

    ERIC Educational Resources Information Center

    Bergeron, Bryan P.; And Others

    1995-01-01

    Presents a connectionist approach to modeling that relies on neural networks to control conventional simulations of multimedia clinical patient simulations. These neural networks simplify the medical expert's task of validating and maintaining patient simulations with diagnostic capabilities and serves as the basis of clinical decision support…

  9. Use of simulated patients to develop communication skills in nursing education: An integrative review.

    PubMed

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

    2017-01-01

    Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. An Integrative review. A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased

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

    ERIC Educational Resources Information Center

    Vieck, Jana

    2013-01-01

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

  11. 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.

  12. A customized simulation system with computer integrated auto-evaluation function for upper endoscopy training.

    PubMed

    Surangsrirat, Decho; Deshpande, Amar R; Surangsrirat, Surapon; Tapia, Moiez A; Zhao, Weizhao

    2011-01-01

    Competence in performing endoscopy requires a considerable amount of hands-on practice for a physician to master. In an effort to reduce the involvement of patients in the training process, simulation has become an important part of endoscopic training. This paper presents a low-cost training and evaluation system for upper endoscopy that serves as an additional or alternative tool, particularly for entry-level gastroenterology fellows. The protocol of making a customized mechanical training model that provides realistic visual appearances of the upper GI tract was created. The materials and methods used in the fabrication are outlined step-by-step in this report. A software application associated with the mechanical model was also developed to provide help for trainee during practice, evaluate the performance automatically upon completion of the training tasks, and record the performance and results in a database for review or further analysis by the trainee or instructor. Our software provides trainee with an interactive training experience. A survey obtained from sixteen gastroenterologists shows a promising feasibility of using the developed system. The developed low-cost upper endoscopy simulator can provide both training and evaluation functions with substantially low investment.

  13. Patient-individualized boundary conditions for CFD simulations using time-resolved 3D angiography.

    PubMed

    Boegel, Marco; Gehrisch, Sonja; Redel, Thomas; Rohkohl, Christopher; Hoelter, Philip; Doerfler, Arnd; Maier, Andreas; Kowarschik, Markus

    2016-06-01

    Hemodynamic simulations are of increasing interest for the assessment of aneurysmal rupture risk and treatment planning. Achievement of accurate simulation results requires the usage of several patient-individual boundary conditions, such as a geometric model of the vasculature but also individualized inflow conditions. We propose the automatic estimation of various parameters for boundary conditions for computational fluid dynamics (CFD) based on a single 3D rotational angiography scan, also showing contrast agent inflow. First the data are reconstructed, and a patient-specific vessel model can be generated in the usual way. For this work, we optimize the inflow waveform based on two parameters, the mean velocity and pulsatility. We use statistical analysis of the measurable velocity distribution in the vessel segment to estimate the mean velocity. An iterative optimization scheme based on CFD and virtual angiography is utilized to estimate the inflow pulsatility. Furthermore, we present methods to automatically determine the heart rate and synchronize the inflow waveform to the patient's heart beat, based on time-intensity curves extracted from the rotational angiogram. This will result in a patient-individualized inflow velocity curve. The proposed methods were evaluated on two clinical datasets. Based on the vascular geometries, synthetic rotational angiography data was generated to allow a quantitative validation of our approach against ground truth data. We observed an average error of approximately [Formula: see text] for the mean velocity, [Formula: see text] for the pulsatility. The heart rate was estimated very precisely with an average error of about [Formula: see text], which corresponds to about 6 ms error for the duration of one cardiac cycle. Furthermore, a qualitative comparison of measured time-intensity curves from the real data and patient-specific simulated ones shows an excellent match. The presented methods have the potential to accurately

  14. 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…

  15. FARSITE: Fire Area Simulator-model development and evaluation

    Treesearch

    Mark A. Finney

    1998-01-01

    A computer simulation model, FARSITE, includes existing fire behavior models for surface, crown, spotting, point-source fire acceleration, and fuel moisture. The model's components and assumptions are documented. Simulations were run for simple conditions that illustrate the effect of individual fire behavior models on two-dimensional fire growth.

  16. 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…

  17. A users evaluation of SAMIS. [Solar Array Manufacturing Industry Simulation

    NASA Technical Reports Server (NTRS)

    Grenon, L. A.; Coleman, M. G.

    1981-01-01

    SAMIS, the Solar Array Manufacturing Industry Simulation computer program was developed by Jet Propulsion Laboratories (JPL) to provide a method whereby manufacturers or potential manufacturers of photovoltaics could simulate a solar industry using their own particular approach. This paper analyzes the usefulness of SAMIS to a growing photovoltaic industry and clearly illustrates its limitations as viewed by an industrial user.

  18. A users evaluation of SAMIS. [Solar Array Manufacturing Industry Simulation

    NASA Technical Reports Server (NTRS)

    Grenon, L. A.; Coleman, M. G.

    1981-01-01

    SAMIS, the Solar Array Manufacturing Industry Simulation computer program was developed by Jet Propulsion Laboratories (JPL) to provide a method whereby manufacturers or potential manufacturers of photovoltaics could simulate a solar industry using their own particular approach. This paper analyzes the usefulness of SAMIS to a growing photovoltaic industry and clearly illustrates its limitations as viewed by an industrial user.

  19. 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…

  20. Evaluation of SHABERTH: A bearing simulation computer program

    NASA Technical Reports Server (NTRS)

    1978-01-01

    To investigate lubrication effects on bearing thermal performance, an investigation was performed to determine the feasibility of using the SKF program SHABERTH for simulating the performance of cryogenically lubricated ball bearings. As a part of this study, the particular application chosen for SHABERTH was to simulate the performance of the Space Shuttle main engine turbo-pump and pre-burner bearing system.

  1. An Evaluation of the Simulated Minority Admissions Exercise.

    ERIC Educational Resources Information Center

    Sedlacek, William E.; Prieto, Dario O.

    1982-01-01

    The Simulated Minority Admissions Exercise, an educational technique that simulates a typical medical school admissions situation, is described. The main objective is to help medical schools to select potentially successful minority applicants and to improve their retention by ensuring that they enter medical school under positive circumstances.…

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

    SciTech Connect

    Not Available

    1990-04-01

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

  3. Evaluating Australian football league player contributions using interactive network simulation.

    PubMed

    Sargent, Jonathan; Bedford, Anthony

    2013-01-01

    This paper focuses on the contribution of Australian Football League (AFL) players to their team's on-field network by simulating player interactions within a chosen team list and estimating the net effect on final score margin. A Visual Basic computer program was written, firstly, to isolate the effective interactions between players from a particular team in all 2011 season matches and, secondly, to generate a symmetric interaction matrix for each match. Negative binomial distributions were fitted to each player pairing in the Geelong Football Club for the 2011 season, enabling an interactive match simulation model given the 22 chosen players. Dynamic player ratings were calculated from the simulated network using eigenvector centrality, a method that recognises and rewards interactions with more prominent players in the team network. The centrality ratings were recorded after every network simulation and then applied in final score margin predictions so that each player's match contribution-and, hence, an optimal team-could be estimated. The paper ultimately demonstrates that the presence of highly rated players, such as Geelong's Jimmy Bartel, provides the most utility within a simulated team network. It is anticipated that these findings will facilitate optimal AFL team selection and player substitutions, which are key areas of interest to coaches. Network simulations are also attractive for use within betting markets, specifically to provide information on the likelihood of a chosen AFL team list "covering the line ". Key pointsA simulated interaction matrix for Australian Rules football players is proposedThe simulations were carried out by fitting unique negative binomial distributions to each player pairing in a sideEigenvector centrality was calculated for each player in a simulated matrix, then for the teamThe team centrality measure adequately predicted the team's winning marginA player's net effect on margin could hence be estimated by replacing him in

  4. 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…

  5. 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…

  6. Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

    PubMed Central

    Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

    2012-01-01

    OBJECTIVE: To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. DESIGN: Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. SETTING: Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia. INTERVENTIONS: The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. RESULTS: A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. CONCLUSIONS: A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes. PMID:23372405

  7. Left molar approach improves laryngeal view in patients with simulated limitation of cervical movements.

    PubMed

    Saini, S; Bala, R; Singh, R

    2008-07-01

    Immobilized cervical spine, because of either diseases or stabilizing devices, poses considerable difficulties with endotracheal intubation due to poor laryngoscopic view. The left molar (LM) approach has been shown to be useful in difficult sporadic intubation cases. We evaluated efficacy of this approach of laryngoscopy to improve laryngeal view in patients with simulated limitation of cervical movements. Thirty patients of American Society of Anesthesiologists grade I/II, who were scheduled to undergo routine surgical procedures under general anaesthesia and endotracheal intubation, were studied. A two-piece semi-rigid cervical collar was used to immobilize the cervical spine. Under standardized anaesthesia and neuromuscular blocking agent, conventional laryngoscopy using a curved Macintosh blade was performed and glottic view was recorded with and without optimal external laryngeal manipulation (OELM). Subsequently, in the same subjects the laryngoscope blade was withdrawn and re-inserted through the LM approach and glottic view was recorded with and without OELM followed by tracheal intubation. With the conventional approach, laryngeal view was recorded as grade II in five patients, grade III in 24 patients, and grade IV in one patient. However, with the LM approach, laryngeal view was grade I in 25 patients, grade II in five patients, and grade III or IV in none (P<0.001). Tracheal intubation with the LM approach required the use of a flexible stylet to guide the tube tip into the larynx. The laryngeal view is improved by the LM approach in patients with simulated limited cervical movements with a high success rate of tracheal intubation, but requires orientation for negotiation of the tube through the narrow oropharyngeal space available.

  8. 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.

  9. Efficient patient modeling for visuo-haptic VR simulation using a generic patient atlas.

    PubMed

    Mastmeyer, Andre; Fortmeier, Dirk; Handels, Heinz

    2016-08-01

    This work presents a new time-saving virtual patient modeling system by way of example for an existing visuo-haptic training and planning virtual reality (VR) system for percutaneous transhepatic cholangio-drainage (PTCD). Our modeling process is based on a generic patient atlas to start with. It is defined by organ-specific optimized models, method modules and parameters, i.e. mainly individual segmentation masks, transfer functions to fill the gaps between the masks and intensity image data. In this contribution, we show how generic patient atlases can be generalized to new patient data. The methodology consists of patient-specific, locally-adaptive transfer functions and dedicated modeling methods such as multi-atlas segmentation, vessel filtering and spline-modeling. Our full image volume segmentation algorithm yields median DICE coefficients of 0.98, 0.93, 0.82, 0.74, 0.51 and 0.48 regarding soft-tissue, liver, bone, skin, blood and bile vessels for ten test patients and three selected reference patients. Compared to standard slice-wise manual contouring time saving is remarkable. Our segmentation process shows out efficiency and robustness for upper abdominal puncture simulation systems. This marks a significant step toward establishing patient-specific training and hands-on planning systems in a clinical environment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. 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.

  11. 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…

  12. Evaluation of regional climate simulations over the Great Lakes region driven by three global data sets

    Treesearch

    Shiyuan Zhong; Xiuping Li; Xindi Bian; Warren E. Heilman; L. Ruby Leung; William I. Jr. Gustafson

    2012-01-01

    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-...

  13. Preoperative planning with three-dimensional reconstruction of patient's anatomy, rapid prototyping and simulation for endoscopic mitral valve repair.

    PubMed

    Sardari Nia, Peyman; Heuts, Samuel; Daemen, Jean; Luyten, Peter; Vainer, Jindrich; Hoorntje, Jan; Cheriex, Emile; Maessen, Jos

    2017-02-01

    Mitral valve repair performed by an experienced surgeon is superior to mitral valve replacement for degenerative mitral valve disease; however, many surgeons are still deterred from adapting this procedure because of a steep learning curve. Simulation-based training and planning could improve the surgical performance and reduce the learning curve. The aim of this study was to develop a patient-specific simulation for mitral valve repair and provide a proof of concept of personalized medicine in a patient prospectively planned for mitral valve surgery. A 65-year old male with severe symptomatic mitral valve regurgitation was referred to our mitral valve heart team. On the basis of three-dimensional (3D) transoesophageal echocardiography and computed tomography, 3D reconstructions of the patient's anatomy were constructed. By navigating through these reconstructions, the repair options and surgical access were chosen (minimally invasive repair). Using rapid prototyping and negative mould fabrication, we developed a process to cast a patient-specific mitral valve silicone replica for preoperative repair in a high-fidelity simulator. Mitral valve and negative mould were printed in systole to capture the pathology when the valve closes. A patient-specific mitral valve silicone replica was casted and mounted in the simulator. All repair techniques could be performed in the simulator to choose the best repair strategy. As the valve was printed in systole, no special testing other than adjusting the coaptation area was required. Subsequently, the patient was operated, mitral valve pathology was validated and repair was successfully done as in the simulation. The patient-specific simulation and planning could be applied for surgical training, starting the (minimally invasive) mitral valve repair programme, planning of complex cases and the evaluation of new interventional techniques. The personalized medicine could be a possible pathway towards enhancing reproducibility

  14. Acknowledging patient heterogeneity in economic evaluation : a systematic literature review.

    PubMed

    Grutters, Janneke P C; Sculpher, Mark; Briggs, Andrew H; Severens, Johan L; Candel, Math J; Stahl, James E; De Ruysscher, Dirk; Boer, Albert; Ramaekers, Bram L T; Joore, Manuela A

    2013-02-01

    Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic evaluations pay only limited attention to patient heterogeneity. The objective of the present paper is to provide a comprehensive overview of the current knowledge regarding patient heterogeneity within economic evaluation of healthcare programmes. A systematic literature review was performed to identify methodological papers on the topic of patient heterogeneity in economic evaluation. Data were obtained using a keyword search of the PubMed database and manual searches. Handbooks were also included. Relevant data were extracted regarding potential sources of patient heterogeneity, in which of the input parameters of an economic evaluation these occur, methods to acknowledge patient heterogeneity and specific concerns associated with this acknowledgement. A total of 20 articles and five handbooks were included. The relevant sources of patient heterogeneity (demographics, preferences and clinical characteristics) and the input parameters where they occurred (baseline risk, treatment effect, health state utility and resource utilization) were combined in a framework. Methods were derived for the design, analysis and presentation phases of an economic evaluation. Concerns related mainly to the danger of false-positive results and equity issues. By systematically reviewing current knowledge regarding patient heterogeneity within economic evaluations of healthcare programmes, we provide guidance for future economic evaluations. Guidance is provided on which sources of patient heterogeneity to consider, how to acknowledge them in economic evaluation and potential concerns. The improved acknowledgement of patient heterogeneity in future economic evaluations may well improve the

  15. [Hemodynamic evaluation of the patient with microvarices].

    PubMed

    Alvarez Sánchez, J A; Vega Gómez, M E; Rodríguez Lacaba, B; Martínez Griñán, M A

    1992-01-01

    The present study included 21 lower limbs with micro varicosities, 56 lower limbs with retrograde flow-varicosities (positive Rivlin) and 35 health lower limbs. Technics used for diagnosis were: Doppler ultrasonography and strain gauge plethysmography. We found a higher incidence of valvular failure on the varicose patients with retrograde flow (showing changes on their viscoelastic features of their venous walls). On the contrary, patient with microvaricosities showed an hemodynamics similar to the healty patient: we did not found any difference on the variables analyzed between the two groups. We conclude that the presence of microvaricosities has no influence on the analyzed hemodynamic parametres.

  16. Evaluation of ergonomic dental stools through clinical simulation.

    PubMed

    Parsell, D E; Weber, M D; Anderson, B C; Cobb, G W

    2000-01-01

    Work-related musculoskeletal pain occurs commonly within the dental community. Three stool designs were utilized in this study: a standard dental stool, a stool with dual arm supports, and a stool with dual arm supports and chest support. Electromyographic data from four muscle groups were collected on 13 clinicians during a simulated crown preparation procedure. Clinical simulation suggests that a potential musculoskeletal benefit to the clinician exists through utilization of dental stool designs which incorporate static arm supports.

  17. Implementing and Evaluating an Innovative Approach to Simulation Training Acquisitions

    DTIC Science & Technology

    2006-01-01

    busi- ness model, compares it with other approaches for buying simulations and simulation training, reviews economic theories relevant to the model, and...Points in Common with Other Approaches but Also Some Distinctive Characteristics ........................... 53 Contents vii CHAPTER FOUR The Economic ...Appropriate? .................... 65 4.3. Summary of Key Findings from Economic Theory .............. 72 xiii Summary In the wake of the failure of the Joint

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

    PubMed

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

    2013-01-01

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

  19. Safety evaluation of single-use medical devices after submission to simulated reutilization cycles.

    PubMed

    da Silva, Mônica Valero; Ribeiro, Alberto de Freitas; Pinto, Terezinha de Jesus A

    2005-01-01

    Pyrogenic and toxic reactions, especially in immunologically compromised patients, are among the risks associated with reuse of single-use medical devices (SUDs) with recurrent damaged surfaces. These drawbacks have raised serious doubts about the true benefits of the reprocessing practice. Taking into consideration prolonged patients' stay in hospitals due to adverse reactions provoked by recycled SUDs, the safety of these reprocessed materials was evaluated. The reprocessing cycles were simulated after intentional contamination of selected test material such as intravenous catheters, 3-way stopcocks, and tracheostomy tubes with Bacillus subtilis var. niger ATCC 9372 spores (10(7) CFU/unit). The repeated reprocessing cycles consisted of subsequent wash with enzymatic detergent followed by drying and sterilization with ethylene oxide-CFC (12 + 88), 600 mg/L at 55 degrees C, relative humidity 60%, for 3 h. After each reprocessing cycle, specimen samples were evaluated by pour plate microbial counts, direct and indirect inoculation sterility tests, cytotoxicity evaluation, and scanning electron microscopy (SEM). Microbial counts as high as 10(3) CFU were evident even after the 10th reprocessing cycle, besides scratched and damaged surfaces observed by SEM. Risk-benefit viewpoints are discussed.

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

    NASA Technical Reports Server (NTRS)

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

    1975-01-01

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

  1. 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:…

  2. Evaluation of surgical training in the era of simulation.

    PubMed

    Shaharan, Shazrinizam; Neary, Paul

    2014-09-16

    To assess where we currently stand in relation to simulator-based training within modern surgical training curricula. 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. 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. 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.

  3. Design, Implementation, and Evaluation of a Simulation-Based Clinical Correlation Curriculum as an Adjunctive Pedagogy in an Anatomy Course.

    PubMed

    Coombs, Carmen M; Shields, Ryan Y; Hunt, Elizabeth A; Lum, Ying Wei; Sosnay, Patrick R; Perretta, Julianne S; Lieberman, Rhett H; Shilkofski, Nicole A

    2017-04-01

    Because reported use of simulation in preclinical basic science courses is limited, the authors describe the design, implementation, and preliminary evaluation of a simulation-based clinical correlation curriculum in an anatomy course for first-year medical students at Perdana University Graduate School of Medicine (in collaboration with Johns Hopkins University School of Medicine). The simulation curriculum, with five weekly modules, was a component of a noncadaveric human anatomy course for three classes (n = 81 students) from September 2011 to November 2013. The modules were designed around major anatomical regions (thorax; abdomen and pelvis; lower extremities and back; upper extremities; and head and neck) and used various types of simulation (standardized patients, high-fidelity simulators, and task trainers). Several methods were used to evaluate the curriculum's efficacy, including comparing pre- versus posttest scores and comparing posttest scores against the score on 15 clinical correlation final exam questions. A total of 81 students (response rate: 100%) completed all pre- and posttests and consented to participate. Posttest scores suggest significant knowledge acquisition and better consistency of performance after participation in the curriculum. The comparison of performance on the posttests and final exam suggests that using simulation as an adjunctive pedagogy can lead to excellent short-term knowledge retention. Simulation-based medical education may prove useful in preclinical basic science curricula. Next steps should be to validate the use of this approach, demonstrate cost-efficacy or the "return on investment" for educational and institutional leadership, and examine longer-term knowledge retention.

  4. Preoperative Evaluation of Patients with Diabetes Mellitus.

    PubMed

    Miller, Joshua D; Richman, Deborah C

    2016-03-01

    There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.

  5. Evaluation of drug information for cardiology patients.

    PubMed Central

    Baker, D; Roberts, D E; Newcombe, R G; Fox, K A

    1991-01-01

    1. Cardiologists and pharmacists at the University Hospital of Wales collaborated to write 20 individual leaflets incorporating guidelines for a range of drugs used in the treatment of cardiology patients. The Plain English Campaign advised on the intelligibility and presentation of the information. 2. One hundred and twenty-five patients from the Regional Cardiology Unit, University Hospital of Wales were randomly allocated to receive usual verbal counselling about their drug treatment with or without an individualised drug information wallet. Two weeks after discharge from hospital patients completed a postal questionnaire to determine their satisfaction with the information about their drug treatment and their understanding of it. Forty-nine questionnaires were returned from the leaflet group and 52 from the control group. 3. The provision of written guidelines resulted in significant improvements in patients' satisfaction with their drug treatment (chi 2 = 33.3, P less than 0.001) and their understanding of it (P less than 0.001, Mann-Whitney test). Overall, patients who received leaflets were more likely to be aware of the potential side effects of their drugs but less likely to be apprehensive about them. Succinct guidelines concerning drug therapy can be assimilated by cardiology patients and provide them with a permanent record for future reference. PMID:1888619

  6. [Nutritional evaluation and functional class in hospitalized cardiopathy patients].

    PubMed

    Herrera Franco, R; Martínez Martínez, E; López Vega, L T; Astudillo Sandoval, R; Benítez Pérez, C; Ariza Andraca, H

    1999-01-01

    The nutritional state evaluation of any patient with heart disease must include the anthropometric measures, organic metabolic and cellular immunity test. We evaluated the nutritional state of 75 hospitalized patients with heart disease, and its correlation with New York Heart Association class and heart disease type. There was 36 patients (48%) with normal nutritional state, 24 (32%) with grade I malnutrition, 12 (16%) with grade II malnutrition, and 3 (4%) with grade III malnutrition. Of 23 patients with rheumatic valvular heart disease 83.4% have some degree of malnutrition, 37 patients with ischemic heart disease 25% was under nourished. Fifty percent of patients with hypertensive cardiopathy, 75% of the patients with cardiomyopathy and 83% of the 7 patients with other type of heart disease had some degree of malnourishment. There was a direct correlation between nutritional state and functional class, we found no patient in IV class functional with normal nutritional state, or grade I malnutrition.

  7. Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability.

    PubMed

    McClimens, Alex; Lewis, Robin; Brewster, Jacqui

    2012-09-01

    Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

  8. [The development and current status of high-fidelity patient simulation teaching].

    PubMed

    Chen, Shiah-Lian; Lee, Mei-Li; Liao, I-Chen; Liang, Tienli

    2013-04-01

    High-fidelity patient simulation teaching represents one of the most important innovations in healthcare education in the past two decades. In Taiwan, many medical centers and medical colleges now have clinical skill centers equipped with a high-fidelity patient simulator. Practicing clinical scenarios in this simulated environment can help strengthen students' professional essentials and competencies outside of classroom and clinical teaching settings. High-fidelity simulation teaching is an integrated teaching strategy that is continuing to receive greater attention. This article describes the historical development of high-fidelity patient simulation teaching, its current status, and applications in nursing education as a reference for nursing educators.

  9. 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.

  10. The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy.

    PubMed

    Rossetti, Andrew; Chadha, Manjeet; Torres, B Nelson; Lee, Jae K; Hylton, Donald; Loewy, Joanne V; Harrison, Louis B

    2017-09-01

    Radiation therapy (RT) is associated with high stress levels. The role of music therapy (MT) for patients receiving RT is not well described. This study evaluates the impact of MT on anxiety and distress during simulation in patients with newly diagnosed head and neck or breast cancer. This institutional review board-approved randomized trial of MT versus no MT at the time of simulation included the pre-State-Trait Anxiety Inventory (STAI-S Anxiety) questionnaire and Symptom Distress Thermometer (SDT). Patients randomized to MT received a consultation with a music therapist, during which music of the patients' choice to be played during simulation was selected. The no-MT patients did not receive the MT consultation, nor did they hear prerecorded music during simulation. Subsequent to the simulation, all patients repeated the STAI-S Anxiety questionnaire and the SDT. Of the 78 patients enrolled (39 in MT group and 39 in no-MT group), 38 had breast cancer and 40 had head and neck cancer. The male-female ratio was 27:51. The overall mean pre- and post-simulation STAI-S scores were 38.7 (range, 20-60) and 35.2 (range, 20-72), respectively. The overall mean pre- and post-simulation SDT scores were 3.2 (range, 0-10) and 2.5 (range, 0-10), respectively. The MT group had mean pre- and post-simulation STAI-S scores of 39.1 and 31.0, respectively (P<.0001), and the mean SDT scores before and after simulation were 3.2 and 1.7, respectively (P<.0001). The no-MT group's mean pre- and post-simulation STAI-S scores were 38.3 and 39.5, respectively (P=.46), and the mean SDT scores were 3 and 3.2, respectively (P=.51). MT significantly lowered patient anxiety and distress during the simulation procedure on the basis of the STAI-S questionnaire and SDT. Incorporating culturally centered individualized MT may be an effective intervention to reduce stressors. Continued research defining the role of MT intervention in improving the patient experience by reducing anxiety is

  11. 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.

  12. Reinforcement learning versus proportional-integral-derivative control of hypnosis in a simulated intraoperative patient.

    PubMed

    Moore, Brett L; Quasny, Todd M; Doufas, Anthony G

    2011-02-01

    Research has demonstrated the efficacy of closed-loop control of anesthesia using bispectral index (BIS) as the controlled variable. Model-based and proportional-integral-derivative (PID) controllers outperform manual control. We investigated the application of reinforcement learning (RL), an intelligent systems control method, to closed-loop BIS-guided, propofol-induced hypnosis in simulated intraoperative patients. We also compared the performance of the RL agent against that of a conventional PID controller. The RL and PID controllers were evaluated during propofol induction and maintenance of hypnosis. The patient-hypnotic episodes were designed to challenge both controllers with varying degrees of interindividual variation and noxious surgical stimulation. Each controller was tested in 1000 simulated patients, and control performance was assessed by calculating the median performance error (MDPE), median absolute performance error (MDAPE), Wobble, and Divergence for each controller group. A separate analysis was performed for the induction and maintenance phases of hypnosis. During maintenance, RL control demonstrated an MDPE of -1% and an MDAPE of 3.75%, with 80% of the time at BIS(target) ± 5. The PID controller yielded a MDPE of -8.5% and an MDAPE of 8.6%, with 57% of the time at BIS(target) ± 5. In comparison, the MDAPE in the worst-controlled patient of the RL group was observed to be almost half that of the worst-controlled patient in the PID group. When compared with the PID controller, RL control resulted in slower induction but less overshoot and faster attainment of steady state. No difference in interindividual patient variation and noxious destabilizing challenge on control performance was observed between the 2 patient groups.

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

    Horvat, Nejc; Koder, Marko; Kos, Mitja

    2012-01-01

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

  15. Validation of simulated difficult bag-mask ventilation as a training and evaluation method for first-year internal medicine house staff.

    PubMed

    Pastis, Nicholas J; Doelken, Peter; Vanderbilt, Allison A; Walker, John; Schaefer, John J

    2013-02-01

    The past decade has witnessed the increased use of patient simulation in medical training as a method to teach complex bedside skills. Although effective bag-mask ventilation (BMV) is a critical part of airway management, the quality of training in this skill has been questioned. First-year internal medicine house staff (novices) were used to evaluate a computerized patient simulator as a tool to teach difficult BMV. A novice group and an expert group (certified registered nurse anesthetists and anesthesiologists) were tested to validate the simulator's ability to distinguish between these 2 skill levels. The difference between the novice and expert groups in the ability to perform difficult BMV was statistically significant (P < 0.0001). Brief training for novices led to a 100% pass rate and competence as measured by the simulator. Simulation training was effective in increasing the ability to ventilate a simulated difficult-to-ventilate patient (P < 0.0001). This study suggests that this computerized patient simulator was validated as a simulation model for teaching difficult BMV and differentiating skill levels in BMV. Using the simulator with brief training on difficult BMV allowed new internal medicine house staff to successfully ventilate a simulated difficult patient.

  16. Rhabdomyolysis: an evaluation of 475 hospitalized patients.

    PubMed

    Melli, Giorgia; Chaudhry, Vinay; Cornblath, David R

    2005-11-01

    Rhabdomyolysis is a common and potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. Myoglobinuria is the most significant consequence, leading to acute renal failure (ARF) in 15%-33% of patients with rhabdomyolysis. Rhabdomyolysis occurs from inherited diseases, toxins, muscle compression or overexertion, or inflammatory processes, among other disorders. In some cases, no cause is found. We describe 475 patients from the Johns Hopkins Hospital inpatient records between January 1993 and December 2001 for the following discharge diagnosis codes: myoglobinuria, rhabdomyolysis, myopathy, toxic myopathy, malignant hyperthermia, neuroleptic malignant syndrome, and polymyositis. Of 1362 patients, 475 patients with an acute neuromuscular illness with serum creatine kinase (CK) more than 5 times the upper limit of normal (>975 IU/L) were included. Patients with recent myocardial infarction or stroke were excluded. The etiology was assigned by chart review. For all, the highest values of serum CK, serum creatinine and urine myoglobin, hemoglobin, and red blood cells were recorded. Forty-one patients had muscle biopsy within at least 2 months from the onset of rhabdomyolysis.Of the 475 patients, 151 were female and 324 were male (median age, 47 yr; range, 4-95 yr). Exogenous toxins were the most common cause of rhabdomyolysis, with illicit drugs, alcohol, and prescribed drugs responsible for 46%. Among the medical drugs, antipsychotics, statins, zidovudine, colchicine, selective serotonin reuptake inhibitors, and lithium were the most frequently involved. In 60% of all cases, multiple factors were present. In 11% of all cases, rhabdomyolysis was recurrent. Underlying myopathy or muscle metabolic defects were responsible for 10% of cases, in which there was a high percentage of recurrence, only 1 etiologic factor, and a low incidence of ARF. In 7%, no cause was found. ARF was present in 218 (46

  17. Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model.

    PubMed

    Kono, Kenichi; Shintani, Aki; Okada, Hideo; Terada, Tomoaki

    2013-01-01

    Silicone models of cerebral aneurysms are used for evaluation of devices, training, or hemodynamic studies. We report preoperative simulations of endovascular treatment for a case with an unruptured wide-neck aneurysm of the anterior communicating artery using a patient-specific silicone model. Using a rapid prototyping system, we created a silicone model based on the vascular image obtained by three-dimensional rotational angiogram. The aneurysm and vessels formed a cavity in the silicone block model. We performed endovascular simulations using several difference devices and attempted possible methods for coil embolization. We designed treatment strategies based on the simulations and performed balloon-assisted coil embolization of the aneurysm. The simulations were especially useful in navigation of a microcatheter by planning the shape of its tip beforehand. There was one significant difference between the silicone model simulations and actual treatment: the shape of the vessel in the silicone block model was not changed by insertion of a catheter or guidewire. This is the first study to describe preoperative endovascular simulations using a patient-specific silicone model. Our methods of creating a patient-specific model are relatively simple and easy. Although this is a single case, we demonstrate that the simulations are feasible and helpful for designing a treatment strategy and safe manipulation of endovascular devices by experiencing their behavior before actual treatment.

  18. 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.

  19. 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

  20. Design and evaluation of a computer controlled solar collector simulator

    NASA Astrophysics Data System (ADS)

    Kotas, J. F.; Wood, B. D.

    1980-11-01

    A computer-controlled system has been developed to simulate the thermal processes of a flat-plate solar collector. The simulator is based on four water heaters of capacities of 1.5, 2.5, 5.0 and 5.0 kW providing a maximum design output of 14.0 kW which are controlled by a Nova 3 minicomputer, which also monitors temperatures in the fluid stream. Measurements have been obtained of the steady-state operating values and time constants of the individual heaters at different flow rates in order to utilize effectively their thermal outputs. Software was designed to control the heater system so the total thermal output closely approximates that of an actual heater array, utilizing steady-state or dynamic control modes. Simulation of the heat output of a previously tested collector has resulted in simulated values differing from actual output by a maximum of 3% under identical operating conditions, thus indicating that the simulator represents a viable alternative to the testing of a large field of collectors.

  1. An educational training simulator for advanced perfusion techniques using a high-fidelity virtual patient model.

    PubMed

    Tokaji, Megumi; Ninomiya, Shinji; Kurosaki, Tatsuya; Orihashi, Kazumasa; Sueda, Taijiro

    2012-12-01

    The operation of cardiopulmonary bypass procedure requires an advanced skill in both physiological and mechanical knowledge. We developed a virtual patient simulator system using a numerical cardiovascular regulation model to manage perfusion crisis. This article evaluates the ability of the new simulator to prevent perfusion crisis. It combined short-term baroreflex regulation of venous capacity, vascular resistance, heart rate, time-varying elastance of the heart, and plasma-refilling with a simple lumped parameter model of the cardiovascular system. The combination of parameters related to baroreflex regulation was calculated using clinical hemodynamic data. We examined the effect of differences in autonomous-nerve control parameter settings on changes in blood volume and hemodynamic parameters and determined the influence of the model on operation of the control arterial line flow and blood volume during the initiation and weaning from cardiopulmonary bypass. Typical blood pressure (BP) changes (hypertension, stable, and hypotension) were reproducible using a combination of four control parameters that can be estimated from changes in patient physiology, BP, and blood volume. This simulation model is a useful educational tool to learn the recognition and management skills of extracorporeal circulation. Identification method for control parameter can be applied for diagnosis of heart failure.

  2. 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.

  3. 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.

  4. A space debris simulation facility for spacecraft materials evaluation

    NASA Technical Reports Server (NTRS)

    Taylor, Roy A.

    1987-01-01

    A facility to simulate the effects of space debris striking an orbiting spacecraft is described. This facility was purchased in 1965 to be used as a micrometeoroid simulation facility. Conversion to a Space Debris Simulation Facility began in July 1984 and it was placed in operation in February 1985. The facility consists of a light gas gun with a 12.7-mm launch tube capable of launching 2.5-12.7 mm projectiles with a mass of 4-300 mg and velocities of 2-8 km/sec, and three target tanks of 0.067 m, 0.53 a m and 28.5 a m. Projectile velocity measurements are accomplished via pulsed X-ray, laser diode detectors, and a Hall photographic station. This facility is being used to test development structural configurations and candidate materials for long duration orbital spacecraft. A summary of test results are also described.

  5. Eye Tracking: A Novel Approach for Evaluating and Improving the Safety of Healthcare Processes in the Simulated Setting.

    PubMed

    Henneman, Elizabeth A; Marquard, Jenna L; Fisher, Donald L; Gawlinski, Anna

    2017-02-01

    Eye tracking, used to evaluate a clinician's eye movements, is an example of an existing technology being used in novel ways by patient safety researchers in the simulated setting. The use of eye-tracking technology has the potential to augment current teaching, evaluation, and research methods in simulated settings by using this quantitative, objective data to better understand why an individual performed as he or she did on a simulated or naturalistic task. Selected literature was reviewed with the purpose of explicating how eye tracking can be used by researchers and educators to evaluate error-prone processes. The literature reviewed was obtained by querying the databases PubMed, CINHAL, and Google Scholar using the key words eye tracking, patient safety, and medical errors from 2005 through 2015.An introduction to the use of eye tracking, including both theoretical underpinnings and technological considerations, is presented. In addition, examples of how eye tracking has been used in research studies conducted in both simulated and naturalistic settings are provided. The use of eye-tracking technology to capture the eye movements of novice and expert clinicians has provided new insight into behaviors associated with the identification of medical errors. The study of novices' and experts' eye movements provides data about clinician performance not possible with existing evaluation methods such as direct observation, verbal reports, and thinking out loud. The use of eye tracking to capture the behaviors of experts can lead to the development of training protocols to guide the education of students and novice practitioners. Eye-tracking technology clearly has the potential to transform the way clinical simulation is used to improve patient safety practices.

  6. Speech evaluation for patients with cleft palate.

    PubMed

    Kummer, Ann W

    2014-04-01

    Children with cleft palate are at risk for speech problems, particularly those caused by velopharyngeal insufficiency. There may be an additional risk of speech problems caused by malocclusion. This article describes the speech evaluation for children with cleft palate and how the results of the evaluation are used to make treatment decisions. Instrumental procedures that provide objective data regarding the function of the velopharyngeal valve, and the 2 most common methods of velopharyngeal imaging, are also described. Because many readers are not familiar with phonetic symbols for speech phonemes, Standard English letters are used for clarity.

  7. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. 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.

  9. 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

  10. The Evaluation of Elderly Patients by a Psychiatric Emergency Service

    PubMed Central

    Baker, F. M.; Scholhamer, Nanne

    1988-01-01

    A retrospective descriptive study of older patients evaluated by the psychiatric emergency service (PES) of a general hospital was implemented. The medical records of all patients aged 65 years and older evaluated by the PES during the 1980 calendar year were reviewed. Seventy-four patients were identified, 38 male and 36 female. Forty-three percent of the sample had no medical problems, 59 percent had a prior psychiatric history, and 38 percent had a diagnosis of organic brain syndrome. After their evaluation, 43 percent of these older patients were discharged home with a referral for outpatient treatment. In contrast to prior studies, only 35 percent of the sample were taking two or more psychoactive medications. Only two patients were referred for evaluation from skilled nursing homes. PMID:3404560

  11. Evaluation of model parameters for simulating TiO(2) coated UV reactors.

    PubMed

    Duran, J E; Taghipour, F; Mohseni, M

    2011-01-01

    A CFD-based model for simulating TiO(2) coated photocatalytic reactors used in drinking water treatment applications was preliminarily evaluated. The model includes aspects of hydrodynamics, mass transfer, UV-radiation field, and surface chemical reactions. Appropriate models for each of the associated physicochemical phenomena were experimentally or analytically examined. Once defined and evaluated, the individual models were integrated into a CFD-based model for simulating photocatalytic reactor performance, which was experimentally evaluated.

  12. Evaluation concepts to compare observed and simulated deposition areas of mass movements

    NASA Astrophysics Data System (ADS)

    Heiser, Micha; Scheidl, Christian; Kaitna, Roland

    2017-04-01

    A delineation of potentially endangered areas by geophysical mass flows, like debris flows, rock and snow avalanches, is an important for regional and urban planning. For this numerical simulation programs have become an important tool in engineering hazard assessment. However, when being confronted with the evaluation of model performance and sensitivity there are no standard, objective approaches. In this contribution we present a new approach to quantitatively compare 2D simulations of observed and simulated deposition patterns - a concept derived from a literature review of 75 peer reviewed articles which inverse modelled real events of different types of mass flows. It seems that existing evaluation concepts with respect to the deposition distribution does only account for one or a combination of two possible evaluation errors based on overestimation, underestimation and/or overlap of the simulation outcome with the observed reference. The proposed evaluation concept integrates all three possible errors and yields a single metric between -1 (no fit) and 1 (perfect fit). Combined with a ternary plot we further show that the proposed evaluation concept might act as a simple decision support tool to i) identify weaknesses and strengths of the simulation model, ii) to find the best simulation setup and iii) to test whether higher complexity of simulation models are balanced by higher accuracies. This method shall help developers and end-users of simulation models to better understand model behavior and provide a possibility for comparison of model results, independent of simulation platform and type of mass flow.

  13. Evaluation of null-point detection methods on simulation data

    NASA Astrophysics Data System (ADS)

    Olshevsky, Vyacheslav; Fu, Huishan; Vaivads, Andris; Khotyaintsev, Yuri; Lapenta, Giovanni; Markidis, Stefano

    2014-05-01

    We model the measurements of artificial spacecraft that resemble the configuration of CLUSTER propagating in the particle-in-cell simulation of turbulent magnetic reconnection. The simulation domain contains multiple isolated X-type null-points, but the majority are O-type null-points. Simulations show that current pinches surrounded by twisted fields, analogous to laboratory pinches, are formed along the sequences of O-type nulls. In the simulation, the magnetic reconnection is mainly driven by the kinking of the pinches, at spatial scales of several ion inertial lentghs. We compute the locations of magnetic null-points and detect their type. When the satellites are separated by the fractions of ion inertial length, as it is for CLUSTER, they are able to locate both the isolated null-points, and the pinches. We apply the method to the real CLUSTER data and speculate how common are pinches in the magnetosphere, and whether they play a dominant role in the dissipation of magnetic energy.

  14. The Role of Simulation in Test and Evaluation

    DTIC Science & Technology

    2010-01-01

    beneficial for video data reducers who were not familiar with recon/attack operations. Simulator benefits N Minimal risk to crew members, N a ‘‘low...Journal Acknowledgments AB3 FDT&E test team (Figure 5): MAJ Cornelius L. Allen, Jr. (test officer), Dr. Bruce Wardlow (analyst), LTC Brian Apgar

  15. 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…

  16. 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.

  17. Evaluating relative sensitivity of SWAT-simulated nitrogen ...

    EPA Pesticide Factsheets

    We investigated how projected changes in land cover and climate affected simulated nitrate (NO3−) and organic nitrogen (ORGN) discharge for two watersheds within the Neuse River Basin North Carolina, USA for years 2010 to 2070. We applied the Soil and Water Assessment Tool (SWAT) watershed model to predict nitrogen discharge using (1) atmospheric carbon dioxide (CO2) concentrations predicted by the Intergovernmental Panel on Climate Change (IPCC), (2) land cover change predicted by the Integrated Climate and Land Use Change (ICLUS) project and (3) precipitation and temperature simulated by two statistically downscaled and bias-corrected Global Circulation Models (GCMs). We determined the sensitivity of simulated nitrogen discharge to separate changes in each treatment ([1] CO2, [2] land cover, and [3] precipitation and temperature (PT)) by comparing each treatment to a reference condition. Results showed nitrogen discharges were most sensitive to changes in PT over the 60-year simulation. Nitrogen discharges had similar sensitivities to the CO2 and land cover treatments which were only one-tenth the influence of the PT treatment. Under the CO2 treatment, nitrogen discharges increased with increasing ambient CO2. NO3− discharge decreased with increased urbanization; however, ORGN had a varied response. Under the PT treatment, there was high spatial variability in nitrogen discharges. In a single year, certain sub-basins showed an 80% increase in nitrogen disc

  18. Agent Based Simulation Seas Evaluation of DoDAF Architecture

    DTIC Science & Technology

    2004-03-01

    04-05 Abstract With Department of Defense (DoD) weapon systems being deeply rooted in the command, control, communications, computers, intelligence ...Communication, Computers, Intelligence , Surveillance, and Reconnaissance (C4ISR). Operational studies have shown agent based simulation utilizing this...traffic, people in crowds, artificial characters in computer games, agents in financial markets, and humans and machines on battlefields [28]. Agent

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

    ERIC Educational Resources Information Center

    McEneaney, John E.

    2016-01-01

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

  20. 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.

  1. Evaluation of assertiveness training for psychiatric patients.

    PubMed

    Lin, Yen-Ru; Wu, Mei-Hsuen; Yang, Cheng-I; Chen, Tsai-Hwei; Hsu, Chen-Chuan; Chang, Yue-Cune; Tzeng, Wen-Chii; Chou, Yuan-Hwa; Chou, Kuei-Ru

    2008-11-01

    To investigate the effectiveness of assertiveness training programmes on psychiatric patients' assertiveness, self-esteem and social anxiety. Assertiveness training programmes are designed to improve an individual's assertive beliefs and behaviours, which can help the individual change how they view themselves and establish self-confidence and social anxiety. It is useful for patients with depression, depressive phase of bipolar disorder, anxiety disorder or adjustment disorder. Experimental. There were 68 subjects (28, experimental group; 40, diagnosis-matched comparison group). Subjects in experimental groups participated in experimenter-designed assertiveness training twice a week (two hours each) for four weeks. The comparison groups participated the usual activities. Data were collected in the two groups at the same time: before, after and one month after training programme. Efficacy was measured by assertiveness, self-esteem and social anxiety inventories. A generalised estimating equation was used for analysis. After training, subjects had a significant increase in assertiveness immediately after the assertiveness training programme and one-month follow-up. There was a significant decrease in social anxiety after training, but the improvement was not significant after one month. Self-esteem did not increase significantly after training. With our sample of patients with mixed diagnoses, assertiveness seemed to be improved after assertiveness training. Patients would benefit more from the assertiveness training programme for the change in how they view themselves, improve their assertiveness, properly express their individual moods and thoughts and further establish self-confidence. The assertiveness training protocol could be provided as a reference guide to clinical nurses.

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

    PubMed Central

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

    2012-01-01

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

  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. Impact of a medical student alcohol intervention workshop using recovering alcoholics as simulated patients

    PubMed Central

    Johnson, J Aaron; Seale, J Paul; Shellenberger, Sylvia; Velasquez, Mary M; Alick, Candice; Turk, Katherine

    2014-01-01

    Background Alcohol screening and brief intervention (SBI) reduces drinking among at-risk drinkers. Lack of training and negative attitudes represents a barrier to SBI performance. This study evaluates the impact of a medical student workshop using recovering alcoholics in simulated patient interviews to teach SBI skills. Methods Third-year students (n=94) were surveyed before and after a 3-hour alcohol SBI workshop regarding their perceived importance and confidence in performing eleven SBI behaviors. Students were also asked to list factors increasing and decreasing motivation to conduct SBI. Students completing off-campus rotations (n=71) served as controls, completing surveys during the same time period but without attending the workshop. Results Analysis of variance found a significant interaction effect between the students participating in the workshop and control students on both importance scores [F(2,174)=3.34] and confidence scores [F(2,174)=9.13], indicating higher scores for the workshop students at the follow-up time periods. Commonly listed motivators for performing SBI included clinical experience with alcohol misuse and the impact of alcohol on health and relationships. High relapse rates and patient reactions to questions about alcohol use decreased the motivation to perform SBI. Conclusion SBI workshops that include recovering alcoholics as simulated patients can produce long-term improvements in students’ perceived importance and confidence in performing SBI. PMID:24855409

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

    PubMed

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

    2014-07-09

    To evaluate how community pharmacists manage patients with anaphylaxis. A randomised, cross-sectional, simulated patient study of community pharmacist practice. 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. 300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen). Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis). 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). 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). Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis action plans. Pharmacists who had a more comprehensive discussion about anaphylaxis

  6. 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

  7. Patient evaluation of the redesigned follitropin alfa pen injector.

    PubMed

    Schertz, Joan; Worton, Hilary

    2017-04-01

    We aimed to evaluate the overall impressions of learning and subsequent use of the redesigned GONAL-f® (follitropin alfa) pen injector by women with recent or current infertility requiring assisted reproductive technologies (ART) or in vitro fertilization (IVF). This was a simulated-use study including 86 women with infertility and 30 fertility nurses. Nurses trained the women on the use of the redesigned pen. The opinions of the women on the pen injector were collected during a questionnaire interview. Fertility nurse opinions on patient anxiety were collected before training. The pen injector was considered easy to learn to use and easy to use, particularly setting the dose and reading the number on the dial. After training, most women felt confident they could self-administer medication without further training. Most women would recommend the redesigned pen injector to friends and family requiring IVF treatment. Overall, fertility nurses overestimated how anxious the women would be when using the pen injector. This study demonstrated that both IVF/ART-experienced and -naïve women with infertility found the redesigned pen injector easy to learn to use and to use.

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

    PubMed

    Denham, Charles R; Guilloteau, Franck R

    2012-09-01

    The ultimate objective of this program is to provide an approach to understanding and communicating health-care harm and cost to compel health-care provider leadership teams to vote "yes" to investments in patient safety initiatives, with the confidence that clinical, financial, and operational performance will be improved by such programs. Through a coordinated combination of literature evaluations, careful mapping of high impact scenarios using simulated patients and consensus review of clinical, operational, and financial factors, we confirmed value in such approaches to decision support information for hospital leadership teams to invest in patient safety projects. The study resulted in the following preliminary findings: ·Communication between hospital quality and finance departments