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Sample records for simulated patients evaluation

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

    NASA Astrophysics Data System (ADS)

    Byrd, Kenneth A.; Yauger, Sunny

    2012-06-01

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

  2. 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

  3. A data-integrated simulation model to evaluate nurse-patient assignments.

    PubMed

    Sundaramoorthi, Durai; Chen, Victoria C P; Rosenberger, Jay M; Kim, Seoung Bum; Buckley-Behan, Deborah F

    2009-09-01

    This research develops a novel data-integrated simulation to evaluate nurse-patient assignments (SIMNA) based on a real data set provided by a northeast Texas hospital. Tree-based models and kernel density estimation (KDE) were utilized to extract important knowledge from the data for the simulation. Classification and Regression Tree models, data mining tools for prediction and classification, were used to develop five tree structures: (a) four classification trees from which transition probabilities for nurse movements are determined, and (b) a regression tree from which the amount of time a nurse spends in a location is predicted based on factors such as the primary diagnosis of a patient and the type of nurse. Kernel density estimation is used to estimate the continuous distribution for the amount of time a nurse spends in a location. Results obtained from SIMNA to evaluate nurse-patient assignments in Medical/Surgical unit I of the northeast Texas hospital are discussed.

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. 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…

  11. 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.

  12. 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…

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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

  19. 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).

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. A computer management system for patient simulations.

    PubMed

    Finkelsteine, M W; Johnson, L A; Lilly, G E

    1991-04-01

    A series of interactive videodisc patient simulations is being used to teach clinical problem-solving skills, including diagnosis and management, to dental students. This series is called Oral Disease Simulations for Diagnosis and Management (ODSDM). A computer management system has been developed in response to the following needs. First, the sequence in which students perform simulations is critical. Second, maintaining records of completed simulations and student performance on each simulation is a time-consuming task for faculty. Third, the simulations require ongoing evaluation to ensure high quality instruction. The primary objective of the management system is to ensure that each student masters diagnosis. Mastery must be obtained at a specific level before advancing to the next level. The management system does this by individualizing the sequence of the simulations to adapt to the needs of each student. The management system generates reports which provide information about students or the simulations. Student reports contain demographic and performance information. System reports include information about individual patient simulations and act as a quality control mechanism for the simulations.

  5. 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

  6. "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…

  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. 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

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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…

  16. 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

  17. 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.

  18. [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).

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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)

  16. 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.

  17. 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.

  18. 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…

  19. 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.

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

    ERIC Educational Resources Information Center

    Shellman, Stephen M.; Turan, Kursad

    2006-01-01

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

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. 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…

  8. Field Evaluation of a General Purpose Simulator.

    ERIC Educational Resources Information Center

    Spangenberg, Ronald W.

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

  9. 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.

  10. 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…

  11. 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…

  12. 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.

  13. 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.

  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. 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.

  16. 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

  17. 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…

  18. 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.

  19. 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

  20. 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.

  1. Energy Navigation: Simulation Evaluation and Benefit Analysis

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  2. 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

  3. 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.

  4. 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.

  5. Evaluating a Cross-Continent EU Simulation

    ERIC Educational Resources Information Center

    Jones, Rebecca

    2008-01-01

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

  6. 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

  7. 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

  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. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.…

  16. 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)

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. Evaluation of atopy in patients with COPD*

    PubMed Central

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

    2013-01-01

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

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  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. 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

  15. 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…

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  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. 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.

  7. 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…

  8. 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.

  9. [Does simulator-based team training improve patient safety?].

    PubMed

    Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

    2013-10-01

    Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

  10. 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…

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. 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.

  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. 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. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. [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].

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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)

  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. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 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.

  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.; Kamae, Y.; Zhang, Z.; Abe-Ouchi, A.; Chandler, M. A.; Jost, A.; Lohmann, G.; Otto-Bliesner, B. L.; Ramstein, G.; Ueda, H.

    2014-01-01

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

  14. 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

  15. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2009-08-01

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

  17. 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.

  18. 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.

  19. 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…

  20. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2004-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2005-05-01

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

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

    NASA Astrophysics Data System (ADS)

    Jackson, Hank D., II; 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.

  4. 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.

  5. 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

  6. A data-integrated simulation-based optimization for assigning nurses to patient admissions.

    PubMed

    Sundaramoorthi, Duraikannan; Chen, Victoria C P; Rosenberger, Jay M; Kim, Seoung Bum; Buckley-Behan, Deborah F

    2010-09-01

    The health care system in the United States has a shortage of nurses. A careful planning of nurse resources is needed to ease the health care system from the burden of the nurse shortage and standardize nurse workload. An earlier research study developed a data-integrated simulation to evaluate nurse-patient assignments (SIMNA) at the beginning of a shift based on a real data set provided by a northeast Texas hospital. In this research, with the aid of the same SIMNA model, two policies are developed to make nurse-to-patient assignments when new patients are admitted during a shift. A heuristic (HEU) policy assigns a newly-admitted patient to the nurse who has performed the least assigned direct care among all the nurses. A partially-optimized (OPT) policy seeks to minimize the difference in workload among nurses for the entire shift by estimating the assigned direct care from SIMNA. Results comparing HEU and OPT policies are presented.

  7. 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.

  8. 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

  9. 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…

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. [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.

  15. 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.

  16. Evaluating abuse in the patient with dementia.

    PubMed

    Tronetti, Pamela

    2014-11-01

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

  17. [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.

  18. 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.

  19. 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

  20. 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

  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.

  2. 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.

  3. 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

  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. 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.

  6. 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.

  7. 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.

  8. 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…

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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…

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

    PubMed Central

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

    2012-01-01

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

  4. 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

  5. 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

  6. Laboratory evaluation of a bleeding patient.

    PubMed Central

    Wallerstein, R O

    1989-01-01

    Most causes of abnormal bleeding can be determined from a complete blood count including platelet count and bleeding, prothrombin, activated partial thromboplastin, and thrombin times. Occasionally, further evaluation is necessary, such as tests of factor XIII function, fibrinolysis, and vascular integrity. Possible diagnoses include disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, vitamin K deficiency, von Willebrand's disease, heparin-induced thrombocytopenia, acquired inhibitors of factor VIII, lupus anticoagulants, and coagulation disorders related to the acquired immunodeficiency syndrome. PMID:2660407

  7. 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…

  8. 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

  9. 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.

  10. Ultrasonic evaluation of patients with acute right upper quadrant pain.

    PubMed

    Laing, F C; Federle, M P; Jeffrey, R B; Brown, T W

    1981-08-01

    To define the role of ultrasound in evaluating acute right upper quadrant pain, a prospective study was performed on 52 patients having clinically suspected acute cholecystitis. Ultrasonographic determination of acute or chronic cholecystitis, or diagnosis of a normal gallbladder, was based on analysis of location of tenderness, calculi, sludge, and wall thickness. The diagnosis of acute cholecystitis (34.6% of patients) was based on the highly significant observations of focal gallbladder tenderness and calculi. Sludge and wall thickening were also statistically significant, but to a lesser degree. Cholelithiasis allowed differentiation of patients with chronic cholecystitis (32.7%) from patients with normal gallbladders (32.7%). Neither of these two groups had significant focal gallbladder tenderness, sludge, or thickened walls. Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.

  11. 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

  12. Early evaluation and resuscitation of the pediatric trauma patient.

    PubMed

    DeRoss, Anthony L; Vane, Dennis W

    2004-05-01

    Trauma is the leading case of death for children in the United States. Effective initial resuscitation of pediatric trauma patients can reduce mortality. Guidelines have been developed to facilitate patient care in a systematic and productive manner. Advances have been made in both diagnostic and therapeutic methods. The evaluation and treatment of trauma patients will continue to engage pediatric surgeons as efforts in trauma prevention become more successful.

  13. 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

  14. 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.

  15. 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.

  16. The dyspeptic syndrome in migraine: morphofunctional evaluation on 53 patients.

    PubMed

    Centonze, V; Polito, B M; Cassiano, M A; Doronzo, F; Ricchetti, G; Portincasa, P; Bassi, A; Albano, O

    1996-01-01

    The authors, in order to evaluate the important role of gastrointestinal dysfunction during the migraine attack, have studied 53 patients with migraine without aura during the asymptomatic stage between attacks. Patients were examined functionally with a pH meter test of the gastroesophageal tract over 24 hours and morphologically with esophagogastroduodenoscopy. The results of this study point out that in a high percentage of patients with migraine, both evaluations are normal. The authors suggest the possibility of detecting, even hypothetically, an alteration of the common neurotransmitter substrate in the origin of migraine attacks and accompanying symptoms.

  17. 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.

  18. 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

  19. Lunate implant arthroplasty. Evaluation of 19 patients.

    PubMed

    Eiken, O; Necking, L E

    1984-01-01

    The results of lunate implant arthroplasty are unpredictable and many untoward postoperative problems are encountered. A retrospective review of 19 patients operated on for lunatomalacia (Kienböck's disease) by Silastic (HP) implant arthroplasty suggests that prevention of postoperative scapholunate dissociation seems to be the key to successful results. Knowledge of the predominant role played by the palmar ulnolunate and radiolunate ligaments is important to the understanding of this mechanism. The intrinsic stability accomplished by the geometry of the carpal bones requires adequate ligamentous support. This restraint, however, may be weakened by pre-existing absence of certain palmar fibres, by the disease process or by the surgery. In the present study three operative methods have been assessed: dorsal approach and implant stem fixation; dorsal approach, removal of implant stem and Kirschner-wire fixation; volar approach, removal of implant stem, no internal fixation but palmar capsuloligamentous reinforcement. Consistently good results have been obtained using the latter technique. It seems as if most of the usual postoperative problems of lunate implant arthroplasty can be avoided by this method which warrants continued trial.

  20. When and how to evaluate a patient with nephrolithiasis.

    PubMed

    Rivers, K; Shetty, S; Menon, M

    2000-05-01

    Nephrolithiasis is a common disorder that afflicts up to 12% of the population and continues to be a significant cause of patient injury. Evaluation of these patients should include the assessment of their comorbidities and underlying medical conditions. Patients who form stones can undergo a streamlined evaluation. A cause can be found in more than 90% of these patients. With medical treatment, stone-recurrence rates can be decreased by 85% for calcium oxalate stone formation, which affects a large proportion of patients. Introduction of nonspecific medical therapy in uncomplicated calcium stone disease may improve the quality of life for these patients and allow utilization a simple diagnostic protocol. This is in contrast to the previous recommendations of disease-specific therapy. Because patients without complications represent the majority of those who form stones, a simplified approach greatly reduces the cost of evaluation and treatment. Underlying medical conditions, however, require disease-specific therapy. The protocol represented here should aid physicians and patients in the approach to management of stone disease. The fasting calcium-load test is not required, and the entire evaluation can be performed in an ambulatory setting in two visits. Two 24-hour urine samples should be obtained on a random and restricted diet. Patients who form calcium stones can be subdivided into those who form hypercalciuric and normocalciuric stones. Patients who form normocalciuric stones are treated with conservative measures (increased fluid intake) and potassium and magnesium citrate. Patients who form hypercalciuric stones are treated with a combination of thiazides and potassium and magnesium citrate.

  1. Improving patient information leaflets: developing and applying an evaluative model of patient-centredness for text.

    PubMed

    Fage-Butler, Antoinette

    2013-01-01

    The purpose of this paper is to present an evaluative model of patient-centredness for text and to illustrate how this can be applied to patient information leaflets (PILs) that accompany medication in the European Union. Patients have criticized PILs for sidelining their experiences, knowledge and affective needs, and denying their individuality. The health communication paradigm of patient-centredness provides valuable purchase on these issues, taking its starting point in the dignity and integrity of the patient as a person. Employing this evaluative model involves two stages. First, a Foucauldian Discourse Analysis is performed of sender and receiver and of the main discourses in PILs. These aspects are then evaluated using the perspectives of patient-centredness theory relating to the medical practitioner, patient and content. The evaluative model is illustrated via a PIL for medication for depression and panic attacks. Evaluation reveals a preponderance of biomedical statements, with a cluster of patient-centred statements primarily relating to the construction of the patient. The paper contributes a new method and evaluative approach to PIL and qualitative health research, as well as outlining a method that facilitates the investigation of interdiscursivity, a recent focus of critical genre analysis.

  2. 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

  3. [Medical evaluation of the climacteric patient].

    PubMed

    Forsbach, G; Lozano, P; Pinto, E; González, O; Calderón, L; Martínez, R; Martínez, G

    1995-10-01

    A pilot program with primary care physicians was established in Clinica Cuauhtémoc y Famosa, focused to evaluate women older than 35 years with climateric symptoms. This program included a survey, a complete gynecological examination with Pap smears, ultrasound pelvic examination and mamography. Also, blood samples were collected for cholesterol, tryglycerides, calcium, phosphorus and alkaline phosphatase. An ECG, bone densitometry of the radius and X-rays of the vertebral column were obtained. This group was formed by 69 women with an age media of 50 years (SD 7.6 years, median 49 years). The survey disclosed that 34/65 women had been hysterectomized, and only 34/64 had received antitetanic immunization in the last 10 years. A preexistent chronic disease occurred in 36/59 women, these were diabetes mellitus, arterial hypertension or degenerative osteoarthritis. Alcohol consumption was recorded in 5/66 women and tabac consumption in 9/66 women, and 32/68 women accepted to be sedentary. Laboratory examinations disclosed hypercholesterolemia in 19/66 women and hypertryglyceridemia in 8/64 women. Osteopenia was detected in 33/60 women. This findings support a systematic plan to provide medical assistance for women in this age, specially if previous epidemiologycal studies have disclosed that coronary disease is the main cause of death for women older than 50 years in this region, that also belongs to the area of highest incidence of diabetes.

  4. 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

  5. Auditorium acoustics evaluation based on simulated impulse response

    NASA Astrophysics Data System (ADS)

    Wu, Shuoxian; Wang, Hongwei; Zhao, Yuezhe

    2001-05-01

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

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

    PubMed

    Oquendo, M A

    1996-06-01

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

  7. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    PubMed Central

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

    2015-01-01

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

  8. Evaluation of patient satisfaction with physical therapy following primary THA.

    PubMed

    Issa, Kimona; Naziri, Qais; Johnson, Aaron J; Memon, Talha; Dattilo, Jonathan; Harwin, Steven F; Mont, Michael A

    2013-05-01

    Physical therapy following total hip arthroplasty (THA) is intended to maximize a patient's range of motion and function and improve the quality of life. No universally accepted standard of care exists for physical therapy among physicians or therapists. However, it may be crucial to enhance efforts to more fully elucidate contributing parameters that affect patient experiences. The purpose of this study was to evaluate various factors contributing to patient satisfaction with postoperative physical therapy. One hundred consecutive patients (110 hips) who underwent THA were prospectively surveyed for satisfaction with postoperative physical therapy. All surveys were filled out anonymously by the patients, and investigators were blinded to clinical outcomes and who was surveyed. Seventy-six percent of patients reported being satisfied with their rehabilitation experiences. Factors, including patient age and sex, duration of therapy, number of patients per session, continuity of care with the same therapist, amount of hands-on time spent with the therapist, number of patients per session, and total number of sessions completed, were significantly correlated with patient satisfaction. Co-pay amount did not significantly affect patient satisfaction. These factors may be underappreciated by physicians and physical therapists. To maximize patient satisfaction with physical therapy, physicians should identify institutions whose therapists are willing to spend adequate hands-on time during one-on-one or small-group sessions while maintaining the greatest possible continuity of care with a single provider.

  9. Evaluation of an antipsychotic information sheet for patients.

    PubMed

    Whiskey, Eromona; Taylor, David

    2005-01-01

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

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

    ERIC Educational Resources Information Center

    Garson, G. David

    2009-01-01

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

  12. 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.

  13. 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…

  14. 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.

  15. 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.

  16. Evaluation of the Quality of Online Information for Patients with Rare Cancers: Thyroid Cancer.

    PubMed

    Kuenzel, Ulrike; Monga Sindeu, Tabea; Schroth, Sarah; Huebner, Jutta; Herth, Natalie

    2017-01-24

    The Internet offers an easy and quick access to a vast amount of patient information. However, several studies point to the poor quality of many websites and the resulting hazards of false information. The aim of this study was to assess quality of information on thyroid cancer. A patients' search for information about thyroid cancer on German websites was simulated using the search engine Google and the patient portal "Patienten-Information.de". The websites were assessed using a standardized instrument with formal and content aspects from the German Cancer Society. Supporting the results of prior studies that analysed patient information on the Internet, the data showed that the quality of patient information on thyroid cancer is highly heterogeneous depending on the website providers. The majority of website providers are represented by media and health providers other than health insurances, practices and professionals offering patient information of relatively poor quality. Moreover, most websites offer patient information of low-quality content. Only a few trustworthy, high-quality websites exist. Especially Google, a common search engine, focuses more on the dissemination of information than on quality aspects. In order to improve the patient information from the Internet, the visibility of high-quality websites must be improved. For that, education programs to improve patients' eHealth literacy are needed. A quick and easy evaluation tool for online information suited for patients should be implemented, and patients should be taught to integrate such a tool into their research process.

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  19. An evaluation of nursing care in cancer patients.

    PubMed

    Karadeniz, G; Yanikkerem, E; Altiparmak, S; Sevil, U; Ertem, G; Esen, A

    2004-01-01

    The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p < 0.05). The majority of the cancer patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.

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

    ERIC Educational Resources Information Center

    McCoy, Lise

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  2. 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…

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  4. 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.

  5. Perspective: authentic patient perspectives in simulations for procedural and surgical skills.

    PubMed

    Nestel, Debra; Kneebone, Roger

    2010-05-01

    In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

  6. Evaluation of Thrombin Generation Assay in Patients With Hemophilia.

    PubMed

    Haghpanah, Sezaneh; Bazrafshan, Asghar; Silavizadeh, Samir; Dehghani, Javad; Afrasiabi, Abdolreza; Karimi, Mehran

    2016-05-01

    We evaluated the correlation between thrombin generation (TG) parameters with bleeding symptoms and disease severity in patients with hemophilia. In this cross-sectional study, 59 patients with hemophilia without inhibitors and regardless of their severity were randomly selected from southern Iran and TG assays were conducted. Bleeding score (BS) was calculated by performing a clinical evaluation using Tosetto questionnaire. Only lag time showed a statistically significant correlation with BS (rs = .316,P= .016). All TG parameters except peak showed association with disease severity (P< .05). Endogenous thrombin potential showed a significant correlation with factor activity level (rs = .459,P< .001). Both lag time and start tail showed significant negative correlations with factor activity level (rs = -0.488,P< .001 andrs = - .289,P< .026, respectively). Although most of the TG parameters evaluated were not significantly correlated with the BS of patients with hemophilia, the majority of TG parameters were significantly associated with factor activity level and disease severity.

  7. 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.

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

    PubMed Central

    Li, Li; Lin, Chunqing; Guan, Jihui

    2014-01-01

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

  9. Population pharmacokinetics and dosing simulations of cefepime in septic shock patients receiving continuous renal replacement therapy.

    PubMed

    Carlier, Mieke; Taccone, Fabio S; Beumier, Majorie; Seyler, Lucie; Cotton, Frédéric; Jacobs, Frédérique; Roberts, Jason A

    2015-10-01

    The aim of this study was to describe the population pharmacokinetics of cefepime in septic shock patients requiring continuous renal replacement therapy and to determine whether current or alternative dosing regimens can achieve PK/PD targets. In this observational PK study, 62 samples from 13 patients were analysed using non-linear mixed-effects modelling. Different dosing regimens were evaluated using Monte Carlo simulations with ultrafiltration flow rates (UFRs) of 1000, 1500 and 2000 mL/h. The probability of target attainment was calculated against a conservative (60% T(>MIC)) and a higher PK/PD target (100% T(>MIC)) against an MIC of 8 mg/L, the clinical susceptibility breakpoint for Pseudomonas aeruginosa. A one-compartment model with between-subject variability (BSV) on clearance and volume of distribution (V(d)) described the data adequately. UFR was supported as a covariate on both parameters. Typical values for clearance and V(d) were 4.4L/h (BSV 37%) and 40.9L (BSV 20%), respectively. Dosing simulations showed failure to achieve both a conservative and a higher PK/PD target using a dose of 1g q12h for patients treated with a high UFR (≥1500 mL/h). The dose of 2g q8h or 1g q6h leads to optimal target attainment for high UFR. One gram q8h is optimal for low UFR (≤1000 mL/h). We found important variability in PK parameters. Dosing simulations show that a dose of 2g q8h or 1g q6h is needed to ensure rapid achievement of adequate levels if the UFR is ≥1500 mL/h and 1g q8h for low UFR (≤1000 mL/h).

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

    PubMed Central

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

    2013-01-01

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

  11. 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.

  12. 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.

  13. 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

  14. Evaluation of Heart Function in Patients With Hemophilia.

    PubMed

    Amoozgar, Hamid; Fath, Maedeh; Jooya, Parisa; Karimi, Mehran

    2015-11-04

    There are conflicting reports about the protective effect of hemophilia on the occurrence of ischemic heart disease. This study focuses on evaluation of heart function in patients with hemophilia. Cross-sectional, case-control study was done on all patients with hemophilia A or B who came to hemophilia center, and data were compared to controls. The data were collected from their charts, and heart function was evaluated by 2-dimensional, Doppler and pulse tissue Doppler. The serum troponin I level was measured in all patients as a marker of myocardial damage. Fifty patients with hemophilia took part in this study. All of them were male with mean age 29.1 years. Systolic blood pressure (mean = 121.52 ± 11 vs 115.61 ± 9.81, P = .038) and diastolic (mean = 81.94 ± 4.51 vs 75.21 ± 3.95, P = .042) blood pressure were higher in the patients. Five (10%) patients had systolic hypertension and 7 (14%) patients had diastolic hypertension. The M-mode echocardiography results showed that interventricular septum in diastole in patients with hemophilia (mean 1.143 ± 0.29) was significantly thicker than the control group (mean 0.828 ± 0.22, P < .001). Tissue Doppler echocardiography showed that late diastolic velocity of septum (Aa; P = .030), systolic velocity (S) of lateral mitral valve (P = .006), late diastolic velocity of lateral mitral (Aa) annulus (P = .038), and late velocity of (Aa) tricuspid (P = .004) had significant difference compared with the control group (P < .05). Troponin enzyme level was < 0.1 in all patients. Patients with hemophilia had higher blood pressure and more hypertension. Echocardiographic study of patients with hemophilia showed some increase in septal thickness and changes in diastolic dysfunction.

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

    PubMed

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

    2016-03-01

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

  16. 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.

  17. 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.

  18. 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

  19. Evaluation and treatment of fever in intensive care unit patients.

    PubMed

    Ferguson, Anne

    2007-01-01

    Fever is a common complaint in hospitalized patients, with estimates that more than 30% of ward patients and as much as 90% of critically ill patients will experience fever. Much of the treatment of fever, however, is based on tradition and the belief the fever is harmful to the patient rather than on scientific evidence. There is a need to determine via analysis of the literature the best evidence-based approach to the identification and treatment of fever with attention to appropriate measurement of body temperature, diagnostic evaluation, changing of indwelling catheters, administration of antipyretics, and alteration in antimicrobial therapy. The advanced practice nurse is uniquely capable of gathering this evidence and implementing a plan of care that meets the individual needs of the patient, family, nursing staff, and healthcare system.

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

    PubMed

    Huet, Matthieu

    2013-05-01

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

  1. Evaluation of patients with intracranial tumors and central diabetes insipidus.

    PubMed

    Varan, Ali; Atas, Erman; Aydın, Burça; Yalçın, Bilgehan; Akyüz, Canan; Kutluk, Tezer; Büyükpamukçu, Münevver

    2013-10-01

    The aim of the study is to evaluate the etiologic and clinical characteristics, treatment regimens, and outcome of the patients with intracranial tumors presenting with central diabetes insipidus (DI). Sixty-nine patients with intracranial tumors presenting with central DI between 1972 and 2012 were retrospectively evaluated. Fifty-three out of 69 patients were included in the analysis. Male/female ratio was 1.52, median age was 7.6 years. Of 53 patients, 37 patients (69.8%) were diagnosed with Langerhans cell histiocytosis, 14 patients (26.4%) with germinoma, 1 (1.9%) with astrocytoma, and 1 (1.9%) with optic glioma. 10-year overall survival (OS) rate and disease-free survival rate for all patients were 91.7% and 52%. 10-year OS rate according to diagnostic criteria was 91% for Langerhans cell histiocytosis (LCH) cases, 79% for intracranial germinoma, which was statistically significant (P = .0001). Central DI may be very important clinical presentation of serious underlying disease in children. Intracranial tumors are the most frequent cause of DI. Most frequent diagnosis were LCH and germ cell tumors in our series.

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

    PubMed Central

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

    2015-01-01

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

  3. Patient-Specific Simulation of Cardiac Blood Flow From High-Resolution Computed Tomography.

    PubMed

    Lantz, Jonas; Henriksson, Lilian; Persson, Anders; Karlsson, Matts; Ebbers, Tino

    2016-12-01

    Cardiac hemodynamics can be computed from medical imaging data, and results could potentially aid in cardiac diagnosis and treatment optimization. However, simulations are often based on simplified geometries, ignoring features such as papillary muscles and trabeculae due to their complex shape, limitations in image acquisitions, and challenges in computational modeling. This severely hampers the use of computational fluid dynamics in clinical practice. The overall aim of this study was to develop a novel numerical framework that incorporated these geometrical features. The model included the left atrium, ventricle, ascending aorta, and heart valves. The framework used image registration to obtain patient-specific wall motion, automatic remeshing to handle topological changes due to the complex trabeculae motion, and a fast interpolation routine to obtain intermediate meshes during the simulations. Velocity fields and residence time were evaluated, and they indicated that papillary muscles and trabeculae strongly interacted with the blood, which could not be observed in a simplified model. The framework resulted in a model with outstanding geometrical detail, demonstrating the feasibility as well as the importance of a framework that is capable of simulating blood flow in physiologically realistic hearts.

  4. 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

  5. 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.

  6. 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.

  7. USING COMPUTATIONAL PATIENTS TO EVALUATE ILLNESS MECHANISMS IN SCHIZOPHRENIA

    PubMed Central

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

    2011-01-01

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

  8. 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.

  9. 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.

  10. Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

    PubMed

    Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

    2015-06-01

    Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.

  11. Evaluating Functional Decline in Patients with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Rosenblum, Sara; Weiss, Patrice L.

    2010-01-01

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

  12. Evaluation of Ocular Movements in Patients with Dyslexia

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  13. Evaluation of Care Provided to Terminally Ill Patients.

    ERIC Educational Resources Information Center

    Loomis, Margaret T.; Williams, T. Franklin

    1983-01-01

    Studied the quality of terminal care in 40 patients in an acute care facility and a chronic care facility. Minimial difficulty was observed in making the transition from active to comfort care. An evaluation method and a model of terminal care emphasizing improved communication and emotional support are proposed. (Author/JAC)

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

    EPA Science Inventory

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

  15. 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.

  16. 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

  17. 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…

  18. 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.

  19. Otologic evaluation of patients with primary antibody deficiency.

    PubMed

    Magliulo, Giuseppe; Iannella, Giannicola; Granata, Guido; Ciofalo, Andrea; Pasquariello, Benedetta; Angeletti, Diletta; La Marra, Fabiola; Quinti, Isabella

    2016-11-01

    Common variable immunodeficiency (CVID) represents the most frequent primary immunodeficiency, often encountered in the ENT clinical practice. The clinical spectrum of CVID is quite broad, but otitis media are certainly among the most common clinical manifestations. This prospective study enrolled 60 patients (34 males, 26 females) with a previous diagnosis of CVID with the aim of performing an otologic evaluation and a more precision characterization of incidence, diagnosis, and treatment of otitis media in this group of patients. In consideration that Eustachian tube dysfunction (ETD) could be the 'primum movens' of otitis media, we wanted to assess whether a Eustachian tube dysfunction was present in these patients. Besides, we propose a possible diagnostic algorithm of middle ear pathologies to use in all cases of primary antibody deficiency patients. Results of our otologic examination showed that: 5 % of patients had chronic suppurative otitis media, 25 % bilateral otitis media with effusion and 10 % reported unilateral OME with associated contralateral ETD. There was bilateral isolated ETD and unilateral isolated ETD in 5 and 15 % of patients, respectively. All patients with unilateral OME had associated contralateral ETD. Finally, 40 % of patients were bilaterally negative at otoscopic examination and all otologic tests.

  20. UTI: diagnosis and evaluation in symptomatic pediatric patients.

    PubMed

    Heldrich, F J; Barone, M A; Spiegler, E

    2000-08-01

    We retrospectively reviewed data on 260 hospitalized pediatric patients with symptomatic urinary tract infection (UTI). To ascertain the colony-forming units (CFU)/mL compatible with the diagnosis of UTI, a culture from a catheterized urine specimen containing >1,000 CFU/mL was considered diagnostic of UTI and resulted in imaging by renal ultrasound, voiding cystourethrography, and renal nuclear scan with Tc99m dimercaptosuccinic acid (DMSA). A positive DMSA renal scan is indicative of pyelonephritis. We used logistic regression analysis to determine which patient characteristics were predictive of pyelonephritis. We determined that, in hospitalized pediatric patients, the colony count of the positive urine culture, the type of organism grown in culture, and the voiding cystourethrography (VCUG) result (positive or negative for vesicoureteral reflux) did not predict which patients had pyelonephritis. In females, advancing age of the patient and positive renal ultrasound results were predictive of which patients had pyelonephritis when we controlled for other factors. We feel this emphasizes the importance of a thorough evaluation of hospitalized symptomatic patients, including patients with colony counts of 1,000 to 50,000 CFU/mL, to locate the level of infection and plan appropriate therapy.

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

    PubMed

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

    2016-08-12

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

  2. Evaluation of dry eye findings in patients with vitiligo

    PubMed Central

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  4. Simulating Four Essential Conversations with Hematology/Oncology Trainees: a Qualitative Evaluation.

    PubMed

    Arnaoutakis, Konstantinos; Anders, Michael; Berry, Katherine

    2016-03-01

    Hematologists/oncologists have a crucial responsibility to effectively communicate with patients. However, they have been criticized for ineffective communication with patients. To develop effective communication behaviors that meet the needs of patients and families, trainees need practice and feedback about their performance. Medical faculties frequently teach communication skills using simulation-based curricula; however, they often include only general communication skills, without tailored approaches for specialties. This study examined Hematology/Oncology trainees' qualitative perceptions about the value of and techniques used for simulations of specialty specific, essential conversations with patients and families, and debriefing sessions. Results demonstrate a highly effective curriculum and positive learner experiences. While most reports on this topic take place within major academic cancer centers, outcomes from a mid-sized Hematology/Oncology training program are unknown. The study confirms feasibility for implementing a simulation-based communications program in a mid-sized Hematology/Oncology program and describes simulation techniques that were effective.

  5. Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

    PubMed

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

    2016-04-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

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

    SciTech Connect

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

    2015-04-24

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

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

  10. Verification and Evaluation of Aquatic Contaminant Simulation Module (CSM)

    DTIC Science & Technology

    2016-08-01

    existing hydrologic and hydraulic (H&H) models. The CSM computes internal source and sinks for a wide range of contaminants for both water column and...River Analysis System (HEC-RAS) (HEC 2010a, b) and Soil and Water Assessment Tool (SWAT) (Arnold et al. 1998, Neitsch et al. 2011). It will also be...RECOVERY model (Boyer et al. 1994, Ruiz et al. 2000) and Water - quality Analysis Simulation Program (WASP) model (Wool et al. 2006). This technical note (TN

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

    SciTech Connect

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

    2013-01-01

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

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

    PubMed

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

    2006-01-01

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

  13. Development of an atmospheric turbulence simulator for deformable mirror evaluation

    NASA Astrophysics Data System (ADS)

    Lee, Jun Ho; Shin, Sunmi; Rhee, Hyug-Gyo; Yang, Ho-Soon; Lee, Ho-Jae

    2016-10-01

    Currently we are developing a 10 cm silicon carbide (SiC) deformable mirror with 37 actuators operating at 500 Hz. The deformable mirror will be applied in a 1.5 m telescope. An adaptive optics system capability for the deformable mirror was simulated and performance was predicted based on the Kolmogorov atmospheric turbulence model. However, in order to confirm the predictions, a closed-loop adaptive optics system was constructed with the insertion of an atmospheric turbulence simulator consisting of two point sources, a Boston deformable mirror, and double random phase plates. In order to simulate a binary star, the two point sources are mounted on 3-axis micron meter stages and are optically merged into a single beam path by a beam splitter cube. The light intensity of each source is adjustable to a corresponding stellar magnitude, while the angular separation can be precisely adjusted by moving the 3-axis stages. The atmospheric disturbance is generated by shaping the Boston deformable mirror and also by rotating the double phase plates. The Fried parameter of the generated the atmospheric disturbance corresponds to an area from 7 to 15 cm at 500 nm at the telescope pupil plane, which represents typical seeing conditions at the Bohyun observatory, South Korea.

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

    PubMed

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

    2013-01-08

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

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

    SciTech Connect

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

    2014-06-01

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

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

    PubMed Central

    Ayyildiz, Simel; Emir, Faruk; Sahin, Cem

    2015-01-01

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

  17. Psychological distress in patients presenting for initial renal transplant evaluation.

    PubMed

    Kuntz, Kristin K; Bonfiglio, Diane B V

    2011-09-01

    The comorbidity of psychological disorders with end-stage renal disease (ESRD) presents challenges for renal transplantation, including increased likelihood of medication noncompliance and poorer quality of life. Estimates of rates and severity of affective and anxiety disorders have varied significantly across studies of renal transplant patients, possibly due in part to variation in the methodology and timing of evaluations. To this point, few researchers have examined the psychological condition of patients who are newly referred for renal transplantation. This study examined rates of psychological distress using the Patient Health Questionnaire (PHQ) in a sample of 518 ESRD patients at the specific time point of first contact with the transplant center. In this sample, 15.1% of patients endorsed symptoms consistent with a depressive condition and 7.6% of patients endorsed an anxiety condition. These rates were lower than expected, which may be due to decreased distress in this sample, selection biases, or underreporting of symptoms due to patients' motivation to present themselves positively.

  18. Performance evaluation of Biograph PET/CT system based on Monte Carlo simulation

    NASA Astrophysics Data System (ADS)

    Wang, Bing; Gao, Fei; Liu, Hua-Feng

    2010-10-01

    Combined lutetium oxyorthosilicate (LSO) Biograph PET/CT is developed by Siemens Company and has been introduced into medical practice. There is no septa between the scintillator rings, the acquisition mode is full 3D mode. The PET components incorporate three rings of 48 detector blocks which comprises a 13×13 matrix of 4×4×20mm3 elements. The patient aperture is 70cm, the transversal field of view (FOV) is 58.5cm, and the axial field of view is 16.2cm. The CT components adopt 16 slices spiral CT scanner. The physical performance of this PET/CT scanner has been evaluated using Monte Carlo simulation method according to latest NEMA NU 2-2007 standard and the results have been compared with real experiment results. For PET part, in the center FOV the average transversal resolution is 3.67mm, the average axial resolution is 3.94mm, and the 3D-reconstructed scatter fraction is 31.7%. The sensitivities of the PET scanner are 4.21kcps/MBq and 4.26kcps/MBq at 0cm and 10cm off the center of the transversal FOV. The peak NEC is 95.6kcps at a concentration of 39.2kBq/ml. The spatial resolution of CT part is up to 1.12mm at 10mm off the center. The errors between simulated and real results are permitted.

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

    NASA Technical Reports Server (NTRS)

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

    2008-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

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

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

    PubMed

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

    2014-07-18

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  4. Braiding Simulation and Slip Evaluation for Arbitrary Mandrels

    NASA Astrophysics Data System (ADS)

    Akkerman, Remko; Villa Rodríguez, Blasimir Hadir

    2007-04-01

    Braiding is a manufacturing process that is increasingly being used to manufacture pre-forms for Resin Transfer Moulding. A fast simulation method is presented for the prediction of the fibre distribution on complex braided parts and complex kinetic situations (e.g. changes in velocity, orientation). The implementation is suited for triangular surface representations as generated by many CAD software packages in use. Experimental results show that the results are sensitive to the friction conditions in particular regions. The friction conditions between the yarns and the mandrel are analysed, leading to the development of a slip indicator.

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

    SciTech Connect

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

    2009-11-18

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

  6. Simulation and evaluation of latent heat thermal energy storage

    NASA Technical Reports Server (NTRS)

    Sigmon, T. W.

    1980-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Mason, M. G.

    1975-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  9. Evaluation of rodded BWR assembly pin powers with simulate

    SciTech Connect

    Bahadir, T.; Lindahl, S. Oe.

    2012-07-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Rossler, Kelly Lynn

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

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

  13. Use of clinical simulations for patient education: targeting an untapped audience.

    PubMed

    Siwe, Karin; Berterö, Carina; Pugh, Carla; Wijma, Barbro

    2009-01-01

    In most cases, the health professional has been the target for simulation based learning curricula. We have developed a simulation based curriculum for patient education. In our curriculum lay-women learn how to perform the clinical female pelvic examination using a manikin-based trainer. Learner assessments show that prior negative expectations turned into positive expectations regarding future pelvic examinations.

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

    SciTech Connect

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

    2014-05-15

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

  15. Dual source CT (DSCT) imaging of obese patients: evaluation of CT number accuracy, uniformity, and noise

    NASA Astrophysics Data System (ADS)

    Walz-Flannigan, A.; Schmidt, B.,; Apel, A.; Eusemann, C.; Yu, L.; McCollough, C. H.

    2009-02-01

    Obese patients present challenges in obtaining sufficient x-ray exposure over reasonable time periods for acceptable CT image quality. To overcome this limitation, the exposure can be divided between two x-ray sources using a dualsource (DS) CT system. However, cross-scatter issues in DS CT may also compromise image quality. We evaluated a DS CT system optimized for imaging obese patients, comparing the CT number accuracy and uniformity to the same images obtained with a single-source (SS) acquisition. The imaging modes were compared using both solid cylindrical PMMA phantoms and a semi-anthropomorphic thorax phantom fitted with extension rings to simulate different size patients. Clinical protocols were used and CTDIvol and kVp were held constant between SS and DS modes. Results demonstrated good agreement in CT number between SS and DS modes in CT number, with the DS mode showing better axial uniformity for the largest phantoms.

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

    NASA Astrophysics Data System (ADS)

    Cassidy, Jeffrey; Betz, Vaughn; Lilge, Lothar

    2015-03-01

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

  17. Exercise instruments, schemes, and protocols for evaluating the dyspneic patient.

    PubMed

    Hansen, J E

    1984-02-01

    A number of exercise instruments, schemes, and protocols for evaluating the dyspneic patient are characterized. The cycle is safe, allows quantification of external work and work efficiency, and has less measurement artifact, whereas the treadmill allows a higher maximum oxygen uptake. Repeated measures of cardiorespiratory function at rest, during several minutes of warmup, and during work, with equal 1-min increments, to a symptom-limited maximum in approximately 10 min is an advantageous protocol.

  18. Evaluating simulated functional trait patterns and quantifying modelled trait diversity effects on simulated ecosystem fluxes

    NASA Astrophysics Data System (ADS)

    Pavlick, R.; Schimel, D.

    2014-12-01

    Dynamic Global Vegetation Models (DGVMs) typically employ only a small set of Plant Functional Types (PFTs) to represent the vast diversity of observed vegetation forms and functioning. There is growing evidence, however, that this abstraction may not adequately represent the observed variation in plant functional traits, which is thought to play an important role for many ecosystem functions and for ecosystem resilience to environmental change. The geographic distribution of PFTs in these models is also often based on empirical relationships between present-day climate and vegetation patterns. Projections of future climate change, however, point toward the possibility of novel regional climates, which could lead to no-analog vegetation compositions incompatible with the PFT paradigm. Here, we present results from the Jena Diversity-DGVM (JeDi-DGVM), a novel traits-based vegetation model, which simulates a large number of hypothetical plant growth strategies constrained by functional tradeoffs, thereby allowing for a more flexible temporal and spatial representation of the terrestrial biosphere. First, we compare simulated present-day geographical patterns of functional traits with empirical trait observations (in-situ and from airborne imaging spectroscopy). The observed trait patterns are then used to improve the tradeoff parameterizations of JeDi-DGVM. Finally, focusing primarily on the simulated leaf traits, we run the model with various amounts of trait diversity. We quantify the effects of these modeled biodiversity manipulations on simulated ecosystem fluxes and stocks for both present-day conditions and transient climate change scenarios. The simulation results reveal that the coarse treatment of plant functional traits by current PFT-based vegetation models may contribute substantial uncertainty regarding carbon-climate feedbacks. Further development of trait-based models and further investment in global in-situ and spectroscopic plant trait observations

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

    SciTech Connect

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

    2013-11-15

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

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

    SciTech Connect

    Biello, D.R.

    1987-06-19

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

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

    SciTech Connect

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

    1989-07-01

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

  2. [Patient admission: hospitality in the hospital--concept and evaluation].

    PubMed

    Vandenbulcke, C

    1999-06-01

    Welcoming is an everyday act, performed all day long, in different places. But, when it comes to welcoming a patient, it is a matter of health care, for which we are the only responsible. Since this person arrives in a place where his (her) body and mind are going to be ill-treated (s)he will be all the more receptive to his (her) new environment. Faced with feelings of fear, anguish, stress, the patient and ourselves try to establish a relationship made of confidence and a feeling of safety, which are necessary to his (her) integration. This will be achieved by means of verbal and non-verbal communication, by reducing or even getting round the obstacles. By studying this moment, this meeting, with different evaluation tools, I have been able to sort out the strong and weak points of my Institution, in order to propose adequate means of improvements, (creation of a team dynamics on this subject, working out of a definition, evaluation grids and application). The staff will thus be able to readjust his care as well as possible, at the level of the information to be given, and above all the attitude to adopt, in order to improve the quality of welcoming, as, eventually, it is what the patient will keep in mind and what he will use for his evaluation.

  3. Rapid evaluation of particle properties using inverse SEM simulations

    SciTech Connect

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

    2017-01-01

    The characteristic X-rays produced by the interactions of the electron beam with the sample in a scanning electron microscope (SEM) are usually captured with a variable-energy detector, a process termed energy dispersive spectrometry (EDS). The purpose of this work is to exploit inverse simulations of SEM-EDS spectra to enable rapid determination of sample properties, particularly elemental composition. This is accomplished using penORNL, a modified version of PENELOPE, and a modified version of the traditional Levenberg Marquardt nonlinear optimization algorithm, which together is referred to as MOZAIK-SEM. The overall conclusion of this work is that MOZAIK-SEM is a promising method for performing inverse analysis of X-ray spectra generated within a SEM. As this methodology exists now, MOZAIK-SEM has been shown to calculate the elemental composition of an unknown sample within a few percent of the actual composition.

  4. Rapid Evaluation of Particle Properties using Inverse SEM Simulations

    SciTech Connect

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

    2016-01-01

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

  5. Evaluation of leptin and insulin resistance in patients with cholelithiasis.

    PubMed

    Atamer, Aytaç; Ovünç, Ayşe Oya Kurdaş; Yeşil, Atakan; Atamer, Yildiz

    2013-08-01

    The association between insulin resistance, lipoproteins and leptin was evaluated in cholelithiasis. The study group included 55 women (68.8%) and 25 men (31.3%) with a mean age and SD of 50.56 +/- 14.28 yrs. The control group included 25 women (62.5%) and 15 men (37.5%) with a mean age of 50.93 +/- 11.73 yrs. Serum leptin levels were measured by the enzyme immunoassay method. HOMA-IR was determined by using fasting glucose and insulin levels. Insulin, total cholesterol (TC), LDL-C, HOMA-IR (p < 0.01) and leptin (p < 0.001) were significantly higher in the cholelithiasis group, compared to the controls. In patients with a HOMA-IR >2.2, age, body mass index (BMI), glucose, insulin, triglycerides (TG), TC and leptin levels were higher than in patients with a HOMA-IR < 2.2. In patients with glucose levels >100 mg/dl, mean BMI, HOMA-IR, insulin, TG, TC and leptin levels were significantly higher than in patients with glucose levels <100 mg/dl. In patients with TG levels >150 mg/dl, mean age, BMI, glucose, insulin, TC, leptin and HOMA-IR were significantly higher than in patients with TG levels < 150 mg/dl. In patients with BMI > 25 kg/m2, mean age, glucose, insulin, TG, TC, leptin, HOMA-IR were significantly higher than in patients with BMI < 25. In cholelithiasis group, there was a positive correlation between leptin and age, BMI, glucose, insulin, TG, TC, LDL-C or HOMA-IR. In conclusion, we found a positive association between increased leptin levels and abnormal lipoprotein metabolism in cholelithiasis. Cholelithiasis subjects with insulin resistance showed higher cardiometabolic risk factors than those without it.

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

    PubMed

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

    2015-12-01

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

  7. Evaluating the Linkage Between Emergency Medical Services and the Provision of Scarce Resources Through Simulation

    PubMed Central

    Klafehn, Keith A.; Owens, Deborah L.; Felter, Robert A.; Vonneman, Nancy; McKinnon, Carla J.

    1989-01-01

    A simulation model of the flow of patients in the emergency room of a pediatric hospital was used to investigate the linkage between the emergency medical services provided and the efficient mix of scarce resources. Specific attention was given to the results of the patient flows as they were affected by whether there was one or two triage nurses, the nurse complement for non-urgent patients, and the number of orthopedic groups available for diagnosis and prescription.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-08-25

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

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

    PubMed

    Gharibian, Katherine N; Mueller, Bruce A

    2016-07-01

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

  11. Motor Simulation during Action Word Processing in Neurosurgical Patients

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Dahlgren, J. B.

    1973-01-01

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

  13. [Evaluation of satisfaction of patients hospitalized at the Kairouan Hospital].

    PubMed

    Mtiraoui, Ali; Alouini, Borhane

    2002-03-01

    The patients' satisfaction studies are more and more utilized to underline the health centers' deficiencies and consequently set improvement action plans. Our survey aims to measure inpatients' satisfaction in its different dimensions. A survey centered around a transversal inquiry has been conducted during a period going from February to April 2000 and reached a total number of 817 patients hospitalized in six service units at kairouan hospital. The data has been gathered by structured interviews led by a previously trained social worker. The investigation tool was a standardized questionnaire prepared by a group of experts from WHO in the Oriental Mediterranean region. The main results are as follow: High satisfaction level concerning the global evaluation of the hospital service units was recorded (score = 70%). The patient who are more satisfied are those who have the feeling that their health situation has considerably improved, and who will probably recommend this hospital to their surroundings. Big proportion of the patients (77%) was expecting better services. The main reason behind their unhappiness is the information emanated whether from the nurses or the doctors, the comfort and the cleanness of waiting room, linen, room comfort, food and the emergency. These results showed that the quality of care improvements priorities, according to patient expectations are especially in relation with the quality of information, the relational aspects and the hospital stay conditions.

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

    PubMed

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

    2015-11-01

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

  15. [Evaluation and treatment of the critically ill cirrhotic patient].

    PubMed

    Fernández, Javier; Aracil, Carles; Solà, Elsa; Soriano, Germán; Cinta Cardona, Maria; Coll, Susanna; Genescà, Joan; Hombrados, Manoli; Morillas, Rosa; Martín-Llahí, Marta; Pardo, Albert; Sánchez, Jordi; Vargas, Victor; Xiol, Xavier; Ginès, Pere

    2016-11-01

    Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions.

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

    ERIC Educational Resources Information Center

    Hussin, Virginia

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Wilson, David L.

    1991-01-01

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

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

    ERIC Educational Resources Information Center

    Smith, Brian Daniel; Silk, Kami

    2011-01-01

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

  19. Teaching clinical reasoning and problem-solving skills using human patient simulation.

    PubMed

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

    2011-11-10

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

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

    SciTech Connect

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

    2013-02-15

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

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

    PubMed

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

    2010-01-01

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

  2. LWIR scene simulator developed for end-to-end performance evaluation of focal planes

    NASA Technical Reports Server (NTRS)

    Thompson, Niels A.; Bowser, William M.; Song, Sung H.; Skiff, Laura T.; Powell, William W.; Romero, Charles

    1992-01-01

    The development of a long-wave infrared optical simulator facilitates evaluation of the end-to-end performance of long wavelength infrared (LWIR) focal plane arrays (FPAs) in a system-like environment. This simulator provides selectable structured scene inputs to a focal plane module or array. Background irradiances as low as 10 exp 10 photons/sq cm s are achievable when the simulator is cooled with liquid helium. The optical simulator can generate single or multiple targets of controllable intensities, and uniform or structured background irradiances. The infrared scenes can be viewed in a stationary mode or dynamically scanned across the focal plane.

  3. Effectiveness of Simulation Preparation on Novice Nurses' Competence and Self-Efficacy in a Multiple-Patient Simulation.

    PubMed

    Franklin, Ashley E; Gubrud-Howe, Paula; Sideras, Stephanie; Lee, Christopher S

    2015-01-01

    This study examined the influence of three simulation preparation methods (expert modeling/intervention, voice-over PowerPoint/active control, and reading assignments/passive control) on improving novice nurses' competence and self-efficacy for providing care to multiple simulated patients. Both competence and self-efficacy were measured at baseline and following a five-week intervention. Twenty senior pre-licensure nursing students participated in the trial. One-way ANOVAs and parametric/nonparametric correlations were used. Voice-over PowerPoint and expert modeling resulted in greater improvements in self-efficacy compared with traditional reading assignments as simulation preparation. However, there was no relationship between change in competence and self-efficacy over time.

  4. Wargame Simulation Theory and Evaluation Method for Emergency Evacuation of Residents from Urban Waterlogging Disaster Area

    PubMed Central

    Chen, Peng; Zhang, Jiquan; Sun, Yingyue; Liu, Xiaojing

    2016-01-01

    Urban waterlogging seriously threatens the safety of urban residents and properties. Wargame simulation research on resident emergency evacuation from waterlogged areas can determine the effectiveness of emergency response plans for high risk events at low cost. Based on wargame theory and emergency evacuation plans, we used a wargame exercise method, incorporating qualitative and quantitative aspects, to build an urban waterlogging disaster emergency shelter using a wargame exercise and evaluation model. The simulation was empirically tested in Daoli District of Harbin. The results showed that the wargame simulation scored 96.40 points, evaluated as good. From the simulation results, wargame simulation of urban waterlogging emergency procedures for disaster response can improve the flexibility and capacity for command, management and decision-making in emergency management departments. PMID:28009805

  5. Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy

    PubMed Central

    Şenyurt, Mahmut; Aybek, Hulya; Herken, Hasan; Kaptanoglu, Bunyamin; Korkmaz, Ali

    2017-01-01

    Objective Electroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress. Methods Fourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs. Results TOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006). Conclusion As a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed. PMID:28138109

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

    PubMed Central

    2013-01-01

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

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

    EPA Science Inventory

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

  8. Enhancing clinical practice and education with high-fidelity human patient simulators.

    PubMed

    Peteani, Leigh Ann

    2004-01-01

    Research shows that students exhibit increased autonomy and self-confidence when delivering patient care after practicing first with high-fidelity human patient simulators (HPS). Practicing clinical skills on a high-fidelity HPS allows students to learn in a highly adaptable, safe educational environment that fosters autonomy, independence, and the development of sound analytical skills. The author discusses the use of patient simulators in nursing education, a definition of a high-fidelity HPS, and their value to clinical practice and education. A cost-effective example of how to acquire a high-fidelity HPS without going over budget is provided.

  9. Knee surgery assistance: patient model construction, motion simulation, and biomechanical visualization.

    PubMed

    Chen, J X; Wechsler, H; Pullen, J M; Zhu, Y; MacMahon, E B

    2001-09-01

    We present a new system that integrates computer graphics, physics-based modeling, and interactive visualization to assist knee study and surgical operation. First, we discuss generating patient-specific three-dimensional (3-D) knee models from patient's magnetic resonant images (MRIs). The 3-D model is obtained by deforming a reference model to match the MRI dataset. Second, we present simulating knee motion that visualizes patient-specific motion data on the patient-specific knee model. Third, we introduce visualizing biomechanical information on a patient-specific model. The focus is on visualizing contact area, contact forces, and menisci deformation. Traditional methods have difficulty in visualizing knee contact area without using invasive methods. The approach presented here provides an alternative of visualizing the knee contact area and forces without any risk to the patient. Finally, a virtual surgery can be performed. The constructed 3-D knee model is the basis of motion simulation, biomechanical visualization, and virtual surgery. Knee motion simulation determines the knee rotation angles as well as knee contact points. These parameters are used to solve the biomechanical model. Our results integrate 3-D construction, motion simulation, and biomechanical visualization into one system. Overall, the methodologies here are useful elements for future virtual medical systems where all the components of visualization, automated model generation, and surgery simulation come together.

  10. Evaluation and management of patients with refractory ascites

    PubMed Central

    Senousy, Bahaa Eldeen; Draganov, Peter V

    2009-01-01

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

  11. Usefulness of Submental Ultrasonographic Evaluation for Dysphagia Patients

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed

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

    2004-08-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

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

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

    SciTech Connect

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

    2012-06-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2008-12-01

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

  19. Computer simulation and capacity evaluation of Panama Canal alternatives

    SciTech Connect

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

    1994-12-31

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  1. Partnering With Gastroenterologists to Evaluate Patients With Chronic Constipation

    PubMed Central

    Lacy, Brian E.; Brunton, Stephen A.

    2005-01-01

    Abstract and Introduction Abstract Constipation is a highly prevalent and bothersome disorder that negatively affects patients' social and professional lives and imposes a heavy economic burden on patients and society. Most patients with chronic constipation are evaluated and treated in the primary care setting. Primary care clinicians often underestimate how much they can accomplish in the evaluation of a patient with constipation before they make a referral. There are numerous steps that primary care clinicians can take to address these issues and maximize the benefits of the referral process, including understanding key elements of an effective diagnostic work-up, familiarizing themselves with the utility of various diagnostic tests of colonic and anorectal function, implementing strategies/instruments to optimally communicate what they are striving to achieve through the referral process (eg, via a referral form), and developing a network of long-term working relationships with local gastroenterologists. Introduction Constipation is a highly prevalent disorder that affects approximately 12% to 19% of North Americans – estimates vary widely depending on study design and methodology.[1–6] For many persons, constipation is a chronic problem, lasting from several months to several years.[2] The multiple symptoms of chronic constipation encompass much more than reduced stool frequency; many patients report straining, feelings of incomplete evacuation, abdominal pain/discomfort, bloating, hard and/or small stools, or a need for digital manipulation to enable defecation.[5,7–12] For research purposes (eg, enrolling patients into clinical trials), the Rome II diagnostic criteria for constipation are generally used (Table 1).[2,13] Chronic constipation leads to decreased quality of life. The general well-being of patients with this disorder is lower than that of comparable normal populations,[14,15] and symptom severity has a negative correlation with perceived

  2. Evaluation of dairy allergy among ulcerative colitis patients

    PubMed Central

    Judaki, Arezo; Hafeziahmadi, Mohamadreza; Yousefi, Atefe; Havasian, Mohamad Reza; Panahi, Jafar; Sayehmiri, Koroush; Alizadeh, Sajjad

    2014-01-01

    The intestine is the largest mucosal organ of the body and also the first line immune homeostasis. Inflammatory bowel disease or IBD is divided into ulcerative colitis and Crohn's disease. One of the problems that can occur with UC is dietary allergy to some foods. This study aimed to evaluated the dairy allergy among patients with ulcerative colitis. This study is a Case - control study, that studied 72 patients with Ulcerative Colitis, after recording history of the disease, colonoscopy and confirmed by biopsy and 72 person without history of colitis. In this study, in order to investigate of food allergy, used of the EUROMMUM kit with an international code number DP3420-1601-11E. We used chi-square and Monte Carlo method for analysis of data. Among UC patients, 30.6% mild, 52.8% moderate and 16.6% of cases were in sever stage. 9.7% of them reported a history of abdominal surgery due to disease. According to the chi-square and Monte Carlo methods, dairy allergy (including: cow milk, cow milk UHT and casein) in UC group was significant (P=0.00). This study indicated that there is significant relationship between UC and cow milk, cow milk UHT and casein. UC patients who are allergic to dairy products and the use of dairy products can increase the severity of UC. PMID:25512686

  3. An acoustic method of automatically evaluating patient inhaler technique.

    PubMed

    Holmes, Martin S; D'Arcy, Shona; Costello, Richard W; Reilly, Richard B

    2013-01-01

    Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. Inhalers are devices utilized to deliver medication in small doses directly to the airways in the treatment of asthma and COPD. Despite the proven effectiveness of inhaler medication in controlling symptoms, many patients suffer from technique errors leading to decreased levels of medication efficacy. This study employs a recording device attached to a commonly used dry powder inhaler (DPI) to obtain the acoustic signals of patients taking their inhaler medication. The audio files provide information on how a patient uses their inhaler over a period of one month. Manually listening to such a large quantity of audio files would be a time consuming and monotonous process and therefore an algorithm that could automatically carry out this task would be of great benefit. An algorithm was thus designed and developed to detect inhalation, exhalation and blister events in the audio signals, analyze the quantity of each event, the order in which the events took place and finally provide a score on the overall performance. The algorithm was tested on a dataset of 185 audio files obtained from five community dwelling asthmatic patients in real world environments. Evaluation of the algorithm on this dataset revealed that it had an accuracy of 92.8% in deciding the correct technique score compared to manual detection methods.

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

    PubMed

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

    2016-01-01

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

  5. EVOTECH® endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy

    PubMed Central

    2010-01-01

    Background The objective of this study was to perform simulated-use testing as well as a clinical study to assess the efficacy of the EVOTECH® Endoscope Cleaner and Reprocessor (ECR) cleaning for flexible colonoscopes, duodenoscopes, gastroscopes and bronchoscopes. The main aim was to determine if the cleaning achieved using the ECR was at least equivalent to that achieved using optimal manual cleaning. Methods Simulated-use testing consisted of inoculating all scope channels and two surface sites with Artificial Test Soil (ATS) containing 108 cfu/mL of Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. Duodenoscopes, colonoscopes, and bronchoscopes (all Olympus endoscopes) were included in the simulated use testing. Each endoscope type was tested in triplicate and all channels and two surface sites were sampled for each scope. The clinical study evaluated patient-used duodenoscopes, bronchoscopes, colonoscopes, and gastroscopes (scopes used for emergency procedures were excluded) that had only a bedside flush prior to being processed in the ECR (i.e. no manual cleaning). There were 10 to 15 endoscopes evaluated post-cleaning and to ensure the entire ECR cycle was effective, 5 endoscopes were evaluated post-cleaning and post-high level disinfection. All channels and two external surface locations were sampled to evaluate the residual organic and microbial load. Effective cleaning of endoscope surfaces and channels was deemed to have been achieved if there was < 6.4 μg/cm2 of residual protein, < 1.8 μg/cm2 of residual hemoglobin and < 4 Log10 viable bacteria/cm2. Published data indicate that routine manual cleaning can achieve these endpoints so the ECR cleaning efficacy must meet or exceed these to establish that the ECR cleaning cycle could replace manual cleaning Results In the clinical study 75 patient-used scopes were evaluated post cleaning and 98.8% of surfaces and 99.7% of lumens met or surpassed the cleaning endpoints set for protein

  6. The Evaluation of a Pulmonary Display to Detect Adverse Respiratory Events Using High Resolution Human Simulator

    PubMed Central

    Wachter, S. Blake; Johnson, Ken; Albert, Robert; Syroid, Noah; Drews, Frank; Westenskow, Dwayne

    2006-01-01

    Objective Authors developed a picture-graphics display for pulmonary function to present typical respiratory data used in perioperative and intensive care environments. The display utilizes color, shape and emergent alerting to highlight abnormal pulmonary physiology. The display serves as an adjunct to traditional operating room displays and monitors. Design To evaluate the prototype, nineteen clinician volunteers each managed four adverse respiratory events and one normal event using a high-resolution patient simulator which included the new displays (intervention subjects) and traditional displays (control subjects). Between-group comparisons included (i) time to diagnosis and treatment for each adverse respiratory event; (ii) the number of unnecessary treatments during the normal scenario; and (iii) self-reported workload estimates while managing study events. Measurements Two expert anesthesiologists reviewed video-taped transcriptions of the volunteers to determine time to treat and time to diagnosis. Time values were then compared between groups using a Mann-Whitney-U Test. Estimated workload for both groups was assessed using the NASA-TLX and compared between groups using an ANOVA. P-values < 0.05 were considered significant. Results Clinician volunteers detected and treated obstructed endotracheal tubes and intrinsic PEEP problems faster with graphical rather than conventional displays (p < 0.05). During the normal scenario simulation, 3 clinicians using the graphical display, and 5 clinicians using the conventional display gave unnecessary treatments. Clinician-volunteers reported significantly lower subjective workloads using the graphical display for the obstructed endotracheal tube scenario (p < 0.001) and the intrinsic PEEP scenario (p < 0.03). Conclusion Authors conclude that the graphical pulmonary display may serve as a useful adjunct to traditional displays in identifying adverse respiratory events. PMID:16929038

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

    PubMed

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

    2012-06-01

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

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

    PubMed Central

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

    2012-01-01

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

  9. Initial implementation of mixed reality simulation targeting teamwork and patient safety.

    PubMed

    Kozmenko, Valeriy; Paige, John; Chauvin, Sheila

    2008-01-01

    Patient safety is one of the most pressing challenges of modern healthcare. Being a multifactorial problem, patient safety requires improvement interventions on multiple levels including individual, team and organization as a whole. Using high-fidelity human patient simulator in real clinical setting allows creating a mixed reality environment for teaching healthcare teams to improve patient safety. A multidisciplinary group of physicians at Louisiana State University Health Sciences Center in New Orleans has developed and implemented the STEPS program (System for Teamwork Effectiveness and Patient Safety) with the use of MMOR (mobile mock operating room) configuration to train general surgical teams within their own operating room environment. Each simulation session was followed by facilitated debriefing and teaching new team communication skills. Team performances were assessed by both direct observation and team's self-assessment where each team member assessed his or her own performance as well as the performance of all other team members (360 degree assessment).

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

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

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

  11. A model for simulation and patient-specific visualization of the tissue volume of influence during brain microdialysis.

    PubMed

    Diczfalusy, Elin; Zsigmond, Peter; Dizdar, Nil; Kullman, Anita; Loyd, Dan; Wårdell, Karin

    2011-12-01

    Microdialysis can be used in parallel to deep brain stimulation (DBS) to relate biochemical changes to the clinical outcome. The aim of the study was to use the finite element method to predict the tissue volume of influence (TVI(max)) and its cross-sectional radius (r (TVImax)) when using brain microdialysis, and visualize the TVI(max) in relation to patient anatomy. An equation based on Fick's law was used to simulate the TVI(max). Factorial design and regression analysis were used to investigate the impact of the diffusion coefficient, tortuosity and loss rate on the r (TVImax). A calf brain tissue experiment was performed to further evaluate these parameters. The model was implemented with pre-(MRI) and post-(CT) operative patient images for simulation of the TVI(max) for four patients undergoing microdialysis in parallel to DBS. Using physiologically relevant parameter values, the r (TVImax) for analytes with a diffusion coefficient D = 7.5 × 10⁻⁶ cm²/s was estimated to 0.85 ± 0.25 mm. The simulations showed agreement with experimental data. Due to an implanted gold thread, the catheter positions were visible in the post-operative images. The TVI(max) was visualized for each catheter. The biochemical changes could thereby be related to their anatomical origin, facilitating interpretation of results.

  12. Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness

    PubMed Central

    Eukel, Heidi N.; Frenzel, Jeanne E.; Werremeyer, Amy; McDaniel, Becky

    2016-01-01

    Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness. PMID:27899838

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

    PubMed

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

    2012-11-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  15. Extension of the IWA/COST simulation benchmark to include expert reasoning for system performance evaluation.

    PubMed

    Comas, J; Rodríguez-Roda, I; Poch, M; Gernaey, K V; Rosen, C; Jeppsson, U

    2006-01-01

    In this paper the development of an extension module to the IWA/COST simulation benchmark to include expert reasoning is presented. This module enables the detection of suitable conditions for the development of settling problems of biological origin (filamentous bulking, foaming and rising sludge) when applying activated sludge control strategies to the simulation benchmark. Firstly, a flow diagram is proposed for each settling problem, and secondly, the outcome of its application is shown. Results of the benchmark for two evaluated control strategies illustrate that, once applied to the simulation outputs, this module provides supplementary criteria for plant performance assessment. Therefore, simulated control strategies can be evaluated in a more realistic framework, and results can be recognised as more realistic and satisfactory from the point of view of operators and real facilities.

  16. Evaluating the Effects of Stressors on Immune Function during Simulated Dives in Marine Mammals

    DTIC Science & Technology

    2013-09-30

    effects of simulated dive exposures on cellular immune function in beluga whales 2) To evaluate the effects of simulated dive exposures on cellular...immune function following a known stressor event 3) To collect biological samples from wild belugas to compare with aquarium whales and 4) To compare the...exposures will be obtained from beluga whales resident at the Mystic Aquarium. Cells of the immune system will be exposed to increased pressure

  17. Evaluation of patient satisfaction with different hearing aids: A study of 107 patients.

    PubMed

    Ulusoy, Seçkin; Muluk, Nuray Bayar; San, Turhan; Cingi, Cemal

    2017-01-01

    We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients-60 males and 47 females, aged 8 to 84 years (mean: 53.8)-with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.

  18. A Framework for Patient-Specific Spinal Intervention Simulation: Application to Lumbar Spinal Durotomy Repair.

    PubMed

    Lau, Jonathan C; Denning, Lynn; Lownie, Stephen P; Peters, Terry M; Chen, Elvis C S

    2016-01-01

    We present a functional and patient-specific lumbar phantom for the training of spinal durotomy and dura closure under microscopic view, consisting of a lumbar model, pressurized dural surrogate, together immersed in a tissue-mimicking layer simulating fat, muscle and skin. The lumbar model was derived from a patient computed tomography scan, preserving the natural shape and curvature of the lumbar column. The inclusion of the simulated soft-tissue layer was critical for preserving the surgical ergonomics and presented a realistic view under the surgical microscope. As the success of dura repair is indicated by the watertight closure of the thecal sac, the dura surrogate was connected to a pressurized and closed-loop water system to provide functional cerebrospinal fluid leakage during durotomy. This functional phantom is inexpensive to construct, provides a realistic tactile and visual environment for spinal durotomy repair, and can be easily extended to simulate other patient-specific spinal interventions.

  19. Caring for Hispanic patients interactively: simulations and practices for allied health professionals.

    PubMed

    Schitai, Amit

    2004-01-01

    Healthcare providers have a new tool for navigating the challenges of cross-cultural communication when treating Hispanic patients: CHISPA e-learning environment. CHISPA, which means "spark" in Spanish, stands for Caring for the Hispanic Patient Interactively: Simulations and Practices for Allied Health Professionals. It is a computer-based training program that provides solutions to both cultural and linguistic barriers to care. The program allows users to interact with Hispanic patients in realistic patient-care scenarios and receive feedback on their choices, along with a wealth of information on cultural variables, advice on overcoming language barriers, and language exercises to facilitate learning medical terms and expressions in Spanish.

  20. Evaluation of skeletal muscle DTI in patients with duchenne muscular dystrophy.

    PubMed

    Hooijmans, M T; Damon, B M; Froeling, M; Versluis, M J; Burakiewicz, J; Verschuuren, J J G M; Niks, E H; Webb, A G; Kan, H E

    2015-11-01

    Diffusion tensor imaging (DTI) is a popular method to assess differences in fiber organization in diseased and healthy muscle tissue. Previous work has shown that muscle DTI measurements depend on signal-to-noise ratio (SNR), %fat, and tissue T2. The goal of this study was to evaluate the potential biasing effects of these factors on skeletal muscle DTI data in patients with Duchenne Muscular Dystrophy (DMD). MR images were obtained of the right lower leg of 21 DMD patients and 12 healthy controls on a Philips 3T system. DTI measurements were combined with quantitative in-vivo measures of mean water T2, %fat and SNR to evaluate their effect on DTI parameter estimation. All outcome measures were determined within ROIs drawn for six lower leg muscles. Between group analysis, using all ROIs, revealed a significantly elevated FA in the GCL, SOL and PER muscles (p<0.05) and an increased mean diffusivity (p<0.05) and λ3 (p<0.05) in the TA muscle of DMD patients. In-vivo evaluation of the individual confounders showed behaviour in line with predictions from previous simulation work. To account for these confounders, subsequent analysis used only ROIs with SNR greater than 20. With this criterion we found significantly greater MD in the TA muscle of DMD patient (p<0.009) and λ3 in the TA and GCL muscles (p<0.001) of DMD patients, but no differences in FA. As both increased %fat and lower SNR are expected to reduce the apparent MD and λ3, these between-group differences are likely due to pathophysiology. However, the increased FA, observed when using all ROIs, likely reflects the effect of low SNR and %fat on the DTI parameter estimation. These findings suggest that measuring mean water T2, %fat and SNR is essential to ascribe changes in DTI measures to intrinsic diffusion changes or to confounding influences.

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

    NASA Technical Reports Server (NTRS)

    Galanter, E.; Popper, R.

    1980-01-01

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

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

    PubMed

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

    2014-10-01

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

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

    NASA Technical Reports Server (NTRS)

    Moore, Loretta A.

    1993-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Firestone, R. F.; Harada, Y.

    1979-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Perez-Poch, Antoni

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

  8. Facilitating the Use of Satellite Observations for Evaluating CMIP5/IPCC Simulations

    NASA Astrophysics Data System (ADS)

    Teixeira, J.; Waliser, D. E.; Ferraro, R.; Potter, G. L.; Crichton, D. J.; Williams, D. N.; Gleckler, P. J.; Braverman, A. J.; Lee, S.; Taylor, K. E.

    2010-12-01

    Taylor et al (2008) have defined the protocol for the CMIP5 simulations that will be used for the next IPCC Assessment Report, AR5. The protocol defines the scope of simulations that will be undertaken by the participating modeling groups. For several of the prescribed retrospective simulations (e.g, decadal hindcasts, AMIP and 20th Century coupled simulations) observational data sets can be used to evaluate and diagnose the simulation outputs. However, to date, the pertinent observational data sets to perform these particular evaluations have not been optimally identified and coordinated to readily enable their use in the context of CMIP5. In this presentation, we will report on the progress and plans of a collaborative activity between NASA and PCMDI with the objective to provide the community of researchers that will access and evaluate the CMIP5/IPCC climate model results access to analogous sets of satellite data (in terms of variables, temporal and spatial frequency, periods and file format). The data sets will be accessible via the same Earth System Grid (ESG) web portal as the model data, and a number of these data sets are expected to be in place by spring of 2011 so they can be utilized for CMIP5 evaluation. Community input is welcome on the long-term aspects of this project in terms of additional data sets, analysis capabilities, performance metrics, and relevant information technology issues (e.g.,ESG).

  9. Evaluation of electronic jamming effect based on seeker captive flight test and missile flight simulation

    NASA Astrophysics Data System (ADS)

    Gao, Wei; Tie, Weitao

    2017-01-01

    In order to test and evaluate the jamming effect of electronic warfare weapons on missiles, a method based on seeker captive flight jamming test and missile flight simulation test is put forward, in which real data for the jamming effect of the electronic warfare weapon on seekers is obtained by seeker captive flight jamming test, and immitted into a missile digital simulation system to perform large numbers of missile flight simulation tests under jamming, then one could evaluate the jamming effect of the electronic warfare weapon on missiles according to the simulation test results. The method is demonstrated and validated by test and evaluation of the jamming effect of a smokescreen jamming device on TV guidance missiles. The results show that, the method proposed here not only overcomes the shortcomings of both pure digital simulation test and field test, but also combines their advantages, thus could be taken as an easy, economical and reliable method for testing and evaluating electronic jamming effect on missiles.

  10. Using patient flow simulation to improve access at a multidisciplinary sleep centre.

    PubMed

    Pendharkar, Sachin R; Bischak, Diane P; Rogers, Paul; Flemons, Ward; Noseworthy, Tom W

    2015-06-01

    The lack of timely access to diagnosis and treatment for sleep disorders is well described, but little attention has been paid to understanding how multiple system constraints contribute to long waiting times. The objectives of this study were to identify system constraints leading to long waiting times at a multidisciplinary sleep centre, and to use patient flow simulation modelling to test solutions that could improve access. Discrete-event simulation models of patient flow were constructed using historical data from 150 patients referred to the sleep centre, and used to both examine reasons for access delays and to test alternative system configurations that were predicted by administrators to reduce waiting times. Four possible solutions were modelled and compared with baseline, including addition of capacity to different areas at the sleep centre and elimination of prioritization by urgency. Within the model, adding physician capacity improved time from patient referral to initial physician appointment, but worsened time from polysomnography requisition to test completion, and had no effect on time from patient referral to treatment initiation. Adding respiratory therapist did not improve model performance compared with baseline. Eliminating triage prioritization worsened time to physician assessment and treatment initiation for urgent patients without improving waiting times overall. This study demonstrates that discrete-event simulation can identify multiple constraints in access-limited healthcare systems and allow suggested solutions to be tested before implementation. The model of this sleep centre predicted that investments in capacity expansion proposed by administrators would not reduce the time to a clinically meaningful patient outcome.

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

    PubMed

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

    2015-04-01

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

  12. Driving simulator performance and psychomotor functions of schizophrenic patients treated with antipsychotics.

    PubMed

    Brunnauer, Alexander; Laux, Gerd; Zwick, Sarah

    2009-12-01

    The objective of the study is to compare schizophrenic inpatients under antipsychotic monotherapy regarding simulated driving behaviour and psychomotor functions related to driving ability. Schizophrenic inpatients (n = 80) were tested before discharge to outpatient treatment. Data were collected with the computerized Act & React Testsystem and the Wiener Testsystem measuring visual perception, reaction time, attention, vigilance and stress-tolerance. Besides, patients underwent various driving simulations on a static driving simulator (FT-SR 200). Before discharge to outpatient treatment, about 25% of schizophrenic patients must be considered as severely impaired with respect to driving skills. Differences between treatment groups could be shown both in psychomotor measures and in driving simulator performance with a better test performance of patients treated with atypical antipsychotics. Controlling for age, psychopathologic symptoms and extrapyramidal signs, differences in psychomotor measures were most pronounced in concentration and vigilance. As mental disorders itself pose an increased risk of accidents, counselling patients with respect to differential effects of antipsychotic treatment is of great relevance. In addition to psychomotor tests computer-simulated driving seems to be a useful tool in assessing traffic safety under pharmacologic treatment.

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

    PubMed

    Rhodes, Mattie L; Curran, Cynthia

    2005-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2009-08-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

  16. Simulated human patients and patient-centredness: The uncanny hybridity of nursing education, technology, and learning to care.

    PubMed

    Ireland, Aileen V

    2017-01-01

    Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation-what is real and what is simulated-is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, and créolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman.

  17. The patient simulator for training of anesthesia residents in the management of one lung ventilation.

    PubMed

    Hassan, Zaki-Udin; Dorfling, Johannes; McLarney, John T; Sloan, Paul A

    2008-01-01

    Simulators are used extensively for the training of medical personnel. All anesthesia providers should be prepared and trained in the management of one lung ventilation for pulmonary surgery, yet familiarization with one lung ventilation may not be possible on a routine basis in the operating room. Therefore, this reports details the first use of the patient simulator (PS) to enhance the training of anesthesia residents in the management of one lung ventilation. A detailed report of our computer program for simulating one lung ventilation is included.

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

    ERIC Educational Resources Information Center

    Adamson, Katie Anne

    2011-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Jin, Jiming; Wen, Lijuan

    2012-05-01

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

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

    USGS Publications Warehouse

    Arihood, L.D.

    1989-01-01

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

  6. Development of a numerical simulator of human swallowing using a particle method (Part 2. Evaluation of the accuracy of a swallowing simulation using the 3D MPS method).

    PubMed

    Kamiya, Tetsu; Toyama, Yoshio; Michiwaki, Yukihiro; Kikuchi, Takahiro

    2013-01-01

    The aim of this study was to develop and evaluate the accuracy of a three-dimensional (3D) numerical simulator of the swallowing action using the 3D moving particle simulation (MPS) method, which can simulate splashes and rapid changes in the free surfaces of food materials. The 3D numerical simulator of the swallowing action using the MPS method was developed based on accurate organ models, which contains forced transformation by elapsed time. The validity of the simulation results were evaluated qualitatively based on comparisons with videofluorography (VF) images. To evaluate the validity of the simulation results quantitatively, the normalized brightness around the vallecula was used as the evaluation parameter. The positions and configurations of the food bolus during each time step were compared in the simulated and VF images. The simulation results corresponded to the VF images during each time step in the visual evaluations, which suggested that the simulation was qualitatively correct. The normalized brightness of the simulated and VF images corresponded exactly at all time steps. This showed that the simulation results, which contained information on changes in the organs and the food bolus, were numerically correct. Based on these results, the accuracy of this simulator was high and it could be used to study the mechanism of disorders that cause dysphasia. This simulator also calculated the shear rate at a specific point and the timing with Newtonian and non-Newtonian fluids. We think that the information provided by this simulator could be useful for development of food products, medicines, and in rehabilitation facilities.

  7. Evaluation of the team performance observation tool with targeted behavioral markers in simulation-based interprofessional education.

    PubMed

    Zhang, Chao; Miller, Connie; Volkman, Kathleen; Meza, Jane; Jones, Katherine

    2015-05-01

    The primary aim of this study was to decrease the subjectivity of the Team Performance Observation Tool (TPOT) and determine the psychometric properties of this tool when using scenario-specific targeted behavioral markers (TBMs). We used a convenience sample of 47 physical therapy and 25 nursing students at an academic medical center who were organized in interprofessional teams of three to care for a simulated patient. The TPOT demonstrated satisfactory validity and reliability with the use of TBMs. We demonstrated significant correlations between the TPOT overall rating and two scenario-specific outcomes: (1) a negative correlation between the TPOT overall rating and the number of medical errors committed by the 24 teams (r = -0.531, p = 0.008) and (2) a positive correlation between the TPOT overall rating and a time-based functional outcome (r = 0.803, p < 0.001). We demonstrated substantial test-retest reliability (kappa = 0.707, p < 0.001), inter-rater reliability (kappa = 0.730), and good internal consistency reliability (Cronbach's α = 0.921). The results of our study support the use of scenario-specific TBMs to enhance the reliability and validity of the TPOT for use in the evaluation of team-based simulation scenarios. Further evaluation of the TPOT with TBMs from other simulation and training contexts is warranted.

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

    SciTech Connect

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

    2012-06-27

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

  10. Subjective and neurovegetative changes in healthy volunteers and panic patients performing simulated public speaking.

    PubMed

    Parente, Alexandre C B V; Garcia-Leal, Cybele; Del-Ben, Cristina M; Guimarães, Francisco S; Graeff, Frederico G

    2005-12-01

    Drug-free symptomatic panic patients, drug-treated nonsymptomatic patients and healthy controls were submitted to simulated public speaking. Subjective anxiety, cognitive impairment and discomfort measured by the visual analog mood scale as well as skin conductance level were higher in symptomatic patients than in controls at the beginning of the experimental session, nonsymptomatic patients lying in between. Subjective sedation, spontaneous fluctuations of skin conductance, heart rate and blood pressure were similar in the three groups. Preparation and performance of speech decreased sedation while increasing anxiety, cognitive impairment, level and fluctuations of skin conductance, heart rate and blood pressure. Anxiety, cognitive impairment and conductance level were less increased in symptomatic patients than in controls. Electrodermal activity, but not cardiovascular measures of sympathetic arousal correlated with anticipatory anxiety. Chronic treatment with serotonin uptake inhibitors attenuated the differences between panic patients and controls, supporting the participation of serotonin in panic disorder.

  11. Relationship between high-fidelity simulation and patient safety in prelicensure nursing education: a comprehensive review.

    PubMed

    Blum, Cynthia Ann; Parcells, Dax Andrew

    2012-08-01

    Advances in nursing simulation technology raise the question "Are educators feeling pressure to accommodate the learning styles of the techno-age studentry?" This integrative review evaluates the current quantitative evidence from preintervention-postintervention and control-experimental research studies related to the use of simulation in prelicensure nursing education directed at enhancing safety in nursing practice. A thorough review of the available literature using truncated search terms in several databases yielded 258 scholarly, peer-reviewed articles, of which 18 articles directly addressed the posed research question related to simulation and safety. Replete with student reports of simulation as an enjoyable learning activity, the literature does not yet support simulation over other approaches to the teaching-learning of safety competencies in nursing. Therefore, nurse educators must continue to select the most appropriate methods based on the specific course, student, or program type, with concentrated focus on competency-based safety education in nursing.

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

    NASA Astrophysics Data System (ADS)

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

    2010-08-01

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

  13. Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation.

    PubMed

    Karnon, Jonathan

    2003-10-01

    Markov models have traditionally been used to evaluate the cost-effectiveness of competing health care technologies that require the description of patient pathways over extended time horizons. Discrete event simulation (DES) is a more flexible, but more complicated decision modelling technique, that can also be used to model extended time horizons. Through the application of a Markov process and a DES model to an economic evaluation comparing alternative adjuvant therapies for early breast cancer, this paper compares the respective processes and outputs of these alternative modelling techniques. DES displays increased flexibility in two broad areas, though the outputs from the two modelling techniques were similar. These results indicate that the use of DES may be beneficial only when the available data demonstrates particular characteristics.

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

    PubMed

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

    2016-03-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2016-05-01

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

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

    SciTech Connect

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

    2014-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  19. Study on Applicability of Numerical Simulation to Evaluation of Gas Entrainment From Free Surface

    SciTech Connect

    Kei Ito; Takaaki Sakai; Hiroyuki Ohshima

    2006-07-01

    An onset condition of gas entrainment (GE) due to free surface vortex has been studied to establish a design of fast breeder reactor with higher coolant velocity than conventional designs, because the GE might cause the reactor operation instability and therefore should be avoided. The onset condition of the GE has been investigated experimentally and theoretically, however, dependency of the vortex type GE on local geometry configuration of each experimental system and local velocity distribution has prevented researchers from formulating the universal onset condition of the vortex type GE. A real scale test is considered as an accurate method to evaluate the occurrence of the vortex type GE, but the real scale test is generally expensive and not useful in the design study of large and complicated FBR systems, because frequent displacement of inner equipments accompanied by the design change is difficult in the real scale test. Numerical simulation seems to be promising method as an alternative to the real scale test. In this research, to evaluate the applicability of the numerical simulation to the design work, numerical simulations were conducted on the basic experimental system of the vortex type GE. This basic experiment consisted of rectangular flow channel and two important equipments for vortex type GE in the channel, i.e. vortex generation and suction equipments. Generated vortex grew rapidly interacting with the suction flow and the grown vortex formed a free surface dent (gas core). When the tip of the gas core or the bubbles detached from the tip of the gas core reached the suction mouth, the gas was entrained to the suction tube. The results of numerical simulation under the experimental conditions were compared to the experiment in terms of velocity distributions and free surface shape. As a result, the numerical simulation showed qualitatively good agreement with experimental data. The numerical simulation results were similar to the experimental

  20. Effectiveness of Intravenous Infusion Algorithms for Glucose Control in Diabetic Patients Using Different Simulation Models

    PubMed Central

    Farmer, Terry G.; Edgar, Thomas F.

    2009-01-01

    The effectiveness of closed-loop insulin infusion algorithms is assessed for three different mathematical models describing insulin and glucose dynamics within a Type I diabetes patient. Simulations are performed to assess the effectiveness of proportional plus integral plus derivative (PID) control, feedforward control, and a physiologically-based control system with respect to maintaining normal glucose levels during a meal and during exercise. Control effectiveness is assessed by comparing the simulated response to a simulation of a healthy patient during both a meal and exercise and establishing maximum and minimum glucose levels and insulin infusion levels, as well as maximum duration of hyperglycemia. Controller effectiveness is assessed within the minimal model, the Sorensen model, and the Hovorka model. Results showed that no type of control was able to maintain normal conditions when simulations were performed using the minimal model. For both the Sorensen model and the Hovorka model, proportional control was sufficient to maintain normal glucose levels. Given published clinical data showing the ineffectiveness of PID control in patients, the work demonstrates that controller success based on simulation results can be misleading, and that future work should focus on addressing the model discrepancies. PMID:20161147

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

    PubMed Central

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

    2016-01-01

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

  2. Simulated annealing with restrained molecular dynamics using a flexible restraint potential: theory and evaluation with simulated NMR constraints.

    PubMed Central

    Bassolino-Klimas, D.; Tejero, R.; Krystek, S. R.; Metzler, W. J.; Montelione, G. T.; Bruccoleri, R. E.

    1996-01-01

    A new functional representation of NMR-derived distance constraints, the flexible restraint potential, has been implemented in the program CONGEN (Bruccoleri RE, Karplus M, 1987, Biopolymers 26:137-168) for molecular structure generation. In addition, flat-bottomed restraint potentials for representing dihedral angle and vicinal scalar coupling constraints have been introduced into CONGEN. An effective simulated annealing (SA) protocol that combines both weight annealing and temperature annealing is described. Calculations have been performed using ideal simulated NMR constraints, in order to evaluate the use of restrained molecular dynamics (MD) with these target functions as implemented in CONGEN. In this benchmark study, internuclear distance, dihedral angle, and vicinal coupling constant constraints were calculated from the energy-minimized X-ray crystal structure of the 46-amino acid polypeptide crambin (ICRN). Three-dimensional structures of crambin that satisfy these simulated NMR constraints were generated using restrained MD and SA. Polypeptide structures with extended backbone and side-chain conformations were used as starting conformations. Dynamical annealing calculations using extended starting conformations and assignments of initial velocities taken randomly from a Maxwellian distribution were found to adequately sample the conformational space consistent with the constraints. These calculations also show that loosened internuclear constraints can allow molecules to overcome local minima in the search for a global minimum with respect to both the NMR-derived constraints and conformational energy. This protocol and the modified version of the CONGEN program described here are shown to be reliable and robust, and are applicable generally for protein structure determination by dynamical simulated annealing using NMR data. PMID:8845749

  3. Evaluating simulant materials for understanding cranial backspatter from a ballistic projectile.

    PubMed

    Das, Raj; Collins, Alistair; Verma, Anurag; Fernandez, Justin; Taylor, Michael

    2015-05-01

    In cranial wounds resulting from a gunshot, the study of backspatter patterns can provide information about the actual incidents by linking material to surrounding objects. This study investigates the physics of backspatter from a high-speed projectile impact and evaluates a range of simulant materials using impact tests. Next, we evaluate a mesh-free method called smoothed particle hydrodynamics (SPH) to model the splashing mechanism during backspatter. The study has shown that a projectile impact causes fragmentation at the impact site, while transferring momentum to fragmented particles. The particles travel along the path of least resistance, leading to partial material movement in the reverse direction of the projectile motion causing backspatter. Medium-density fiberboard is a better simulant for a human skull than polycarbonate, and lorica leather is a better simulant for a human skin than natural rubber. SPH is an effective numerical method for modeling the high-speed impact fracture and fragmentations.

  4. Evaluation of thermochemical models for particle and continuum simulations of hypersonic flow

    NASA Technical Reports Server (NTRS)

    Boyd, Iain D.; Gokcen, Tahir

    1992-01-01

    Computations are presented for one-dimensional, strong shock waves that are typical of those that form in front of a reentering spacecraft. The fluid mechanics and thermochemistry are modeled using two different approaches. The first employs traditional continuum techniques in solving the Navier-Stokes equations. The second approach employs a particle simulation technique (the direct simulation Monte Carlo method, DSMC). The thermochemical models employed in these two techniques are quite different. The present investigation presents an evaluation of thermochemical models for nitrogen under hypersonic flow conditions. Four separate cases are considered that are dominated in turn by vibrational relaxation, weak dissociation, strong dissociation and weak ionization. In near-continuum, hypersonic flow, the nonequilibrium thermochemical models employed in continuum and particle simulations produce nearly identical solutions. Further, the two approaches are evaluated successfully against available experimental data for weakly and strongly dissociating flows.

  5. 3RIP Evaluation of the Performance of the Search System Using a Realtime Simulation Technique.

    ERIC Educational Resources Information Center

    Lofstrom, Mats

    This report describes a real-time simulation experiment to evaluate the performance of the search and editing system 3RIP, an interactive system written in the language BLISS on a DEC-10 computer. The test vehicle, preliminary test runs, and capacity test are detailed, and the following conclusions are reported: (1) 3RIP performs well up to the…

  6. A simulation model for reliability evaluation of space station power systems

    SciTech Connect

    Singh, C.; Patton, A.D.; Kumar, M. ); Wagner, H. )

    1991-03-01

    This paper presents a detailed simulation model for reliability evaluation of space station electrical power systems. Dependence of reliability and storage characteristics during the sun and eclipse periods is considered. The charging and discharging of energy storage modules is included on a continuous basis. Sample system studies are also presented.

  7. Dynamic Evaluation of Two Decades of CMAQ Simulations over the Continental United States

    EPA Science Inventory

    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 emis...

  8. EVALUATION OF CHROMOMYCIN A3 ASSAY IN HUMAN SPERM AFTER SIMULATED OVERNIGHT SHIPMENT

    EPA Science Inventory

    EVALUATION OF CHROMOMYCIN A3ASSAY IN HUMAN SPERM AFTER SIMULATED OVERNIGHT SHIPMENT.
    SC Jeffay1, R Morris Buus1, LF Strader1, AF Olshan2, DP Evenson3, SD Perreault1. 1US EPA/ORD, RTP, NC;2UNC-CH, Chapel Hill, NC;3SDSU, Brookings, SD.

    Semen collection kits that allow ...

  9. The Interior Design Simulator. Courseware Evaluation for Vocational and Technical Education.

    ERIC Educational Resources Information Center

    Worts, Nancy; And Others

    This courseware evaluation rates the Interior Design Simulator program developed by Orange Juice Software Systems. (This program--not contained in this document--allows the user to design a room of any shape with maximum dimensions of 14 x 26 feet.) Part A describes the program in terms of subject area (furniture arrangement) and hardware…

  10. Simulation Based Evaluation of Integrated Adaptive Control and Flight Planning Technologies

    NASA Technical Reports Server (NTRS)

    Campbell, Stefan Forrest; Kaneshige, John T.

    2008-01-01

    The objective of this work is to leverage NASA resources to enable effective evaluation of resilient aircraft technologies through simulation. This includes examining strengths and weaknesses of adaptive controllers, emergency flight planning algorithms, and flight envelope determination algorithms both individually and as an integrated package.

  11. Evaluation of the Course of the Flight Simulators from the Perspective of Students and University Teachers

    ERIC Educational Resources Information Center

    Kaysi, Feyzi; Bavli, Bünyamin; Gürol, Aysun

    2016-01-01

    The study evaluates the flight simulators course which was opened to fulfill the intermediate staff need of the sector. To collect data, Qualitative techniques were applied. Within this scope, the case study method was employed in the study. The study group consisted of students and instructors. In-depth and focus group interviews were conducted…

  12. Airspace Concept Evaluation System (ACES), Concept Simulations using Communication, Navigation and Surveillance (CNS) System Models

    NASA Technical Reports Server (NTRS)

    Kubat, Greg; Vandrei, Don

    2006-01-01

    Project Objectives include: a) CNS Model Development; b Design/Integration of baseline set of CNS Models into ACES; c) Implement Enhanced Simulation Capabilities in ACES; d) Design and Integration of Enhanced (2nd set) CNS Models; and e) Continue with CNS Model Integration/Concept evaluations.

  13. Evaluation of a patient with suspected chronic demyelinating polyneuropathy.

    PubMed

    Jani-Acsadi, Agnes; Lewis, Richard A

    2013-01-01

    Demyelinating neuropathies are typically characterized by physiological slowing of conduction velocity and pathologically by segmental loss of myelin and in some instances, evidence of remyelination. Clinically, patients with demyelinating neuropathy can be seen with inherited disorders (Charcot-Marie-Tooth disease) or acquired disorders, typically immune-mediated or inflammatory. The acquired disorders can be either acute or subacute as seen in the acute inflammatory demyelinating polyneuropathy (AIDP) form of Guillain-Barré syndrome or chronic progressive or relapsing disorders such as chronic inflammatory demyelinating polyneuropathy. It is important to develop a logical approach to diagnosing these disorders. This requires an understanding of the clinical, genetic, physiological, and pathological features of these neuropathies. Clinically, important features to consider are the temporal progression, degree of symmetry, and involvement of proximal as well as distal muscles. Genetically, recognizing the different inheritance patterns and age of onset allow for a coordinated approach to determining a specific genotype. Physiologically, besides nerve conduction slowing, other physiological hallmarks of demyelination include temporal dispersion of compound motor action potentials (CMAP) on proximal stimulation, conduction block, and distal CMAP duration prolongation with certain patterns of involvement pointing to specific disorders. This chapter focuses on these various aspects of the evaluation of patients with chronic acquired demyelinating neuropathies to develop a comprehensive and thoughtful diagnostic concept.

  14. A clinical evaluation denture adhesives used by patients with xerostomia.

    PubMed

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

    2015-02-01

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

  15. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab

    PubMed Central

    Aira, Lazaro E.; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A.; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease. PMID:26466969

  16. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab.

    PubMed

    Aira, Lazaro E; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease.

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

    PubMed

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

    1981-12-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. Smith-Magenis syndrome: clinical evaluation in seven Brazilian patients.

    PubMed

    Gamba, B F; Vieira, G H; Souza, D H; Monteiro, F F; Lorenzini, J J; Carvalho, D R; Morreti-Ferreira, D

    2011-10-31

    Smith-Magenis syndrome (SMS) is a complex congenital anomaly characterized by craniofacial anomalies, neurological and behavioral disorders. SMS is caused by a deletion in region 17p11.2, which includes the RAI1 gene (90% of cases), or by point mutation in the RAI1 gene (10% of cases). Laboratory diagnosis is through cytogenetic analysis by GTG banding and molecular cytogenetic analysis by FISH. We carried out an active search for patients in Associations of Parents and Friends of Exceptional Children (APAE) of São Paulo and genetic centers in Brazil. Forty-eight patients were screened for mental retardation, craniofacial abnormalities and stereotyped behavior with a diagnosis of SMS. In seven of them, chromosome banding at high resolution demonstrated chromosome 17p11.2 deletions, confirmed by FISH. We also made a meta-analysis of 165 cases reported between 1982 and 2010 to compare with the clinical data of our sample. We demonstrated differences between the frequencies of clinical signs among the cases reported and seven Brazilian cases of this study, such as dental anomalies, strabismus, ear infections, deep hoarse voice, hearing loss, and cardiac defects. Although the gold standard for diagnosis of SMS is FISH, we found that the GTG banding technique developed to evaluate chromosome 17 can be used for the SMS diagnosis in areas where the FISH technique is not available.

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

    PubMed

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

    2015-07-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  3. [Simulation training for better patient safety-learning from team work].

    PubMed

    Hoppu, Sanna; Niemi-Murola, Leila; Handolin, Lauri

    2014-01-01

    At work, healthcare personnel will encounter various emergency situations and patients who are in poor physical condition and require urgent care. A multidisciplinary team of experts must be able to carry out seamless collaboration, even when working together for the first time. Described in this review is how systematically arranged simulation rehearsals help form a united expert group from a group of individual experts.

  4. Applying Positioning Theory to Examine Interactions between Simulated Patients and Medical Students: A Narrative Analysis

    ERIC Educational Resources Information Center

    Sargeant, Sally; McLean, Michelle; Green, Patricia; Johnson, Patricia

    2017-01-01

    In their journey to becoming doctors, students engage with a range of teachers and trainers. Among these are simulated patients (SPs), who, through role-playing, assist students to develop their communication and physical examination skills, in contexts of formative and summative assessments. This paper explores the teaching and learning…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Johnson-Frey, Scott H.

    2004-01-01

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

  7. Weaving the tapestry of learning: simulation, standardized patients, and virtual communities.

    PubMed

    Holland, Brian; Landry, Karen; Mountain, Angela; Middlebrooks, Mary Alice; Heim, Deborah; Missildine, Kathy

    2013-01-01

    Using situated cognition learning theory, nursing faculty developed simulated clinical learning experiences integrating virtual communities and standardized patients. These learning experiences provide authenticity and realism not easily achieved using the individual techniques in isolation. The authors describe the process of weaving these strategies into a rich learning experience for students.

  8. Monte Carlo simulation of Ray-Scan 64 PET system and performance evaluation using GATE toolkit

    NASA Astrophysics Data System (ADS)

    Li, Suying; Zhang, Qiushi; Vuletic, Ivan; Xie, Zhaoheng; Yang, Kun; Ren, Qiushi

    2017-02-01

    In this study, we aimed to develop a GATE model for the simulation of Ray-Scan 64 PET scanner and model its performance characteristics. A detailed implementation of system geometry and physical process were included in the simulation model. Then we modeled the performance characteristics of Ray-Scan 64 PET system for the first time, based on National Electrical Manufacturers Association (NEMA) NU-2 2007 protocols and validated the model against experimental measurement, including spatial resolution, sensitivity, counting rates and noise equivalent count rate (NECR). Moreover, an accurate dead time module was investigated to simulate the counting rate performance. Overall results showed reasonable agreement between simulation and experimental data. The validation results showed the reliability and feasibility of the GATE model to evaluate major performance of Ray-Scan 64 PET system. It provided a useful tool for a wide range of research applications.

  9. Difficulties in applying numerical simulations to an evaluation of occupational hazards caused by electromagnetic fields.

    PubMed

    Zradziński, Patryk

    2015-01-01

    Due to the various physical mechanisms of interaction between a worker's body and the electromagnetic field at various frequencies, the principles of numerical simulations have been discussed for three areas of worker exposure: to low frequency magnetic field, to low and intermediate frequency electric field and to radiofrequency electromagnetic field. This paper presents the identified difficulties in applying numerical simulations to evaluate physical estimators of direct and indirect effects of exposure to electromagnetic fields at various frequencies. Exposure of workers operating a plastic sealer have been taken as an example scenario of electromagnetic field exposure at the workplace for discussion of those difficulties in applying numerical simulations. The following difficulties in reliable numerical simulations of workers' exposure to the electromagnetic field have been considered: workers' body models (posture, dimensions, shape and grounding conditions), working environment models (objects most influencing electromagnetic field distribution) and an analysis of parameters for which exposure limitations are specified in international guidelines and standards.

  10. Written debriefing: Evaluating the impact of the addition of a written component when debriefing simulations.

    PubMed

    Reed, Shelly J

    2015-11-01

    Debriefing, the reflective period following a simulation, is said to be where the bulk of simulation learning takes place. Many expert opinions regarding debriefing exist, but evidence-based best practices have yet to be identified. Written debriefing is one of these practices; experts state learning can be extended through the addition of a written component to the debriefing process, but no evidence exists to support this. This study compares three debriefing types: discussion alone, and discussion followed by journaling or blogging. Undergraduate nursing students participating in a simulation were randomized as a simulation group to one of these three debriefing types. Following completion of debriefing activities, students completed a Debriefing Experience Scale, a tool designed to evaluate the student experience during debriefing. Data obtained from completed scales were analyzed with ANOVA followed by Fisher LSD post hoc testing. The results showed the students preferred their experience with discussion debriefing over discussion debriefing with a written component added.

  11. Identification and simulation evaluation of an AH-64 helicopter hover math model

    NASA Technical Reports Server (NTRS)

    Schroeder, J. A.; Watson, D. C.; Tischler, M. B.; Eshow, M. M.

    1991-01-01

    Frequency-domain parameter-identification techniques were used to develop a hover mathematical model of the AH-64 Apache helicopter from flight data. The unstable AH-64 bare-airframe characteristics without a stability-augmentation system were parameterized in the convectional stability-derivative form. To improve the model's vertical response, a simple transfer-function model approximating the effects of dynamic inflow was developed. Additional subcomponents of the vehicle were also modeled and simulated, such as a basic engine response for hover and the vehicle stick dynamic characteristics. The model, with and without stability augmentation, was then evaluated by AH-64 pilots in a moving-base simulation. It was the opinion of the pilots that the simulation was a satisfactory representation of the aircraft for the tasks of interest. The principal negative comment was that height control was more difficult in the simulation than in the aircraft.

  12. Difficulties in applying numerical simulations to an evaluation of occupational hazards caused by electromagnetic fields

    PubMed Central

    Zradziński, Patryk

    2015-01-01

    Due to the various physical mechanisms of interaction between a worker's body and the electromagnetic field at various frequencies, the principles of numerical simulations have been discussed for three areas of worker exposure: to low frequency magnetic field, to low and intermediate frequency electric field and to radiofrequency electromagnetic field. This paper presents the identified difficulties in applying numerical simulations to evaluate physical estimators of direct and indirect effects of exposure to electromagnetic fields at various frequencies. Exposure of workers operating a plastic sealer have been taken as an example scenario of electromagnetic field exposure at the workplace for discussion of those difficulties in applying numerical simulations. The following difficulties in reliable numerical simulations of workers’ exposure to the electromagnetic field have been considered: workers’ body models (posture, dimensions, shape and grounding conditions), working environment models (objects most influencing electromagnetic field distribution) and an analysis of parameters for which exposure limitations are specified in international guidelines and standards. PMID:26323781

  13. Development of the tunneling junction simulation environment for scanning tunneling microscope evaluation

    NASA Astrophysics Data System (ADS)

    Gajewski, Krzysztof; Piasecki, Tomasz; Kopiec, Daniel; Gotszalk, Teodor

    2017-03-01

    Proper configuration of scanning tunneling microscope electronics plays an important role in the atomic scale resolution surface imaging. Device evaluation in the tunneling contact between scanning tip and sample may be prone to the surface quality or mechanical disturbances. Thus the use of tunneling junction simulator makes electronics testing more reliable and increases its repeatability. Here, we present the theoretical background enabling the proper selection of electronic components circuitry used as a tunneling junction simulator. We also show how to simulate mechanics related to the piezoelectric scanner, which is applied in real experiments. Practical use of the proposed simulator and its application in metrological characterization of the developed scanning tunneling microscope is also shown.

  14. Teaching workflow analysis and lean thinking via simulation: a formative evaluation.

    PubMed

    Campbell, Robert James; Gantt, Laura; Congdon, Tamara

    2009-01-01

    This article presents the rationale for the design and development of a video simulation used to teach lean thinking and workflow analysis to health services and health information management students enrolled in a course on the management of health information. The discussion includes a description of the design process, a brief history of the use of simulation in healthcare, and an explanation of how video simulation can be used to generate experiential learning environments. Based on the results of a survey given to 75 students as part of a formative evaluation, the video simulation was judged effective because it allowed students to visualize a real-world process (concrete experience), contemplate the scenes depicted in the video along with the concepts presented in class in a risk-free environment (reflection), develop hypotheses about why problems occurred in the workflow process (abstract conceptualization), and develop solutions to redesign a selected process (active experimentation).

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

    SciTech Connect

    Imbus, H.R.

    1985-12-01

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

  16. Evaluation of delayed type immune reactivity in patients with acne vulgaris.

    PubMed

    Ashorn, R; Uotila, A; Kuokkanen, K; Räsänen, L; Karhumäki, E; Krohn, K

    1980-01-01

    The delayed-type immune reactivities of 39 patients suffering from moderate to severe papulopustular or nodulo-cystic forms of Acne vulgaris were compared with healthy acne-free controls. In vivo reactivity was assessed by skin testing with four common recall antigens. In vitro the afferent arm of the immune system was assayed by antigen and mitogen simulated lymphocyte transformation and the efferent arm by granulocyte random migration and by granulocyte responsiveness to a standard migration inhibitory lymphokine preparation. Spontaneous lymphocyte transformations were also evaluated. In acne patients the skin test reactivities were in general only slightly decreased. Their lymphocytes showed relatively normal responses to mitogen stimulation, but antigen responsiveness was significantly diminished. Furthermore the patients' lymphocytes showed increased spontaneous transformation. All these changes correlated, to some extent, with the severity of the disease. The granulocytes of acne patients showed increased random migration, of borderline significance, but the granulocyte responses to the lymphokine preparation were completely normal. The results suggest that immunologic abnormalities are mild and probably secondary to the inflammatory process.

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

    ERIC Educational Resources Information Center

    Lewis, Carol Ann

    2013-01-01

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

  18. Fast Simulators for Satellite Cloud Optical Centroid Pressure Retrievals, 1. Evaluation of OMI Cloud Retrievals

    NASA Technical Reports Server (NTRS)

    Joiner, J.; Vasilkov, A. P.; Gupta, Pawan; Bhartia, P. K.; Veefkind, Pepijn; Sneep, Maarten; deHaan, Johan; Polonsky, Igor; Spurr, Robert

    2011-01-01

    We have developed a relatively simple scheme for simulating retrieved cloud optical centroid pressures (OCP) from satellite solar backscatter observations. We have compared simulator results with those from more detailed retrieval simulators that more fully account for the complex radiative transfer in a cloudy atmosphere. We used this fast simulator to conduct a comprehensive evaluation of cloud OCPs from the two OMI algorithms using collocated data from CloudSat and Aqua MODIS, a unique situation afforded by the A-train formation of satellites. We find that both OMI algorithms perform reasonably well and that the two algorithms agree better with each other than either does with the collocated CloudSat data. This indicates that patchy snow/ice, cloud 3D, and aerosol effects not simulated with the CloudSat data are affecting both algorithms similarly. We note that the collocation with CloudSat occurs mainly on the East side of OMI's swath. Therefore, we are not able to address cross-track biases in OMI cloud OCP retrievals. Our fast simulator may also be used to simulate cloud OCP from output generated by general circulation models (GCM) with appropriate account of cloud overlap. We have implemented such a scheme and plan to compare OMI data with GCM output in the near future.

  19. Quantitative evaluation of simulated functional brain networks in graph theoretical analysis.

    PubMed

    Lee, Won Hee; Bullmore, Ed; Frangou, Sophia

    2017-02-01

    There is increasing interest in the potential of whole-brain computational models to provide mechanistic insights into resting-state brain networks. It is therefore important to determine the degree to which computational models reproduce the topological features of empirical functional brain networks. We used empirical connectivity data derived from diffusion spectrum and resting-state functional magnetic resonance imaging data from healthy individuals. Empirical and simulated functional networks, constrained by structural connectivity, were defined based on 66 brain anatomical regions (nodes). Simulated functional data were generated using the Kuramoto model in which each anatomical region acts as a phase oscillator. Network topology was studied using graph theory in the empirical and simulated data. The difference (relative error) between graph theory measures derived from empirical and simulated data was then estimated. We found that simulated data can be used with confidence to model graph measures of global network organization at different dynamic states and highlight the sensitive dependence of the solutions obtained in simulated data on the specified connection densities. This study provides a method for the quantitative evaluation and external validation of graph theory metrics derived from simulated data that can be used to inform future study designs.

  20. Evaluation of virtual simulation in a master's-level nurse education certificate program.

    PubMed

    Foronda, Cynthia; Lippincott, Christine; Gattamorta, Karina

    2014-11-01

    Master's-level, nurse education certificate students performed virtual clinical simulations as a portion of their clinical practicum. Virtual clinical simulation is an innovative pedagogy using avatars in Web-based platforms to provide simulated clinical experiences. The purpose of this mixed-methods study was to evaluate nurse educator students' experience with virtual simulation and the effect of virtual simulation on confidence in teaching ability. Aggregated quantitative results yielded no significant change in confidence in teaching ability. Individually, some students indicated change of either increased or decreased confidence, whereas others exhibited no change in confidence after engaging in virtual simulation. Qualitative findings revealed a process of precursors of anxiety and frustration with technical difficulties followed by outcomes of appreciation and learning. Instructor support was a mediating factor to decrease anxiety and technical difficulties. This study served as a starting point regarding the application of a virtual world to teach the art of instruction. As the movement toward online education continues, educators should further explore use of virtual simulation to prepare nurse educators.

  1. Simulation Environment to Evaluate Closed-Loop Insulin Delivery Systems in Type 1 Diabetes

    PubMed Central

    Wilinska, Malgorzata E.; Chassin, Ludovic J.; Acerini, Carlo L.; Allen, Janet M.; Dunger, David B.; Hovorka, Roman

    2010-01-01

    Background Closed-loop insulin delivery systems linking subcutaneous insulin infusion to real-time continuous glucose monitoring need to be evaluated in humans, but progress can be accelerated with the use of in silico testing. We present a simulation environment designed to support the development and testing of closed-loop insulin delivery systems in type 1 diabetes mellitus (T1DM). Methods The principal components of the simulation environment include a mathematical model of glucose regulation representing a virtual population with T1DM, the glucose measurement model, and the insulin delivery model. The simulation environment is highly flexible. The user can specify an experimental protocol, define a population of virtual subjects, choose glucose measurement and insulin delivery models, and specify outcome measures. The environment provides graphical as well as numerical outputs to enable a comprehensive analysis of in silico study results. The simulation environment is validated by comparing its predictions against a clinical study evaluating overnight closed-loop insulin delivery in young people with T1DM using a model predictive controller. Results The simulation model of glucose regulation is described, and population values of 18 synthetic subjects are provided. The validation study demonstrated that the simulation environment was able to reproduce the population results of the clinical study conducted in young people with T1DM. Conclusions Closed-loop trials in humans should be preceded and concurrently guided by highly efficient and resource-saving computer-based simulations. We demonstrate validity of population-based predictions obtained with our simulation environment. PMID:20167177

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

    NASA Technical Reports Server (NTRS)

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

    1977-01-01

    The control evaluated has been designed for the F100-PW-100 turbofan engine. The F100 engine represents the current state-of-the-art in aircraft gas turbine technology. The control makes use of a multivariable, linear quadratic regulator. The evaluation procedure employed utilized a real-time hybrid computer simulation of the F100 engine and an implementation of the control logic on the NASA LeRC digital computer/controller. The results of the evaluation indicated that the control logic and its implementation will be capable of controlling the engine throughout its operating range.

  3. Using soft systems methodology to develop a simulation of out-patient services.

    PubMed

    Lehaney, B; Paul, R J

    1994-10-01

    Discrete event simulation is an approach to modelling a system in the form of a set of mathematical equations and logical relationships, usually used for complex problems, which are difficult to address by using analytical or numerical methods. Managing out-patient services is such a problem. However, simulation is not in itself a systemic approach, in that it provides no methodology by which system boundaries and system activities may be identified. The investigation considers the use of soft systems methodology as an aid to drawing system boundaries and identifying system activities, for the purpose of simulating the outpatients' department at a local hospital. The long term aims are to examine the effects that the participative nature of soft systems methodology has on the acceptability of the simulation model, and to provide analysts and managers with a process that may assist in planning strategies for health care.

  4. Control of thermal barrier performance by optimized nanoparticle size and experimental evaluation using a solar simulator

    NASA Astrophysics Data System (ADS)

    Gonome, Hiroki; Baneshi, Mehdi; Okajima, Junnosuke; Komiya, Atsuki; Yamada, Noboru; Maruyama, Shigenao

    2014-12-01

    An experimental investigation to evaluate the radiative properties of a selectively transparent thin coating on a substrate of a different material has been performed in order to evaluate its thermal behavior for applications where a low temperature at the surface exposed to the sun is desired. Copper (II) oxide (CuO) micro-particles have been used to create a pigmented coating on a paper substrate. The particle volume fraction and size have been optimized by the theoretical methodology. The spectral reflectance was measured using spectroscopy in the visible (VIS) and near-infrared (NIR) regions. The spectral emissivity was evaluated from the reflectance in IR region. The temperatures of the designed coatings and typical black paints are measured in a solar simulator. The temperature measurement was simulated by numerical analysis. The temperature of CuO coating on standard white paper was 10 °C lower than the ones of typical black paint while keeping the desired dark tone.

  5. Development of an evaluation framework suitable for assessing humanitarian workforce competencies during crisis simulation exercises.

    PubMed

    Cranmer, Hilarie; Chan, Jennifer L; Kayden, Stephanie; Musani, Altaf; Gasquet, Philippe E; Walker, Peter; Burkle, Frederick M; Johnson, Kirsten

    2014-02-01

    The need to provide a professionalization process for the humanitarian workforce is well established. Current competency-based curricula provided by existing academically affiliated training centers in North America, the United Kingdom, and the European Union provide a route toward certification. Simulation exercises followed by timely evaluation is one way to mimic the field deployment process, test knowledge of core competences, and ensure that a competent workforce can manage the inevitable emergencies and crises they will face. Through a 2011 field-based exercise that simulated a humanitarian crisis, delivered under the auspices of the World Health Organization (WHO), a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers.

  6. A simulator evaluation of the use of spoilers on a light aircraft

    NASA Technical Reports Server (NTRS)

    Brainerd, C. H.; Kohlman, D. L.

    1972-01-01

    A fixed-base flight simulator was used to evaluate wing spoilers for longitudinal flight path control on a modified Cessna Cardinal aircraft. Spoilers which generated the proper pitching moment to maintain aircraft trim C sub L constant could be used as an effective descent rate control. More than 100 simulated ILS approaches were flown by evaluation pilots using both conventional methods and spoiler descent rate control. Three spoiler control schemes were evaluated during the ILS approaches. Using the spoilers for control, instrument approaches could be flown smoothly and precisely with constant airspeed and pitch attitude. While the spoilers could adequately control ILS approaches, a spoiler system with greater authority would be desirable for use in visual approaches.

  7. Simulating physiological conditions to evaluate nanoparticles for magnetic fluid hyperthermia (MFH) therapy applications

    NASA Astrophysics Data System (ADS)

    Chen, Shihwei; Chiang, Chen-li; Hsieh, Shuchen

    2010-01-01

    Magnetite nanoparticles with high self-heating capacity and low toxicity characteristics are a promising candidate for cancer hyperthermia treatment. In order to achieve minimum dosage to a patient, magnetic nanoparticles with high heating capacity are needed. In addition, the influence of physiological factors on the heat capacity of a material should be investigated in order to determine the feasibility. In this study, magnetite nanoparticles coated with lauric acid were prepared by co-precipitation of Fe 3+:Fe 2+ in a ratio of 2:1, 5:3, 3:2, and 4:3, and the pH was controlled using NaOH. Structural and magnetization characterization by means of X-ray diffractometry (XRD) and a superconducting quantum interference device (SQUID) revealed that the main species was Fe 3O 4 and further showed that most of the nanoparticles exhibited superparamagnetic properties. All of the magnetic nanoparticles showed a specific absorption rate (SAR) increase that was linear with the magnetic field strength and frequency of the alternating magnetic field. Among all, the magnetic nanoparticles prepared in a 3:2 ratio showed the highest SAR. To further test the influence of physiological factors on the 3:2 ratio magnetic nanoparticles, we simulated the environment with protein (bovine serum albumin, BSA), blood sugar (dextrose), electrolytes (commercial norm-saline) and viscosity (glycerol) to examine the heating capacity under these conditions. Our results showed that the SAR value was unaffected by the protein and blood sugar environments. On the other hand, the SAR value was significantly reduced in the electrolyte environment, due to precipitation and aggregation with sodium ions. For the simulated viscous environment with glycerol, the result showed that the SAR values reduced with increasing glycerol concentration. We have further tested the heating capacity contribution from the Néel mechanism by trapping the magnetic nanoparticles in a solid form of polydimethylsiloxane

  8. County-level effects of prehospital regionalization of critically ill patients: a simulation study

    PubMed Central

    Seymour, Christopher W.; Alotaik, Osama; Wallace, David J.; Elhabashy, Ahmed E.; Chhatwal, Jagpreet; Rea, Thomas D; Angus, Derek C.; Nichol, Graham; Kahn, Jeremy M.

    2016-01-01

    Objective Regionalization may improve critical care delivery, yet stakeholders cite concerns about its feasibility. We sought to determine the operational effects of prehospital regionalization of non-trauma, non-arrest critical illness. Design Discrete event simulation study Patients and setting All 2006 hospital discharge data from King County, Washington, linked to all adult, eligible patients transported by county EMS agencies. Methods We simulated active triage of high-risk patients to designated referral centers using a validated prehospital risk score; we studied three regionalization scenarios: (1) up triage, (2) up & down triage, (3) up & down triage after reducing intensive care unit (ICU) beds by 25%. We determined the effect on patient routing, ICU occupancy at referral and non-referral hospitals, and EMS transport times. Measurements and Main Results 119,117 patients were hospitalized at 11 non-referral centers and 76,817 patients were hospitalized at three referral centers. Among 20,835 EMS patients, 7,817 (43%) patients were eligible for up triage and 10,242 (57%) patients were eligible for down triage. At baseline mean daily ICU bed occupancy was 61% referral and 47% at non-referral hospitals. Up-triage increased referral ICU occupancy to 68%, up and down triage to 64%, and up and down triage with bed reduction to 74%. Mean daily non-referral ICU occupancy did not exceed 60%. Total EMS transport time increased by less than 3% with up and down triage. Conclusions Regionalization based on prehospital triage of the critically ill can allocate high-risk patients to referral hospitals without adversely affecting ICU occupancy or prehospital travel time. PMID:26102251

  9. Influences of 3-dimensional PET scanner components on increased scatter evaluated by a Monte Carlo simulation.

    PubMed

    Hirano, Yoshiyuki; Koshino, Kazuhiro; Iida, Hidehiro

    2017-03-13

    Monte Carlo simulation is widely applied to evaluate the performance of three-dimensional positron emission tomography (3D-PET). For accurate scatter simulations, all components that generate scatter need to be taken into account. The aim of this work was to identify the components that influence scatter. The simulated geometries of a PET scanner were: a precisely reproduced configuration including all of the components; a configuration with the bed, the tunnel and shields; a configuration with the bed and shields; and the simplest geometry with only the bed. We measured and simulated the scatter fraction using two different set-ups: 1) as prescribed by NEMA-NU 2007 and 2) a similar set-up but with a shorter line source, so that all activity was contained only inside the field-of-view (FOV), in order to reduce influences of components outside the FOV. These experimental scatter fractions were respectively 45% and 38%. In the simulation, the former two configurations were in good agreement with experimental results, but simulation results of the simplest geometry were significantly different at the edge of the FOV. From the simulation of the precise configuration, the object (scatter phantom) was the source of more than 90% of the scatter. This was also confirmed by visualization of photon trajectories. Then, the bed and the tunnel were mainly the sources of the rest of the scatter. From the simulation results, it was concluded that the precise construction was not needed; the shields, the tunnel, the bed and the object were sufficient for accurate scatter simulations.

  10. Evaluation of Global Observations-Based Evapotranspiration Datasets and IPCC AR4 Simulations

    NASA Technical Reports Server (NTRS)

    Mueller, B.; Seneviratne, S. I.; Jimenez, C.; Corti, T.; Hirschi, M.; Balsamo, G.; Ciais, P.; Dirmeyer, P.; Fisher, J. B.; Guo, Z.; Jung, M.; Maignan, F.; McCabe, M. F.; Reichle, R.; Reichstein, M.; Rodell, M.; Sheffield, J.; Teuling, A. J.; Wang, K.; Wood, E. F.; Zhang, Y.

    2011-01-01

    Quantification of global land evapotranspiration (ET) has long been associated with large uncertainties due to the lack of reference observations. Several recently developed products now provide the capacity to estimate ET at global scales. These products, partly based on observational data, include satellite ]based products, land surface model (LSM) simulations, atmospheric reanalysis output, estimates based on empirical upscaling of eddycovariance flux measurements, and atmospheric water balance datasets. The LandFlux-EVAL project aims to evaluate and compare these newly developed datasets. Additionally, an evaluation of IPCC AR4 global climate model (GCM) simulations is presented, providing an assessment of their capacity to reproduce flux behavior relative to the observations ]based products. Though differently constrained with observations, the analyzed reference datasets display similar large-scale ET patterns. ET from the IPCC AR4 simulations was significantly smaller than that from the other products for India (up to 1 mm/d) and parts of eastern South America, and larger in the western USA, Australia and China. The inter-product variance is lower across the IPCC AR4 simulations than across the reference datasets in several regions, which indicates that uncertainties may be underestimated in the IPCC AR4 models due to shared biases of these simulations.

  11. [Evaluation of patient-ventilator synchrony of three new types of ventilators with pressure sunnort ventilation mode].

    PubMed

    Zhou, Juan; Wu, Hao; Cao, Desen

    2014-08-01

    Pressure-support ventilation (PSV) is a form of important ventilation mode. Patient-ventilator synchrony of pressure support ventilation can be divided into inspiration-triggered and expiration-triggered ones. Whether the ventilator can track the patient's inspiration and expiration very well or not is an important evaluating item of the performance of the ventilator. The ventilator should response to the patient's inspiration effort on time and deliver the air flow to the patient under various conditions, such as different patient's lung types and inspiration effort, etc. Similarly, the ventilator should be able to response to the patient's expiration action, and to decrease the patient lung's internal pressure rapidly. Using the Active Servo Lung (ASL5000) respiratory simulation system, we evaluated the spontaneous breathing of PSV mode on E5, Servo i and Evital XL. The following parameters, the delay time before flow to the patient starts once the trigger variable signaling the start of inspiration, the lowest inspiratory airway pressure generated prior to the initiation of PSV, etc. were measured.

  12. Effects of simulator motion and visual characteristics on rotorcraft handling qualities evaluations

    NASA Technical Reports Server (NTRS)

    Mitchell, David G.; Hart, Daniel C.

    1993-01-01

    The pilot's perceptions of aircraft handling qualities are influenced by a combination of the aircraft dynamics, the task, and the environment under which the evaluation is performed. When the evaluation is performed in a groundbased simulator, the characteristics of the simulation facility also come into play. Two studies were conducted on NASA Ames Research Center's Vertical Motion Simulator to determine the effects of simulator characteristics on perceived handling qualities. Most evaluations were conducted with a baseline set of rotorcraft dynamics, using a simple transfer-function model of an uncoupled helicopter, under different conditions of visual time delays and motion command washout filters. Differences in pilot opinion were found as the visual and motion parameters were changed, reflecting a change in the pilots' perceptions of handling qualities, rather than changes in the aircraft model itself. The results indicate a need for tailoring the motion washout dynamics to suit the task. Visual-delay data are inconclusive but suggest that it may be better to allow some time delay in the visual path to minimize the mismatch between visual and motion, rather than eliminate the visual delay entirely through lead compensation.

  13. Evaluation of rainfall simulations over West Africa in dynamically downscaled CMIP5 global circulation models

    NASA Astrophysics Data System (ADS)

    Akinsanola, A. A.; Ajayi, V. O.; Adejare, A. T.; Adeyeri, O. E.; Gbode, I. E.; Ogunjobi, K. O.; Nikulin, G.; Abolude, A. T.

    2017-03-01

    This study presents evaluation of the ability of Rossby Centre Regional Climate Model (RCA4) driven by nine global circulation models (GCMs), to skilfully reproduce the key features of rainfall climatology over West Africa for the period of 1980-2005. The seasonal climatology and annual cycle of the RCA4 simulations were assessed over three homogenous subregions of West Africa (Guinea coast, Savannah, and Sahel) and evaluated using observed precipitation data from the Global Precipitation Climatology Project (GPCP). Furthermore, the model output was evaluated using a wide range of statistical measures. The interseasonal and interannual variability of the RCA4 were further assessed over the subregions and the whole of the West Africa domain. Results indicate that the RCA4 captures the spatial and interseasonal rainfall pattern adequately but exhibits a weak performance over the Guinea coast. Findings from the interannual rainfall variability indicate that the model performance is better over the larger West Africa domain than the subregions. The largest difference across the RCA4 simulated annual rainfall was found in the Sahel. Result from the Mann-Kendall test showed no significant trend for the 1980-2005 period in annual rainfall either in GPCP observation data or in the model simulations over West Africa. In many aspects, the RCA4 simulation driven by the HadGEM2-ES perform best over the region. The use of the multimodel ensemble mean has resulted to the improved representation of rainfall characteristics over the study domain.

  14. Dynamic finite element knee simulation for evaluation of knee replacement mechanics.

    PubMed

    Baldwin, Mark A; Clary, Chadd W; Fitzpatrick, Clare K; Deacy, James S; Maletsky, Lorin P; Rullkoetter, Paul J

    2012-02-02

    In vitro pre-clinical testing of total knee replacement (TKR) devices is a necessary step in the evaluation of new implant designs. Whole joint knee simulators, like the Kansas knee simulator (KKS), provide a controlled and repeatable loading environment for comparative evaluation of component designs or surgical alignment under dynamic conditions. Experimental testing, however, is time and cost prohibitive for design-phase evaluation of tens or hundreds of design variations. Experimentally-verified computational models provide an efficient platform for analysis of multiple components, sizes, and alignment conditions. The purpose of the current study was to develop and verify a computational model of a dynamic, whole joint knee simulator. Experimental internal-external and valgus-varus laxity tests, followed by dynamic deep knee bend and gait simulations in the KKS were performed on three cadaveric specimens. Specimen-specific finite element (FE) models of posterior-stabilized TKR were created from magnetic resonance images and CAD geometry. The laxity data was used to optimize mechanical properties of tibiofemoral soft-tissue structures on a specimen-specific basis. Each specimen was subsequently analyzed in a computational model of the experimental KKS, simulating both dynamic activities. The computational model represented all joints and actuators in the experimental setup, including a proportional-integral-derivative (PID) controller to drive quadriceps actuation. The computational model was verified against six degree-of-freedom patellofemoral (PF) and tibiofemoral (TF) kinematics and actuator loading during both deep knee bend and gait activities, with good agreement in trends and magnitudes between model predictions and experimental kinematics; differences were less than 1.8 mm and 2.2° for PF and TF translations and rotations. The whole joint FE simulator described in this study can be applied to investigate a wide range of clinical and research questions.

  15. Hypertrophic herpes simplex simulating anal neoplasia in AIDS patients: report of five cases.

    PubMed

    Nadal, Sidney R; Calore, Edenilson E; Manzione, Carmen R; Horta, Sergio C; Ferreira, Aurea F; Almeida, Lis V

    2005-12-01

    Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.

  16. Laboratory evaluation and application of microwave absorption properties under simulated conditions for planetary atmospheres

    NASA Technical Reports Server (NTRS)

    Steffes, Paul G.

    1987-01-01

    Laboratory measurements were conducted to evaluate properties of atmospheric gases under simulated conditions for the outer planets. A significant addition to this effort was the capability to make such measurements at millimeter wavelengths. Measurements should soon be completed on the millimeter wave absorption from ammonia under Jovian conditions. Also studied will be the feasibility of measuring the microwave and millimeter wave properties of phosphine (PH3) under simulated Jovian conditions. Further analysis and application of the laboratory results to microwave and millimeter wave absorption data for the outer planet, such as Voyager Radio Occultation experiments, will be pursued.

  17. Evaluation of emergency-locator-transmitter performance in real and simulated crash tests

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1981-01-01

    Emergency locator transmitter (ELT) activation problems were investigated by testing a sampling of ELT units in actual airplane crashes and in a special test apparatus which simulated longitudinal crash pulses with superimposed local structural resonances. Probable causes of excessive false alarms and nonactivations of ELT's during crash situations were determined and solutions to the current operational and technical problems were obtained. The results, which considered placement, mounting, and activation of ELT's under simulated crash impacts, and an evaluation of the sensitivity of ELT impact switches to orientation and to local structural vibrations are discussed.

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

    SciTech Connect

    Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John

    2009-10-15

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

  19. In Vitro Validation of Patient-Specific Hemodynamic Simulations in Coronary Aneurysms Caused by Kawasaki Disease

    PubMed Central

    Kung, Ethan; Kahn, Andrew M.; Burns, Jane C.; Marsden, Alison

    2014-01-01

    To perform experimental validation of computational fluid dynamics (CFD) applied to patient specific coronary aneurysm anatomy of Kawasaki disease. We quantified hemodynamics in a patient-specific coronary artery aneurysm physical phantom under physiologic rest and exercise flow conditions. Using phase contrast MRI (PCMRI), we acquired 3-component flow velocity at two slice locations in the aneurysms. We then performed numerical simulations with the same geometry and inflow conditions, and performed qualitative and quantitative comparisons of velocities between experimental measurements and simulation results. We observed excellent qualitative agreement in flow pattern features. The quantitative spatially and temporally varying differences in velocity between P