WorldWideScience

Sample records for fidelity medical simulation

  1. Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students.

    Science.gov (United States)

    Shah, Nighat; Baig, Lubna; Shah, Nusrat; Hussain, Riffat; Aly, Syed Moyn

    2017-10-01

    To assess the effectiveness of medium fidelity simulator in teaching normal vaginal delivery to medical students. The quasi-experimental study was conducted at the professional development centre of the Jinnah Sindh Medical University, Karachi, from June to December 2015, and comprised medical students. Third-year medical students were included. They were divided into two groups. Group A was taught normal delivery through traditional PowerPoint and group B through simulator. The instruments used for assessing knowledge were pre-test and post-test, for skills of labour/delivery checklist of performance was used, and perception forms were filled to evaluate workshops/learning environment by students. Of the 76 participants, there were 36(47.4%) in group A and 40(52.6%) in group B. The overall mean age of the participants was 20.86±0.76 years in group B and 20.60±0.95 years in group A (p=0.19). The mean grade point average of the participants was 2.89±0.47 in group A and 2.87±0.48 in group B (p=0.81).Group B performed much better in skill of delivery having a mean score of 8.91±3.20compared to group A which had mean of 5.67±1.84 (pSimulation-based skill learning showed significantly better results.

  2. High-Fidelity Simulation: Preparing Dental Hygiene Students for Managing Medical Emergencies.

    Science.gov (United States)

    Bilich, Lisa A; Jackson, Sarah C; Bray, Brenda S; Willson, Megan N

    2015-09-01

    Medical emergencies can occur at any time in the dental office, so being prepared to properly manage the situation can be the difference between life and death. The entire dental team must be properly trained regarding all aspects of emergency management in the dental clinic. The aim of this study was to evaluate a new educational approach using a high-fidelity simulator to prepare dental hygiene students for medical emergencies. This study utilized high-fidelity simulation (HFS) to evaluate the abilities of junior dental hygiene students at Eastern Washington University to handle a medical emergency in the dental hygiene clinic. Students were given a medical emergency scenario requiring them to assess the emergency and implement life-saving protocols in a simulated "real-life" situation using a high-fidelity manikin. Retrospective data were collected for four years from the classes of 2010 through 2013 (N=114). The results indicated that learning with simulation was effective in helping the students identify the medical emergency in a timely manner, implement emergency procedures correctly, locate and correctly utilize contents of the emergency kit, administer appropriate intervention/treatment for a specific patient, and provide the patient with appropriate follow-up instructions. For dental hygiene programs seeking to enhance their curricula in the area of medical emergencies, this study suggests that HFS is an effective tool to prepare students to appropriately handle medical emergencies. Faculty calibration is essential to standardize simulation.

  3. A study on the usefulness of high fidelity patient simulation in undergraduate medical education

    Directory of Open Access Journals (Sweden)

    Bikramjit Pal

    2018-01-01

    Full Text Available Introduction: Simulation is the imitation of the operation of a real-world process or system over time. Innovative simulation training solutions are now being used to train medical professionals in an attempt to reduce the number of safety concerns that have adverse effects on the patients. Objectives: (a To determine its usefulness as a teaching or learning tool for management of surgical emergencies, both in the short term and medium term by students’ perception. (b To plan future teaching methodology regarding hi-fidelity simulation based on the study outcomes and re-assessment of the current training modules. Methods: Quasi-experimental time series design with pretest-posttest interventional study. Quantitative data was analysed in terms of Mean, Standard Deviation and standard error of Mean. Statistical tests of significance like Repeated Measure of Analysis of Variance (ANOVA were used for comparisons. P value < 0.001 was considered to be statistically significant. Results: The students opined that the simulated sessions on high fidelity simulators had encouraged their active participation which was appropriate to their current level of learning. It helped them to think fast and the training sessions resembled a real life situation. The study showed that learning had progressively improved with each session of simulation with corresponding decrease in stress. Conclusion: Implementation of high fidelity simulation based learning in our Institute had been perceived favourably by a large number of students in enhancing their knowledge over time in management of trauma and surgical emergencies.

  4. Fidelity in clinical simulation

    DEFF Research Database (Denmark)

    Jensen, Sanne; Nøhr, Christian; Rasmussen, Stine Loft

    2013-01-01

    Clinical simulation may be used to identify user needs for context sensitive functionalities in e-Health. The objective with this paper is to describe how user requirements and use cases in a large EHR-platform procurement may be validated by clinical simulation using a very low-fidelity prototype...... without any existing test data. Instead of using test scenarios and use cases, the healthcare professionals who are participating in the clinical simulation are generating both scenario and patient data themselves. We found that this approach allows for an imaginative discussion, not restricted by known...... functionalities and limitations, of the ideal EHR-platform. Subsequently, we discuss benefits and challenges of using an extremely low fidelity environment and discuss the degree of fidelity necessary for conducting clinical simulation....

  5. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

    Science.gov (United States)

    Issenberg, S Barry; McGaghie, William C; Petrusa, Emil R; Lee Gordon, David; Scalese, Ross J

    2005-01-01

    1969 to 2003, 34 years. Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical

  6. High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost

    Directory of Open Access Journals (Sweden)

    Holland Carolyn

    2006-10-01

    Full Text Available Abstract Background This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. Methods Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMan™ to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. Results The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of $440 and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234, but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029. Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other

  7. Severe Trauma Stress Inoculation Training for Combat Medics using High Fidelity Simulation

    Science.gov (United States)

    2013-12-01

    expressions; and improved sensors and communication systems for current medical training simulators. He has prior experience in software development for DoD...the "look and feel" of such injuries by providing the highly realistic visual, auditory, and haptic (touch) stimuli necessary to elicit stress...addressed during development included the following: • Microcontroller-based control system for monitoring sensors and automating the actions of the

  8. Simulation-based rhomboid flap skills training during medical education: comparing low- and high-fidelity bench models.

    Science.gov (United States)

    Denadai, Rafael; Saad-Hossne, Rogerio; Raposo-Amaral, Cassio Eduardo

    2014-11-01

    To assess if the bench model fidelity interferes in the acquisition of rhomboid flap skills by medical students. Sixty novice medical students were randomly assigned to 5 practice conditions with instructor-directed Limberg rhomboid flap skills training: didactic materials (control group 1), low-fidelity rubberized line (group 2) or ethylene-vinyl acetate (group 3) bench models; high-fidelity chicken leg skin (group 4) or pig foot skin (group 5) bench models. Pretests and posttests were applied, and Global Rating Scale, effect size, and self-perceived confidence were used to evaluate all flap performances. Medical students from groups 2 to 5 showed better flap performances based on the Global Rating Scale (all P 0.05). The magnitude of the effect was considered large (>0.80) in all measurements. There was acquisition of rhomboid flap skills regardless of bench model fidelity.

  9. Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves.

    Science.gov (United States)

    Harris, David M; Ryan, Kathleen; Rabuck, Cynthia

    2012-09-01

    Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.

  10. Nuclear power plant training simulator fidelity assessment

    International Nuclear Information System (INIS)

    Carter, R.J.; Laughery, K.R.

    1985-01-01

    The fidelity assessment portion of a methodology for evaluating nuclear power plant simulation facilities in regard to their appropriateness for conducting the Nuclear Regulatory Commission's operating test was described. The need for fidelity assessment, data sources, and fidelity data to be collected are addressed. Fidelity data recording, collection, and analysis are discussed. The processes for drawing conclusions from the fidelity assessment and evaluating the adequacy of the simulator control-room layout were presented. 3 refs

  11. Utilizing Three-Dimensional Printing Technology to Assess the Feasibility of High-Fidelity Synthetic Ventricular Septal Defect Models for Simulation in Medical Education.

    Science.gov (United States)

    Costello, John P; Olivieri, Laura J; Krieger, Axel; Thabit, Omar; Marshall, M Blair; Yoo, Shi-Joon; Kim, Peter C; Jonas, Richard A; Nath, Dilip S

    2014-07-01

    The current educational approach for teaching congenital heart disease (CHD) anatomy to students involves instructional tools and techniques that have significant limitations. This study sought to assess the feasibility of utilizing present-day three-dimensional (3D) printing technology to create high-fidelity synthetic heart models with ventricular septal defect (VSD) lesions and applying these models to a novel, simulation-based educational curriculum for premedical and medical students. Archived, de-identified magnetic resonance images of five common VSD subtypes were obtained. These cardiac images were then segmented and built into 3D computer-aided design models using Mimics Innovation Suite software. An Objet500 Connex 3D printer was subsequently utilized to print a high-fidelity heart model for each VSD subtype. Next, a simulation-based educational curriculum using these heart models was developed and implemented in the instruction of 29 premedical and medical students. Assessment of this curriculum was undertaken with Likert-type questionnaires. High-fidelity VSD models were successfully created utilizing magnetic resonance imaging data and 3D printing. Following instruction with these high-fidelity models, all students reported significant improvement in knowledge acquisition (P 3D printing technology to create high-fidelity heart models with complex intracardiac defects. Furthermore, this tool forms the foundation for an innovative, simulation-based educational approach to teach students about CHD and creates a novel opportunity to stimulate their interest in this field. © The Author(s) 2014.

  12. An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport.

    Science.gov (United States)

    DeForest, Christine A; Blackman, Virginia; Alex, John E; Reeves, Lauren; Mora, Alejandra; Perez, Crystal; Maddry, Joseph; Selby, Domenique; Walrath, Benjamin

    2018-03-14

    Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. Historically, evaluations of ERC and patient outcomes have been based on retrospective analyses of incomplete data sets that provide limited insight on ERC practices. Little evidence exists to determine if current training is adequate to care for the most common injuries seen in combat trauma patients. Simulation technology facilitates a standardized patient encounter to enable complete, prospective data collection while studying provider type as the independent variable. Information acquired through skill performance observation can be used to make evidence-based recommendations to improve ERC training. This IRB approved multi-center study funded through a Congressionally Directed Medical Research Program grant from the Combat Casualty Care Intramural Research Joint En Route Care portfolio evaluated Navy ERC providers. The study evaluated 84 SMT, ERC RN, and physician participants in the performance of critical and secondary actions during an immersive, high-fidelity, patient transport simulation scenario focused on the care during an interfacility transfer. Simulation evaluators with military ERC expertise, blinded to participant training and background, graded each participant's performance. Inter-rater reliability was calculated using Cohen's Kappa to evaluate concordance between evaluator assessments. Categorical data were reported as frequencies and percentages. Performance attempt and accuracy rates were compared with likelihood ratio chi-square or Fisher's exact test

  13. High Fidelity BWR Fuel Simulations

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Su Jong [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-08-01

    This report describes the Consortium for Advanced Simulation of Light Water Reactors (CASL) work conducted for completion of the Thermal Hydraulics Methods (THM) Level 3 milestone THM.CFD.P13.03: High Fidelity BWR Fuel Simulation. High fidelity computational fluid dynamics (CFD) simulation for Boiling Water Reactor (BWR) was conducted to investigate the applicability and robustness performance of BWR closures. As a preliminary study, a CFD model with simplified Ferrule spacer grid geometry of NUPEC BWR Full-size Fine-mesh Bundle Test (BFBT) benchmark has been implemented. Performance of multiphase segregated solver with baseline boiling closures has been evaluated. Although the mean values of void fraction and exit quality of CFD result for BFBT case 4101-61 agreed with experimental data, the local void distribution was not predicted accurately. The mesh quality was one of the critical factors to obtain converged result. The stability and robustness of the simulation was mainly affected by the mesh quality, combination of BWR closure models. In addition, the CFD modeling of fully-detailed spacer grid geometry with mixing vane is necessary for improving the accuracy of CFD simulation.

  14. Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study.

    Directory of Open Access Journals (Sweden)

    Andrea Cortegiani

    Full Text Available High-fidelity simulation (HFS is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS, in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge and an objective section (measuring level of knowledge containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2 than in group C (mean 65.5, SD 14.3, p = 0.0017, 95% C.I. 3.34 - 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22-5.99 and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13-6.53. Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074. A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079. HFS showed a beneficial effect on knowledge of ALS among medical students

  15. Physiological Based Simulator Fidelity Design Guidance

    Science.gov (United States)

    Schnell, Thomas; Hamel, Nancy; Postnikov, Alex; Hoke, Jaclyn; McLean, Angus L. M. Thom, III

    2012-01-01

    The evolution of the role of flight simulation has reinforced assumptions in aviation that the degree of realism in a simulation system directly correlates to the training benefit, i.e., more fidelity is always better. The construct of fidelity has several dimensions, including physical fidelity, functional fidelity, and cognitive fidelity. Interaction of different fidelity dimensions has an impact on trainee immersion, presence, and transfer of training. This paper discusses research results of a recent study that investigated if physiological-based methods could be used to determine the required level of simulator fidelity. Pilots performed a relatively complex flight task consisting of mission task elements of various levels of difficulty in a fixed base flight simulator and a real fighter jet trainer aircraft. Flight runs were performed using one forward visual channel of 40 deg. field of view for the lowest level of fidelity, 120 deg. field of view for the middle level of fidelity, and unrestricted field of view and full dynamic acceleration in the real airplane. Neuro-cognitive and physiological measures were collected under these conditions using the Cognitive Avionics Tool Set (CATS) and nonlinear closed form models for workload prediction were generated based on these data for the various mission task elements. One finding of the work described herein is that simple heart rate is a relatively good predictor of cognitive workload, even for short tasks with dynamic changes in cognitive loading. Additionally, we found that models that used a wide range of physiological and neuro-cognitive measures can further boost the accuracy of the workload prediction.

  16. Developing a tool for observing group critical thinking skills in first-year medical students: a pilot study using physiology-based, high-fidelity patient simulations.

    Science.gov (United States)

    Nguyen, Khoa; Ben Khallouq, Bertha; Schuster, Amanda; Beevers, Christopher; Dil, Nyla; Kay, Denise; Kibble, Jonathan D; Harris, David M

    2017-12-01

    Most assessments of physiology in medical school use multiple choice tests that may not provide information about a student's critical thinking (CT) process. There are limited performance assessments, but high-fidelity patient simulations (HFPS) may be a feasible platform. The purpose of this pilot study was to determine whether a group's CT process could be observed over a series of HFPS. An instrument [Critical Thinking Skills Rating Instrument CTSRI)] was designed with the IDEAS framework. Fifteen groups of students participated in three HFPS that consisted of a basic knowledge quiz and introduction, HFPS session, and debriefing. HFPS were video recorded, and two raters reviewed and scored all HFPS encounters with the CTSRI independently. Interrater analysis suggested good reliability. There was a correlation between basic knowledge scores and three of the six observations on the CTSRI providing support for construct validity. The median CT ratings significantly increased for all observations between the groups' first and last simulation. However, there were still large percentages of video ratings that indicated students needed substantial prompting during the HFPS. The data from this pilot study suggest that it is feasible to observe CT skills in HFPS using the CTSRI. Based on the findings from this study, we strongly recommend that first-year medical students be competent in basic knowledge of the relevant physiology of the HFPS before participating, to minimize the risk of a poor learning experience. Copyright © 2017 the American Physiological Society.

  17. RELAP5: Applications to high fidelity simulation

    International Nuclear Information System (INIS)

    Johnsen, G.W.; Chen, Y.S.

    1988-01-01

    RELAP5 is a pressurized water reactor system transient simulation code for use in nuclear power plant safety analysis. The latest version, MOD2, may be used to simulate and study a wide variety of abnormal events, including loss-of-coolant accidents, operational transients, and transients in which the entire secondary system must be modeled. In this paper, a basic overview of the code is given, its assessment and application illustrated, and progress toward its use as a high fidelity simulator described. 7 refs., 7 figs

  18. High-Fidelity Roadway Modeling and Simulation

    Science.gov (United States)

    Wang, Jie; Papelis, Yiannis; Shen, Yuzhong; Unal, Ozhan; Cetin, Mecit

    2010-01-01

    Roads are an essential feature in our daily lives. With the advances in computing technologies, 2D and 3D road models are employed in many applications, such as computer games and virtual environments. Traditional road models were generated by professional artists manually using modeling software tools such as Maya and 3ds Max. This approach requires both highly specialized and sophisticated skills and massive manual labor. Automatic road generation based on procedural modeling can create road models using specially designed computer algorithms or procedures, reducing the tedious manual editing needed for road modeling dramatically. But most existing procedural modeling methods for road generation put emphasis on the visual effects of the generated roads, not the geometrical and architectural fidelity. This limitation seriously restricts the applicability of the generated road models. To address this problem, this paper proposes a high-fidelity roadway generation method that takes into account road design principles practiced by civil engineering professionals, and as a result, the generated roads can support not only general applications such as games and simulations in which roads are used as 3D assets, but also demanding civil engineering applications, which requires accurate geometrical models of roads. The inputs to the proposed method include road specifications, civil engineering road design rules, terrain information, and surrounding environment. Then the proposed method generates in real time 3D roads that have both high visual and geometrical fidelities. This paper discusses in details the procedures that convert 2D roads specified in shape files into 3D roads and civil engineering road design principles. The proposed method can be used in many applications that have stringent requirements on high precision 3D models, such as driving simulations and road design prototyping. Preliminary results demonstrate the effectiveness of the proposed method.

  19. High Fidelity In Situ Shoulder Dystocia Simulation

    Directory of Open Access Journals (Sweden)

    Andrew Pelikan, MD

    2018-04-01

    Full Text Available Audience: Resident physicians, emergency department (ED staff Introduction: Precipitous deliveries are high acuity, low occurrence in most emergency departments. Shoulder dystocia is a rare but potentially fatal complication of labor that can be relieved by specific maneuvers that must be implemented in a timely manner. This simulation is designed to educate resident learners on the critical management steps in a shoulder dystocia presenting to the emergency department. A special aspect of this simulation is the unique utilization of the “Noelle” model with an instructing physician at bedside maneuvering the fetus through the stations of labor and providing subtle adjustments to fetal positioning not possible though a mechanized model. A literature search of “shoulder dystocia simulation” consists primarily of obstetrics and mid-wife journals, many of which utilize various mannequin models. None of the reviewed articles utilized a bedside provider maneuvering the fetus with the Noelle model, making this method unique. While the Noelle model is equipped with a remote-controlled motor that automatically rotates and delivers the baby either to the head or to the shoulders and can produce a turtle sign and which will prevent delivery of the baby until signaled to do so by the instructor, using the bedside instructor method allows this simulation to be reproduced with less mechanistically advanced and lower cost models.1-5 Objectives: At the end of this simulation, learners will: 1 Recognize impending delivery and mobilize appropriate resources (ie, both obstetrics [OB] and NICU/pediatrics; 2 Identify risk factors for shoulder dystocia based on history and physical; 3 Recognize shoulder dystocia during delivery; 4 Demonstrate maneuvers to relieve shoulder dystocia; 5 Communicate with team members and nursing staff during resuscitation of a critically ill patient. Method: High-fidelity simulation. Topics: High fidelity, in situ, Noelle model

  20. Fidelity Witnesses for Fermionic Quantum Simulations

    Science.gov (United States)

    Gluza, M.; Kliesch, M.; Eisert, J.; Aolita, L.

    2018-05-01

    The experimental interest and developments in quantum spin-1 /2 chains has increased uninterruptedly over the past decade. In many instances, the target quantum simulation belongs to the broader class of noninteracting fermionic models, constituting an important benchmark. In spite of this class being analytically efficiently tractable, no direct certification tool has yet been reported for it. In fact, in experiments, certification has almost exclusively relied on notions of quantum state tomography scaling very unfavorably with the system size. Here, we develop experimentally friendly fidelity witnesses for all pure fermionic Gaussian target states. Their expectation value yields a tight lower bound to the fidelity and can be measured efficiently. We derive witnesses in full generality in the Majorana-fermion representation and apply them to experimentally relevant spin-1 /2 chains. Among others, we show how to efficiently certify strongly out-of-equilibrium dynamics in critical Ising chains. At the heart of the measurement scheme is a variant of importance sampling specially tailored to overlaps between covariance matrices. The method is shown to be robust against finite experimental-state infidelities.

  1. Status report on high fidelity reactor simulation

    International Nuclear Information System (INIS)

    Palmiotti, G.; Smith, M.; Rabiti, C.; Lewis, E.; Yang, W.; Leclere, M.; Siegel, A.; Fischer, P.; Kaushik, D.; Ragusa, J.; Lottes, J.; Smith, B.

    2006-01-01

    This report presents the effort under way at Argonne National Laboratory toward a comprehensive, integrated computational tool intended mainly for the high-fidelity simulation of sodium-cooled fast reactors. The main activities carried out involved neutronics, thermal hydraulics, coupling strategies, software architecture, and high-performance computing. A new neutronics code, UNIC, is being developed. The first phase involves the application of a spherical harmonics method to a general, unstructured three-dimensional mesh. The method also has been interfaced with a method of characteristics. The spherical harmonics equations were implemented in a stand-alone code that was then used to solve several benchmark problems. For thermal hydraulics, a computational fluid dynamics code called Nek5000, developed in the Mathematics and Computer Science Division for coupled hydrodynamics and heat transfer, has been applied to a single-pin, periodic cell in the wire-wrap geometry typical of advanced burner reactors. Numerical strategies for multiphysics coupling have been considered and higher-accuracy efficient methods proposed to finely simulate coupled neutronic/thermal-hydraulic reactor transients. Initial steps have been taken in order to couple UNIC and Nek5000, and simplified problems have been defined and solved for testing. Furthermore, we have begun developing a lightweight computational framework, based in part on carefully selected open source tools, to nonobtrusively and efficiently integrate the individual physics modules into a unified simulation tool

  2. Patterns of communication in high-fidelity simulation.

    Science.gov (United States)

    Anderson, Judy K; Nelson, Kimberly

    2015-01-01

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

  3. Importance of debriefing in high-fidelity simulations

    Directory of Open Access Journals (Sweden)

    Igor Karnjuš

    2014-04-01

    Full Text Available Debriefing has been identified as one of the most important parts of a high-fidelity simulation learning process. During debriefing, the mentor invites learners to critically assess the knowledge and skills used during the execution of a scenario. Regardless of the abundance of studies that have examined simulation-based education, debriefing is still poorly defined.The present article examines the essential features of debriefing, its phases, techniques and methods with a systematic review of recent publications. It emphasizes the mentor’s role, since the effectiveness of debriefing largely depends on the mentor’s skills to conduct it. The guidelines that allow the mentor to evaluate his performance in conducting debriefing are also presented. We underline the importance of debriefing in clinical settings as part of continuous learning process. Debriefing allows the medical teams to assess their performance and develop new strategies to achieve higher competencies.Although the debriefing is the cornerstone of high-fidelity simulation learning process, it also represents an important learning strategy in the clinical setting. Many important aspects of debriefing are still poorly explored and understood, therefore this part of the learning process should be given greater attention in the future.

  4. High Fidelity Simulation of Atomization in Diesel Engine Sprays

    Science.gov (United States)

    2015-09-01

    state Figure 5. Q criterion isosurface colored by streamwise velocity in the diesel spray injector as viewed from the nozzle exit. Figure 6. U contour...fidelity simulation approach was adopted to study the atom- ization physics of a diesel injector with detailed nozzle internal geometry. The nozzle flow...26; Stanford, CA 14. ABSTRACT A high fidelity numerical simulation of jet breakup and spray formation from a complex diesel fuel injector has been

  5. Fidelity of Simulation for Pilot Training

    Science.gov (United States)

    1980-12-01

    indicators of joint angles. The combination of all the pro- prioceptive senses permits subjects to perceive body accelerations based on the biomechanical ...constraints III. Controllers A. Flight controls 1. Center stick, column, side stick, collective 2. Pedals (yaw control, brakes) 3. Thrust controllers 4...the most sensitive elements in terms of fidelity require- ments. The force-generating systems associated with the stick or column and pedals are

  6. Recommendations on Model Fidelity for Wind Turbine Gearbox Simulations: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Y.; Keller, J.; La Cava, W.; Austin, J.; Nejad, A. R.; Halse, C.; Bastard, L.; Helsen, J.

    2015-01-01

    This work investigates the minimum level of fidelity required to accurately simulate wind turbine gearboxes using state-of-the-art design tools. Excessive model fidelity including drivetrain complexity, gearbox complexity, excitation sources, and imperfections, significantly increases computational time, but may not provide a commensurate increase in the value of the results. Essential design parameters are evaluated, including the planetary load-sharing factor, gear tooth load distribution, and sun orbit motion. Based on the sensitivity study results, recommendations for the minimum model fidelities are provided.

  7. Interprofessional education in pharmacology using high-fidelity simulation.

    Science.gov (United States)

    Meyer, Brittney A; Seefeldt, Teresa M; Ngorsuraches, Surachat; Hendrickx, Lori D; Lubeck, Paula M; Farver, Debra K; Heins, Jodi R

    2017-11-01

    This study examined the feasibility of an interprofessional high-fidelity pharmacology simulation and its impact on pharmacy and nursing students' perceptions of interprofessionalism and pharmacology knowledge. Pharmacy and nursing students participated in a pharmacology simulation using a high-fidelity patient simulator. Faculty-facilitated debriefing included discussion of the case and collaboration. To determine the impact of the activity on students' perceptions of interprofessionalism and their ability to apply pharmacology knowledge, surveys were administered to students before and after the simulation. Attitudes Toward Health Care Teams scale (ATHCT) scores improved from 4.55 to 4.72 on a scale of 1-6 (p = 0.005). Almost all (over 90%) of the students stated their pharmacology knowledge and their ability to apply that knowledge improved following the simulation. A simulation in pharmacology is feasible and favorably affected students' interprofessionalism and pharmacology knowledge perceptions. Pharmacology is a core science course required by multiple health professions in early program curricula, making it favorable for incorporation of interprofessional learning experiences. However, reports of high-fidelity interprofessional simulation in pharmacology courses are limited. This manuscript contributes to the literature in the field of interprofessional education by demonstrating that an interprofessional simulation in pharmacology is feasible and can favorably affect students' perceptions of interprofessionalism. This manuscript provides an example of a pharmacology interprofessional simulation that faculty in other programs can use to build similar educational activities. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2012-06-01

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

  9. The Effect of Model Fidelity on Learning Outcomes of a Simulation-Based Education Program for Central Venous Catheter Insertion.

    Science.gov (United States)

    Diederich, Emily; Mahnken, Jonathan D; Rigler, Sally K; Williamson, Timothy L; Tarver, Stephen; Sharpe, Matthew R

    2015-12-01

    Simulation-based education for central venous catheter (CVC) insertion has been repeatedly documented to improve performance, but the impact of simulation model fidelity has not been described. The aim of this study was to examine the impact of the physical fidelity of the simulation model on learning outcomes for a simulation-based education program for CVC insertion. Forty consecutive residents rotating through the medical intensive care unit of an academic medical center completed a simulation-based education program for CVC insertion. The curriculum was designed in accordance with the principles of deliberate practice and mastery learning. Each resident underwent baseline skills testing and was then randomized to training on a commercially available CVC model with high physical fidelity (High-Fi group) or a simply constructed model with low physical fidelity (Low-Fi group) in a noninferiority trial. Upon completion of their medical intensive care unit rotation 4 weeks later, residents returned for repeat skills testing on the high-fidelity model using a 26-item checklist. The mean (SD) posttraining score on the 26-item checklist for the Low-Fi group was 23.8 (2.2) (91.5%) and was not inferior to the mean (SD) score for the High-Fi group of 22.5 (2.6) (86.5%) (P Simulation-based education using equipment with low physical fidelity can achieve learning outcomes comparable with those with high-fidelity equipment, as long as other aspects of fidelity are maintained and robust educational principles are applied during the design of the curriculum.

  10. Hand ultrasound: a high-fidelity simulation of lung sliding.

    Science.gov (United States)

    Shokoohi, Hamid; Boniface, Keith

    2012-09-01

    Simulation training has been effectively used to integrate didactic knowledge and technical skills in emergency and critical care medicine. In this article, we introduce a novel model of simulating lung ultrasound and the features of lung sliding and pneumothorax by performing a hand ultrasound. The simulation model involves scanning the palmar aspect of the hand to create normal lung sliding in varying modes of scanning and to mimic ultrasound features of pneumothorax, including "stratosphere/barcode sign" and "lung point." The simple, reproducible, and readily available simulation model we describe demonstrates a high-fidelity simulation surrogate that can be used to rapidly illustrate the signs of normal and abnormal lung sliding at the bedside. © 2012 by the Society for Academic Emergency Medicine.

  11. High Fidelity Simulation of Primary Atomization in Diesel Engine Sprays

    Science.gov (United States)

    Ivey, Christopher; Bravo, Luis; Kim, Dokyun

    2014-11-01

    A high-fidelity numerical simulation of jet breakup and spray formation from a complex diesel fuel injector at ambient conditions has been performed. A full understanding of the primary atomization process in fuel injection of diesel has not been achieved for several reasons including the difficulties accessing the optically dense region. Due to the recent advances in numerical methods and computing resources, high fidelity simulations of atomizing flows are becoming available to provide new insights of the process. In the present study, an unstructured un-split Volume-of-Fluid (VoF) method coupled to a stochastic Lagrangian spray model is employed to simulate the atomization process. A common rail fuel injector is simulated by using a nozzle geometry available through the Engine Combustion Network. The working conditions correspond to a single orifice (90 μm) JP-8 fueled injector operating at an injection pressure of 90 bar, ambient condition at 29 bar, 300 K filled with 100% nitrogen with Rel = 16,071, Wel = 75,334 setting the spray in the full atomization mode. The experimental dataset from Army Research Lab is used for validation in terms of spray global parameters and local droplet distributions. The quantitative comparison will be presented and discussed. Supported by Oak Ridge Associated Universities and the Army Research Laboratory.

  12. Towards developing high-fidelity simulated learning environment training modules in audiology.

    Science.gov (United States)

    Dzulkarnain, A A; Rahmat, S; Mohd Puzi, N A F; Badzis, M

    2017-02-01

    This discussion paper reviews and synthesises the literature on simulated learning environment (SLE) from allied health sciences, medical and nursing in general and audiology specifically. The focus of the paper is on discussing the use of high-fidelity (HF) SLE and describing the challenges for developing a HF SLE for clinical audiology training. Through the review of the literature, this paper discusses seven questions, (i) What is SLE? (ii) What are the types of SLEs? (iii) How is SLE classified? (iv) What is HF SLE? (v) What types of SLEs are available in audiology and their level of fidelity? (vi) What are the components needed for developing HF SLE? (vii) What are the possible types of HF SLEs that are suitable for audiology training? Publications were identified by structured searches from three major databases PubMed, Web of Knowledge and PsychInfo and from the reference lists of relevant articles. The authors discussed and mapped the levels of fidelity of SLE audiology training modules from the literature and the learning domains involved in the clinical audiology courses. The discussion paper has highlighted that most of the existing SLE audiology training modules consist of either low- or medium-fidelity types of simulators. Those components needed to achieve a HF SLE for audiology training are also highlighted. Overall, this review recommends that the combined approach of different levels and types of SLE could be used to obtain a HF SLE training module in audiology training.

  13. High fidelity simulation effectiveness in nursing students' transfer of learning.

    Science.gov (United States)

    Kirkman, Tera R

    2013-07-13

    Members of nursing faculty are utilizing interactive teaching tools to improve nursing student's clinical judgment; one method that has been found to be potentially effective is high fidelity simulation (HFS). The purpose of this time series design study was to determine whether undergraduate nursing students were able to transfer knowledge and skills learned from classroom lecture and a HFS clinical to the traditional clinical setting. Students (n=42) were observed and rated on their ability to perform a respiratory assessment. The observations and ratings took place at the bedside, prior to a respiratory lecture, following the respiratory lecture, and following simulation clinical. The findings indicated that there was a significant difference (p=0.000) in transfer of learning demonstrated over time. Transfer of learning was demonstrated and the use of HFS was found to be an effective learning and teaching method. Implications of results are discussed.

  14. Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios.

    Science.gov (United States)

    O'Leary, Fenton; Pegiazoglou, Ioannis; McGarvey, Kathryn; Novakov, Ruza; Wolfsberger, Ingrid; Peat, Jennifer

    2018-02-01

    To measure scenario participant and faculty self-reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre-based simulations. A prospective survey of scenario participants and faculty completing in situ and centre-based paediatric simulations. There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre-based simulations. Scenario participant responses showed significantly higher ratings for the centre-based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P realism for engagement and learning. © 2017 The Authors Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator.

    Science.gov (United States)

    Cheng, Homan; Podolsky, Dale J; Fisher, David M; Wong, Karen W; Lorenz, H Peter; Khosla, Rohit K; Drake, James M; Forrest, Christopher R

    2018-01-01

    Cleft palate repair is a challenging procedure for cleft surgeons to teach. A novel high-fidelity cleft palate simulator has been described for surgeon training. This study evaluates the simulator's effect on surgeon procedural confidence and palatoplasty knowledge among learners. Plastic surgery trainees attended a palatoplasty workshop consisting of a didactic session on cleft palate anatomy and repair followed by a simulation session. Participants completed a procedural confidence questionnaire and palatoplasty knowledge test immediately before and after the workshop. All participants reported significantly higher procedural confidence following the workshop (p cleft palate surgery experience had higher procedural confidence before (p cleft palate experience did not have higher mean baseline test scores than those with no experience (30 percent versus 28 percent; p > 0.05), but did have significantly higher scores after the workshop (61 percent versus 35 percent; p cleft palate simulator as a training tool to teach palatoplasty. Improved procedural confidence and knowledge were observed after a single session, with benefits seen among trainees both with and without previous cleft experience.

  16. Fidelity considerations for simulation-based usability assessments of mobile ICT for hospitals

    DEFF Research Database (Denmark)

    Dahl, Yngve; Alsos, Ole A; Svanæs, Dag

    2010-01-01

    training simulation fidelity theories. Based on a review of the training simulation literature, a set of fidelity dimensions through which training simulations are often adjusted to meet specific goals are identified. It is argued that the same mechanisms can be used in usability assessments of mobile ICT...... for hospitals. Our argument is substantiated by using the identified set of fidelity dimensions in a retrospective analysis of two usability assessments. The analysis explains how the configuration of fidelity dimensions, each reflecting various degrees of realism vis-à-vis the actual performance context...

  17. Prospective randomized comparison of standard didactic lecture versus high-fidelity simulation for radiology resident contrast reaction management training.

    Science.gov (United States)

    Wang, Carolyn L; Schopp, Jennifer G; Petscavage, Jonelle M; Paladin, Angelisa M; Richardson, Michael L; Bush, William H

    2011-06-01

    The objective of our study was to assess whether high-fidelity simulation-based training is more effective than traditional didactic lecture to train radiology residents in the management of contrast reactions. This was a prospective study of 44 radiology residents randomized into a simulation group versus a lecture group. All residents attended a contrast reaction didactic lecture. Four months later, baseline knowledge was assessed with a written test, which we refer to as the "pretest." After the pretest, the 21 residents in the lecture group attended a repeat didactic lecture and the 23 residents in the simulation group underwent high-fidelity simulation-based training with five contrast reaction scenarios. Next, all residents took a second written test, which we refer to as the "posttest." Two months after the posttest, both groups took a third written test, which we refer to as the "delayed posttest," and underwent performance testing with a high-fidelity severe contrast reaction scenario graded on predefined critical actions. There was no statistically significant difference between the simulation and lecture group pretest, immediate posttest, or delayed posttest scores. The simulation group performed better than the lecture group on the severe contrast reaction simulation scenario (p = 0.001). The simulation group reported improved comfort in identifying and managing contrast reactions and administering medications after the simulation training (p ≤ 0.04) and was more comfortable than the control group (p = 0.03), which reported no change in comfort level after the repeat didactic lecture. When compared with didactic lecture, high-fidelity simulation-based training of contrast reaction management shows equal results on written test scores but improved performance during a high-fidelity severe contrast reaction simulation scenario.

  18. The effect of high fidelity simulated learning methods on physiotherapy pre-registration education: a systematic review protocol.

    Science.gov (United States)

    Roberts, Fiona; Cooper, Kay

    2017-11-01

    The objective of this review is to identify if high fidelity simulated learning methods are effective in enhancing clinical/practical skills compared to usual, low fidelity simulated learning methods in pre-registration physiotherapy education.

  19. Effect on High versus Low Fidelity Haptic Feedback in a Virtual Reality Baseball Simulation

    DEFF Research Database (Denmark)

    Ryge, Andreas Nicolaj; Thomsen, Lui Albæk; Berthelsen, Theis

    2017-01-01

    In this paper we present a within-subjects study (n=26) comparing participants' experience of three kinds of haptic feedback (no haptic feedback, low fidelity haptic feedback and high fidelity haptic feedback) simulating the impact between a virtual baseball bat and ball. We noticed some minor ef...

  20. High-Fidelity Simulation for Neonatal Nursing Education: An Integrative Review of the Literature.

    Science.gov (United States)

    Cooper, Allyson

    2015-01-01

    The lack of safe avenues to develop neonatal nursing competencies using human subjects leads to the notion that simulation education for neonatal nurses might be an ideal form of education. This integrative literature review compares traditional, teacher-centered education with high-fidelity simulation education for neonatal nurses. It examines the theoretical frameworks used in neonatal nursing education and outlines the advantages of this type of training, including improving communication and teamwork; providing an innovative pedagogical approach; and aiding in skill acquisition, confidence, and participant satisfaction. The importance of debriefing is also examined. High-fidelity simulation is not without disadvantages, including its significant cost, the time associated with training, the need for very complex technical equipment, and increased faculty resource requirements. Innovative uses of high-fidelity simulation in neonatal nursing education are suggested. High-fidelity simulation has great potential but requires additional research to fully prove its efficacy.

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

    Science.gov (United States)

    Ann Kirkham, Lucy

    2018-02-07

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

  2. High Fidelity Simulation of Littoral Environments: Applications and Coupling of Participating Models

    National Research Council Canada - National Science Library

    Allard, Richard

    2003-01-01

    The High Fidelity Simulation of Littoral Environments (HFSoLE) Challenge Project (C75) encompasses a suite of seven oceanographic models capable of exchanging information in a physically meaningful sense across the littoral environment...

  3. Advanced High and Low Fidelity HPC Simulations of FCS Concept Designs for Dynamic Systems

    National Research Council Canada - National Science Library

    Sandhu, S. S; Kanapady, R; Tamma, K. K

    2004-01-01

    ...) resources of many Army initiatives. In this paper we present a new and advanced HPC based rigid and flexible modeling and simulation technology capable of adaptive high/low fidelity modeling that is useful in the initial design concept...

  4. A Low Fidelity Simulation To Examine The Design Space For An Expendable Active Decoy

    Science.gov (United States)

    2017-12-01

    SIMULATIONS FOR ANALYSIS ................................11 C. BENEFITS OF MODELING AND SIMULATION IN THE SYSTEM ENGINEERING PROCESS ... simulation may be able to predict the performance parameters of the system of interest (SOI) accurately. The systems engineering process utilizes the low...fidelity simulation developed in this thesis during the early phases of the systems acquisition process : namely, the concept exploration, concept of

  5. Simulator fidelity and training effectiveness: a comprehensive bibliography with selected annotations

    International Nuclear Information System (INIS)

    Rankin, W.L.; Bolton, P.A.; Shikiar, R.; Saari, L.M.

    1984-05-01

    This document contains a comprehensive bibliography on the topic of simulator fidelity and training effectiveness, prepared during the preliminary phases of work on an NRC-sponsored project on the Role of Nuclear Power Plant Simulators in Operator Licensing and Training. Section A of the document is an annotated bibliography consisting of articles and reports with relevance to the psychological aspects of simulator fidelity and the effectiveness of training simulators in a variety of settings, including military. The annotated items are drawn from a more comprehensive bibliography, presented in Section B, listing documents treating the role of simulators in operator training both in the nuclear industry and elsewhere

  6. Judicious use of simulation technology in continuing medical education.

    Science.gov (United States)

    Curtis, Michael T; DiazGranados, Deborah; Feldman, Moshe

    2012-01-01

    Use of simulation-based training is fast becoming a vital source of experiential learning in medical education. Although simulation is a common tool for undergraduate and graduate medical education curricula, the utilization of simulation in continuing medical education (CME) is still an area of growth. As more CME programs turn to simulation to address their training needs, it is important to highlight concepts of simulation technology that can help to optimize learning outcomes. This article discusses the role of fidelity in medical simulation. It provides support from a cross section of simulation training domains for determining the appropriate levels of fidelity, and it offers guidelines for creating an optimal balance of skill practice and realism for efficient training outcomes. After defining fidelity, 3 dimensions of fidelity, drawn from the human factors literature, are discussed in terms of their relevance to medical simulation. From this, research-based guidelines are provided to inform CME providers regarding the use of simulation in CME training. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  7. High-Fidelity Simulation in Occupational Therapy Curriculum: Impact on Level II Fieldwork Performance

    Directory of Open Access Journals (Sweden)

    Rebecca Ozelie

    2016-10-01

    Full Text Available Simulation experiences provide experiential learning opportunities during artificially produced real-life medical situations in a safe environment. Evidence supports using simulation in health care education yet limited quantitative evidence exists in occupational therapy. This study aimed to evaluate the differences in scores on the AOTA Fieldwork Performance Evaluation for the Occupational Therapy Student of Level II occupational therapy students who received high-fidelity simulation training and students who did not. A retrospective analysis of 180 students from a private university was used. Independent samples nonparametric t tests examined mean differences between Fieldwork Performance Evaluation scores of those who did and did not receive simulation experiences in the curriculum. Mean ranks were also analyzed for subsection scores and practice settings. Results of this study found no significant difference in overall Fieldwork Performance Evaluation scores between the two groups. The students who completed simulation and had fieldwork in inpatient rehabilitation had the greatest increase in mean rank scores and increases in several subsections. The outcome measure used in this study was found to have limited discriminatory capability and may have affected the results; however, this study finds that using simulation may be a beneficial supplement to didactic coursework in occupational therapy curriculums.

  8. Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model

    International Nuclear Information System (INIS)

    Giuliani, Meredith; Gillan, Caitlin; Wong, Olive; Harnett, Nicole; Milne, Emily; Moseley, Doug; Thompson, Robert; Catton, Pamela; Bissonnette, Jean-Pierre

    2014-01-01

    To evaluate the feasibility and educational value of high-fidelity, interprofessional team-based simulation in radiation oncology. The simulation event was conducted in a radiation oncology department during a non-clinical day. It involved 5 simulation scenarios that were run over three 105 minute timeslots in a single day. High-acuity, low-frequency clinical situations were selected and included HDR brachytherapy emergency, 4D CT artifact management, pediatric emergency clinical mark-up, electron scalp trial set-up and a cone beam CT misregistration incident. A purposive sample of a minimum of 20 trainees was required to assess recruitment feasibility. A faculty radiation oncologist (RO), medical physicist (MP) or radiation therapist (RTT), facilitated each case. Participants completed a pre event survey of demographic data and motivation for participation. A post event survey collected perceptions of familiarity with the clinical content, comfort with interprofessional practice, and event satisfaction, scored on a 1–10 scale in terms of clinical knowledge, clinical decision making, clinical skills, exposure to other trainees and interprofessional communication. Means and standard deviations were calculated. Twenty-one trainees participated including 6 ROs (29%), 6 MPs (29%), and 9 RTTs (43%). All 12 cases (100%) were completed within the allocated 105 minutes. Nine faculty facilitators, (3MP, 2 RO, 4 RTTs) were required for 405 minutes each. Additional costs associated with this event were 154 hours to build the high fidelity scenarios, 2 standardized patients (SPs) for a total of 15.5 hours, and consumables.The mean (±SD) educational value score reported by participants with respect to clinical knowledge was 8.9 (1.1), clinical decision making 8.9 (1.3), clinical skills 8.9 (1.1), exposure to other trainees 9.1 (2.3) and interprofessional communication 9.1 (1.0). Fifteen (71%) participants reported the cases were of an appropriate complexity. The importance

  9. Recommendations on Model Fidelity for Wind Turbine Gearbox Simulations; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Keller, J.; Lacava, W.; Austin, J.; Nejad, A.; Halse, C.; Bastard, L.; Helsen, J.

    2015-02-01

    This work investigates the minimum level of fidelity required to accurately simulate wind turbine gearboxes using state-of-the-art design tools. Excessive model fidelity including drivetrain complexity, gearbox complexity, excitation sources, and imperfections, significantly increases computational time, but may not provide a commensurate increase in the value of the results. Essential designparameters are evaluated, including the planetary load-sharing factor, gear tooth load distribution, and sun orbit motion. Based on the sensitivity study results, recommendations for the minimum model fidelities are provided.

  10. High-fidelity haptic and visual rendering for patient-specific simulation of temporal bone surgery.

    Science.gov (United States)

    Chan, Sonny; Li, Peter; Locketz, Garrett; Salisbury, Kenneth; Blevins, Nikolas H

    2016-12-01

    Medical imaging techniques provide a wealth of information for surgical preparation, but it is still often the case that surgeons are examining three-dimensional pre-operative image data as a series of two-dimensional images. With recent advances in visual computing and interactive technologies, there is much opportunity to provide surgeons an ability to actively manipulate and interpret digital image data in a surgically meaningful way. This article describes the design and initial evaluation of a virtual surgical environment that supports patient-specific simulation of temporal bone surgery using pre-operative medical image data. Computational methods are presented that enable six degree-of-freedom haptic feedback during manipulation, and that simulate virtual dissection according to the mechanical principles of orthogonal cutting and abrasive wear. A highly efficient direct volume renderer simultaneously provides high-fidelity visual feedback during surgical manipulation of the virtual anatomy. The resulting virtual surgical environment was assessed by evaluating its ability to replicate findings in the operating room, using pre-operative imaging of the same patient. Correspondences between surgical exposure, anatomical features, and the locations of pathology were readily observed when comparing intra-operative video with the simulation, indicating the predictive ability of the virtual surgical environment.

  11. High-fidelity simulation among bachelor students in simulation groups and use of different roles.

    Science.gov (United States)

    Thidemann, Inger-Johanne; Söderhamn, Olle

    2013-12-01

    Cost limitations might challenge the use of high-fidelity simulation as a teaching-learning method. This article presents the results of a Norwegian project including two simulation studies in which simulation teaching and learning were studied among students in the second year of a three-year bachelor nursing programme. The students were organised into small simulation groups with different roles; nurse, physician, family member and observer. Based on experiences in different roles, the students evaluated the simulation design characteristics and educational practices used in the simulation. In addition, three simulation outcomes were measured; knowledge (learning), Student Satisfaction and Self-confidence in Learning. The simulation was evaluated to be a valuable teaching-learning method to develop professional understanding and insight independent of roles. Overall, the students rated the Student Satisfaction and Self-confidence in Learning as high. Knowledge about the specific patient focus increased after the simulation activity. Students can develop practical, communication and collaboration skills, through experiencing the nurse's role. Assuming the observer role, students have the potential for vicarious learning, which could increase the learning value. Both methods of learning (practical experience or vicarious learning) may bridge the gap between theory and practice and contribute to the development of skills in reflective and critical thinking. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Progress in the Utilization of High-Fidelity Simulation in Basic Science Education

    Science.gov (United States)

    Helyer, Richard; Dickens, Peter

    2016-01-01

    High-fidelity patient simulators are mainly used to teach clinical skills and remain underutilized in teaching basic sciences. This article summarizes our current views on the use of simulation in basic science education and identifies pitfalls and opportunities for progress.

  13. Developing High-Fidelity Health Care Simulation Scenarios: A Guide for Educators and Professionals

    Science.gov (United States)

    Alinier, Guillaume

    2011-01-01

    The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteer to act as the patient, or even obtaining ready-made scenarios from another simulation…

  14. High-Fidelity Simulation in Biomedical and Aerospace Engineering

    Science.gov (United States)

    Kwak, Dochan

    2005-01-01

    Contents include the following: Introduction / Background. Modeling and Simulation Challenges in Aerospace Engineering. Modeling and Simulation Challenges in Biomedical Engineering. Digital Astronaut. Project Columbia. Summary and Discussion.

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

    Science.gov (United States)

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

    2018-02-12

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

  16. Technical Basis for Physical Fidelity of NRC Control Room Training Simulators for Advanced Reactors

    Energy Technology Data Exchange (ETDEWEB)

    Minsk, Brian S.; Branch, Kristi M.; Bates, Edward K.; Mitchell, Mark R.; Gore, Bryan F.; Faris, Drury K.

    2009-10-09

    The objective of this study is to determine how simulator physical fidelity influences the effectiveness of training the regulatory personnel responsible for examination and oversight of operating personnel and inspection of technical systems at nuclear power reactors. It seeks to contribute to the U.S. Nuclear Regulatory Commission’s (NRC’s) understanding of the physical fidelity requirements of training simulators. The goal of the study is to provide an analytic framework, data, and analyses that inform NRC decisions about the physical fidelity requirements of the simulators it will need to train its staff for assignment at advanced reactors. These staff are expected to come from increasingly diverse educational and experiential backgrounds.

  17. Advancing interprofessional education through the use of high fidelity human patient simulators

    Directory of Open Access Journals (Sweden)

    Kane-Gill SL

    2013-06-01

    Full Text Available Background: Modern medical care increasingly requires coordinated teamwork and communication between healthcare professionals of different disciplines. Unfortunately, healthcare professional students are rarely afforded the opportunity to learn effective methods of interprofessional (IP communication and teamwork strategies during their education. The question of how to best incorporate IP interactions in the curricula of the schools of health professions remains unanswered.Objective: We aim to solve the lack of IP education in the pharmacy curricula through the use of high fidelity simulation (HFS to allow teams of medical, pharmacy, nursing, physician assistant, and social work students to work together in a controlled environment to solve cases of complex medical and social issues.Methods: Once weekly for a 4-week time period, students worked together to complete complex simulation scenarios in small IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students. Student perception of the use of HFS was evaluated by a survey given at the conclusion of the HFS sessions. Team communication was evaluated through the use of Communication and Teamwork Skills (CATS Assessment by 2 independent evaluators external to the project.Results: The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01, 2 to 3 (p = 0.035, and overall from 1 to 4 (p = 0.001. The inter-rater reliability between evaluators was high (0.85, 95% CI 0.71, 0.99. Students perceived the HFS improved: their ability to communicate with other professionals (median =4; confidence in patient care in an IP team (median=4. It also stimulated student interest in IP work (median=4.5, and was an efficient use of student time (median=4.5Conclusion: The use of HFS improved student teamwork and communication and was an accepted teaching modality. This method of exposing students of the health sciences to IP care should be incorporated throughout the

  18. Low vs. high fidelity: the importance of 'realism' in the simulation of a stone treatment procedure.

    Science.gov (United States)

    Sarmah, Piyush; Voss, Jim; Ho, Adrian; Veneziano, Domenico; Somani, Bhaskar

    2017-07-01

    Simulation training for stone surgery is now increasingly used as part of training curricula worldwide. A combination of low and high fidelity simulators has been used with varying degrees of 'realism' provided by them. In this review, we discuss low and high fidelity simulators used for ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) stone procedures with their advantages, disadvantages and future direction for endourological simulation surgery. The final goal will be to understand whether or not 'realism' has to be considered as a critical element in simulation for this field. There is a wide range of simulators available for URS and PCNL training ranging from basic bench-type model to advanced virtual reality and cadaveric models, all providing various levels of realism. Although basic models might be more useful to novices, advanced models allow for complex and more realistic simulation training. With a wide variety of simulators now available and given the latest novelties in modular training curriculums, combination of low and high fidelity simulators that provide a realistic and cost-effective option seems to be the way forward. It is unavoidable that simulators will play an increasing role in endourological training.

  19. The Validity and Incremental Validity of Knowledge Tests, Low-Fidelity Simulations, and High-Fidelity Simulations for Predicting Job Performance in Advanced-Level High-Stakes Selection

    Science.gov (United States)

    Lievens, Filip; Patterson, Fiona

    2011-01-01

    In high-stakes selection among candidates with considerable domain-specific knowledge and experience, investigations of whether high-fidelity simulations (assessment centers; ACs) have incremental validity over low-fidelity simulations (situational judgment tests; SJTs) are lacking. Therefore, this article integrates research on the validity of…

  20. A High-Fidelity Batch Simulation Environment for Integrated Batch and Piloted Air Combat Simulation Analysis

    Science.gov (United States)

    Goodrich, Kenneth H.; McManus, John W.; Chappell, Alan R.

    1992-01-01

    A batch air combat simulation environment known as the Tactical Maneuvering Simulator (TMS) is presented. The TMS serves as a tool for developing and evaluating tactical maneuvering logics. The environment can also be used to evaluate the tactical implications of perturbations to aircraft performance or supporting systems. The TMS is capable of simulating air combat between any number of engagement participants, with practical limits imposed by computer memory and processing power. Aircraft are modeled using equations of motion, control laws, aerodynamics and propulsive characteristics equivalent to those used in high-fidelity piloted simulation. Databases representative of a modern high-performance aircraft with and without thrust-vectoring capability are included. To simplify the task of developing and implementing maneuvering logics in the TMS, an outer-loop control system known as the Tactical Autopilot (TA) is implemented in the aircraft simulation model. The TA converts guidance commands issued by computerized maneuvering logics in the form of desired angle-of-attack and wind axis-bank angle into inputs to the inner-loop control augmentation system of the aircraft. This report describes the capabilities and operation of the TMS.

  1. Debriefing after High-Fidelity Simulation and Knowledge Retention: A Quasi-Experimental Study

    Science.gov (United States)

    Olson, Susan L.

    2013-01-01

    High-fidelity simulation (HFS) use in nursing education has been a frequent research topic in recent years. Previous research included studies on the use of HFS with nursing students, focusing on their feelings of self-confidence and anxiety. However, research focused specifically on the debriefing portion of HFS was limited. This quantitative,…

  2. Evaluating Outcomes of High Fidelity Simulation Curriculum in a Community College Nursing Program

    Science.gov (United States)

    Denlea, Gregory Richard

    2017-01-01

    This study took place at a Wake Technical Community College, a multi-campus institution in Raleigh, North Carolina. An evaluation of the return on investment in high fidelity simulation used by an associate degree of nursing program was conducted with valid and reliable instruments. The study demonstrated that comparable student outcomes are…

  3. Pharmacy Students' Learning and Satisfaction With High-Fidelity Simulation to Teach Drug-Induced Dyspepsia

    Science.gov (United States)

    2013-01-01

    Objective. To assess second-year pharmacy students’ acquisition of pharmacotherapy knowledge and clinical competence from participation in a high-fidelity simulation, and to determine the impact on the simulation experience of implementing feedback from previous students. Design. A high-fidelity simulation was used to present a patient case scenario of drug-induced dyspepsia with gastrointestinal bleeding. The simulation was revised based on feedback from a previous class of students to include a smaller group size, provision of session material to students in advance, and an improved learning environment. Assessment. Student performance on pre- and post-simulation knowledge and clinical competence tests documented significant improvements in students' knowledge of dyspepsia and associated symptoms, with the greatest improvement on questions relating to the hemodynamic effects of gastrointestinal bleeding. Students were more satisfied with the simulation experience compared to students in the earlier study. Conclusion. Participation in a high-fidelity simulation allowed pharmacy students to apply knowledge and skills learned in the classroom. Improved student satisfaction with the simulation suggests that implementing feedback obtained through student course evaluations can be an effective means of improving the curriculum. PMID:23519773

  4. High Fidelity Regolith Simulation Tool for ISRU Applications, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA has serious unmet needs for simulation tools capable of predicting the behavior of lunar regolith in proposed excavation, transport and handling systems....

  5. Specification of Training Simulator Fidelity: A Research Plan

    Science.gov (United States)

    1982-02-01

    Knowlede --Dunnette (1976) has recently reviewed the literature in the areas of human skills, abilities, and knowledges. The establishment of what types... management 6. Other than rational user responses to R&D studies and to training simulators 7. Deficiencies in training simulator design 23...proficient at managing the introduction of training innovations by applying those factors that can be controlled to influence acceptance. (p. 19) The

  6. A high fidelity model and code generator for the simulation of BOP systems

    International Nuclear Information System (INIS)

    Galen, S.; Vinay, M.

    1993-01-01

    TOPMERET represents a significant advance in the modelling fidelity of Balance of Plant systems (BOP). It is extremely flexible and can accommodate a variety of systems, including main steam, feedwater, turbine, condenser, offgas, large volumes, such as the containment, and water systems such as service water. It handles both normal and abnormal operating scenarios, including pipe break accidents. It was tested successfully on various simulators, and meets the fidelity required of BOP system models so as to successfully integrate with the high level of control automation of European designs. (Z.S.) 1 ref

  7. GNES-R: Global nuclear energy simulator for reactors task 1: High-fidelity neutron transport

    International Nuclear Information System (INIS)

    Clarno, K.; De Almeida, V.; D'Azevedo, E.; De Oliveira, C.; Hamilton, S.

    2006-01-01

    A multi-laboratory, multi-university collaboration has formed to advance the state-of-the-art in high-fidelity, coupled-physics simulation of nuclear energy systems. We are embarking on the first-phase in the development of a new suite of simulation tools dedicated to the advancement of nuclear science and engineering technologies. We seek to develop and demonstrate a new generation of multi-physics simulation tools that will explore the scientific phenomena of tightly coupled physics parameters within nuclear systems, support the design and licensing of advanced nuclear reactors, and provide benchmark quality solutions for code validation. In this paper, we have presented the general scope of the collaborative project and discuss the specific challenges of high-fidelity neutronics for nuclear reactor simulation and the inroads we have made along this path. The high-performance computing neutronics code system utilizes the latest version of SCALE to generate accurate, problem-dependent cross sections, which are used in NEWTRNX - a new 3-D, general-geometry, discrete-ordinates solver based on the Slice-Balance Approach. The Global Nuclear Energy Simulator for Reactors (GNES-R) team is embarking on a long-term simulation development project that encompasses multiple laboratories and universities for the expansion of high-fidelity coupled-physics simulation of nuclear energy systems. (authors)

  8. High Fidelity Simulation of Transcritical Liquid Jet in Crossflow

    Science.gov (United States)

    Li, Xiaoyi; Soteriou, Marios

    2017-11-01

    Transcritical injection of liquid fuel occurs in many practical applications such as diesel, rocket and gas turbine engines. In these applications, the liquid fuel, with a supercritical pressure and a subcritical temperature, is introduced into an environment where both the pressure and temperature exceeds the critical point of the fuel. The convoluted physics of the transition from subcritical to supercritical conditions poses great challenges for both experimental and numerical investigations. In this work, numerical simulation of a binary system of a subcritical liquid injecting into a supercritical gaseous crossflow is performed. The spatially varying fluid thermodynamic and transport properties are evaluated using established cubic equation of state and extended corresponding state principles with established mixing rules. To efficiently account for the large spatial gradients in property variations, an adaptive mesh refinement technique is employed. The transcritical simulation results are compared with the predictions from the traditional subcritical jet atomization simulations.

  9. Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment.

    Science.gov (United States)

    Bussard, Michelle E

    2016-09-01

    Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated. This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study. Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice. This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.]. Copyright 2016, SLACK Incorporated.

  10. High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.

    Science.gov (United States)

    Kennedy, Joshua L; Jones, Stacie M; Porter, Nicholas; White, Marjorie L; Gephardt, Grace; Hill, Travis; Cantrell, Mary; Nick, Todd G; Melguizo, Maria; Smith, Chris; Boateng, Beatrice A; Perry, Tamara T; Scurlock, Amy M; Thompson, Tonya M

    2013-01-01

    Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P clinics (all P ≤ .004). Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  11. Simulation Learning PC Screen-Based vs. High Fidelity

    Science.gov (United States)

    2011-08-01

    agency or compliance inspection by the HHS or Food and Drug Administration (FDA) or other outside governmental agency concerning clinical investigation...patient wearing BDUs, four different cervical collars (long, regular, short, no neck), litter, dog tags 1 Attachment G. C-Spine Pilot algorithm Personnel...PMH: healthy male, history of fracture right humerus playing rugby in high-school. No known allergies . Last medical clinic VS: 120/78, HR

  12. Use of Low-Fidelity Simulation Laboratory Training for Teaching Radiology Residents CT-Guided Procedures.

    Science.gov (United States)

    Picard, Melissa; Nelson, Rachel; Roebel, John; Collins, Heather; Anderson, M Bret

    2016-11-01

    To determine the benefit of the addition of low-fidelity simulation-based training to the standard didactic-based training in teaching radiology residents common CT-guided procedures. This was a prospective study involving 24 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by low-fidelity simulation-based training on three common CT-guided procedures: random liver biopsy, lung nodule biopsy, and drain placement. Baseline knowledge, confidence, and performance assessments were obtained after the didactic session and before the simulation training session. Approximately 2 months later, all residents participated in a simulation-based training session covering all three of these procedures. Knowledge, confidence, and performance data were obtained afterward. These assessments covered topics related to preprocedure workup, intraprocedure steps, and postprocedure management. Knowledge data were collected based on a 15-question assessment. Confidence data were obtained based on a 5-point Likert-like scale. Performance data were obtained based on successful completion of predefined critical steps. There was significant improvement in knowledge (P = .005), confidence (P simulation-based training to the standard didactic curriculum for all procedures. This study suggests that the addition of low-fidelity simulation-based training to a standard didactic-based curriculum is beneficial in improving resident knowledge, confidence, and tested performance of common CT-guided procedures. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. An Investigation of the Impact of Aerodynamic Model Fidelity on Close-In Combat Effectiveness Prediction in Piloted Simulation

    Science.gov (United States)

    Persing, T. Ray; Bellish, Christine A.; Brandon, Jay; Kenney, P. Sean; Carzoo, Susan; Buttrill, Catherine; Guenther, Arlene

    2005-01-01

    Several aircraft airframe modeling approaches are currently being used in the DoD community for acquisition, threat evaluation, training, and other purposes. To date there has been no clear empirical study of the impact of airframe simulation fidelity on piloted real-time aircraft simulation study results, or when use of a particular level of fidelity is indicated. This paper documents a series of piloted simulation studies using three different levels of airframe model fidelity. This study was conducted using the NASA Langley Differential Maneuvering Simulator. Evaluations were conducted with three pilots for scenarios requiring extensive maneuvering of the airplanes during air combat. In many cases, a low-fidelity modified point-mass model may be sufficient to evaluate the combat effectiveness of the aircraft. However, in cases where high angle-of-attack flying qualities and aerodynamic performance are a factor or when precision tracking ability of the aircraft must be represented, use of high-fidelity models is indicated.

  14. A high-fidelity approach towards simulation of pool boiling

    Energy Technology Data Exchange (ETDEWEB)

    Yazdani, Miad; Radcliff, Thomas; Soteriou, Marios; Alahyari, Abbas A. [United Technologies Research Center, East Hartford, Connecticut 06108 (United States)

    2016-01-15

    A novel numerical approach is developed to simulate the multiscale problem of pool-boiling phase change. The particular focus is to develop a simulation technique that is capable of predicting the heat transfer and hydrodynamic characteristics of nucleate boiling and the transition to critical heat flux on surfaces of arbitrary shape and roughness distribution addressing a critical need to design enhanced boiling heat transfer surfaces. The macro-scale of the phase change and bubble dynamics is addressed through employing off-the-shelf Computational Fluid Dynamics (CFD) methods for interface tracking and interphase mass and energy transfer. The micro-scale of the microlayer, which forms at early stage of bubble nucleation near the wall, is resolved through asymptotic approximation of the thin-film theory which provides a closed-form solution for the distribution of the micro-layer and its influence on the evaporation process. In addition, the sub-grid surface roughness is represented stochastically through probabilistic density functions and its role in bubble nucleation and growth is then represented based on the thermodynamics of nucleation process. This combination of deterministic CFD, local approximation, and stochastic representation allows the simulation of pool boiling on any surface with known roughness and enhancement characteristics. The numerical model is validated for dynamics and hydrothermal characteristics of a single nucleated bubble on a flat surface against available literature data. In addition, the prediction of pool-boiling heat transfer coefficient is verified against experimental measurements as well as reputable correlations for various roughness distributions and different surface orientations. Finally, the model is employed to demonstrate pool-boiling phenomenon on enhanced structures with reentrance cavities and to explore the effect of enhancement feature design on thermal and hydrodynamic characteristics of these surfaces.

  15. A high-fidelity approach towards simulation of pool boiling

    International Nuclear Information System (INIS)

    Yazdani, Miad; Radcliff, Thomas; Soteriou, Marios; Alahyari, Abbas A.

    2016-01-01

    A novel numerical approach is developed to simulate the multiscale problem of pool-boiling phase change. The particular focus is to develop a simulation technique that is capable of predicting the heat transfer and hydrodynamic characteristics of nucleate boiling and the transition to critical heat flux on surfaces of arbitrary shape and roughness distribution addressing a critical need to design enhanced boiling heat transfer surfaces. The macro-scale of the phase change and bubble dynamics is addressed through employing off-the-shelf Computational Fluid Dynamics (CFD) methods for interface tracking and interphase mass and energy transfer. The micro-scale of the microlayer, which forms at early stage of bubble nucleation near the wall, is resolved through asymptotic approximation of the thin-film theory which provides a closed-form solution for the distribution of the micro-layer and its influence on the evaporation process. In addition, the sub-grid surface roughness is represented stochastically through probabilistic density functions and its role in bubble nucleation and growth is then represented based on the thermodynamics of nucleation process. This combination of deterministic CFD, local approximation, and stochastic representation allows the simulation of pool boiling on any surface with known roughness and enhancement characteristics. The numerical model is validated for dynamics and hydrothermal characteristics of a single nucleated bubble on a flat surface against available literature data. In addition, the prediction of pool-boiling heat transfer coefficient is verified against experimental measurements as well as reputable correlations for various roughness distributions and different surface orientations. Finally, the model is employed to demonstrate pool-boiling phenomenon on enhanced structures with reentrance cavities and to explore the effect of enhancement feature design on thermal and hydrodynamic characteristics of these surfaces

  16. Bioelectric Control of a 757 Class High Fidelity Aircraft Simulation

    Science.gov (United States)

    Jorgensen, Charles; Wheeler, Kevin; Stepniewski, Slawomir; Norvig, Peter (Technical Monitor)

    2000-01-01

    This paper presents results of a recent experiment in fine grain Electromyographic (EMG) signal recognition, We demonstrate bioelectric flight control of 757 class simulation aircraft landing at San Francisco International Airport. The physical instrumentality of a pilot control stick is not used. A pilot closes a fist in empty air and performs control movements which are captured by a dry electrode array on the arm, analyzed and routed through a flight director permitting full pilot outer loop control of the simulation. A Vision Dome immersive display is used to create a VR world for the aircraft body mechanics and flight changes to pilot movements. Inner loop surfaces and differential aircraft thrust is controlled using a hybrid neural network architecture that combines a damage adaptive controller (Jorgensen 1998, Totah 1998) with a propulsion only based control system (Bull & Kaneshige 1997). Thus the 757 aircraft is not only being flown bioelectrically at the pilot level but also demonstrates damage adaptive neural network control permitting adaptation to severe changes in the physical flight characteristics of the aircraft at the inner loop level. To compensate for accident scenarios, the aircraft uses remaining control surface authority and differential thrust from the engines. To the best of our knowledge this is the first time real time bioelectric fine-grained control, differential thrust based control, and neural network damage adaptive control have been integrated into a single flight demonstration. The paper describes the EMG pattern recognition system and the bioelectric pattern recognition methodology.

  17. High Fidelity Ion Beam Simulation of High Dose Neutron Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Was, Gary; Wirth, Brian; Motta, Athur; Morgan, Dane; Kaoumi, Djamel; Hosemann, Peter; Odette, Robert

    2018-04-30

    Project Objective: The objective of this proposal is to demonstrate the capability to predict the evolution of microstructure and properties of structural materials in-reactor and at high doses, using ion irradiation as a surrogate for reactor irradiations. “Properties” includes both physical properties (irradiated microstructure) and the mechanical properties of the material. Demonstration of the capability to predict properties has two components. One is ion irradiation of a set of alloys to yield an irradiated microstructure and corresponding mechanical behavior that are substantially the same as results from neutron exposure in the appropriate reactor environment. Second is the capability to predict the irradiated microstructure and corresponding mechanical behavior on the basis of improved models, validated against both ion and reactor irradiations and verified against ion irradiations. Taken together, achievement of these objectives will yield an enhanced capability for simulating the behavior of materials in reactor irradiations

  18. First experiences of high-fidelity simulation training in junior nursing students in Korea.

    Science.gov (United States)

    Lee, Suk Jeong; Kim, Sang Suk; Park, Young-Mi

    2015-07-01

    This study was conducted to explore first experiences of high-fidelity simulation training in Korean nursing students, in order to develop and establish more effective guidelines for future simulation training in Korea. Thirty-three junior nursing students participated in high-fidelity simulation training for the first time. Using both qualitative and quantitative methods, data were collected from reflective journals and questionnaires of simulation effectiveness after simulation training. Descriptive statistics were used to analyze simulation effectiveness and content analysis was performed with the reflective journal data. Five dimensions and 31 domains, both positive and negative experiences, emerged from qualitative analysis: (i) machine-human interaction in a safe environment; (ii) perceived learning capability; (iii) observational learning; (iv) reconciling practice with theory; and (v) follow-up debriefing effect. More than 70% of students scored high on increased ability to identify changes in the patient's condition, critical thinking, decision-making, effectiveness of peer observation, and debriefing in effectiveness of simulation. This study reported both positive and negative experiences of simulation. The results of this study could be used to set the level of task difficulty in simulation. Future simulation programs can be designed by reinforcing the positive experiences and modifying the negative results. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

  19. Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia.

    Science.gov (United States)

    El-Mallakh, Peggy; Howard, Patricia B; Rayens, Mary Kay; Roque, Autumn P; Adkins, Sarah

    2013-11-01

    Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients' urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings. Copyright 2013, SLACK Incorporated.

  20. Use of high fidelity operating room simulation to assess and teach communication, teamwork and laparoscopic skills: initial experience.

    Science.gov (United States)

    Gettman, Matthew T; Pereira, Claudio W; Lipsky, Katja; Wilson, Torrence; Arnold, Jacqueline J; Leibovich, Bradley C; Karnes, R Jeffrey; Dong, Yue

    2009-03-01

    Structured opportunities for learning communication, teamwork and laparoscopic principles are limited for urology residents. We evaluated and taught teamwork, communication and laparoscopic skills to urology residents in a simulated operating room. Scenarios related to laparoscopy (insufflator failure, carbon dioxide embolism) were developed using mannequins, urology residents and nurses. These scenarios were developed based on Accreditation Council for Graduate Medical Education core competencies and performed in a simulation center. Between the pretest scenario (insufflation failure) and the posttest scenario (carbon dioxide embolism) instruction was given on teamwork, communication and laparoscopic skills. A total of 19 urology residents participated in the training that involved participation in at least 2 scenarios. Performance was evaluated using validated teamwork instruments, questionnaires and videotape analysis. Significant improvement was noted on validated teamwork instruments between scenarios based on resident (pretest 24, posttest 27, p = 0.01) and expert (pretest 16, posttest 25, p = 0.008) evaluation. Increased teamwork and team performance were also noted between scenarios on videotape analysis with significant improvement for adherence to best practice (p = 0.01) and maintenance of positive rapport among team members (p = 0.02). Significant improvement in the setup of the laparoscopic procedure was observed (p = 0.01). Favorable face and content validity was noted for both scenarios. Teamwork, intraoperative communication and laparoscopic skills of urology residents improved during the high fidelity simulation course. Face and content validity of the individual sessions was favorable. In this study high fidelity simulation was effective for assessing and teaching Accreditation Council for Graduate Medical Education core competencies related to intraoperative communication, teamwork and laparoscopic skills.

  1. Evaluation of simulation motion fidelity criteria in the vertical and directional axes

    Science.gov (United States)

    Schroeder, Jeffery A.

    1993-01-01

    An evaluation of existing motion fidelity criteria was conducted on the NASA Ames Vertical Motion Simulator. Experienced test pilots flew single-axis repositioning tasks in both the vertical and the directional axes. Using a first-order approximation of a hovering helicopter, tasks were flown with variations only in the filters that attenuate the commands to the simulator motion system. These filters had second-order high-pass characteristics, and the variations were made in the filter gain and natural frequency. The variations spanned motion response characteristics from nearly full math-model motion to fixed-base. Between configurations, pilots recalibrated their motion response perception by flying the task with full motion. Pilots subjectively rated the motion fidelity of subsequent configurations relative to this full motion case, which was considered the standard for comparison. The results suggested that the existing vertical-axis criterion was accurate for combinations of gain and natural frequency changes. However, if only the gain or the natural frequency was changed, the rated motion fidelity was better than the criterion predicted. In the vertical axis, the objective and subjective results indicated that a larger gain reduction was tolerated than the existing criterion allowed. The limited data collected in the yaw axis revealed that pilots had difficulty in distinguishing among the variations in the pure yaw motion cues.

  2. Multi-fidelity uncertainty quantification in large-scale predictive simulations of turbulent flow

    Science.gov (United States)

    Geraci, Gianluca; Jofre-Cruanyes, Lluis; Iaccarino, Gianluca

    2017-11-01

    The performance characterization of complex engineering systems often relies on accurate, but computationally intensive numerical simulations. It is also well recognized that in order to obtain a reliable numerical prediction the propagation of uncertainties needs to be included. Therefore, Uncertainty Quantification (UQ) plays a fundamental role in building confidence in predictive science. Despite the great improvement in recent years, even the more advanced UQ algorithms are still limited to fairly simplified applications and only moderate parameter dimensionality. Moreover, in the case of extremely large dimensionality, sampling methods, i.e. Monte Carlo (MC) based approaches, appear to be the only viable alternative. In this talk we describe and compare a family of approaches which aim to accelerate the convergence of standard MC simulations. These methods are based on hierarchies of generalized numerical resolutions (multi-level) or model fidelities (multi-fidelity), and attempt to leverage the correlation between Low- and High-Fidelity (HF) models to obtain a more accurate statistical estimator without introducing additional HF realizations. The performance of these methods are assessed on an irradiated particle laden turbulent flow (PSAAP II solar energy receiver). This investigation was funded by the United States Department of Energy's (DoE) National Nuclear Security Administration (NNSA) under the Predicitive Science Academic Alliance Program (PSAAP) II at Stanford University.

  3. Are Simulation Stethoscopes a Useful Adjunct for Emergency Residents' Training on High-fidelity Mannequins?

    Science.gov (United States)

    Warrington, Steven J; Beeson, Michael S; Fire, Frank L

    2013-05-01

    Emergency medicine residents use simulation training for many reasons, such as gaining experience with critically ill patients and becoming familiar with disease processes. Residents frequently criticize simulation training using current high-fidelity mannequins due to the poor quality of physical exam findings present, such as auscultatory findings, as it may lead them down an alternate diagnostic or therapeutic pathway. Recently wireless remote programmed stethoscopes (simulation stethoscopes) have been developed that allow wireless transmission of any sound to a stethoscope receiver, which improves the fidelity of a physical examination and the simulation case. Following institutional review committee approval, 14 PGY1-3 emergency medicine residents were assessed during 2 simulation-based cases using pre-defined scoring anchors on multiple actions, such as communication skills and treatment decisions (Appendix 1). Each case involved a patient presenting with dyspnea requiring management based off physical examination findings. One case was a patient with exacerbation of heart failure, while the other was a patient with a tension pneumothorax. Each resident was randomized into a case associated with the simulation stethoscope. Following the cases residents were asked to fill out an evaluation questionnaire. Residents perceived the most realistic physical exam findings on those associated with the case using the simulation stethoscope (13/14, 93%). Residents also preferred the simulation stethoscope as an adjunct to the case (13/14, 93%), and they rated the simulation stethoscope case to have significantly more realistic auscultatory findings (4.4/5 vs. 3.0/5 difference of means 1.4, p=0.0007). Average scores of residents were significantly better in the simulation stethoscope-associated case (2.5/3 vs. 2.3/3 difference of means 0.2, p=0.04). There was no considerable difference in the total time taken per case. A simulation stethoscope may be a useful adjunct to

  4. Are Simulation Stethoscopes a Useful Adjunct for Emergency Residents' Training on High-Fidelity Mannequins?

    Directory of Open Access Journals (Sweden)

    Steven J Warrington

    2013-05-01

    Full Text Available Introduction: Emergency medicine residents use simulation training for many reasons, such as gaining experience with critically ill patients and becoming familiar with disease processes. Residents frequently criticize simulation training using current high-fidelity mannequins due to the poor quality of physical exam findings present, such as auscultatory findings, as it may lead them down an alternate diagnostic or therapeutic pathway. Recently wireless remote programmed stethoscopes (simulation stethoscopes have been developed that allow wireless transmission of any sound to a stethoscope receiver, which improves the fidelity of a physical examination and the simulation case. Methods: Following institutional review committee approval, 14 PGY1-3 emergency medicine residents were assessed during 2 simulation-based cases using pre-defined scoring anchors on multiple actions, such as communication skills and treatment decisions (Appendix 1. Each case involved a patient presenting with dyspnea requiring management based off physical examination findings. One case was a patient with exacerbation of heart failure, while the other was a patient with a tension pneumothorax. Each resident was randomized into a case associated with the simulation stethoscope. Following the cases residents were asked to fill out an evaluation questionnaire. Results: Residents perceived the most realistic physical exam findings on those associated with the case using the simulation stethoscope (13/14, 93%. Residents also preferred the simulation stethoscope as an adjunct to the case (13/14, 93%, and they rated the simulation stethoscope case to have significantly more realistic auscultatory findings (4.4/5 vs. 3.0/5 difference of means 1.4, P = 0.0007. Average scores of residents were significantly better in the simulation stethoscope-associated case (2.5/3 vs. 2.3/3 difference of means 0.2, P = 0.04. There was no considerable difference in the total time taken per case

  5. Medical Simulations for Exploration Medicine

    Science.gov (United States)

    Reyes, David; Suresh, Rahul; Pavela, James; Urbina, Michelle; Mindock, Jennifer; Antonsen, Erik

    2018-01-01

    Medical simulation is a useful tool that can be used to train personnel, develop medical processes, and assist cross-disciplinary communication. Medical simulations have been used in the past at NASA for these purposes, however they are usually created ad hoc. A stepwise approach to scenario development has not previously been used. The NASA Exploration Medical Capability (ExMC) created a medical scenario development tool to test medical procedures, technologies, concepts of operation and for use in systems engineering (SE) processes.

  6. HIGH-FIDELITY SIMULATION-DRIVEN MODEL DEVELOPMENT FOR COARSE-GRAINED COMPUTATIONAL FLUID DYNAMICS

    Energy Technology Data Exchange (ETDEWEB)

    Hanna, Botros N.; Dinh, Nam T.; Bolotnov, Igor A.

    2016-06-01

    Nuclear reactor safety analysis requires identifying various credible accident scenarios and determining their consequences. For a full-scale nuclear power plant system behavior, it is impossible to obtain sufficient experimental data for a broad range of risk-significant accident scenarios. In single-phase flow convective problems, Direct Numerical Simulation (DNS) and Large Eddy Simulation (LES) can provide us with high fidelity results when physical data are unavailable. However, these methods are computationally expensive and cannot be afforded for simulation of long transient scenarios in nuclear accidents despite extraordinary advances in high performance scientific computing over the past decades. The major issue is the inability to make the transient computation parallel, thus making number of time steps required in high-fidelity methods unaffordable for long transients. In this work, we propose to apply a high fidelity simulation-driven approach to model sub-grid scale (SGS) effect in Coarse Grained Computational Fluid Dynamics CG-CFD. This approach aims to develop a statistical surrogate model instead of the deterministic SGS model. We chose to start with a turbulent natural convection case with volumetric heating in a horizontal fluid layer with a rigid, insulated lower boundary and isothermal (cold) upper boundary. This scenario of unstable stratification is relevant to turbulent natural convection in a molten corium pool during a severe nuclear reactor accident, as well as in containment mixing and passive cooling. The presented approach demonstrates how to create a correction for the CG-CFD solution by modifying the energy balance equation. A global correction for the temperature equation proves to achieve a significant improvement to the prediction of steady state temperature distribution through the fluid layer.

  7. A Review of the Literature on Training Simulators: Translators: Transfer of Training and Simulator Fidelity.

    Science.gov (United States)

    1984-04-01

    Noise is distracting especially in complex tasks that require close attention and concentration (Finkelman 1975). Improper lighting (Tinker 1943...before coping with . the entire systemi. However, the functional fidelity may be affected due to the isolation of a £ articular subsystem. Curry (1981

  8. Novel high-fidelity realistic explosion damage simulation for urban environments

    Science.gov (United States)

    Liu, Xiaoqing; Yadegar, Jacob; Zhu, Youding; Raju, Chaitanya; Bhagavathula, Jaya

    2010-04-01

    Realistic building damage simulation has a significant impact in modern modeling and simulation systems especially in diverse panoply of military and civil applications where these simulation systems are widely used for personnel training, critical mission planning, disaster management, etc. Realistic building damage simulation should incorporate accurate physics-based explosion models, rubble generation, rubble flyout, and interactions between flying rubble and their surrounding entities. However, none of the existing building damage simulation systems sufficiently faithfully realize the criteria of realism required for effective military applications. In this paper, we present a novel physics-based high-fidelity and runtime efficient explosion simulation system to realistically simulate destruction to buildings. In the proposed system, a family of novel blast models is applied to accurately and realistically simulate explosions based on static and/or dynamic detonation conditions. The system also takes account of rubble pile formation and applies a generic and scalable multi-component based object representation to describe scene entities and highly scalable agent-subsumption architecture and scheduler to schedule clusters of sequential and parallel events. The proposed system utilizes a highly efficient and scalable tetrahedral decomposition approach to realistically simulate rubble formation. Experimental results demonstrate that the proposed system has the capability to realistically simulate rubble generation, rubble flyout and their primary and secondary impacts on surrounding objects including buildings, constructions, vehicles and pedestrians in clusters of sequential and parallel damage events.

  9. Hybrid High-Fidelity Modeling of Radar Scenarios Using Atemporal, Discrete-Event, and Time-Step Simulation

    Science.gov (United States)

    2016-12-01

    10 Figure 1.8 High-efficiency and high-fidelity radar system simulation flowchart . 15 Figure 1.9...Methodology roadmaps: experimental-design flowchart showing hybrid sensor models integrated from three simulation categories, followed by overall...simulation display and output produced by Java Simkit program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Figure 4.5 Hybrid

  10. Getting a head start: high-fidelity, simulation-based operating room team training of interprofessional students.

    Science.gov (United States)

    Paige, John T; Garbee, Deborah D; Kozmenko, Valeriy; Yu, Qingzhao; Kozmenko, Lyubov; Yang, Tong; Bonanno, Laura; Swartz, William

    2014-01-01

    Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immediate impact of conducting interprofessional student OR team training using high-fidelity simulation (HFS) on students' team-related attitudes and behaviors. Ten HFS OR interprofessional student team training sessions were conducted involving 2 standardized HFS scenarios, each of which was followed by a structured debriefing that targeted team-based competencies. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using the t-test. Additionally, mean scores of observer ratings of team performance after each scenario and participant ratings after the second scenario for an 11-item Likert-type teamwork scale were calculated and analyzed using one-way ANOVA and t-test. Eighteen nursing students, 20 nurse anesthetist students, and 28 medical students participated in the training. Statistically significant gains from mean pre- to post-training scores occurred on 11 of the 15 self-efficacy items. Statistically significant gains in mean observer performance scores were present on all 3 subscales of the teamwork scale from the first scenario to the second. A statistically significant difference was found in comparisons of mean observer scores with mean participant scores for the team-based behaviors subscale. High-fidelity simulation OR interprofessional student team training improves students' team-based attitudes and behaviors. Students tend to overestimate their team-based behaviors. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Use of simulated data sets to evaluate the fidelity of Metagenomicprocessing methods

    Energy Technology Data Exchange (ETDEWEB)

    Mavromatis, Konstantinos; Ivanova, Natalia; Barry, Kerri; Shapiro, Harris; Goltsman, Eugene; McHardy, Alice C.; Rigoutsos, Isidore; Salamov, Asaf; Korzeniewski, Frank; Land, Miriam; Lapidus, Alla; Grigoriev, Igor; Richardson, Paul; Hugenholtz, Philip; Kyrpides, Nikos C.

    2006-12-01

    Metagenomics is a rapidly emerging field of research for studying microbial communities. To evaluate methods presently used to process metagenomic sequences, we constructed three simulated data sets of varying complexity by combining sequencing reads randomly selected from 113 isolate genomes. These data sets were designed to model real metagenomes in terms of complexity and phylogenetic composition. We assembled sampled reads using three commonly used genome assemblers (Phrap, Arachne and JAZZ), and predicted genes using two popular gene finding pipelines (fgenesb and CRITICA/GLIMMER). The phylogenetic origins of the assembled contigs were predicted using one sequence similarity--based (blast hit distribution) and two sequence composition--based (PhyloPythia, oligonucleotide frequencies) binning methods. We explored the effects of the simulated community structure and method combinations on the fidelity of each processing step by comparison to the corresponding isolate genomes. The simulated data sets are available online to facilitate standardized benchmarking of tools for metagenomic analysis.

  12. Collective efficacy in a high-fidelity simulation of an airline operations center

    Science.gov (United States)

    Jinkerson, Shanna

    This study investigated the relationships between collective efficacy, teamwork, and team performance. Participants were placed into teams, where they worked together in a high-fidelity simulation of an airline operations center. Each individual was assigned a different role to represent different jobs within an airline (Flight Operations Coordinator, Crew Scheduling, Maintenance, Weather, Flight Scheduling, or Flight Planning.) Participants completed a total of three simulations with an After Action Review between each. Within this setting, both team performance and teamwork behaviors were shown to be positively related to expectations for subsequent performance (collective efficacy). Additionally, teamwork and collective efficacy were not shown to be concomitantly related to subsequent team performance. A chi-square test was used to evaluate existence of performance spirals, and they were not supported. The results of this study were likely impacted by lack of power, as well as a lack of consistency across the three simulations.

  13. Use of simulated data sets to evaluate the fidelity of metagenomic processing methods

    Energy Technology Data Exchange (ETDEWEB)

    Mavromatis, K [U.S. Department of Energy, Joint Genome Institute; Ivanova, N [U.S. Department of Energy, Joint Genome Institute; Barry, Kerrie [U.S. Department of Energy, Joint Genome Institute; Shapiro, Harris [U.S. Department of Energy, Joint Genome Institute; Goltsman, Eugene [U.S. Department of Energy, Joint Genome Institute; McHardy, Alice C. [IBM T. J. Watson Research Center; Rigoutsos, Isidore [IBM T. J. Watson Research Center; Salamov, Asaf [U.S. Department of Energy, Joint Genome Institute; Korzeniewski, Frank [U.S. Department of Energy, Joint Genome Institute; Land, Miriam L [ORNL; Lapidus, Alla L. [U.S. Department of Energy, Joint Genome Institute; Grigoriev, Igor [U.S. Department of Energy, Joint Genome Institute; Hugenholtz, Philip [U.S. Department of Energy, Joint Genome Institute; Kyrpides, Nikos C [U.S. Department of Energy, Joint Genome Institute

    2007-01-01

    Metagenomics is a rapidly emerging field of research for studying microbial communities. To evaluate methods presently used to process metagenomic sequences, we constructed three simulated data sets of varying complexity by combining sequencing reads randomly selected from 113 isolate genomes. These data sets were designed to model real metagenomes in terms of complexity and phylogenetic composition. We assembled sampled reads using three commonly used genome assemblers (Phrap, Arachne and JAZZ), and predicted genes using two popular gene-finding pipelines (fgenesb and CRITICA/GLIMMER). The phylogenetic origins of the assembled contigs were predicted using one sequence similarity-based ( blast hit distribution) and two sequence composition-based (PhyloPythia, oligonucleotide frequencies) binning methods. We explored the effects of the simulated community structure and method combinations on the fidelity of each processing step by comparison to the corresponding isolate genomes. The simulated data sets are available online to facilitate standardized benchmarking of tools for metagenomic analysis.

  14. High-Fidelity Contrast Reaction Simulation Training: Performance Comparison of Faculty, Fellows, and Residents.

    Science.gov (United States)

    Pfeifer, Kyle; Staib, Lawrence; Arango, Jennifer; Kirsch, John; Arici, Mel; Kappus, Liana; Pahade, Jay

    2016-01-01

    Reactions to contrast material are uncommon in diagnostic radiology, and vary in clinical presentation from urticaria to life-threatening anaphylaxis. Prior studies have demonstrated a high error rate in contrast reaction management, with smaller studies using simulation demonstrating variable data on effectiveness. We sought to assess the effectiveness of high-fidelity simulation in teaching contrast reaction management for residents, fellows, and attendings. A 20-question multiple-choice test assessing contrast reaction knowledge, with Likert-scale questions assessing subjective comfort levels of management of contrast reactions, was created. Three simulation scenarios that represented a moderate reaction, a severe reaction, and a contrast reaction mimic were completed in a one-hour period in a simulation laboratory. All participants completed a pretest and a posttest at one month. A six-month delayed posttest was given, but was optional for all participants. A total of 150 radiologists participated (residents = 52; fellows = 24; faculty = 74) in the pretest and posttest; and 105 participants completed the delayed posttest (residents = 31; fellows = 17; faculty = 57). A statistically significant increase was found in the one-month posttest (P < .00001) and the six-month posttest scores (P < .00001) and Likert scores (P < .001) assessing comfort level in managing all contrast reactions, compared with the pretest. Test scores and comfort level for moderate and severe reactions significantly decreased at six months, compared with the one-month posttest (P < .05). High-fidelity simulation is an effective learning tool, allowing practice of "high-acuity" situation management in a nonthreatening environment; the simulation training resulted in significant improvement in test scores, as well as an increase in subjective comfort in management of reactions, across all levels of training. A six-month refresher course is suggested, to maintain knowledge and comfort level in

  15. Using "The Burns Suite" as a Novel High Fidelity Simulation Tool for Interprofessional and Teamwork Training.

    Science.gov (United States)

    Sadideen, Hazim; Wilson, David; Moiemen, Naiem; Kneebone, Roger

    2016-01-01

    Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed based on "advanced trauma and life support" and "emergency management of severe burns" principles, refined utilizing expert opinion through cognitive task analysis. The focus of this analysis was on nontechnical and interpersonal skills of clinicians and nurses within the scenario, mirroring what happens in real life. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's alpha was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twenty-two participants completed TBS resuscitation scenario. Mean face and content validity ratings were high (4.4 and 4.7 respectively; range 4-5). The internal consistency of questions was high. Qualitative data analysis revealed two new themes. Participants reported that the experience felt particularly authentic because the simulation had high psychological and social fidelity, and there was a demand for such a facility to be made available to improve nontechnical skills and interprofessional relations. TBS provides a realistic, novel tool for SBTT, addressing both nontechnical and interprofessional team skills. Recreating clinical challenge is crucial to optimize SBTT. With a better understanding of the theories underpinning simulation and interprofessional education, future simulation scenarios can be designed to provide

  16. High-fidelity simulation in Neonatology and the Italian experience of Nina

    Directory of Open Access Journals (Sweden)

    Armando Cuttano

    2012-10-01

    Full Text Available The modern methodology of simulation was born in the aeronautical field. In medicine, anesthetists showed great attention for technological advances and simulation, closely followed by surgeons with minimally invasive surgery. In Neonatology training in simulation is actually useful in order to face unexpected dramatic events, to minimize clinical risk preventing errors and to optimize team work. Critical issues in simulation are: teachers-learners relationship, focus on technical and non-technical skills, training coordination, adequate scenarios, effective debriefing. Therefore, the quality of a simulation training center is multi-factorial and is not only related to the mannequin equipment. High-fidelity simulation is the most effective method in education. In Italy simulation for education in Medicine has been used for a few years only. In Pisa we founded Nina (that is the acronymous for the Italian name of the Center, CeNtro di FormazIone e SimulazioNe NeonAtale, the first neonatal simulation center dedicated but integrated within a Hospital Unit in Italy. This paper describes how we manage education in Nina Center, in order to offer a model for other similar experiences.

  17. The experiences of last-year student midwives with High-Fidelity Perinatal Simulation training: A qualitative descriptive study.

    Science.gov (United States)

    Vermeulen, Joeri; Beeckman, Katrien; Turcksin, Rivka; Van Winkel, Lies; Gucciardo, Léonardo; Laubach, Monika; Peersman, Wim; Swinnen, Eva

    2017-06-01

    Simulation training is a powerful and evidence-based teaching method in healthcare. It allows students to develop essential competences that are often difficult to achieve during internships. High-Fidelity Perinatal Simulation exposes them to real-life scenarios in a safe environment. Although student midwives' experiences need to be considered to make the simulation training work, these have been overlooked so far. To explore the experiences of last-year student midwives with High-Fidelity Perinatal Simulation training. A qualitative descriptive study, using three focus group conversations with last-year student midwives (n=24). Audio tapes were transcribed and a thematic content analysis was performed. The entire data set was coded according to recurrent or common themes. To achieve investigator triangulation and confirm themes, discussions among the researchers was incorporated in the analysis. Students found High-Fidelity Perinatal Simulation training to be a positive learning method that increased both their competence and confidence. Their experiences varied over the different phases of the High-Fidelity Perinatal Simulation training. Although uncertainty, tension, confusion and disappointment were experienced throughout the simulation trajectory, they reported that this did not affect their learning and confidence-building. As High-Fidelity Perinatal Simulation training constitutes a helpful learning experience in midwifery education, it could have a positive influence on maternal and neonatal outcomes. In the long term, it could therefore enhance the midwifery profession in several ways. The present study is an important first step in opening up the debate about the pedagogical use of High-Fidelity Perinatal Simulation training within midwifery education. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. High fidelity case-based simulation debriefing: everything you need to know.

    Science.gov (United States)

    Hart, Danielle; McNeil, Mary Ann; Griswold-Theodorson, Sharon; Bhatia, Kriti; Joing, Scott

    2012-09-01

    In this 30-minute talk, the authors take an in-depth look at how to debrief high-fidelity case-based simulation sessions, including discussion on debriefing theory, goals, approaches, and structure, as well as ways to create a supportive and safe learning environment, resulting in successful small group learning and self-reflection. Emphasis is placed on the "debriefing with good judgment" approach. Video clips of sample debriefing attempts, highlighting the "dos and don'ts" of simulation debriefing, are included. The goal of this talk is to provide you with the necessary tools and information to develop a successful and effective debriefing approach. There is a bibliography and a quick reference guide in Data Supplements S1 and S2 (available as supporting information in the online version of this paper). © 2012 by the Society for Academic Emergency Medicine.

  19. Proof-of-principle of high-fidelity coupled CRUD deposition and cycle depletion simulation

    International Nuclear Information System (INIS)

    Walter, Daniel J.; Kendrick, Brian K.; Petrov, Victor; Manera, Annalisa; Collins, Benjamin; Downar, Thomas

    2015-01-01

    A multiphysics framework for the high-fidelity simulation of CRUD deposition is developed to better understand the coupled physics and their respective feedback mechanisms. This framework includes the primary physics of lattice depletion, computational fluid dynamics, and CRUD chemistry. The three physics are coupled together via the operator-splitting technique, where predictor–corrector and fixed-point iteration schemes are utilized to converge the nonlinear solution. High-fidelity simulations may provide a means to predict and assess potential operating issues, including CRUD induced power shift and CRUD induced localized corrosion, known as CIPS and CILC, respectively. As a proof-of-principle, a coupled 500-day cycle depletion simulation of a pressurized water reactor fuel pin cell was performed using the coupled code suite; a burnup of 31 MWd/kgHM was reached. The simulation recreated the classic striped CRUD pattern often seen on pulled fuel rods containing CRUD. It is concluded that the striping is caused by the flow swirl induced by spacer grid mixing vanes. Two anti-correlated effects contribute to the striping: (1) the flow swirl yields significant azimuthal temperature variations, which impact the locations where CRUD deposits, and (2) the flow swirl is correlated to increased shear stress along the cladding surface and subsequent erosion of the CRUD layer. The CIPS condition of the core is concluded to be primarily controlled by lithium tetraborate precipitation, referred to as boron hideout, which occurs in regions experiencing subcooled nucleate boiling as soluble boron and lithium species reach their solubility limit within the CRUD layer. Subsequently, a localized reduction in power occurs due to the high neutron absorption cross section of boron-10

  20. ROSE: A realtime object oriented software environment for high fidelity replica simulation

    International Nuclear Information System (INIS)

    Abramovitch, A.

    1994-01-01

    An object oriented software environment used for the production testing and documentation of real time models for high fidelity training simulators encompasses a wide variety of software constructs including code generators for various classes of physical systems, model executive control programs, a high resolution graphics editor, as well as databases and associated access routines used to store and control information transfer among the various software entities. CAE Electronics' newly developed ROSE allows for the generation and integrated test of thermalhydraulic, analog control, digital control and electrical system models. Based on an iconical/standard subroutine representation of standard plant components along with an admittance matrix solution governed by the topology of the system under consideration, the ROSE blends together network solution algorithms and standard component models, both previously time tested via manual implementation into a single integrated automated software environment. The methodology employed to construct the ROSE, along with a synopsis of the various CASE tools integrated together to form a complete graphics based system for high fidelity real time code generation and validation is described in the presentation. (1 fig.)

  1. [Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study].

    Science.gov (United States)

    Mejía, Vilma; Gonzalez, Carlos; Delfino, Alejandro E; Altermatt, Fernando R; Corvetto, Marcia A

    The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents. After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects' performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making. 28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025), prioritization of initial actions of management (p = 0.003), recognize complications (p = 0.025) and communication (p = 0.025). Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032). Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies. Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights

  2. Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study

    Directory of Open Access Journals (Sweden)

    Vilma Mejía

    Full Text Available Abstract Introduction: The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents. Methods: After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects' performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making. Results: 28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025, prioritization of initial actions of management (p = 0.003, recognize complications (p = 0.025 and communication (p = 0.025. Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032. Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies. Conclusion: Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents.

  3. High-fidelity simulations for clean and efficient combustion of alternative fuels

    Energy Technology Data Exchange (ETDEWEB)

    Oefelein, J C; Chen, J H [Reacting Flow Research Department, Sandia National Laboratories, Livermore, CA 94550 (United States); Sankaran, R, E-mail: oefelei@sandia.go [National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37831 (United States)

    2009-07-01

    There is an urgent and growing demand for high-fidelity simulations that capture complex turbulence-chemistry interactions in propulsion and power systems, and in particular, that capture and discriminate the effects of fuel variability. This project addresses this demand using the Large Eddy Simulation (LES) technique (led by Oefelein) and the Direct Numerical Simulation (DNS) technique (led by Chen). In particular, we are conducting research under the INCITE program that is tightly coupled with funded projects established under the DOE Basic Energy Sciences and Energy Efficiency and Renewable Energy programs that will provide the foundational science required to develop a predictive modeling capability for design of advanced engines for transportation. Application of LES provides the formal ability to treat the full range of multidimensional time and length scales that exist in turbulent reacting flows in a computationally feasible manner and thus provides a way to simulate reacting flow phenomena in complex internal-combustion engine geometries at device relevant conditions. Application of DNS provides a way to study fundamental issues related to small-scale combustion processes in canonical configurations to understand dynamics that occur over a range of reactive-diffusive scales. Here we describe the challenges and present representative examples of the types of simulations each respective tool has been used for as part of the INCITE program. We focus on recent experiences on the Oak Ridge National Laboratory (ORNL) National Center for Computational Sciences (NCCS) Cray-XT Platform (i.e., Jaguar).

  4. Medical simulator with injection device

    NARCIS (Netherlands)

    2011-01-01

    medical simulator 611 comprises a vessel 609 representing a simulated blood vessel. The vessel comprises a simulated vessel wall capable of being punctured by an electrically conductive injection needle 503. The vessel wall comprises a first electrically conductive layer for closing an electric

  5. High-Fidelity Simulation of Pediatric Emergency Care: An Eye-Opening Experience for Baccalaureate Nursing Students.

    Science.gov (United States)

    Small, Sandra P; Colbourne, Peggy A; Murray, Cynthia L

    2018-01-01

    Background Little attention has been given to in-depth examination of what high-fidelity simulation is like for nursing students within the context of a pediatric emergency, such as a cardiopulmonary arrest. It is possible that such high-fidelity simulation could provoke in nursing students intense psychological reactions. Purpose The purpose of this study was to learn about baccalaureate nursing students' lived experience of high-fidelity simulation of pediatric cardiopulmonary arrest. Method Phenomenological methods were used. Twenty-four interviews were conducted with 12 students and were analyzed for themes. Results The essence of the experience is that it was eye-opening. The students found the simulation to be a surprisingly realistic nursing experience as reflected in their perceiving the manikin as a real patient, thinking that they were saving their patient's life, feeling like a real nurse, and feeling relief after mounting stress. It was a surprisingly valuable learning experience in that the students had an increased awareness of the art and science of nursing and increased understanding of the importance of teamwork and were feeling more prepared for clinical practice and wanting more simulation experiences. Conclusion Educators should capitalize on the benefits of high-fidelity simulation as a pedagogy, while endeavoring to provide psychologically safe learning.

  6. Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study

    Directory of Open Access Journals (Sweden)

    Vilma Mejía

    2018-05-01

    Full Text Available Introduction: The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents. Methods: After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects’ performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making. Results: 28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025, prioritization of initial actions of management (p = 0.003, recognize complications (p = 0.025 and communication (p = 0.025. Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032. Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies. Conclusion: Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents. Resumo: Introdução: O objetivo prim

  7. Embedding High-Fidelity Simulation Into a Foundations of Nursing Course.

    Science.gov (United States)

    Talbot, Megan Sary

    2015-01-01

    Delay in recognizing the need for and initiating lifesaving measures is unacceptable in health care. It is never too early to teach novice nursing students to recognize and respond to early warning signs of patient deterioration. The rapid response system was developed to expedite recognition of and response to changes in a patient's condition. Use of high-fidelity simulation by beginning nursing students to practice recognizing and responding to patient deterioration is vital to both the welfare of patients and the edification of students. Recognizing and responding quickly to patients' early warning signs of deterioration can determine a patient's outcome. This article discusses the importance of instructing beginning nursing students in identifying and reacting appropriately to early signs of patient deterioration and in following the chain of command to activate the rapid response team.

  8. Nuclear fuel cycle system simulation tool based on high-fidelity component modeling

    Energy Technology Data Exchange (ETDEWEB)

    Ames, David E.,

    2014-02-01

    The DOE is currently directing extensive research into developing fuel cycle technologies that will enable the safe, secure, economic, and sustainable expansion of nuclear energy. The task is formidable considering the numerous fuel cycle options, the large dynamic systems that each represent, and the necessity to accurately predict their behavior. The path to successfully develop and implement an advanced fuel cycle is highly dependent on the modeling capabilities and simulation tools available for performing useful relevant analysis to assist stakeholders in decision making. Therefore a high-fidelity fuel cycle simulation tool that performs system analysis, including uncertainty quantification and optimization was developed. The resulting simulator also includes the capability to calculate environmental impact measures for individual components and the system. An integrated system method and analysis approach that provides consistent and comprehensive evaluations of advanced fuel cycles was developed. A general approach was utilized allowing for the system to be modified in order to provide analysis for other systems with similar attributes. By utilizing this approach, the framework for simulating many different fuel cycle options is provided. Two example fuel cycle configurations were developed to take advantage of used fuel recycling and transmutation capabilities in waste management scenarios leading to minimized waste inventories.

  9. Terascale High-Fidelity Simulations of Turbulent Combustion with Detailed Chemistry

    Energy Technology Data Exchange (ETDEWEB)

    Hong G. Im; Arnaud Trouve; Christopher J. Rutland; Jacqueline H. Chen

    2009-02-02

    The TSTC project is a multi-university collaborative effort to develop a high-fidelity turbulent reacting flow simulation capability utilizing terascale, massively parallel computer technology. The main paradigm of our approach is direct numerical simulation (DNS) featuring highest temporal and spatial accuracy, allowing quantitative observations of the fine-scale physics found in turbulent reacting flows as well as providing a useful tool for development of sub-models needed in device-level simulations. The code named S3D, developed and shared with Chen and coworkers at Sandia National Laboratories, has been enhanced with new numerical algorithms and physical models to provide predictive capabilities for spray dynamics, combustion, and pollutant formation processes in turbulent combustion. Major accomplishments include improved characteristic boundary conditions, fundamental studies of auto-ignition in turbulent stratified reactant mixtures, flame-wall interaction, and turbulent flame extinction by water spray. The overarching scientific issue in our recent investigations is to characterize criticality phenomena (ignition/extinction) in turbulent combustion, thereby developing unified criteria to identify ignition and extinction conditions. The computational development under TSTC has enabled the recent large-scale 3D turbulent combustion simulations conducted at Sandia National Laboratories.

  10. Terascale High-Fidelity Simulations of Turbulent Combustion with Detailed Chemistry

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hong G [University of Michigan; Trouve, Arnaud [University of Maryland; Rutland, Christopher J [University of Wisconsin; Chen, Jacqueline H [Sandia National Laboratories

    2012-08-13

    The TSTC project is a multi-university collaborative effort to develop a high-fidelity turbulent reacting flow simulation capability utilizing terascale, massively parallel computer technology. The main paradigm of our approach is direct numerical simulation (DNS) featuring highest temporal and spatial accuracy, allowing quantitative observations of the fine-scale physics found in turbulent reacting flows as well as providing a useful tool for development of sub-models needed in device-level simulations. The code named S3D, developed and shared with Chen and coworkers at Sandia National Laboratories, has been enhanced with new numerical algorithms and physical models to provide predictive capabilities for spray dynamics, combustion, and pollutant formation processes in turbulent combustion. Major accomplishments include improved characteristic boundary conditions, fundamental studies of auto-ignition in turbulent stratified reactant mixtures, flame-wall interaction, and turbulent flame extinction by water spray. The overarching scientific issue in our recent investigations is to characterize criticality phenomena (ignition/extinction) in turbulent combustion, thereby developing unified criteria to identify ignition and extinction conditions. The computational development under TSTC has enabled the recent large-scale 3D turbulent combustion simulations conducted at Sandia National Laboratories.

  11. On the Fidelity of Semi-distributed Hydrologic Model Simulations for Large Scale Catchment Applications

    Science.gov (United States)

    Ajami, H.; Sharma, A.; Lakshmi, V.

    2017-12-01

    Application of semi-distributed hydrologic modeling frameworks is a viable alternative to fully distributed hyper-resolution hydrologic models due to computational efficiency and resolving fine-scale spatial structure of hydrologic fluxes and states. However, fidelity of semi-distributed model simulations is impacted by (1) formulation of hydrologic response units (HRUs), and (2) aggregation of catchment properties for formulating simulation elements. Here, we evaluate the performance of a recently developed Soil Moisture and Runoff simulation Toolkit (SMART) for large catchment scale simulations. In SMART, topologically connected HRUs are delineated using thresholds obtained from topographic and geomorphic analysis of a catchment, and simulation elements are equivalent cross sections (ECS) representative of a hillslope in first order sub-basins. Earlier investigations have shown that formulation of ECSs at the scale of a first order sub-basin reduces computational time significantly without compromising simulation accuracy. However, the implementation of this approach has not been fully explored for catchment scale simulations. To assess SMART performance, we set-up the model over the Little Washita watershed in Oklahoma. Model evaluations using in-situ soil moisture observations show satisfactory model performance. In addition, we evaluated the performance of a number of soil moisture disaggregation schemes recently developed to provide spatially explicit soil moisture outputs at fine scale resolution. Our results illustrate that the statistical disaggregation scheme performs significantly better than the methods based on topographic data. Future work is focused on assessing the performance of SMART using remotely sensed soil moisture observations using spatially based model evaluation metrics.

  12. A comparison of color fidelity metrics for light sources using simulation of color samples under lighting conditions

    Science.gov (United States)

    Kwon, Hyeokjun; Kang, Yoojin; Jang, Junwoo

    2017-09-01

    Color fidelity has been used as one of indices to evaluate the performance of light sources. Since the Color Rendering Index (CRI) was proposed at CIE, many color fidelity metrics have been proposed to increase the accuracy of the metric. This paper focuses on a comparison of the color fidelity metrics in an aspect of accuracy with human visual assessments. To visually evaluate the color fidelity of light sources, we made a simulator that reproduces the color samples under lighting conditions. In this paper, eighteen color samples of the Macbeth color checker under test light sources and reference illuminant for each of them are simulated and displayed on a well-characterized monitor. With only a spectrum set of the test light source and reference illuminant, color samples under any lighting condition can be reproduced. In this paper, the spectrums of the two LED and two OLED light sources that have similar values of CRI are used for the visual assessment. In addition, the results of the visual assessment are compared with the two color fidelity metrics that include CRI and IES TM-30-15 (Rf), proposed by Illuminating Engineering Society (IES) in 2015. Experimental results indicate that Rf outperforms CRI in terms of the correlation with visual assessment.

  13. Inspiring Careers in STEM and Healthcare Fields through Medical Simulation Embedded in High School Science Education

    Science.gov (United States)

    Berk, Louis J.; Muret-Wagstaff, Sharon L.; Goyal, Riya; Joyal, Julie A.; Gordon, James A.; Faux, Russell; Oriol, Nancy E.

    2014-01-01

    The most effective ways to promote learning and inspire careers related to science, technology, engineering, and mathematics (STEM) remain elusive. To address this gap, we reviewed the literature and designed and implemented a high-fidelity, medical simulation-based Harvard Medical School MEDscience course, which was integrated into high school…

  14. Striving for Better Medical Education: the Simulation Approach.

    Science.gov (United States)

    Sakakushev, Boris E; Marinov, Blagoi I; Stefanova, Penka P; Kostianev, Stefan St; Georgiou, Evangelos K

    2017-06-01

    Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties. Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used. Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators. The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

  15. Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review.

    Science.gov (United States)

    Al-Ghareeb, Amal Z; Cooper, Simon J

    2016-01-01

    This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education. In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education. An integrative review adapted a systematic approach. Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied. The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education. Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted. Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator." Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. The Effect of High-Fidelity Cardiopulmonary Resuscitation (CPR) Simulation on Athletic Training Student Knowledge, Confidence, Emotions, and Experiences

    Science.gov (United States)

    Tivener, Kristin Ann; Gloe, Donna Sue

    2015-01-01

    Context: High-fidelity simulation is widely used in healthcare for the training and professional education of students though literature of its application to athletic training education remains sparse. Objective: This research attempts to address a wide-range of data. This includes athletic training student knowledge acquisition from…

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

    Science.gov (United States)

    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…

  18. Bridging burn care education with modern technology, an integration with high fidelity human patient simulation.

    Science.gov (United States)

    Reeves, Patrick T; Borgman, Matthew A; Caldwell, Nicole W; Patel, Leela; Aden, James; Duggan, John P; Serio-Melvin, Maria L; Mann-Salinas, Elizabeth A

    2018-08-01

    The Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. This prospective, evidenced-based practice project was conducted in a single simulation center employing the American Burn Association's ABLS curriculum using HFHPS. Participants managed 7 separate simulated polytrauma and burn scenarios with resultant clinical complications. After training, participants completed written and practical examinations as well as satisfaction surveys. From 2012 to 2013, 71 students participated in this training. Simulation (ABLS-Sim) participants demonstrated a 2.5% increase in written post-test scores compared to traditional ABLS Provider Course (ABLS Live) (p=0.0016). There was no difference in the practical examination when comparing ABLS-Sim versus ABLS Live. Subjectively, 60 (85%) participants completed surveys. The Educational Practice Questionnaire showed best practices rating of 4.5±0.7; with importance of learning rated at 4.4±0.8. The Simulation Design Scale rating for design was 4.6±0.6 with an importance rating of 4.4±0.8. Overall Satisfaction and Self-Confidence with Learning were 4.4±0.7 and 4.5±0.7, respectfully. Integrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

  19. Evaluating scintillators used in radiation detectors of medical imaging systems by the effective fidelity index method

    International Nuclear Information System (INIS)

    Kandarakis, I.; Cavouras, D.; Prassopoulos, P.; Kanellopoulos, E.; Nomicos, C.D.; Panayiotakis, G.S.

    1999-01-01

    Objective: The performance of medical X-ray image receptors depends: (1) on the scintillator light emission efficiency; and (2) on the compatibility of the scintillator light spectrum with the spectral sensitivity of the light detector (film, photocathode, or photodiode), employed in conjunction with the scintillator. In this study, a scintillator performance measure, the effective fidelity index (EFI), is defined as function of both the scintillator light emission efficiency and spectral compatibility. Materials and Method: CsI:Na, Gd 2 O 2 S:Tb and La 2 O 2 S:Tb scintillators were employed in the form of phosphor screens prepared in our laboratory with various coating thicknesses. The screens were irradiated with X-rays employing tube voltages ranging between 50-120 kVp. Results: The EFI performance of CsI:Na was found to increase with screen coating thickness and it was best when combined with the orthochromatic film or the ES/20 photocathode. Gd 2 O 2 S:Tb showed peak EFI performance at 70 mg/cm 2 coating thickness and it was well combined with the light detectors considered. Conclusion: In accordance with our results, CsI:Na may be employed in radiography when adequately protected against humidity. Gd 2 O 2 S:Tb suitability for conventional imaging was verified and it was found that it may be useful in all types of digital imaging. La 2 O 2 S:Tb could also be used in digital detectors of imaging applications demanding medium X-ray tube voltages

  20. Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance.

    Science.gov (United States)

    Bartel, Billie J

    2014-08-01

    This pilot study explored the use of multidisciplinary high-fidelity simulation and additional pharmacist-focused training methods in training postgraduate year 1 (PGY1) pharmacy residents to provide Advanced Cardiovascular Life Support (ACLS) care. Pharmacy resident confidence and comfort level were assessed after completing these training requirements. The ACLS training requirements for pharmacy residents were revised to include didactic instruction on ACLS pharmacology and rhythm recognition and participation in multidisciplinary high-fidelity simulation ACLS experiences in addition to ACLS provider certification. Surveys were administered to participating residents to assess the impact of this additional education on resident confidence and comfort level in cardiopulmonary arrest situations. The new ACLS didactic and simulation training requirements resulted in increased resident confidence and comfort level in all assessed functions. Residents felt more confident in all areas except providing recommendations for dosing and administration of medications and rhythm recognition after completing the simulation scenarios than with ACLS certification training and the didactic components alone. All residents felt the addition of lectures and simulation experiences better prepared them to function as a pharmacist in the ACLS team. Additional ACLS training requirements for pharmacy residents increased overall awareness of pharmacist roles and responsibilities and greatly improved resident confidence and comfort level in performing most essential pharmacist functions during ACLS situations. © The Author(s) 2013.

  1. Embedding Microethical Dilemmas in High-Fidelity Simulation Scenarios: Preparing Nursing Students for Ethical Practice.

    Science.gov (United States)

    Krautscheid, Lorretta C

    2017-01-01

    Despite the inclusion of ethics education in the formal curriculum, students felt ill-prepared to manage ethical issues and protect patients' health and well-being. Nursing students reported knowing what should be done to promote optimal patient care; however, they also reported an inability to act on their convictions due to fear of reprisal, powerlessness, and low confidence. Bloom's Taxonomy guided the development and implementation of experiential-applied ethics education via microethical dilemmas embedded in existing high-fidelity simulation (HFS) scenarios. Students were unaware that ethical dilemmas would be presented, replicating complex and spontaneous practice environments. Students reported that the educational strategy was powerful, increasing ethical decision-making confidence, empowering effective advocacy, and building courage to overcome fears and defend ethical practice. Simulation extends ethics education beyond the cognitive domain, ensuring the purposeful integration of affective and psychomotor learning, which promotes congruence between knowing what to do and acting on one's convictions. [J Nurs Educ. 2017;56(1):55-58.]. Copyright 2017, SLACK Incorporated.

  2. A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

    Science.gov (United States)

    Gong, Ren Hui; Jenkins, Brad; Sze, Raymond W.; Yaniv, Ziv

    2014-03-01

    The skills required for obtaining informative x-ray fluoroscopy images are currently acquired while trainees provide clinical care. As a consequence, trainees and patients are exposed to higher doses of radiation. Use of simulation has the potential to reduce this radiation exposure by enabling trainees to improve their skills in a safe environment prior to treating patients. We describe a low cost, high fidelity, fluoroscopy simulation system. Our system enables operators to practice their skills using the clinical device and simulated x-rays of a virtual patient. The patient is represented using a set of temporal Computed Tomography (CT) images, corresponding to the underlying dynamic processes. Simulated x-ray images, digitally reconstructed radiographs (DRRs), are generated from the CTs using ray-casting with customizable machine specific imaging parameters. To establish the spatial relationship between the CT and the fluoroscopy device, the CT is virtually attached to a patient phantom and a web camera is used to track the phantom's pose. The camera is mounted on the fluoroscope's intensifier and the relationship between it and the x-ray source is obtained via calibration. To control image acquisition the operator moves the fluoroscope as in normal operation mode. Control of zoom, collimation and image save is done using a keypad mounted alongside the device's control panel. Implementation is based on the Image-Guided Surgery Toolkit (IGSTK), and the use of the graphics processing unit (GPU) for accelerated image generation. Our system was evaluated by 11 clinicians and was found to be sufficiently realistic for training purposes.

  3. Developing and Testing a High-Fidelity Simulation Scenario for an Uncommon Life-Threatening Disease: Severe Malaria

    Directory of Open Access Journals (Sweden)

    Andrew Kestler

    2011-01-01

    Full Text Available Background. Severe malaria is prevalent globally, yet it is an uncommon disease posing a challenge to education in nonendemic countries. High-fidelity simulation (sim may be well suited to teaching its management. Objective. To develop and evaluate a teaching tool for severe malaria, using sim. Methods. A severe malaria sim scenario was developed based on 5 learning objectives. Sim sessions, conducted at an academic center, utilized METI ECS mannequin. After sim, participants received standardized debriefing and completed a test assessing learning and a survey assessing views on sim efficacy. Results. 29 participants included 3rd year medical students (65%, 3rd year EM residents (28%, and EM nurses (7%. Participants scored average 85% on questions related to learning objectives. 93% felt that sim was effective or very effective in teaching severe malaria, and 83% rated it most effective. All respondents felt that sim increased their knowledge on malaria. Conclusion. Sim is an effective tool for teaching severe malaria in and may be superior to other modalities.

  4. Evaluating Multiple Levels of an Interaction Fidelity Continuum on Performance and Learning in Near-Field Training Simulations.

    Science.gov (United States)

    Bhargava, Ayush; Bertrand, Jeffrey W; Gramopadhye, Anand K; Madathil, Kapil C; Babu, Sabarish V

    2018-04-01

    With costs of head-mounted displays (HMDs) and tracking technology decreasing rapidly, various virtual reality applications are being widely adopted for education and training. Hardware advancements have enabled replication of real-world interactions in virtual environments to a large extent, paving the way for commercial grade applications that provide a safe and risk-free training environment at a fraction of the cost. But this also mandates the need to develop more intrinsic interaction techniques and to empirically evaluate them in a more comprehensive manner. Although there exists a body of previous research that examines the benefits of selected levels of interaction fidelity on performance, few studies have investigated the constituent components of fidelity in a Interaction Fidelity Continuum (IFC) with several system instances and their respective effects on performance and learning in the context of a real-world skills training application. Our work describes a large between-subjects investigation conducted over several years that utilizes bimanual interaction metaphors at six discrete levels of interaction fidelity to teach basic precision metrology concepts in a near-field spatial interaction task in VR. A combined analysis performed on the data compares and contrasts the six different conditions and their overall effects on performance and learning outcomes, eliciting patterns in the results between the discrete application points on the IFC. With respect to some performance variables, results indicate that simpler restrictive interaction metaphors and highest fidelity metaphors perform better than medium fidelity interaction metaphors. In light of these results, a set of general guidelines are created for developers of spatial interaction metaphors in immersive virtual environments for precise fine-motor skills training simulations.

  5. Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper.

    Science.gov (United States)

    Bland, Andrew J; Topping, Annie; Tobbell, Jane

    2014-07-01

    High-fidelity patient simulation is a method of education increasingly utilised by educators of nursing to provide authentic learning experiences. Fidelity and authenticity, however, are not conceptually equivalent. Whilst fidelity is important when striving to replicate a life experience such as clinical practice, authenticity can be produced with low fidelity. A challenge for educators of undergraduate nursing is to ensure authentic representation of the clinical situation which is a core component for potential success. What is less clear is the relationship between fidelity and authenticity in the context of simulation based learning. Authenticity does not automatically follow fidelity and as a result, educators of nursing cannot assume that embracing the latest technology-based educational tools will in isolation provide a learning environment perceived authentic by the learner. As nursing education programmes increasingly adopt simulators that offer the possibility of representing authentic real world situations, there is an urgency to better articulate and understand the terms fidelity and authenticity. Without such understanding there is a real danger that simulation as a teaching and learning resource in nurse education will never reach its potential and be misunderstood, creating a potential barrier to learning. This paper examines current literature to promote discussion within nurse education, concluding that authenticity in the context of simulation-based learning is complex, relying on far more than engineered fidelity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Analysis of precipitation teleconnections in CMIP models as a measure of model fidelity in simulating precipitation

    Science.gov (United States)

    Langenbrunner, B.; Neelin, J.; Meyerson, J.

    2011-12-01

    The accurate representation of precipitation is a recurring issue in global climate models, especially in the tropics. Poor skill in modeling the variability and climate teleconnections associated with El Niño/Southern Oscillation (ENSO) also persisted in the latest Climate Model Intercomparison Project (CMIP) campaigns. Observed ENSO precipitation teleconnections provide a standard by which we can judge a given model's ability to reproduce precipitation and dynamic feedback processes originating in the tropical Pacific. Using CMIP3 Atmospheric Model Intercomparison Project (AMIP) runs as a baseline, we compare precipitation teleconnections between models and observations, and we evaluate these results against available CMIP5 historical and AMIP runs. Using AMIP simulations restricts evaluation to the atmospheric response, as sea surface temperatures (SSTs) in AMIP are prescribed by observations. We use a rank correlation between ENSO SST indices and precipitation to define teleconnections, since this method is robust to outliers and appropriate for non-Gaussian data. Spatial correlations of the modeled and observed teleconnections are then evaluated. We look at these correlations in regions of strong precipitation teleconnections, including equatorial S. America, the "horseshoe" region in the western tropical Pacific, and southern N. America. For each region and season, we create a "normalized projection" of a given model's teleconnection pattern onto that of the observations, a metric that assesses the quality of regional pattern simulations while rewarding signals of correct sign over the region. Comparing this to an area-averaged (i.e., more generous) metric suggests models do better when restrictions on exact spatial dependence are loosened and conservation constraints apply. Model fidelity in regional measures remains far from perfect, suggesting intrinsic issues with the models' regional sensitivities in moist processes.

  7. Prospective randomized study of contrast reaction management curricula: Computer-based interactive simulation versus high-fidelity hands-on simulation

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Carolyn L., E-mail: wangcl@uw.edu [Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7115 (United States); Schopp, Jennifer G.; Kani, Kimia [Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7115 (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, 500 University Drive, Hershey, PA 17033 (United States); Zaidi, Sadaf; Hippe, Dan S.; Paladin, Angelisa M.; Bush, William H. [Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7115 (United States)

    2013-12-01

    Purpose: We developed a computer-based interactive simulation program for teaching contrast reaction management to radiology trainees and compared its effectiveness to high-fidelity hands-on simulation training. Materials and methods: IRB approved HIPAA compliant prospective study of 44 radiology residents, fellows and faculty who were randomized into either the high-fidelity hands-on simulation group or computer-based simulation group. All participants took separate written tests prior to and immediately after their intervention. Four months later participants took a delayed written test and a hands-on high-fidelity severe contrast reaction scenario performance test graded on predefined critical actions. Results: There was no statistically significant difference between the computer and hands-on groups’ written pretest, immediate post-test, or delayed post-test scores (p > 0.6 for all). Both groups’ scores improved immediately following the intervention (p < 0.001). The delayed test scores 4 months later were still significantly higher than the pre-test scores (p ≤ 0.02). The computer group's performance was similar to the hands-on group on the severe contrast reaction simulation scenario test (p = 0.7). There were also no significant differences between the computer and hands-on groups in performance on the individual core competencies of contrast reaction management during the contrast reaction scenario. Conclusion: It is feasible to develop a computer-based interactive simulation program to teach contrast reaction management. Trainees that underwent computer-based simulation training scored similarly on written tests and on a hands-on high-fidelity severe contrast reaction scenario performance test as those trained with hands-on high-fidelity simulation.

  8. Prospective randomized study of contrast reaction management curricula: Computer-based interactive simulation versus high-fidelity hands-on simulation

    International Nuclear Information System (INIS)

    Wang, Carolyn L.; Schopp, Jennifer G.; Kani, Kimia; Petscavage-Thomas, Jonelle M.; Zaidi, Sadaf; Hippe, Dan S.; Paladin, Angelisa M.; Bush, William H.

    2013-01-01

    Purpose: We developed a computer-based interactive simulation program for teaching contrast reaction management to radiology trainees and compared its effectiveness to high-fidelity hands-on simulation training. Materials and methods: IRB approved HIPAA compliant prospective study of 44 radiology residents, fellows and faculty who were randomized into either the high-fidelity hands-on simulation group or computer-based simulation group. All participants took separate written tests prior to and immediately after their intervention. Four months later participants took a delayed written test and a hands-on high-fidelity severe contrast reaction scenario performance test graded on predefined critical actions. Results: There was no statistically significant difference between the computer and hands-on groups’ written pretest, immediate post-test, or delayed post-test scores (p > 0.6 for all). Both groups’ scores improved immediately following the intervention (p < 0.001). The delayed test scores 4 months later were still significantly higher than the pre-test scores (p ≤ 0.02). The computer group's performance was similar to the hands-on group on the severe contrast reaction simulation scenario test (p = 0.7). There were also no significant differences between the computer and hands-on groups in performance on the individual core competencies of contrast reaction management during the contrast reaction scenario. Conclusion: It is feasible to develop a computer-based interactive simulation program to teach contrast reaction management. Trainees that underwent computer-based simulation training scored similarly on written tests and on a hands-on high-fidelity severe contrast reaction scenario performance test as those trained with hands-on high-fidelity simulation

  9. High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management.

    Science.gov (United States)

    Lee, Jason Y; Mucksavage, Phillip; Canales, Cecilia; McDougall, Elspeth M; Lin, Sharon

    2012-04-01

    Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents. Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales. A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments. Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents

  10. Simulation Learning: PC-Screen Based (PCSB) versus High Fidelity Simulation (HFS)

    Science.gov (United States)

    2013-08-01

    1.00 (0.00) Score Change (mean change and sd) Assemble Equipment (Yes/No) 1. Water soluble lubricant 2. Suction equipment 3. Selecting correct...0.92 (0.25) 0.64 (0.31) 0.86 (0.22) 0.98 (0.07) Mean score change and sd Procedural Steps (Yes/No) 1. Lubricate tube with water -soluble...w., Johnson, C., Hsu, E. and  Wasser , T. (2006). Using innovative  simulation modalities for civilian based, chemical, biological, radiological

  11. A survey of modelling methods for high-fidelity wind farm simulations using large eddy simulation

    DEFF Research Database (Denmark)

    Breton, Simon-Philippe; Sumner, J.; Sørensen, Jens Nørkær

    2017-01-01

    surveys the most common schemes available to model the rotor, atmospheric conditions and terrain effects within current state-of-the-art LES codes, of which an overview is provided. A summary of the experimental research data available for validation of LES codes within the context of single and multiple......Large eddy simulations (LES) of wind farms have the capability to provide valuable and detailed information about the dynamics of wind turbine wakes. For this reason, their use within the wind energy research community is on the rise, spurring the development of new models and methods. This review...

  12. Simulation-based medical education in clinical skills laboratory.

    Science.gov (United States)

    Akaike, Masashi; Fukutomi, Miki; Nagamune, Masami; Fujimoto, Akiko; Tsuji, Akiko; Ishida, Kazuko; Iwata, Takashi

    2012-01-01

    Clinical skills laboratories have been established in medical institutions as facilities for simulation-based medical education (SBME). SBME is believed to be superior to the traditional style of medical education from the viewpoint of the active and adult learning theories. SBME can provide a learning cycle of debriefing and feedback for learners as well as evaluation of procedures and competency. SBME offers both learners and patients a safe environment for practice and error. In a full-environment simulation, learners can obtain not only technical skills but also non-technical skills, such as leadership, team work, communication, situation awareness, decision-making, and awareness of personal limitations. SBME is also effective for integration of clinical medicine and basic medicine. In addition, technology-enhanced simulation training is associated with beneficial effects for outcomes of knowledge, skills, behaviors, and patient-related outcomes. To perform SBME, effectively, not only simulators including high-fidelity mannequin-type simulators or virtual-reality simulators but also full-time faculties and instructors as professionals of SBME are essential in a clinical skills laboratory for SBME. Clinical skills laboratory is expected to become an integrated medical education center to achieve continuing professional development, integrated learning of basic and clinical medicine, and citizens' participation and cooperation in medical education.

  13. A practical discrete-adjoint method for high-fidelity compressible turbulence simulations

    International Nuclear Information System (INIS)

    Vishnampet, Ramanathan; Bodony, Daniel J.; Freund, Jonathan B.

    2015-01-01

    Methods and computing hardware advances have enabled accurate predictions of complex compressible turbulence phenomena, such as the generation of jet noise that motivates the present effort. However, limited understanding of underlying physical mechanisms restricts the utility of such predictions since they do not, by themselves, indicate a route to design improvements. Gradient-based optimization using adjoints can circumvent the flow complexity to guide designs, though this is predicated on the availability of a sufficiently accurate solution of the forward and adjoint systems. These are challenging to obtain, since both the chaotic character of the turbulence and the typical use of discretizations near their resolution limits in order to efficiently represent its smaller scales will amplify any approximation errors made in the adjoint formulation. Formulating a practical exact adjoint that avoids such errors is especially challenging if it is to be compatible with state-of-the-art simulation methods used for the turbulent flow itself. Automatic differentiation (AD) can provide code to calculate a nominally exact adjoint, but existing general-purpose AD codes are inefficient to the point of being prohibitive for large-scale turbulence simulations. Here, we analyze the compressible flow equations as discretized using the same high-order workhorse methods used for many high-fidelity compressible turbulence simulations, and formulate a practical space–time discrete-adjoint method without changing the basic discretization. A key step is the definition of a particular discrete analog of the continuous norm that defines our cost functional; our selection leads directly to an efficient Runge–Kutta-like scheme, though it would be just first-order accurate if used outside the adjoint formulation for time integration, with finite-difference spatial operators for the adjoint system. Its computational cost only modestly exceeds that of the flow equations. We confirm that

  14. A High Fidelity Approach to Data Simulation for Space Situational Awareness Missions

    Science.gov (United States)

    Hagerty, S.; Ellis, H., Jr.

    2016-09-01

    Space Situational Awareness (SSA) is vital to maintaining our Space Superiority. A high fidelity, time-based simulation tool, PROXOR™ (Proximity Operations and Rendering), supports SSA by generating realistic mission scenarios including sensor frame data with corresponding truth. This is a unique and critical tool for supporting mission architecture studies, new capability (algorithm) development, current/future capability performance analysis, and mission performance prediction. PROXOR™ provides a flexible architecture for sensor and resident space object (RSO) orbital motion and attitude control that simulates SSA, rendezvous and proximity operations scenarios. The major elements of interest are based on the ability to accurately simulate all aspects of the RSO model, viewing geometry, imaging optics, sensor detector, and environmental conditions. These capabilities enhance the realism of mission scenario models and generated mission image data. As an input, PROXOR™ uses a library of 3-D satellite models containing 10+ satellites, including low-earth orbit (e.g., DMSP) and geostationary (e.g., Intelsat) spacecraft, where the spacecraft surface properties are those of actual materials and include Phong and Maxwell-Beard bidirectional reflectance distribution function (BRDF) coefficients for accurate radiometric modeling. We calculate the inertial attitude, the changing solar and Earth illumination angles of the satellite, and the viewing angles from the sensor as we propagate the RSO in its orbit. The synthetic satellite image is rendered at high resolution and aggregated to the focal plane resolution resulting in accurate radiometry even when the RSO is a point source. The sensor model includes optical effects from the imaging system [point spread function (PSF) includes aberrations, obscurations, support structures, defocus], detector effects (CCD blooming, left/right bias, fixed pattern noise, image persistence, shot noise, read noise, and quantization

  15. Cognitive load, emotion, and performance in high-fidelity simulation among beginning nursing students: a pilot study.

    Science.gov (United States)

    Schlairet, Maura C; Schlairet, Timothy James; Sauls, Denise H; Bellflowers, Lois

    2015-03-01

    Establishing the impact of the high-fidelity simulation environment on student performance, as well as identifying factors that could predict learning, would refine simulation outcome expectations among educators. The purpose of this quasi-experimental pilot study was to explore the impact of simulation on emotion and cognitive load among beginning nursing students. Forty baccalaureate nursing students participated in teaching simulations, rated their emotional state and cognitive load, and completed evaluation simulations. Two principal components of emotion were identified representing the pleasant activation and pleasant deactivation components of affect. Mean rating of cognitive load following simulation was high. Linear regression identiffed slight but statistically nonsignificant positive associations between principal components of emotion and cognitive load. Logistic regression identified a negative but statistically nonsignificant effect of cognitive load on assessment performance. Among lower ability students, a more pronounced effect of cognitive load on assessment performance was observed; this also was statistically non-significant. Copyright 2015, SLACK Incorporated.

  16. The effect of high-fidelity patient simulation on the critical thinking and clinical decision-making skills of new graduate nurses.

    Science.gov (United States)

    Maneval, Rhonda; Fowler, Kimberly A; Kays, John A; Boyd, Tiffany M; Shuey, Jennifer; Harne-Britner, Sarah; Mastrine, Cynthia

    2012-03-01

    This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear. Copyright 2012, SLACK Incorporated.

  17. Benefits of a Unified LaSRS++ Simulation for NAS-Wide and High-Fidelity Modeling

    Science.gov (United States)

    Glaab, Patricia; Madden, Michael

    2014-01-01

    The LaSRS++ high-fidelity vehicle simulation was extended in 2012 to support a NAS-wide simulation mode. Since the initial proof-of-concept, the LaSRS++ NAS-wide simulation is maturing into a research-ready tool. A primary benefit of this new capability is the consolidation of the two modeling paradigms under a single framework to save cost, facilitate iterative concept testing between the two tools, and to promote communication and model sharing between user communities at Langley. Specific benefits of each type of modeling are discussed along with the expected benefits of the unified framework. Current capability details of the LaSRS++ NAS-wide simulations are provided, including the visualization tool, live data interface, trajectory generators, terminal routing for arrivals and departures, maneuvering, re-routing, navigation, winds, and turbulence. The plan for future development is also described.

  18. Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator.

    Science.gov (United States)

    Podolsky, Dale J; Fisher, David M; Wong Riff, Karen W; Szasz, Peter; Looi, Thomas; Drake, James M; Forrest, Christopher R

    2018-06-01

    This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise. Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale. The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard. A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.

  19. Enhancing nurse and physician collaboration in clinical decision making through high-fidelity interdisciplinary simulation training.

    Science.gov (United States)

    Maxson, Pamela M; Dozois, Eric J; Holubar, Stefan D; Wrobleski, Diane M; Dube, Joyce A Overman; Klipfel, Janee M; Arnold, Jacqueline J

    2011-01-01

    To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making. Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests. Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p = .82), were more likely to be women (95.0% vs 12.5%; p nurses and physicians (p = .04) and that both medical and nursing concerns influence the decision-making process (p = .02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decision-making process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p nurses and physicians and enhanced the patient care decision-making process.

  20. High-fidelity simulations of moving and flexible airfoils at low Reynolds numbers

    Energy Technology Data Exchange (ETDEWEB)

    Visbal, Miguel R.; Gordnier, Raymond E.; Galbraith, Marshall C. [Air Force Research Laboratory, Computational Sciences Branch, Air Vehicles Directorate, Wright-Patterson AFB, OH (United States)

    2009-05-15

    The present paper highlights results derived from the application of a high-fidelity simulation technique to the analysis of low-Reynolds-number transitional flows over moving and flexible canonical configurations motivated by small natural and man-made flyers. This effort addresses three separate fluid dynamic phenomena relevant to small fliers, including: laminar separation and transition over a stationary airfoil, transition effects on the dynamic stall vortex generated by a plunging airfoil, and the effect of flexibility on the flow structure above a membrane airfoil. The specific cases were also selected to permit comparison with available experimental measurements. First, the process of transition on a stationary SD7003 airfoil section over a range of Reynolds numbers and angles of attack is considered. Prior to stall, the flow exhibits a separated shear layer which rolls up into spanwise vortices. These vortices subsequently undergo spanwise instabilities, and ultimately breakdown into fine-scale turbulent structures as the boundary layer reattaches to the airfoil surface. In a time-averaged sense, the flow displays a closed laminar separation bubble which moves upstream and contracts in size with increasing angle of attack for a fixed Reynolds number. For a fixed angle of attack, as the Reynolds number decreases, the laminar separation bubble grows in vertical extent producing a significant increase in drag. For the lowest Reynolds number considered (Re{sub c} = 10 {sup 4}), transition does not occur over the airfoil at moderate angles of attack prior to stall. Next, the impact of a prescribed high-frequency small-amplitude plunging motion on the transitional flow over the SD7003 airfoil is investigated. The motion-induced high angle of attack results in unsteady separation in the leading edge and in the formation of dynamic-stall-like vortices which convect downstream close to the airfoil. At the lowest value of Reynolds number (Re{sub c}=10 {sup 4

  1. An Immersed Boundary - Adaptive Mesh Refinement solver (IB-AMR) for high fidelity fully resolved wind turbine simulations

    Science.gov (United States)

    Angelidis, Dionysios; Sotiropoulos, Fotis

    2015-11-01

    The geometrical details of wind turbines determine the structure of the turbulence in the near and far wake and should be taken in account when performing high fidelity calculations. Multi-resolution simulations coupled with an immersed boundary method constitutes a powerful framework for high-fidelity calculations past wind farms located over complex terrains. We develop a 3D Immersed-Boundary Adaptive Mesh Refinement flow solver (IB-AMR) which enables turbine-resolving LES of wind turbines. The idea of using a hybrid staggered/non-staggered grid layout adopted in the Curvilinear Immersed Boundary Method (CURVIB) has been successfully incorporated on unstructured meshes and the fractional step method has been employed. The overall performance and robustness of the second order accurate, parallel, unstructured solver is evaluated by comparing the numerical simulations against conforming grid calculations and experimental measurements of laminar and turbulent flows over complex geometries. We also present turbine-resolving multi-scale LES considering all the details affecting the induced flow field; including the geometry of the tower, the nacelle and especially the rotor blades of a wind tunnel scale turbine. This material is based upon work supported by the Department of Energy under Award Number DE-EE0005482 and the Sandia National Laboratories.

  2. High Fidelity, “Faster than Real-Time” Simulator for Predicting Power System Dynamic Behavior - Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Flueck, Alex [Illinois Inst. of Technology, Chicago, IL (United States)

    2017-07-14

    The “High Fidelity, Faster than Real­Time Simulator for Predicting Power System Dynamic Behavior” was designed and developed by Illinois Institute of Technology with critical contributions from Electrocon International, Argonne National Laboratory, Alstom Grid and McCoy Energy. Also essential to the project were our two utility partners: Commonwealth Edison and AltaLink. The project was a success due to several major breakthroughs in the area of large­scale power system dynamics simulation, including (1) a validated faster than real­ time simulation of both stable and unstable transient dynamics in a large­scale positive sequence transmission grid model, (2) a three­phase unbalanced simulation platform for modeling new grid devices, such as independently controlled single­phase static var compensators (SVCs), (3) the world’s first high fidelity three­phase unbalanced dynamics and protection simulator based on Electrocon’s CAPE program, and (4) a first­of­its­ kind implementation of a single­phase induction motor model with stall capability. The simulator results will aid power grid operators in their true time of need, when there is a significant risk of cascading outages. The simulator will accelerate performance and enhance accuracy of dynamics simulations, enabling operators to maintain reliability and steer clear of blackouts. In the long­term, the simulator will form the backbone of the newly conceived hybrid real­time protection and control architecture that will coordinate local controls, wide­area measurements, wide­area controls and advanced real­time prediction capabilities. The nation’s citizens will benefit in several ways, including (1) less down time from power outages due to the faster­than­real­time simulator’s predictive capability, (2) higher levels of reliability due to the detailed dynamics plus protection simulation capability, and (3) more resiliency due to the three­ phase unbalanced simulator’s ability to

  3. Investigation of the impact of high liquid viscosity on jet atomization in crossflow via high-fidelity simulations

    Science.gov (United States)

    Li, Xiaoyi; Gao, Hui; Soteriou, Marios C.

    2017-08-01

    Atomization of extremely high viscosity liquid can be of interest for many applications in aerospace, automotive, pharmaceutical, and food industries. While detailed atomization measurements usually face grand challenges, high-fidelity numerical simulations offer the advantage to comprehensively explore the atomization details. In this work, a previously validated high-fidelity first-principle simulation code HiMIST is utilized to simulate high-viscosity liquid jet atomization in crossflow. The code is used to perform a parametric study of the atomization process in a wide range of Ohnesorge numbers (Oh = 0.004-2) and Weber numbers (We = 10-160). Direct comparisons between the present study and previously published low-viscosity jet in crossflow results are performed. The effects of viscous damping and slowing on jet penetration, liquid surface instabilities, ligament formation/breakup, and subsequent droplet formation are investigated. Complex variations in near-field and far-field jet penetrations with increasing Oh at different We are observed and linked with the underlying jet deformation and breakup physics. Transition in breakup regimes and increase in droplet size with increasing Oh are observed, mostly consistent with the literature reports. The detailed simulations elucidate a distinctive edge-ligament-breakup dominated process with long surviving ligaments for the higher Oh cases, as opposed to a two-stage edge-stripping/column-fracture process for the lower Oh counterparts. The trend of decreasing column deflection with increasing We is reversed as Oh increases. A predominantly unimodal droplet size distribution is predicted at higher Oh, in contrast to the bimodal distribution at lower Oh. It has been found that both Rayleigh-Taylor and Kelvin-Helmholtz linear stability theories cannot be easily applied to interpret the distinct edge breakup process and further study of the underlying physics is needed.

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

    Science.gov (United States)

    Ahn, Heejung; Kim, Hyun-Young

    2015-05-01

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

  5. Progress Toward Affordable High Fidelity Combustion Simulations Using Filtered Density Functions for Hypersonic Flows in Complex Geometries

    Science.gov (United States)

    Drozda, Tomasz G.; Quinlan, Jesse R.; Pisciuneri, Patrick H.; Yilmaz, S. Levent

    2012-01-01

    Significant progress has been made in the development of subgrid scale (SGS) closures based on a filtered density function (FDF) for large eddy simulations (LES) of turbulent reacting flows. The FDF is the counterpart of the probability density function (PDF) method, which has proven effective in Reynolds averaged simulations (RAS). However, while systematic progress is being made advancing the FDF models for relatively simple flows and lab-scale flames, the application of these methods in complex geometries and high speed, wall-bounded flows with shocks remains a challenge. The key difficulties are the significant computational cost associated with solving the FDF transport equation and numerically stiff finite rate chemistry. For LES/FDF methods to make a more significant impact in practical applications a pragmatic approach must be taken that significantly reduces the computational cost while maintaining high modeling fidelity. An example of one such ongoing effort is at the NASA Langley Research Center, where the first generation FDF models, namely the scalar filtered mass density function (SFMDF) are being implemented into VULCAN, a production-quality RAS and LES solver widely used for design of high speed propulsion flowpaths. This effort leverages internal and external collaborations to reduce the overall computational cost of high fidelity simulations in VULCAN by: implementing high order methods that allow reduction in the total number of computational cells without loss in accuracy; implementing first generation of high fidelity scalar PDF/FDF models applicable to high-speed compressible flows; coupling RAS/PDF and LES/FDF into a hybrid framework to efficiently and accurately model the effects of combustion in the vicinity of the walls; developing efficient Lagrangian particle tracking algorithms to support robust solutions of the FDF equations for high speed flows; and utilizing finite rate chemistry parametrization, such as flamelet models, to reduce

  6. High Fidelity Simulations for Unsteady Flow Through the Orbiter LH2 Feedline Flowliner

    Science.gov (United States)

    Kiris, Cetin C.; Kwak, Dochan; Chan, William; Housman, Jeffrey

    2005-01-01

    High fidelity computations were carried out to analyze the orbiter M2 feedline flowliner. Various computational models were used to characterize the unsteady flow features in the turbopump, including the orbiter Low-Pressure-Fuel-Turbopump (LPFTP) inducer, the orbiter manifold and a test article used to represent the manifold. Unsteady flow originating from the orbiter LPFTP inducer is one of the major contributors to the high frequency cyclic loading that results in high cycle fatigue damage to the gimbal flowliners just upstream of the LPFTP. The flow fields for the orbiter manifold and representative test article are computed and analyzed for similarities and differences. An incompressible Navier-Stokes flow solver INS3D, based on the artificial compressibility method, was used to compute the flow of liquid hydrogen in each test article.

  7. A high-fidelity, six-degree-of-freedom batch simulation environment for tactical guidance research and evaluation

    Science.gov (United States)

    Goodrich, Kenneth H.

    1993-01-01

    A batch air combat simulation environment, the tactical maneuvering simulator (TMS), is presented. The TMS is a tool for developing and evaluating tactical maneuvering logics, but it can also be used to evaluate the tactical implications of perturbations to aircraft performance or supporting systems. The TMS can simulate air combat between any number of engagement participants, with practical limits imposed by computer memory and processing power. Aircraft are modeled using equations of motion, control laws, aerodynamics, and propulsive characteristics equivalent to those used in high-fidelity piloted simulations. Data bases representative of a modern high-performance aircraft with and without thrust-vectoring capability are included. To simplify the task of developing and implementing maneuvering logics in the TMS, an outer-loop control system, the tactical autopilot (TA), is implemented in the aircraft simulation model. The TA converts guidance commands by computerized maneuvering logics from desired angle of attack and wind-axis bank-angle inputs to the inner loop control augmentation system of the aircraft. The capabilities and operation of the TMS and the TA are described.

  8. Development of a High-Fidelity Simulation Environment for Shadow-Mode Assessments of Air Traffic Concepts

    Science.gov (United States)

    Robinson, John E., III; Lee, Alan; Lai, Chok Fung

    2017-01-01

    This paper describes the Shadow-Mode Assessment Using Realistic Technologies for the National Airspace System (SMART-NAS) Test Bed. The SMART-NAS Test Bed is an air traffic simulation platform being developed by the National Aeronautics and Space Administration (NASA). The SMART-NAS Test Bed's core purpose is to conduct high-fidelity, real-time, human-in-the-loop and automation-in-the-loop simulations of current and proposed future air traffic concepts for the United States' Next Generation Air Transportation System called NextGen. The setup, configuration, coordination, and execution of realtime, human-in-the-loop air traffic management simulations are complex, tedious, time intensive, and expensive. The SMART-NAS Test Bed framework is an alternative to the current approach and will provide services throughout the simulation workflow pipeline to help alleviate these shortcomings. The principle concepts to be simulated include advanced gate-to-gate, trajectory-based operations, widespread integration of novel aircraft such as unmanned vehicles, and real-time safety assurance technologies to enable autonomous operations. To make this possible, SNTB will utilize Web-based technologies, cloud resources, and real-time, scalable, communication middleware. This paper describes the SMART-NAS Test Bed's vision, purpose, its concept of use, and the potential benefits, key capabilities, high-level requirements, architecture, software design, and usage.

  9. Simulation-based medical teaching and learning

    Directory of Open Access Journals (Sweden)

    Abdulmohsen H Al-Elq

    2010-01-01

    Full Text Available One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation of a real world process to achieve educational goals through experiential learning. Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. Although medical simulation is relatively new, simulation has been used for a long time in other high risk professions such as aviation. Medical simulation allows the acquisition of clinical skills through deliberate practice rather than an apprentice style of learning. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. There are different types and classification of simulators and their cost vary according to the degree of their resemblance to the reality, or ′fidelity′. Simulation- based learning is expensive. However, it is cost-effective if utilized properly. Medical simulation has been found to enhance clinical competence at the undergraduate and postgraduate levels. It has also been found to have many advantages that can improve patient safety and reduce health care costs through the improvement of the medical provider′s competencies. The objective of this narrative review article is to highlight the importance of simulation as a new teaching method in undergraduate and postgraduate education.

  10. Effects of simulation fidelity on user experience in virtual fear of public speaking training - an experimental study.

    Science.gov (United States)

    Poeschl, Sandra; Doering, Nicola

    2014-01-01

    Realistic models in virtual reality training applications are considered to positively influence presence and performance. The experimental study presented, analyzed the effect of simulation fidelity (static vs. animated audience) on presence as a prerequisite for performance in a prototype virtual fear of public speaking application with a sample of N = 40 academic non-phobic users. Contrary to the state of research, no influence was shown on virtual presence and perceived realism, but an animated audience led to significantly higher effects in anxiety during giving a talk. Although these findings could be explained by an application that might not have been realistic enough, they still question the role of presence as a mediating factor in virtual exposure applications.

  11. Medical Simulation Practices 2010 Survey Results

    Science.gov (United States)

    McCrindle, Jeffrey J.

    2011-01-01

    Medical Simulation Centers are an essential component of our learning infrastructure to prepare doctors and nurses for their careers. Unlike the military and aerospace simulation industry, very little has been published regarding the best practices currently in use within medical simulation centers. This survey attempts to provide insight into the current simulation practices at medical schools, hospitals, university nursing programs and community college nursing programs. Students within the MBA program at Saint Joseph's University conducted a survey of medical simulation practices during the summer 2010 semester. A total of 115 institutions responded to the survey. The survey resus discuss overall effectiveness of current simulation centers as well as the tools and techniques used to conduct the simulation activity

  12. Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.

    Science.gov (United States)

    Fawaz, Mirna A; Hamdan-Mansour, Ayman M

    2016-11-01

    High-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students. The purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students. A post-test, quasi-experimental design was used. Two private universities in Lebanon were targeted to implement the intervention. A convenience sample of 56 nursing students from two private universities in Lebanon were recruited. Data were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires. Nursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t=5.23, pmotivation for academic achievement (t=-6.71, pstudents had higher mean scores of motivation (198.6, SD=10.5) in the intervention group than in the control group (161.6, SD=20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda =0.77, F=1.09, p=0.374). There is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Implementation of a novel synchronous multi-site all day high-fidelity simulation.

    Science.gov (United States)

    Abraham, Paul; Verdonk, Franck; Buleon, Clement; Tesniere, Antoine; Lilot, Marc

    2018-01-01

    Integration of simulation in educational curricula for anesthesia and intensive care residents is a hot topic. There is a great interest for simulation centers to share their experiences through multi-site synchronous simulation sessions. The present study results from an experience conducted at three sites in France (Paris, Lyon, and Caen), which involved 16 instructors and 25 residents facing the same scenario across 1 day. Synchronous simulations were performed at each site with local and shared debriefing via teleconference. This innovative approach to simulation was found to be feasible, although certain difficulties were encountered with connectivity.

  14. Ventilator caregiver education through the use of high-fidelity pediatric simulators: a pilot study.

    Science.gov (United States)

    Tofil, Nancy M; Rutledge, Chrystal; Zinkan, J Lynn; Youngblood, Amber Q; Stone, Julie; Peterson, Dawn Taylor; Slayton, Donna; Makris, Chris; Magruder, Terri; White, Marjorie Lee

    2013-11-01

    Introduction. Home ventilator programs (HVP) have been developed to train parents of critically ill children. Simulators are used in health care, but not often for parents. We added simulation to our HVP and assessed parents' response. Methods. In July 2008, the HVP at Children's of Alabama added simulation to parent training. Debriefing was provided after the training session to reinforce correct skills and critical thinking. Follow-up surveys were completed after training. Results. Fifteen families participated. All parents were confident in changing tracheostomies, knowing signs of breathing difficulties, and responding to alarms. 71% strongly agree that simulation resulted in feeling better prepared to care for their child. 86% felt simulation improved their confidence in taking care of their child. Conclusion. Simulators provide a crucial transition between learned skills and application. This novel use of simulation-based education improves parents' confidence in emergencies and may lead to shortened training resulting in cost savings.

  15. Physicians' and pharmacies' overview of patients' medication. An analysis of fidelity coefficients

    DEFF Research Database (Denmark)

    Pottegård, Anton; Hallas, J.

    2011-01-01

    (presc)). The individual user's most frequented pharmacy was also identified and the FC(pharm) calculated in a similar fashion. The average FC(Presc) and average FC(Pharm) were 0.883 (standard deviation 0.158) and 0.927 (0.139), respectively. The estimated difference was 0.0446 (95% confidence interval 0.......0439-0.0453). Among the factors associated with a high FC(presc) and high FC(pharm) were older age, male gender and a high volume of prescriptions. The major drug classes that were most often prescribed by a non-main prescriber were beta-lactams, antidepressants and opioids. Similarly, the major drug classes...... associated with use of non-main pharmacy were beta-lactams, antidepressants and inhaled beta-agonists. Based on this analysis, both prescribers and pharmacies generally have an equal potential for maintaining an excellent overview of their patients' medication, but the pharmacies account for a slightly...

  16. How valid are commercially available medical simulators?

    NARCIS (Netherlands)

    Stunt, J.J.; Wulms, P.H.; Kerkhoffs, G.M.; Dankelman, J.; Van Dijk, C.N.; Tuijthof, G.J.M.

    2014-01-01

    Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on

  17. High-Fidelity Space-Time Adaptive Multiphysics Simulations in Nuclear Engineering

    Energy Technology Data Exchange (ETDEWEB)

    Solin, Pavel [Univ. of Reno, NV (United States); Ragusa, Jean [Texas A & M Univ., College Station, TX (United States)

    2014-03-09

    We delivered a series of fundamentally new computational technologies that have the potential to significantly advance the state-of-the-art of computer simulations of transient multiphysics nuclear reactor processes. These methods were implemented in the form of a C++ library, and applied to a number of multiphysics coupled problems relevant to nuclear reactor simulations.

  18. High-Fidelity Space-Time Adaptive Multiphysics Simulations in Nuclear Engineering

    International Nuclear Information System (INIS)

    Solin, Pavel; Ragusa, Jean

    2014-01-01

    We delivered a series of fundamentally new computational technologies that have the potential to significantly advance the state-of-the-art of computer simulations of transient multiphysics nuclear reactor processes. These methods were implemented in the form of a C++ library, and applied to a number of multiphysics coupled problems relevant to nuclear reactor simulations.

  19. Virtual reality simulation training in a high-fidelity procedure suite

    DEFF Research Database (Denmark)

    Lönn, Lars; Edmond, John J; Marco, Jean

    2012-01-01

    To assess the face and content validity of a novel, full physics, full procedural, virtual reality simulation housed in a hybrid procedure suite.......To assess the face and content validity of a novel, full physics, full procedural, virtual reality simulation housed in a hybrid procedure suite....

  20. How valid are commercially available medical simulators?

    Science.gov (United States)

    Stunt, JJ; Wulms, PH; Kerkhoffs, GM; Dankelman, J; van Dijk, CN; Tuijthof, GJM

    2014-01-01

    Background Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on these simulators can actually improve clinical performance on live patients. Therefore, the aim of this review is to determine the availability of different types of simulators and the evidence of their validation, to offer insight regarding which simulators are suitable to use in the clinical setting as a training modality. Summary Four hundred and thirty-three commercially available simulators were found, from which 405 (94%) were physical models. One hundred and thirty validation studies evaluated 35 (8%) commercially available medical simulators for levels of validity ranging from face to predictive validity. Solely simulators that are used for surgical skills training were validated for the highest validity level (predictive validity). Twenty-four (37%) simulators that give objective feedback had been validated. Studies that tested more powerful levels of validity (concurrent and predictive validity) were methodologically stronger than studies that tested more elementary levels of validity (face, content, and construct validity). Conclusion Ninety-three point five percent of the commercially available simulators are not known to be tested for validity. Although the importance of (a high level of) validation depends on the difficulty level of skills training and possible consequences when skills are insufficient, it is advisable for medical professionals, trainees, medical educators, and companies who manufacture medical simulators to critically judge the available medical simulators for proper validation. This way adequate, safe, and affordable medical psychomotor skills training can be achieved. PMID:25342926

  1. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation.

    Science.gov (United States)

    Sørensen, Jette Led; Østergaard, Doris; LeBlanc, Vicki; Ottesen, Bent; Konge, Lars; Dieckmann, Peter; Van der Vleuten, Cees

    2017-01-21

    Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations. Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of

  2. Web-Based versus High-Fidelity Simulation Training for Certified Registered Nurse Anesthetists in the Management of High Risk/Low Occurrence Anesthesia Events

    Science.gov (United States)

    Kimemia, Judy

    2017-01-01

    Purpose: The purpose of this project was to compare web-based to high-fidelity simulation training in the management of high risk/low occurrence anesthesia related events, to enhance knowledge acquisition for Certified Registered Nurse Anesthetists (CRNAs). This project was designed to answer the question: Is web-based training as effective as…

  3. [High fidelity simulation : a new tool for learning and research in pediatrics].

    Science.gov (United States)

    Bragard, I; Farhat, N; Seghaye, M-C; Schumacher, K

    2016-10-01

    Caring for a sick child represents a high risk activity that requires technical and non-technical skills related to several factors such as the rarity of certain events or the stress of caring for a child. As regard these conditions, medi¬cal simulation provides a learning environment without risk, the control of variables, the reproducibility of situations, and the confrontation with rare events. In this article, we des¬cribe the steps of a simulation session and outline the current knowledge of the use of simulation in paediatrics. A session of simulation includes seven phases following the model of Peter Dieckmann, particularly the scenario and the debriefing that form the heart of the learning experience. Several studies have shown the advantages of simulation for paediatric trai¬ning in terms of changes in attitudes, skills and knowledge. Some studies have demonstrated a beneficial transfer to prac¬tice. In conclusion, simulation provides great potential for training and research in paediatrics. The establishment of a collaborative research program by the whole simulation com¬munity would help ensure that this type of training improves the quality of care.

  4. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training.

    Science.gov (United States)

    Sharma, Mitesh; Horgan, Alan

    2012-08-01

    The aim of this study was to compare fresh-frozen cadavers (FFC) with a high-fidelity virtual reality simulator (VRS) as training tools in minimal access surgery for complex and relatively simple procedures. A prospective comparative face validity study between FFC and VRS (LAP Mentor(™)) was performed. Surgeons were recruited to perform tasks on both FFC and VRS appropriately paired to their experience level. Group A (senior) performed a laparoscopic sigmoid colectomy, Group B (intermediate) performed a laparoscopic incisional hernia repair, and Group C (junior) performed basic laparoscopic tasks (BLT) (camera manipulation, hand-eye coordination, tissue dissection and hand-transferring skills). Each subject completed a 5-point Likert-type questionnaire rating the training modalities in nine domains. Data were analysed using nonparametric tests. Forty-five surgeons were recruited to participate (15 per skill group). Median scores for subjects in Group A were significantly higher for evaluation of FFC in all nine domains compared to VRS (p < 0.01). Group B scored FFC significantly better (p < 0.05) in all domains except task replication (p = 0.06). Group C scored FFC significantly better (p < 0.01) in eight domains but not on performance feedback (p = 0.09). When compared across groups, juniors accepted VRS as a training model more than did intermediate and senior groups on most domains (p < 0.01) except team work. Fresh-frozen cadaver is perceived as a significantly overall better model for laparoscopic training than the high-fidelity VRS by all training grades, irrespective of the complexity of the operative procedure performed. VRS is still useful when training junior trainees in BLT.

  5. Real-Time and High-Fidelity Simulation Environment for Autonomous Ground Vehicle Dynamics

    Science.gov (United States)

    Cameron, Jonathan; Myint, Steven; Kuo, Calvin; Jain, Abhi; Grip, Havard; Jayakumar, Paramsothy; Overholt, Jim

    2013-01-01

    This paper reports on a collaborative project between U.S. Army TARDEC and Jet Propulsion Laboratory (JPL) to develop a unmanned ground vehicle (UGV) simulation model using the ROAMS vehicle modeling framework. Besides modeling the physical suspension of the vehicle, the sensing and navigation of the HMMWV vehicle are simulated. Using models of urban and off-road environments, the HMMWV simulation was tested in several ways, including navigation in an urban environment with obstacle avoidance and the performance of a lane change maneuver.

  6. Dynamic Flight Simulation Utilizing High Fidelity CFD-Based Nonlinear Reduced Order Model, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — The Nonlinear Dynamic Flight Simulation (NL-DFS) system will be developed in the Phase II project by combining the classical nonlinear rigid-body flight dynamics...

  7. High Fidelity Multi-Scale Regolith Simulation Tool for ISRU, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA has serious unmet needs for simulation tools capable of predicting the behavior of lunar regolith in proposed excavation, transport and handling systems....

  8. The Break-Even Point: When Medical Advances Are Less Important Than Improving the Fidelity With Which They Are Delivered

    OpenAIRE

    Woolf, Steven H.; Johnson, Robert E.

    2005-01-01

    Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. In 2 examples (the development of anti-platelet agents an...

  9. The effects of model composition design choices on high-fidelity simulations of motoneuron recruitment and firing behaviors

    Science.gov (United States)

    Allen, John M.; Elbasiouny, Sherif M.

    2018-06-01

    Objective. Computational models often require tradeoffs, such as balancing detail with efficiency; yet optimal balance should incorporate sound design features that do not bias the results of the specific scientific question under investigation. The present study examines how model design choices impact simulation results. Approach. We developed a rigorously-validated high-fidelity computational model of the spinal motoneuron pool to study three long-standing model design practices which have yet to be examined for their impact on motoneuron recruitment, firing rate, and force simulations. The practices examined were the use of: (1) generic cell models to simulate different motoneuron types, (2) discrete property ranges for different motoneuron types, and (3) biological homogeneity of cell properties within motoneuron types. Main results. Our results show that each of these practices accentuates conditions of motoneuron recruitment based on the size principle, and minimizes conditions of mixed and reversed recruitment orders, which have been observed in animal and human recordings. Specifically, strict motoneuron orderly size recruitment occurs, but in a compressed range, after which mixed and reverse motoneuron recruitment occurs due to the overlap in electrical properties of different motoneuron types. Additionally, these practices underestimate the motoneuron firing rates and force data simulated by existing models. Significance. Our results indicate that current modeling practices increase conditions of motoneuron recruitment based on the size principle, and decrease conditions of mixed and reversed recruitment order, which, in turn, impacts the predictions made by existing models on motoneuron recruitment, firing rate, and force. Additionally, mixed and reverse motoneuron recruitment generated higher muscle force than orderly size motoneuron recruitment in these simulations and represents one potential scheme to increase muscle efficiency. The examined model

  10. Error correction in multi-fidelity molecular dynamics simulations using functional uncertainty quantification

    Energy Technology Data Exchange (ETDEWEB)

    Reeve, Samuel Temple; Strachan, Alejandro, E-mail: strachan@purdue.edu

    2017-04-01

    We use functional, Fréchet, derivatives to quantify how thermodynamic outputs of a molecular dynamics (MD) simulation depend on the potential used to compute atomic interactions. Our approach quantifies the sensitivity of the quantities of interest with respect to the input functions as opposed to its parameters as is done in typical uncertainty quantification methods. We show that the functional sensitivity of the average potential energy and pressure in isothermal, isochoric MD simulations using Lennard–Jones two-body interactions can be used to accurately predict those properties for other interatomic potentials (with different functional forms) without re-running the simulations. This is demonstrated under three different thermodynamic conditions, namely a crystal at room temperature, a liquid at ambient pressure, and a high pressure liquid. The method provides accurate predictions as long as the change in potential can be reasonably described to first order and does not significantly affect the region in phase space explored by the simulation. The functional uncertainty quantification approach can be used to estimate the uncertainties associated with constitutive models used in the simulation and to correct predictions if a more accurate representation becomes available.

  11. High-Fidelity Simulations of Electrically-Charged Atomizing Diesel-Type Jets

    Science.gov (United States)

    Gaillard, Benoit; Owkes, Mark; van Poppel, Bret

    2015-11-01

    Combustion of liquid fuels accounts for over a third of the energy usage today. Improving efficiency of combustion systems is critical to meet the energy needs while limiting environmental impacts. Additionally, a shift away from traditional fossil fuels to bio-derived alternatives requires fuel injection systems that can atomize fuels with a wide range of properties. In this work, the potential benefits of electrically-charged atomization is investigated using numerical simulations. Particularly, the electrostatic forces on the hydrodynamic jet are quantified and the impact of the forces is analyzed by comparing simulations of Diesel-type jets at realistic flow conditions. The simulations are performed using a state-of-the-art numerical framework that globally conserves mass, momentum, and the electric charge density even at the gas-liquid interface where discontinuities exist.

  12. Coupled high fidelity thermal hydraulics and neutronics for reactor safety simulations

    International Nuclear Information System (INIS)

    Vincent A. Mousseau; Hongbin Zhang; Haihua Zhao

    2008-01-01

    This work is a continuation of previous work on the importance of accuracy in the simulation of nuclear reactor safety transients. This work is qualitative in nature and future work will be more quantitative. The focus of this work will be on a simplified single phase nuclear reactor primary. The transient of interest investigates the importance of accuracy related to passive (inherent) safety systems. The transient run here will be an Unprotected Loss of Flow (ULOF) transient. Here the coolant pump is turned off and the un-SCRAM-ed reactor transitions from forced to free convection (Natural circulation). Results will be presented that show the difference that the first order in time truncation physics makes on the transient. The purpose of this document is to illuminate a possible problem in traditional reactor simulation approaches. Detailed studies need to be done on each simulation code for each transient analyzed to determine if the first order truncation physics plays an important role

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

    Science.gov (United States)

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

    2017-10-03

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

  14. Improving the fidelity of electrically heated nuclear systems testing using simulated neutronic feedback

    International Nuclear Information System (INIS)

    Bragg-Sitton, Shannon M.; Godfroy, Thomas J.; Webster, Kenny

    2010-01-01

    Nonnuclear test platforms and methodologies can be employed to reduce the overall cost, risk and complexity of testing nuclear systems while allowing one to evaluate the operation of an integrated nuclear system within a reasonable timeframe, providing valuable input to the overall system design. In a nonnuclear test bed, electric heaters are used to simulate the heat from nuclear fuel. Standard electric test techniques allow one to fully assess thermal, heat transfer, and stress related attributes of a given system, but these approaches fail to demonstrate the dynamic response that would be present in an integrated, fueled reactor system. The integration of thermal hydraulic hardware tests with simulated neutronic response provides a bridge between electrically heated testing and testing with nuclear fuel elements installed. By implementing a neutronic response model to simulate the dynamic response that would be expected in a fueled reactor system, one can better understand system integration issues, characterize integrated system response times and response characteristics, and assess potential design improvements at a relatively small fiscal investment. This paper summarizes the results of initial system dynamic response testing for two electrically heated reactor concepts: a heat pipe-cooled reactor simulator with integrated heat exchanger and a gas-cooled reactor simulator with integrated Brayton power conversion system. Initial applications apply a simplified reactor kinetics model with either a single or an averaged measured state point. Preliminary results demonstrate the applicability of the dynamic test methodology to any reactor type, elucidating the variation in system response characteristics in different reactor concepts. These results suggest a need to further enhance the dynamic test approach by incorporating a more accurate model of the reactor dynamics and improved hardware instrumentation for better state estimation in application of the

  15. High-fidelity large eddy simulation for supersonic jet noise prediction

    Science.gov (United States)

    Aikens, Kurt M.

    The problem of intense sound radiation from supersonic jets is a concern for both civil and military applications. As a result, many experimental and computational efforts are focused at evaluating possible noise suppression techniques. Large-eddy simulation (LES) is utilized in many computational studies to simulate the turbulent jet flowfield. Integral methods such as the Ffowcs Williams-Hawkings (FWH) method are then used for propagation of the sound waves to the farfield. Improving the accuracy of this two-step methodology and evaluating beveled converging-diverging nozzles for noise suppression are the main tasks of this work. First, a series of numerical experiments are undertaken to ensure adequate numerical accuracy of the FWH methodology. This includes an analysis of different treatments for the downstream integration surface: with or without including an end-cap, averaging over multiple end-caps, and including an approximate surface integral correction term. Secondly, shock-capturing methods based on characteristic filtering and adaptive spatial filtering are used to extend a highly-parallelizable multiblock subsonic LES code to enable simulations of supersonic jets. The code is based on high-order numerical methods for accurate prediction of the acoustic sources and propagation of the sound waves. Furthermore, this new code is more efficient than the legacy version, allows cylindrical multiblock topologies, and is capable of simulating nozzles with resolved turbulent boundary layers when coupled with an approximate turbulent inflow boundary condition. Even though such wall-resolved simulations are more physically accurate, their expense is often prohibitive. To make simulations more economical, a wall model is developed and implemented. The wall modeling methodology is validated for turbulent quasi-incompressible and compressible zero pressure gradient flat plate boundary layers, and for subsonic and supersonic jets. The supersonic code additions and the

  16. How valid are commercially available medical simulators?

    Directory of Open Access Journals (Sweden)

    Stunt JJ

    2014-10-01

    Full Text Available JJ Stunt,1 PH Wulms,2 GM Kerkhoffs,1 J Dankelman,2 CN van Dijk,1 GJM Tuijthof1,2 1Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Amsterdam, the Netherlands; 2Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Delft, the Netherlands Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on these simulators can actually improve clinical performance on live patients. Therefore, the aim of this review is to determine the availability of different types of simulators and the evidence of their validation, to offer insight regarding which simulators are suitable to use in the clinical setting as a training modality. Summary: Four hundred and thirty-three commercially available simulators were found, from which 405 (94% were physical models. One hundred and thirty validation studies evaluated 35 (8% commercially available medical simulators for levels of validity ranging from face to predictive validity. Solely simulators that are used for surgical skills training were validated for the highest validity level (predictive validity. Twenty-four (37% simulators that give objective feedback had been validated. Studies that tested more powerful levels of validity (concurrent and predictive validity were methodologically stronger than studies that tested more elementary levels of validity (face, content, and construct validity. Conclusion: Ninety-three point five percent of the commercially available simulators are not known to be tested for validity. Although the importance of (a high level of validation depends on the difficulty level of skills training and possible consequences when skills are

  17. High-fidelity meshes from tissue samples for diffusion MRI simulations.

    Science.gov (United States)

    Panagiotaki, Eleftheria; Hall, Matt G; Zhang, Hui; Siow, Bernard; Lythgoe, Mark F; Alexander, Daniel C

    2010-01-01

    This paper presents a method for constructing detailed geometric models of tissue microstructure for synthesizing realistic diffusion MRI data. We construct three-dimensional mesh models from confocal microscopy image stacks using the marching cubes algorithm. Random-walk simulations within the resulting meshes provide synthetic diffusion MRI measurements. Experiments optimise simulation parameters and complexity of the meshes to achieve accuracy and reproducibility while minimizing computation time. Finally we assess the quality of the synthesized data from the mesh models by comparison with scanner data as well as synthetic data from simple geometric models and simplified meshes that vary only in two dimensions. The results support the extra complexity of the three-dimensional mesh compared to simpler models although sensitivity to the mesh resolution is quite robust.

  18. Design and Optimization of Large Accelerator Systems through High-Fidelity Electromagnetic Simulations

    International Nuclear Information System (INIS)

    Ng, Cho; Akcelik, Volkan; Candel, Arno; Chen, Sheng; Ge, Lixin; Kabel, Andreas; Lee, Lie-Quan; Li, Zenghai; Prudencio, Ernesto; Schussman, Greg; Uplenchwar1, Ravi; Xiao1, Liling; Ko1, Kwok; Austin, T.; Cary, J.R.; Ovtchinnikov, S.; Smith, D.N.; Werner, G.R.; Bellantoni, L.; TechX Corp.; Fermilab

    2008-01-01

    SciDAC1, with its support for the 'Advanced Computing for 21st Century Accelerator Science and Technology' (AST) project, witnessed dramatic advances in electromagnetic (EM) simulations for the design and optimization of important accelerators across the Office of Science. In SciDAC2, EM simulations continue to play an important role in the 'Community Petascale Project for Accelerator Science and Simulation' (ComPASS), through close collaborations with SciDAC CETs/Institutes in computational science. Existing codes will be improved and new multi-physics tools will be developed to model large accelerator systems with unprecedented realism and high accuracy using computing resources at petascale. These tools aim at targeting the most challenging problems facing the ComPASS project. Supported by advances in computational science research, they have been successfully applied to the International Linear Collider (ILC) and the Large Hadron Collider (LHC) in High Energy Physics (HEP), the JLab 12-GeV Upgrade in Nuclear Physics (NP), as well as the Spallation Neutron Source (SNS) and the Linac Coherent Light Source (LCLS) in Basic Energy Sciences (BES)

  19. Design and optimization of large accelerator systems through high-fidelity electromagnetic simulations

    International Nuclear Information System (INIS)

    Ng, C; Akcelik, V; Candel, A; Chen, S; Ge, L; Kabel, A; Lee, Lie-Quan; Li, Z; Prudencio, E; Schussman, G; Uplenchwar, R; Xiao, L; Ko, K; Austin, T; Cary, J R; Ovtchinnikov, S; Smith, D N; Werner, G R; Bellantoni, L

    2008-01-01

    SciDAC-1, with its support for the 'Advanced Computing for 21st Century Accelerator Science and Technology' project, witnessed dramatic advances in electromagnetic (EM) simulations for the design and optimization of important accelerators across the Office of Science. In SciDAC2, EM simulations continue to play an important role in the 'Community Petascale Project for Accelerator Science and Simulation' (ComPASS), through close collaborations with SciDAC Centers and Insitutes in computational science. Existing codes will be improved and new multi-physics tools will be developed to model large accelerator systems with unprecedented realism and high accuracy using computing resources at petascale. These tools aim at targeting the most challenging problems facing the ComPASS project. Supported by advances in computational science research, they have been successfully applied to the International Linear Collider and the Large Hadron Collider in high energy physics, the JLab 12-GeV Upgrade in nuclear physics, and the Spallation Neutron Source and the Linac Coherent Light Source in basic energy sciences

  20. Implementation of high fidelity models for the conditions of operation in stop in PWR simulators

    International Nuclear Information System (INIS)

    Gonzalez Sevillano, I.; Jimenez Bogarin, R.; Ortega Pascual, F.

    2014-01-01

    The operation in stop cold conditions and in particular the States of operation with reduced inventory, the call of half loop or half nozzle, is becoming increasingly more important. These States of operation are characterized by having the coolant level approximately on the generatrix of the branches, so that any deviation in the level or malfunction of the system for the disposal of waste heat could lead to compromising situations. The importance of this type of situation is reflected in the APS in other modes (APSOM), which show that the risk in these conditions may be comparable to the power. Hence the importance that the simulator training programmes include scenarios that cover these States of operation. The article describes on the one hand, the difficulties encountered in the simulation of situations characterized by low pressure and presence of Non-Condensable and, on the other hand, its implementation, not only in the field of training of plant personnel, but also in the field of review/validation of operating procedures. (Author)

  1. Multi-fidelity numerical simulations of shock/turbulent-boundary layer interaction with uncertainty quantification

    Science.gov (United States)

    Bermejo-Moreno, Ivan; Campo, Laura; Larsson, Johan; Emory, Mike; Bodart, Julien; Palacios, Francisco; Iaccarino, Gianluca; Eaton, John

    2013-11-01

    We study the interaction between an oblique shock wave and the turbulent boundary layers inside a nearly-square duct by combining wall-modeled LES, 2D and 3D RANS simulations, targeting the experiment of Campo, Helmer & Eaton, 2012 (nominal conditions: M = 2 . 05 , Reθ = 6 , 500). A primary objective is to quantify the effect of aleatory and epistemic uncertainties on the STBLI. Aleatory uncertainties considered include the inflow conditions (Mach number of the incoming air stream and thickness of the boundary layers) and perturbations of the duct geometry upstream of the interaction. The epistemic uncertainty under consideration focuses on the RANS turbulence model form by injecting perturbations in the Reynolds stress anisotropy in regions of the flow where the model assumptions (in particular, the Boussinesq eddy-viscosity hypothesis) may be invalid. These perturbations are then propagated through the flow solver into the solution. The uncertainty quantification (UQ) analysis is done through 2D and 3D RANS simulations, assessing the importance of the three-dimensional effects imposed by the nearly-square duct geometry. Wall-modeled LES are used to verify elements of the UQ methodology and to explore the flow features and physics of the STBLI for multiple shock strengths. Financial support from the United States Department of Energy under the PSAAP program is gratefully acknowledged.

  2. Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session.

    Science.gov (United States)

    Borges, Bruno C R; Boet, Sylvain; Siu, Lyndon W; Bruppacher, Heinz R; Naik, Viren N; Riem, Nicole; Joo, Hwan S

    2010-07-01

    Although guidelines for difficult airway management have been published, the extent to which consultant anesthesiologists follow these guidelines has not been determined. The purpose of this study is to observe how consultant anesthesiologists manage a "cannot intubate, cannot ventilate" (CICV) scenario in a high-fidelity simulator and to evaluate whether a simulation teaching session improves their adherence to the American Society of Anesthesiologists (ASA) difficult airway algorithm. With Ethics Board approval and informed consent, all staff anesthesiologists in a single tertiary care institution were invited to enrol in this study where they managed a simulated unanticipated CICV scenario in a high-fidelity simulator. The scenario involved a patient with a difficult airway whose trachea could not be intubated and where it was impossible to ventilate the patient's lungs. Airway management options, including laryngeal mask airway, a fibreoptic bronchoscope, and a Glidescope were available for use but scripted to fail. A percutaneous cricothyroidotomy was required to re-establish adequate ventilation. Following the scenario, there was a personalized one-hour video-assisted expert debriefing focusing on the ASA difficult airway guidelines and "hands-on" cricothyroidotomy teaching. The second scenario followed immediately with an identical CICV scenario. The content to either scenario was not revealed beforehand. Outcome measures included: 1) major deviations from the ASA difficult airway guidelines; 2) time to start cricothyroidotomy; and 3) time to achieve ventilation. Thirty-eight anesthesiologists agreed to participate. The number of major deviations from the ASA algorithm was similar in the first and second sessions. These deviations included: multiple laryngoscopies (0 vs 2 pre-post; P = 0.49), use of fibreoptic bronchoscope (8 vs 7 pre-post; P = 1.0), bypass of laryngeal mask airway attempt (7 vs 13 pre-post; P = 0.19), and failure to call for anesthetic help

  3. Effects of the Use of High-Fidelity Human Simulation in Nursing Education: A Meta-Analysis.

    Science.gov (United States)

    Lee, Jin; Oh, Pok-Ja

    2015-09-01

    This study was conducted to evaluate the effects of high-fidelity human simulation (HFHS) on cognitive, affective, and psychomotor outcomes of learning. PubMed, Cochrane Library, EMBASE, CINAHL, and Korean databases were searched. The RevMan program was used for analysis. A meta-analysis was conducted of 26 controlled trials, with a total of 2,031 nursing students. The use of HFHS tended to have beneficial effects on cognitive and psychomotor domains of learning. In analysis of cognitive outcomes, the weighted average effect size across studies was -0.97 for problem-solving competency, -0.67 for critical thinking, and -2.15 for clinical judgment. The effect size for clinical competence of the psychomotor domain was -0.81. Use of HFHS might positively impact a high level of cognitive skill and clinical skill acquisition. Further research is required to determine the effectiveness of use of HFHS as an educational strategy to improve knowledge acquisition and communication skills. Copyright 2015, SLACK Incorporated.

  4. A New Coupled CFD/Neutron Kinetics System for High Fidelity Simulations of LWR Core Phenomena: Proof of Concept

    Directory of Open Access Journals (Sweden)

    Jorge Pérez Mañes

    2014-01-01

    Full Text Available The Institute for Neutron Physics and Reactor Technology (INR at the Karlsruhe Institute of Technology (KIT is investigating the application of the meso- and microscale analysis for the prediction of local safety parameters for light water reactors (LWR. By applying codes like CFD (computational fluid dynamics and SP3 (simplified transport reactor dynamics it is possible to describe the underlying phenomena in a more accurate manner than by the nodal/coarse 1D thermal hydraulic coupled codes. By coupling the transport (SP3 based neutron kinetics (NK code DYN3D with NEPTUNE-CFD, within a parallel MPI-environment, the NHESDYN platform is created. The newly developed system will allow high fidelity simulations of LWR fuel assemblies and cores. In NHESDYN, a heat conduction solver, SYRTHES, is coupled to NEPTUNE-CFD. The driver module of NHESDYN controls the sequence of execution of the solvers as well as the communication between the solvers based on MPI. In this paper, the main features of NHESDYN are discussed and the proof of the concept is done by solving a single pin problem. The prediction capability of NHESDYN is demonstrated by a code-to-code comparison with the DYNSUB code. Finally, the future developments and validation efforts are highlighted.

  5. Characterization of a novel, highly integrated tubular solid oxide fuel cell system using high-fidelity simulation tools

    Science.gov (United States)

    Kattke, K. J.; Braun, R. J.

    2011-08-01

    A novel, highly integrated tubular SOFC system intended for small-scale power is characterized through a series of sensitivity analyses and parametric studies using a previously developed high-fidelity simulation tool. The high-fidelity tubular SOFC system modeling tool is utilized to simulate system-wide performance and capture the thermofluidic coupling between system components. Stack performance prediction is based on 66 anode-supported tubular cells individually evaluated with a 1-D electrochemical cell model coupled to a 3-D computational fluid dynamics model of the cell surroundings. Radiation is the dominate stack cooling mechanism accounting for 66-92% of total heat loss at the outer surface of all cells at baseline conditions. An average temperature difference of nearly 125 °C provides a large driving force for radiation heat transfer from the stack to the cylindrical enclosure surrounding the tube bundle. Consequently, cell power and voltage disparities within the stack are largely a function of the radiation view factor from an individual tube to the surrounding stack can wall. The cells which are connected in electrical series, vary in power from 7.6 to 10.8 W (with a standard deviation, σ = 1.2 W) and cell voltage varies from 0.52 to 0.73 V (with σ = 81 mV) at the simulation baseline conditions. It is observed that high cell voltage and power outputs directly correspond to tubular cells with the smallest radiation view factor to the enclosure wall, and vice versa for tubes exhibiting low performance. Results also reveal effective control variables and operating strategies along with an improved understanding of the effect that design modifications have on system performance. By decreasing the air flowrate into the system by 10%, the stack can wall temperature increases by about 6% which increases the minimum cell voltage to 0.62 V and reduces deviations in cell power and voltage by 31%. A low baseline fuel utilization is increased by decreasing the

  6. Final year medical students' views on simulation-based teaching: a comparison with the Best Evidence Medical Education Systematic Review.

    Science.gov (United States)

    Paskins, Zoë; Peile, Ed

    2010-01-01

    Simulation is being increasingly used in medical education. The aim of this study was to explore in more depth the features of simulation-based teaching that undergraduate medical students value using the Best Evidence Medical Education (BEME) Systematic Review features that lead to effective learning as a framework. Thematic analysis of four semi-structured focus groups with final year medical students who had been taught acute care skills using a medium-fidelity whole-body simulator manikin (SimMan). Twelve key themes were identified, namely, feedback, integration into curriculum, learning style, learning environment, realism, teamwork, communication skills, confidence/increased self-efficacy, anxiety, performance, perceptions of foundation year 1 (FY1) and SimMan as a resource. Each theme is described with supporting quotes. Six of the ten features listed in the BEME review appeared to be of particular value to the medical students. This study provides a richer understanding of these features. In addition, new insights into the effect of simulation on confidence, anxiety and self-efficacy are discussed which may be affected by the 'performance' nature of simulation role-play. Students also contribute critical thought about the use of SimMan as a resource and provide novel ideas for reducing 'downtime'.

  7. Self vs expert assessment of technical and non-technical skills in high fidelity simulation.

    Science.gov (United States)

    Arora, Sonal; Miskovic, Danilo; Hull, Louise; Moorthy, Krishna; Aggarwal, Rajesh; Johannsson, Helgi; Gautama, Sanjay; Kneebone, Roger; Sevdalis, Nick

    2011-10-01

    Accurate assessment is imperative for learning, feedback and progression. The aim of this study was to examine whether surgeons can accurately self-assess their technical and nontechnical skills compared with expert faculty members' assessments. Twenty-five surgeons performed a laparoscopic cholecystectomy (LC) in a simulated operating room. Technical and nontechnical performance was assessed by participants and faculty members using the validated Objective Structured Assessment of Technical Skills (OSATS) and the Non-Technical Skills for Surgeons scale (NOTSS). Assessment of technical performance correlated between self and faculty members' ratings for experienced (median score, 30.0 vs 31.0; ρ = .831; P = .001) and inexperienced (median score, 22.0 vs 28.0; ρ = .761; P = .003) surgeons. Assessment of nontechnical skills between self and faculty members did not correlate for experienced surgeons (median score, 8.0 vs 10.5; ρ = -.375; P = .229) or their more inexperienced counterparts (median score, 9.0 vs 7.0; ρ = -.018; P = .953). Surgeons can accurately self-assess their technical skills in virtual reality LC. Conversely, formal assessment with faculty members' input is required for nontechnical skills, for which surgeons lack insight into their behaviours. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Nursing leadership competencies: low-fidelity simulation as a teaching strategy.

    Science.gov (United States)

    Pollard, Cheryl L; Wild, Carol

    2014-11-01

    Nurses must demonstrate leadership and followership competencies within complex adaptive team environments to ensure patient and staff safety, effective use of resources, and an adaptive health care system. These competencies are demonstrated through the use of communication strategies that are embedded within a relational practice. Health care professionals, regardless of formal position, need to assert their opinions and perspectives using a communication style that demonstrates value of all team members in open discussions about quality patient care, appropriate access, and stewardship. Challenges to effective communication and relational practice are the individual and organizational patterns of behavior, and the subsequent impact that these behaviors have on others. Students articulate situational awareness when they conduct a critical analysis of individual, team, and organizational functioning, and then use this information and evidence gained from a critical literature review to develop recommendations to improve individual, team, and/or organizational performance. Leadership and followership simulation exercises, inclusive of public feedback and debriefing, are used as a pedagogical/andragogical strategy in a nursing baccalaureate senior leadership course to facilitate learning of team communication skills and improve situational awareness. We view this strategy as an alternative to traditional classroom learning activities which provide little opportunity for recursive learning. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres

    Directory of Open Access Journals (Sweden)

    Laura E. Dodge

    2016-02-01

    Full Text Available Objectives. Little is known about the utility of simulation-based training in office gynaecology. The objective of this cross-sectional study was to evaluate the self-reported effectiveness and acceptability of the PelvicSim™ (VirtaMed, a high-fidelity mobile simulator, to train clinicians in intrauterine device (IUD insertion. Methods. Clinicians at ambulatory healthcare centres participated in a PelvicSim IUD training programme and completed a self-administered survey. The survey assessed prior experience with IUD insertion, pre- and post-training competency and comfort and opinions regarding the acceptability of the PelvicSim. Results. The 237 participants were primarily female (97.5% nurse practitioners (71.3%. Most had experience inserting the levonorgestrel LNG20 IUD and the copper T380A device, but only 4.1% had ever inserted the LNG14 IUD. For all three devices, participants felt more competent following training, with the most striking change reported for insertion of the LNG14 IUD. The majority of participants reported increased comfort with uterine sounding (57.7%, IUD insertion on a live patient (69.8%, and minimizing patient pain (72.8% following training. Of the respondents, 89.6% reported the PelvicSim IUD insertion activities as “valuable” or “very valuable.” All participants would recommend the PelvicSim for IUD training, and nearly all (97.2% reported that the PelvicSim was a better method to teach IUD insertion than the simple plastic models supplied by IUD manufacturers. Conclusions. These findings support the use of the PelvicSim for IUD training, though whether it is superior to traditional methods and improves patient outcomes requires evaluation.

  10. Improvement of the NSSS T/H Module for Enhancing the Simulation Fidelity of KNPEC-2 Simulator

    International Nuclear Information System (INIS)

    Kim, Kyung Doo; Lee, Seung Wook; Jeong, Jae Jun; Lee, Myung Soo

    2005-01-01

    KEPRI(Korea Electric Power Research Institute) and KAERI (Korea Atomic Energy Research Institute) jointly developed and supplied a realistic NSSS (Nuclear Steam Supply System) T/H (Thermal-Hydraulic) module (named ARTS) based on the best-estimate code RETRAN-3D for the improvement of the KNPEC-2 full-scope simulator in 2001. Although ARTS can simulate the most transients in real-time, and its robustness is ensured, real-time calculation and robustness can fail for largebreak (LB) loss-of-coolant accident (LOCA) and longterm, two-phase transients. In order to improve its robustness, ARTS equipped with the backup calculation module to be used whenever a regular ARTS module fails to calculate. When the symptom for the failure of T/H module is detected, the main ARTS module is replaced with the backup module for the calculation of primary and secondary reactor system although most failures of ARTS occur in the calculation of the primary system especially for LB LOCA simulation. The sudden transition from the main ARTS module to the backup module can exhibit the discontinuity of simulation of secondary system on rare occasions. To mitigate the simulation discontinuity, we have improved the backup module of ARTS. The performance of a new approach has been illustrated by the non-integrated standalone test. The improved ARTS module will be incorporated into KNPEC-2 simulator and evaluated its performance in the real simulator environment. This paper presents the brief description of a new backup calculation strategy and the simulation results of LOCA to evaluate the performance of a new backup strategy in standalone test environment

  11. The effects of using high-fidelity simulators and standardized patients on the thorax, lung, and cardiac examination skills of undergraduate nursing students.

    Science.gov (United States)

    Tuzer, Hilal; Dinc, Leyla; Elcin, Melih

    2016-10-01

    Existing research literature indicates that the use of various simulation techniques in the training of physical examination skills develops students' cognitive and psychomotor abilities in a realistic learning environment while improving patient safety. The study aimed to compare the effects of the use of a high-fidelity simulator and standardized patients on the knowledge and skills of students conducting thorax-lungs and cardiac examinations, and to explore the students' views and learning experiences. A mixed-method explanatory sequential design. The study was conducted in the Simulation Laboratory of a Nursing School, the Training Center at the Faculty of Medicine, and in the inpatient clinics of the Education and Research Hospital. Fifty-two fourth-year nursing students. Students were randomly assigned to Group I and Group II. The students in Group 1 attended the thorax-lungs and cardiac examination training using a high-fidelity simulator, while the students in Group 2 using standardized patients. After the training sessions, all students practiced their skills on real patients in the clinical setting under the supervision of the investigator. Knowledge and performance scores of all students increased following the simulation activities; however, the students that worked with standardized patients achieved significantly higher knowledge scores than those that worked with the high-fidelity simulator; however, there was no significant difference in performance scores between the groups. The mean performance scores of students on real patients were significantly higher compared to the post-simulation assessment scores (psimulator in increasing the knowledge scores of students on thorax-lungs and cardiac examinations; however, practice on real patients increased performance scores of all students without any significant difference in two groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Perceived Barriers to the Use of High-Fidelity Hands-On Simulation Training for Contrast Reaction Management: Why Programs are Not Using It.

    Science.gov (United States)

    Chinnugounder, Sankar; Hippe, Daniel S; Maximin, Suresh; O'Malley, Ryan B; Wang, Carolyn L

    2015-01-01

    Although subjective and objective benefits of high-fidelity simulation have been reported in medicine, there has been slow adoption in radiology. The purpose of our study was to identify the perceived barriers in the use of high-fidelity hands-on simulation for contrast reaction management training. An IRB exempt 32 questions online web survey was sent to 179 non-military radiology residency program directors listed in the Fellowship and Residency Electronic Interactive Database Access system (FREIDA). Survey questions included the type of contrast reaction management training, cost, time commitment of residents and faculty, and the reasons for not using simulation training. Responses from the survey were summarized as count (percentage), mean ± standard deviation (SD), or median (range). 84 (47%) of 179 programs responded, of which 88% offered CRM training. Most (72%) conducted the CRM training annually while only 4% conducted it more frequently. Didactic lecture was the most frequently used training modality (97%), followed by HFS (30%) and computer-based simulation (CBS) (19%); 5.5% used both HFS and CBS. Of the 51 programs that offer CRM training but do not use HFS, the most common reason reported was insufficient availability (41%). Other reported reasons included cost (33%), no access to simulation centers (33%), lack of trained faculty (27%) and time constraints (27%). Although high-fidelity hands-on simulation training is the best way to reproduce real-life contrast reaction scenarios, many institutions do not provide this training due to constraints such as cost, lack of access or insufficient availability of simulation labs, and lack of trained faculty. As a specialty, radiology needs to better address these barriers at both an institutional and national level. Copyright © 2015 Mosby, Inc. All rights reserved.

  13. Simulation-based medical education in pediatrics.

    Science.gov (United States)

    Lopreiato, Joseph O; Sawyer, Taylor

    2015-01-01

    The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the past 2 decades and is expected to continue to grow. Similar to other instructional formats used in medical education, SBME is an instructional methodology that facilitates learning. Successful use of SBME in pediatrics requires attention to basic educational principles, including the incorporation of clear learning objectives. To facilitate learning during simulation the psychological safety of the participants must be ensured, and when done correctly, SBME is a powerful tool to enhance patient safety in pediatrics. Here we provide an overview of SBME in pediatrics and review key topics in the field. We first review the tools of the trade and examine various types of simulators used in pediatric SBME, including human patient simulators, task trainers, standardized patients, and virtual reality simulation. Then we explore several uses of simulation that have been shown to lead to effective learning, including curriculum integration, feedback and debriefing, deliberate practice, mastery learning, and range of difficulty and clinical variation. Examples of how these practices have been successfully used in pediatrics are provided. Finally, we discuss the future of pediatric SBME. As a community, pediatric simulation educators and researchers have been a leading force in the advancement of simulation in medicine. As the use of SBME in pediatrics expands, we hope this perspective will serve as a guide for those interested in improving the state of pediatric SBME. Published by Elsevier Inc.

  14. High fidelity simulation and analysis of liquid jet atomization in a gaseous crossflow at intermediate Weber numbers

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xiaoyi, E-mail: lixy2@utrc.utc.com; Soteriou, Marios C. [United Technologies Research Center, East Hartford, Connecticut 06108 (United States)

    2016-08-15

    Recent advances in numerical methods coupled with the substantial enhancements in computing power and the advent of high performance computing have presented first principle, high fidelity simulation as a viable tool in the prediction and analysis of spray atomization processes. The credibility and potential impact of such simulations, however, has been hampered by the relative absence of detailed validation against experimental evidence. The numerical stability and accuracy challenges arising from the need to simulate the high liquid-gas density ratio across the sharp interfaces encountered in these flows are key reasons for this. In this work we challenge this status quo by presenting a numerical model able to deal with these challenges, employing it in simulations of liquid jet in crossflow atomization and performing extensive validation of its results against a carefully executed experiment with detailed measurements in the atomization region. We then proceed to the detailed analysis of the flow physics. The computational model employs the coupled level set and volume of fluid approach to directly capture the spatiotemporal evolution of the liquid-gas interface and the sharp-interface ghost fluid method to stably handle high liquid-air density ratio. Adaptive mesh refinement and Lagrangian droplet models are shown to be viable options for computational cost reduction. Moreover, high performance computing is leveraged to manage the computational cost. The experiment selected for validation eliminates the impact of inlet liquid and gas turbulence and focuses on the impact of the crossflow aerodynamic forces on the atomization physics. Validation is demonstrated by comparing column surface wavelengths, deformation, breakup locations, column trajectories and droplet sizes, velocities, and mass rates for a range of intermediate Weber numbers. Analysis of the physics is performed in terms of the instability and breakup characteristics and the features of downstream

  15. [Simulation in medical education: a synopsis].

    Science.gov (United States)

    Corvetto, Marcia; Bravo, María Pía; Montaña, Rodrigo; Utili, Franco; Escudero, Eliana; Boza, Camilo; Varas, Julián; Dagnino, Jorge

    2013-01-01

    Clinical simulation is defined as a technique (not a technology) to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Over the past few years, there has been a significant growth in its use, both as a learning tool and as an assessment for accreditation. Example of this is the fact that simulation is an integral part of medical education curricula abroad. Some authors have cited it as an unavoidable necessity or as an ethical imperative. In Chile, its formal inclusion in Medical Schools' curricula has just begun. This review is an overview of this important educational tool, presenting the evidence about its usefulness in medical education and describing its current situation in Chile.

  16. Medical Image Registration and Surgery Simulation

    DEFF Research Database (Denmark)

    Bro-Nielsen, Morten

    1996-01-01

    This thesis explores the application of physical models in medical image registration and surgery simulation. The continuum models of elasticity and viscous fluids are described in detail, and this knowledge is used as a basis for most of the methods described here. Real-time deformable models......, and the use of selective matrix vector multiplication. Fluid medical image registration A new and faster algorithm for non-rigid registration using viscous fluid models is presented. This algorithm replaces the core part of the original algorithm with multi-resolution convolution using a new filter, which...... growth is also presented. Using medical knowledge about the growth processes of the mandibular bone, a registration algorithm for time sequence images of the mandible is developed. Since this registration algorithm models the actual development of the mandible, it is possible to simulate the development...

  17. Medical imaging informatics simulators: a tutorial.

    Science.gov (United States)

    Huang, H K; Deshpande, Ruchi; Documet, Jorge; Le, Anh H; Lee, Jasper; Ma, Kevin; Liu, Brent J

    2014-05-01

    A medical imaging informatics infrastructure (MIII) platform is an organized method of selecting tools and synthesizing data from HIS/RIS/PACS/ePR systems with the aim of developing an imaging-based diagnosis or treatment system. Evaluation and analysis of these systems can be made more efficient by designing and implementing imaging informatics simulators. This tutorial introduces the MIII platform and provides the definition of treatment/diagnosis systems, while primarily focusing on the development of the related simulators. A medical imaging informatics (MII) simulator in this context is defined as a system integration of many selected imaging and data components from the MIII platform and clinical treatment protocols, which can be used to simulate patient workflow and data flow starting from diagnostic procedures to the completion of treatment. In these processes, DICOM and HL-7 standards, IHE workflow profiles, and Web-based tools are emphasized. From the information collected in the database of a specific simulator, evidence-based medicine can be hypothesized to choose and integrate optimal clinical decision support components. Other relevant, selected clinical resources in addition to data and tools from the HIS/RIS/PACS and ePRs platform may also be tailored to develop the simulator. These resources can include image content indexing, 3D rendering with visualization, data grid and cloud computing, computer-aided diagnosis (CAD) methods, specialized image-assisted surgical, and radiation therapy technologies. Five simulators will be discussed in this tutorial. The PACS-ePR simulator with image distribution is the cradle of the other simulators. It supplies the necessary PACS-based ingredients and data security for the development of four other simulators: the data grid simulator for molecular imaging, CAD-PACS, radiation therapy simulator, and image-assisted surgery simulator. The purpose and benefits of each simulator with respect to its clinical relevance

  18. Medical education and human trafficking: using simulation.

    Science.gov (United States)

    Stoklosa, Hanni; Lyman, Michelle; Bohnert, Carrie; Mittel, Olivia

    2017-01-01

    Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session's development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care.

  19. Medical education and human trafficking: using simulation

    Science.gov (United States)

    Stoklosa, Hanni; Lyman, Michelle; Bohnert, Carrie; Mittel, Olivia

    2017-01-01

    ABSTRACT Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session’s development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. Abbreviations: HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care PMID:29228882

  20. Intelligent medical image processing by simulated annealing

    International Nuclear Information System (INIS)

    Ohyama, Nagaaki

    1992-01-01

    Image processing is being widely used in the medical field and already has become very important, especially when used for image reconstruction purposes. In this paper, it is shown that image processing can be classified into 4 categories; passive, active, intelligent and visual image processing. These 4 classes are explained at first through the use of several examples. The results show that the passive image processing does not give better results than the others. Intelligent image processing, then, is addressed, and the simulated annealing method is introduced. Due to the flexibility of the simulated annealing, formulated intelligence is shown to be easily introduced in an image reconstruction problem. As a practical example, 3D blood vessel reconstruction from a small number of projections, which is insufficient for conventional method to give good reconstruction, is proposed, and computer simulation clearly shows the effectiveness of simulated annealing method. Prior to the conclusion, medical file systems such as IS and C (Image Save and Carry) is pointed out to have potential for formulating knowledge, which is indispensable for intelligent image processing. This paper concludes by summarizing the advantages of simulated annealing. (author)

  1. Judicious Use of Simulation Technology in Continuing Medical Education

    Science.gov (United States)

    Curtis, Michael T.; DiazGranados, Deborah; Feldman, Moshe

    2012-01-01

    Use of simulation-based training is fast becoming a vital source of experiential learning in medical education. Although simulation is a common tool for undergraduate and graduate medical education curricula, the utilization of simulation in continuing medical education (CME) is still an area of growth. As more CME programs turn to simulation to…

  2. A major trauma course based on posters, audio-guides and simulation improves the management skills of medical students: Evaluation via medical simulator.

    Science.gov (United States)

    Cuisinier, Adrien; Schilte, Clotilde; Declety, Philippe; Picard, Julien; Berger, Karine; Bouzat, Pierre; Falcon, Dominique; Bosson, Jean Luc; Payen, Jean-François; Albaladejo, Pierre

    2015-12-01

    Medical competence requires the acquisition of theoretical knowledge and technical skills. Severe trauma management teaching is poorly developed during internship. Nevertheless, the basics of major trauma management should be acquired by every future physician. For this reason, the major trauma course (MTC), an educational course in major traumatology, has been developed for medical students. Our objective was to evaluate, via a high fidelity medical simulator, the impact of the MTC on medical student skills concerning major trauma management. The MTC contains 3 teaching modalities: posters with associated audio-guides, a procedural workshop on airway management and a teaching session using a medical simulator. Skills evaluation was performed 1 month before (step 1) and 1 month after (step 3) the MTC (step 2). Nineteen students were individually evaluated on 2 different major trauma scenarios. The primary endpoint was the difference between steps 1 and 3, in a combined score evaluating: admission, equipment, monitoring and safety (skill set 1) and systematic clinical examinations (skill set 2). After the course, the combined primary outcome score improved by 47% (P<0.01). Scenario choice or the order of use had no significant influence on the skill set evaluations. This study shows improvement in student skills for major trauma management, which we attribute mainly to the major trauma course developed in our institution. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  3. Status report on multigroup cross section generation code development for high-fidelity deterministic neutronics simulation system

    International Nuclear Information System (INIS)

    Yang, W.S.; Lee, C.H.

    2008-01-01

    Under the fast reactor simulation program launched in April 2007, development of an advanced multigroup cross section generation code was initiated in July 2007, in conjunction with the development of the high-fidelity deterministic neutron transport code UNIC. The general objectives are to simplify the existing multi-step schemes and to improve the resolved and unresolved resonance treatments. Based on the review results of current methods and the fact that they have been applied successfully to fast critical experiment analyses and fast reactor designs for last three decades, the methodologies of the ETOE-2/MC 2 -2/SDX code system were selected as the starting set of methodologies for multigroup cross section generation for fast reactor analysis. As the first step for coupling with the UNIC code and use in a parallel computing environment, the MC 2 -2 code was updated by modernizing the memory structure and replacing old data management package subroutines and functions with FORTRAN 90 based routines. Various modifications were also made in the ETOE-2 and MC 2 -2 codes to process the ENDF/B-VII.0 data properly. Using the updated ETOE-2/MC 2 -2 code system, the ENDF/B-VII.0 data was successfully processed for major heavy and intermediate nuclides employed in sodium-cooled fast reactors. Initial verification tests of the MC 2 -2 libraries generated from ENDF/B-VII.0 data were performed by inter-comparison of twenty-one group infinite dilute total cross sections obtained from MC 2 -2, VIM, and NJOY. For almost all nuclides considered, MC 2 -2 cross sections agreed very well with those from VIM and NJOY. Preliminary validation tests of the ENDF/B-VII.0 libraries of MC 2 -2 were also performed using a set of sixteen fast critical benchmark problems. The deterministic results based on MC 2 -2/TWODANT calculations were in good agreement with MCNP solutions within ∼0.25% Δρ, except a few small LANL fast assemblies. Relative to the MCNP solution, the MC 2 -2/TWODANT

  4. Status report on multigroup cross section generation code development for high-fidelity deterministic neutronics simulation system.

    Energy Technology Data Exchange (ETDEWEB)

    Yang, W. S.; Lee, C. H. (Nuclear Engineering Division)

    2008-05-16

    Under the fast reactor simulation program launched in April 2007, development of an advanced multigroup cross section generation code was initiated in July 2007, in conjunction with the development of the high-fidelity deterministic neutron transport code UNIC. The general objectives are to simplify the existing multi-step schemes and to improve the resolved and unresolved resonance treatments. Based on the review results of current methods and the fact that they have been applied successfully to fast critical experiment analyses and fast reactor designs for last three decades, the methodologies of the ETOE-2/MC{sup 2}-2/SDX code system were selected as the starting set of methodologies for multigroup cross section generation for fast reactor analysis. As the first step for coupling with the UNIC code and use in a parallel computing environment, the MC{sup 2}-2 code was updated by modernizing the memory structure and replacing old data management package subroutines and functions with FORTRAN 90 based routines. Various modifications were also made in the ETOE-2 and MC{sup 2}-2 codes to process the ENDF/B-VII.0 data properly. Using the updated ETOE-2/MC{sup 2}-2 code system, the ENDF/B-VII.0 data was successfully processed for major heavy and intermediate nuclides employed in sodium-cooled fast reactors. Initial verification tests of the MC{sup 2}-2 libraries generated from ENDF/B-VII.0 data were performed by inter-comparison of twenty-one group infinite dilute total cross sections obtained from MC{sup 2}-2, VIM, and NJOY. For almost all nuclides considered, MC{sup 2}-2 cross sections agreed very well with those from VIM and NJOY. Preliminary validation tests of the ENDF/B-VII.0 libraries of MC{sup 2}-2 were also performed using a set of sixteen fast critical benchmark problems. The deterministic results based on MC{sup 2}-2/TWODANT calculations were in good agreement with MCNP solutions within {approx}0.25% {Delta}{rho}, except a few small LANL fast assemblies

  5. Developing a High Fidelity Martian Soil Simulant Based on MSL Measurements: Applications for Habitability, Exploration, and In-Situ Resource Utilization

    Science.gov (United States)

    Cannon, K.; Britt, D. T.; Smith, T. M.; Fritsche, R. F.; Covey, S. D.; Batcheldor, D.; Watson, B.

    2017-12-01

    Powerful instruments, that include CheMin and SAM on the MSL Curiosity rover, have provided an unprecedented look into the mineral, chemical, and volatile composition of Martian soils. Interestingly, the bulk chemistry of the Rocknest windblown soil is a close match to similar measurements from the Spirit and Opportunity rovers, suggesting the presence of a global basaltic soil component. The Martian regolith is likely composed of this global soil mixed with locally to regionally derived components that include alteration products and evolved volcanic compositions. Without returned soil samples, researchers have relied on terrestrial simulants to address fundamental Mars science, habitability, in-situ resource utilization, and hardware for future exploration. However, these past simulants have low fidelity compared to actual Martian soils: JSC Mars-1a is an amorphous palagonitic material with spectral similarities to Martian dust, not soil, and Mojave Mars is simply a ground up terrestrial basalt chosen for its convenient location. Based on our experience creating asteroid regolith simulants, we are developing a high fidelity Martian soil simulant (Mars Global) designed ab initio to match the mineralogy, chemistry, and volatile contents of the global basaltic soil on Mars. The crystalline portion of the simulant is based on CheMin measurements of Rocknest and includes plagioclase, two pyroxenes, olivine, hematite, magnetite, anhydrite, and quartz. The amorphous portion is less well constrained, but we are re-creating it with basaltic glass, synthetic ferrihydrite, ferric sulfate, and carbonates. We also include perchlorate and nitrate salts based on evolved gas analyses from the SAM instrument. Analysis and testing of Mars Global will include physical properties (shear strength, density, internal friction angle), spectral properties, magnetic properties, and volatile release patterns. The simulant is initially being designed for NASA agricultural studies, but

  6. MEDICAL STAFF SCHEDULING USING SIMULATED ANNEALING

    Directory of Open Access Journals (Sweden)

    Ladislav Rosocha

    2015-07-01

    Full Text Available Purpose: The efficiency of medical staff is a fundamental feature of healthcare facilities quality. Therefore the better implementation of their preferences into the scheduling problem might not only rise the work-life balance of doctors and nurses, but also may result into better patient care. This paper focuses on optimization of medical staff preferences considering the scheduling problem.Methodology/Approach: We propose a medical staff scheduling algorithm based on simulated annealing, a well-known method from statistical thermodynamics. We define hard constraints, which are linked to legal and working regulations, and minimize the violations of soft constraints, which are related to the quality of work, psychic, and work-life balance of staff.Findings: On a sample of 60 physicians and nurses from gynecology department we generated monthly schedules and optimized their preferences in terms of soft constraints. Our results indicate that the final value of objective function optimized by proposed algorithm is more than 18-times better in violations of soft constraints than initially generated random schedule that satisfied hard constraints.Research Limitation/implication: Even though the global optimality of final outcome is not guaranteed, desirable solutionwas obtained in reasonable time. Originality/Value of paper: We show that designed algorithm is able to successfully generate schedules regarding hard and soft constraints. Moreover, presented method is significantly faster than standard schedule generation and is able to effectively reschedule due to the local neighborhood search characteristics of simulated annealing.

  7. Medical simulation in interventional cardiology: "More research is needed".

    Science.gov (United States)

    Tajti, Peter; Brilakis, Emmanouil S

    2018-05-01

    Medical simulation is being used for training fellows to perform coronary angiography. Medical simulation training was associated with 2 min less fluoroscopy time per case after adjustment. Whether medical simulation really works needs to be evaluated in additional, well-designed and executed clinical studies. © 2018 Wiley Periodicals, Inc.

  8. Improving medical student toxicology knowledge and self-confidence using mannequin simulation.

    Science.gov (United States)

    Halm, Brunhild M; Lee, Meta T; Franke, Adrian A

    2010-01-01

    Learning medicine without placing patients at increased risk of complications is of utmost importance in the medical profession. High-fidelity patient simulators can potentially achieve this and are therefore increasingly used in the training of medical students. Preclinical medical students have minimal exposure to clinical rotations and commonly feel anxious and apprehensive when starting their clinical years. The objective of this pilot study was to determine if toxicology knowledge and confidence of preclinical second-year medical students could be augmented with simulation training. We designed and implemented a simulation exercise for second-year medical students to enhance learning of Basic Life Support, toxidromes, and management of a semiconscious overdose victim. Groups of 5-6 students were tasked to identify abnormal findings, order tests, and initiate treatment on a mannequin. Faculty observers provided video-assisted feedback immediately afterwards. On-line pre- and posttests were completed in the simulation lab before and after the exercise. This simulation exercise, completed by 52 students, increased test scores on average from 60% to 71% compared to a pre-test. Among the topics tested, students scored worst in identifying normal/abnormal vital signs. Mean confidence increased from 2.0 to 2.6 using a 5-point Likert scale (1-very low to 5-very high). This study suggests that simulation exercises for second-year medical students may be a valuable tool to increase knowledge and student self-confidence at a key transition period prior to beginning clerkship experiences. Further research is needed to prove long-term educational benefits of simulation interventions in the preclinical setting.

  9. The Numerical Nuclear Reactor for High-Fidelity Integrated Simulation of Neutronic, Thermal-Hydraulic, and Thermo-Mechanical Phenomena

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. S.; Ju, H. G.; Jeon, T. H. and others

    2005-03-15

    A comprehensive high fidelity reactor core modeling capability has been developed for detailed analysis of current and advanced reactor designs as part of a US-ROK collaborative I-NERI project. High fidelity was accomplished by integrating highly refined solution modules for the coupled neutronic, thermal-hydraulic, and thermo-mechanical phenomena. Each solution module employs methods and models that are formulated faithfully to the first-principles governing the physics, real geometry, and constituents. Specifically, the critical analysis elements that are incorporated in the coupled code capability are whole-core neutron transport solution, ultra-fine-mesh computational fluid dynamics/heat transfer solution, and finite-element-based thermo-mechanics solution, all obtained with explicit (fuel pin cell level) heterogeneous representations of the components of the core. The vast computational problem resulting from such highly refined modeling is solved on massively parallel computers, and serves as the 'numerical nuclear reactor'. Relaxation of modeling parameters were also pursued to make problems run on clusters of workstations and PCs for smaller scale applications as well.

  10. The Numerical Nuclear Reactor for High-Fidelity Integrated Simulation of Neutronic, Thermal-Hydraulic, and Thermo-Mechanical Phenomena

    International Nuclear Information System (INIS)

    Kim, K. S.; Ju, H. G.; Jeon, T. H. and others

    2005-03-01

    A comprehensive high fidelity reactor core modeling capability has been developed for detailed analysis of current and advanced reactor designs as part of a US-ROK collaborative I-NERI project. High fidelity was accomplished by integrating highly refined solution modules for the coupled neutronic, thermal-hydraulic, and thermo-mechanical phenomena. Each solution module employs methods and models that are formulated faithfully to the first-principles governing the physics, real geometry, and constituents. Specifically, the critical analysis elements that are incorporated in the coupled code capability are whole-core neutron transport solution, ultra-fine-mesh computational fluid dynamics/heat transfer solution, and finite-element-based thermo-mechanics solution, all obtained with explicit (fuel pin cell level) heterogeneous representations of the components of the core. The vast computational problem resulting from such highly refined modeling is solved on massively parallel computers, and serves as the 'numerical nuclear reactor'. Relaxation of modeling parameters were also pursued to make problems run on clusters of workstations and PCs for smaller scale applications as well

  11. A critical review of simulation-based medical education research: 2003-2009.

    Science.gov (United States)

    McGaghie, William C; Issenberg, S Barry; Petrusa, Emil R; Scalese, Ross J

    2010-01-01

    This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969-2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003-2009. The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.

  12. An exploration of the relationship between knowledge and performance-related variables in high-fidelity simulation: designing instruction that promotes expertise in practice.

    Science.gov (United States)

    Hauber, Roxanne P; Cormier, Eileen; Whyte, James

    2010-01-01

    Increasingly, high-fidelity patient simulation (HFPS) is becoming essential to nursing education. Much remains unknown about how classroom learning is connected to student decision-making in simulation scenarios and the degree to which transference takes place between the classroom setting and actual practice. The present study was part of a larger pilot study aimed at determining the relationship between nursing students' clinical ability to prioritize their actions and the associated cognitions and physiologic outcomes of care using HFPS. In an effort to better explain the knowledge base being used by nursing students in HFPS, the investigators explored the relationship between common measures of knowledge and performance-related variables. Findings are discussed within the context of the expert performance approach and concepts from cognitive psychology, such as cognitive architecture, cognitive load, memory, and transference.

  13. Medical image archive node simulation and architecture

    Science.gov (United States)

    Chiang, Ted T.; Tang, Yau-Kuo

    1996-05-01

    It is a well known fact that managed care and new treatment technologies are revolutionizing the health care provider world. Community Health Information Network and Computer-based Patient Record projects are underway throughout the United States. More and more hospitals are installing digital, `filmless' radiology (and other imagery) systems. They generate a staggering amount of information around the clock. For example, a typical 500-bed hospital might accumulate more than 5 terabytes of image data in a period of 30 years for conventional x-ray images and digital images such as Magnetic Resonance Imaging and Computer Tomography images. With several hospitals contributing to the archive, the storage required will be in the hundreds of terabytes. Systems for reliable, secure, and inexpensive storage and retrieval of digital medical information do not exist today. In this paper, we present a Medical Image Archive and Distribution Service (MIADS) concept. MIADS is a system shared by individual and community hospitals, laboratories, and doctors' offices that need to store and retrieve medical images. Due to the large volume and complexity of the data, as well as the diversified user access requirement, implementation of the MIADS will be a complex procedure. One of the key challenges to implementing a MIADS is to select a cost-effective, scalable system architecture to meet the ingest/retrieval performance requirements. We have performed an in-depth system engineering study, and developed a sophisticated simulation model to address this key challenge. This paper describes the overall system architecture based on our system engineering study and simulation results. In particular, we will emphasize system scalability and upgradability issues. Furthermore, we will discuss our simulation results in detail. The simulations study the ingest/retrieval performance requirements based on different system configurations and architectures for variables such as workload, tape

  14. Perspective: fostering biomedical literacy among America's youth: how medical simulation reshapes the strategy.

    Science.gov (United States)

    Gordon, James A; Oriol, Nancy E

    2008-05-01

    Medicine is a uniquely powerful platform for teaching science and ethics, technology and humanity, life and death. Yet, society has historically limited medical education to a select few, and only after an advanced course of premedical studies. In an era when biomedical literacy is increasingly viewed as a national imperative, the authors hypothesized that advanced instruction in medicine could be intellectually transformative among a broad range of young people. Using high-fidelity patient simulators, a group of college and high school students was immersed in a weeklong course designed to replicate the practice of modern medicine. On the basis of the students' reported experiences, the authors feel that patient simulation can foster forceful interest in the life sciences at an early age. Such efforts could catalyze a significant expansion of interest in biomedical science among students nationwide.

  15. Simulation in Medical School Education: Review for Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Shahram Lotfipour

    2011-05-01

    Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  16. A randomized trial comparing didactics, demonstration, and simulation for teaching teamwork to medical residents.

    Science.gov (United States)

    Semler, Matthew W; Keriwala, Raj D; Clune, Jennifer K; Rice, Todd W; Pugh, Meredith E; Wheeler, Arthur P; Miller, Alison N; Banerjee, Arna; Terhune, Kyla; Bastarache, Julie A

    2015-04-01

    Effective teamwork is fundamental to the management of medical emergencies, and yet the best method to teach teamwork skills to trainees remains unknown. In a cohort of incoming internal medicine interns, we tested the hypothesis that expert demonstration of teamwork principles and participation in high-fidelity simulation would each result in objectively assessed teamwork behavior superior to traditional didactics. This was a randomized, controlled, parallel-group trial comparing three teamwork teaching modalities for incoming internal medicine interns. Participants in a single-day orientation at the Vanderbilt University Center for Experiential Learning and Assessment were randomized 1:1:1 to didactic, demonstration-based, or simulation-based instruction and then evaluated in their management of a simulated crisis by five independent, blinded observers using the Teamwork Behavioral Rater score. Clinical performance was assessed using the American Heart Association Advanced Cardiac Life Support algorithm and a novel "Recognize, Respond, Reassess" score. Participants randomized to didactics (n = 18), demonstration (n = 17), and simulation (n = 17) were similar at baseline. The primary outcome of average overall Teamwork Behavioral Rater score for those who received demonstration-based training was similar to simulation participation (4.40 ± 1.15 vs. 4.10 ± 0.95, P = 0.917) and significantly higher than didactic instruction (4.40 ± 1.15 vs. 3.10 ± 0.51, P = 0.045). Clinical performance scores were similar between the three groups and correlated only weakly with teamwork behavior (coefficient of determination [Rs(2)] = 0.267, P teamwork training by expert demonstration resulted in similar teamwork behavior to participation in high-fidelity simulation and was more effective than traditional didactics. Clinical performance was largely independent of teamwork behavior and did not differ between training modalities.

  17. Finding the Needles in the Haystacks: High-Fidelity Models of the Modern and Archean Solar System for Simulating Exoplanet Observations

    Science.gov (United States)

    Roberge, Aki; Rizzo, Maxime J.; Lincowski, Andrew P.; Arney, Giada N.; Stark, Christopher C.; Robinson, Tyler D.; Snyder, Gregory F.; Pueyo, Laurent; Zimmerman, Neil T.; Jansen, Tiffany; hide

    2017-01-01

    We present two state-of-the-art models of the solar system, one corresponding to the present day and one to the Archean Eon 3.5 billion years ago. Each model contains spatial and spectral information for the star, the planets, and the interplanetary dust, extending to 50 au from the Sun and covering the wavelength range 0.3-2.5 micron. In addition, we created a spectral image cube representative of the astronomical backgrounds that will be seen behind deep observations of extrasolar planetary systems, including galaxies and Milky Way stars. These models are intended as inputs to high-fidelity simulations of direct observations of exoplanetary systems using telescopes equipped with high-contrast capability. They will help improve the realism of observation and instrument parameters that are required inputs to statistical observatory yield calculations, as well as guide development of post-processing algorithms for telescopes capable of directly imaging Earth-like planets.

  18. Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study.

    Science.gov (United States)

    Lim, Grace; Krohner, Robert G; Metro, David G; Rosario, Bedda L; Jeong, Jong-Hyeon; Sakai, Tetsuro

    2016-05-01

    There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition. Twenty Post-Graduate Year 2 (PGY-2) anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into 2 groups. Group LF had LF simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted MI training in which they initially were oriented to the epidural kit components and epidural anesthesia was described stepwise in detail, followed by individual mental rehearsal; no physical practice was undertaken. Each resident then individually performed epidural anesthesia on a partial-human task trainer on 3 consecutive occasions under the direct observation of skilled evaluators who were blinded to group assignment. Technical achievement was assessed with the use of a modified validated skills checklist. Scores (0-21) and duration to task completion (minutes) were recorded. A linear mixed-effects model analysis was performed to determine the differences in scores and duration between groups and over time. There was no statistical difference between the 2 groups for scores and duration to task completion. Both groups showed similarly significant increases (P = 0.0015) in scores over time (estimated mean score [SE]: group MI, 15.9 [0.55] to 17.4 [0.55] to 18.6 [0.55]; group LF, 16.2 [0.55] to 17.7 [0.55] to 18.9 [0.55]). Time to complete the procedure decreased

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

    Science.gov (United States)

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

    2014-05-01

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

  20. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses.

    Science.gov (United States)

    McRae, Marion E; Chan, Alice; Hulett, Renee; Lee, Ai Jin; Coleman, Bernice

    2017-06-01

    There are few reports of the effectiveness or satisfaction with simulation to learn cardiac surgical resuscitation skills. To test the effect of simulation on the self-confidence of nurses to perform cardiac surgical resuscitation simulation and nurses' satisfaction with the simulation experience. A convenience sample of sixty nurses rated their self-confidence to perform cardiac surgical resuscitation skills before and after two simulations. Simulation performance was assessed. Subjects completed the Satisfaction with Simulation Experience scale and demographics. Self-confidence scores to perform all cardiac surgical skills as measured by paired t-tests were significantly increased after the simulation (d=-0.50 to 1.78). Self-confidence and cardiac surgical work experience were not correlated with time to performance. Total satisfaction scores were high (mean 80.2, SD 1.06) indicating satisfaction with the simulation. There was no correlation of the satisfaction scores with cardiac surgical work experience (τ=-0.05, ns). Self-confidence scores to perform cardiac surgical resuscitation procedures were higher after the simulation. Nurses were highly satisfied with the simulation experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. A large-scale mass casualty simulation to develop the non-technical skills medical students require for collaborative teamwork.

    Science.gov (United States)

    Jorm, Christine; Roberts, Chris; Lim, Renee; Roper, Josephine; Skinner, Clare; Robertson, Jeremy; Gentilcore, Stacey; Osomanski, Adam

    2016-03-08

    There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.

  2. A typology of educationally focused medical simulation tools.

    Science.gov (United States)

    Alinier, Guillaume

    2007-10-01

    The concept of simulation as an educational tool in healthcare is not a new idea but its use has really blossomed over the last few years. This enthusiasm is partly driven by an attempt to increase patient safety and also because the technology is becoming more affordable and advanced. Simulation is becoming more commonly used for initial training purposes as well as for continuing professional development, but people often have very different perceptions of the definition of the term simulation, especially in an educational context. This highlights the need for a clear classification of the technology available but also about the method and teaching approach employed. The aims of this paper are to discuss the current range of simulation approaches and propose a clear typology of simulation teaching aids. Commonly used simulation techniques have been identified and discussed in order to create a classification that reports simulation techniques, their usual mode of delivery, the skills they can address, the facilities required, their typical use, and their pros and cons. This paper presents a clear classification scheme of educational simulation tools and techniques with six different technological levels. They are respectively: written simulations, three-dimensional models, screen-based simulators, standardized patients, intermediate fidelity patient simulators, and interactive patient simulators. This typology allows the accurate description of the simulation technology and the teaching methods applied. Thus valid comparison of educational tools can be made as to their potential effectiveness and verisimilitude at different training stages. The proposed typology of simulation methodologies available for educational purposes provides a helpful guide for educators and participants which should help them to realise the potential learning outcomes at different technological simulation levels in relation to the training approach employed. It should also be a useful

  3. Teaching medical students a clinical approach to altered mental status: simulation enhances traditional curriculum

    Directory of Open Access Journals (Sweden)

    Jeremy D. Sperling

    2013-04-01

    Full Text Available Introduction: Simulation-based medical education (SBME is increasingly being utilized for teaching clinical skills in undergraduate medical education. Studies have evaluated the impact of adding SBME to third- and fourth-year curriculum; however, very little research has assessed its efficacy for teaching clinical skills in pre-clerkship coursework. To measure the impact of a simulation exercise during a pre-clinical curriculum, a simulation session was added to a pre-clerkship course at our medical school where the clinical approach to altered mental status (AMS is traditionally taught using a lecture and an interactive case-based session in a small group format. The objective was to measure simulation's impact on students’ knowledge acquisition, comfort, and perceived competence with regards to the AMS patient. Methods: AMS simulation exercises were added to the lecture and small group case sessions in June 2010 and 2011. Simulation sessions consisted of two clinical cases using a high-fidelity full-body simulator followed by a faculty debriefing after each case. Student participation in a simulation session was voluntary. Students who did and did not participate in a simulation session completed a post-test to assess knowledge and a survey to understand comfort and perceived competence in their approach to AMS. Results: A total of 154 students completed the post-test and survey and 65 (42% attended a simulation session. Post-test scores were higher in students who attended a simulation session compared to those who did not (p<0.001. Students who participated in a simulation session were more comfortable in their overall approach to treating AMS patients (p=0.05. They were also more likely to state that they could articulate a differential diagnosis (p=0.03, know what initial diagnostic tests are needed (p=0.01, and understand what interventions are useful in the first few minutes (p=0.003. Students who participated in a simulation session

  4. Effects of Low- Versus High-Fidelity Simulations on the Cognitive Burden and Performance of Entry-Level Paramedicine Students: A Mixed-Methods Comparison Trial Using Eye-Tracking, Continuous Heart Rate, Difficulty Rating Scales, Video Observation and Interviews.

    Science.gov (United States)

    Mills, Brennen W; Carter, Owen B-J; Rudd, Cobie J; Claxton, Louise A; Ross, Nathan P; Strobel, Natalie A

    2016-02-01

    High-fidelity simulation-based training is often avoided for early-stage students because of the assumption that while practicing newly learned skills, they are ill suited to processing multiple demands, which can lead to "cognitive overload" and poorer learning outcomes. We tested this assumption using a mixed-methods experimental design manipulating psychological immersion. Thirty-nine randomly assigned first-year paramedicine students completed low- or high-environmental fidelity simulations [low-environmental fidelity simulations (LF(en)S) vs. high-environmental fidelity simulation (HF(en)S)] involving a manikin with obstructed airway (SimMan3G). Psychological immersion and cognitive burden were determined via continuous heart rate, eye tracking, self-report questionnaire (National Aeronautics and Space Administration Task Load Index), independent observation, and postsimulation interviews. Performance was assessed by successful location of obstruction and time-to-termination. Eye tracking confirmed that students attended to multiple, concurrent stimuli in HF(en)S and interviews consistently suggested that they experienced greater psychological immersion and cognitive burden than their LF(en)S counterparts. This was confirmed by significantly higher mean heart rate (P cognitive burden but this has considerable educational merit.

  5. Medical simulation: Overview, and application to wound modelling and management

    Directory of Open Access Journals (Sweden)

    Dinker R Pai

    2012-01-01

    Full Text Available Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a overall increase in the number of medical students vis-à-vis the availability of patients; b increasing awareness among patients of their rights and consequent increase in litigations and c tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research.

  6. Medical simulation: Overview, and application to wound modelling and management.

    Science.gov (United States)

    Pai, Dinker R; Singh, Simerjit

    2012-05-01

    Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a) overall increase in the number of medical students vis-à-vis the availability of patients; b) increasing awareness among patients of their rights and consequent increase in litigations and c) tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body) and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality) simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research.

  7. Medical Students as Facilitators for Laparoscopic Simulator Training

    DEFF Research Database (Denmark)

    Vedel, Cathrine; Bjerrum, Flemming; Mahmood, Badar

    2015-01-01

    BACKGROUND: Teaching basic clinical skills to student peers and residents by medical students has previously been shown effective. This study examines if medical students can facilitate laparoscopic procedural tasks to residents using a virtual reality simulator. METHODS: This was a retrospective...... practicing on a laparoscopic virtual reality simulator....

  8. Integrating Medical Simulation Into the Physician Assistant Physiology Curriculum.

    Science.gov (United States)

    Li, Lixin; Lopes, John; Zhou, Joseph Yi; Xu, Biao

    2016-12-01

    Medical simulation has recently been used in medical education, and evidence indicates that it is a valuable tool for teaching and evaluation. Very few studies have evaluated the integration of medical simulation in medical physiology education, particularly in PA programs. This study was designed to assess the value of integrating medical simulation into the PA physiology curriculum. Seventy-five students from the PA program at Central Michigan University participated in this study. Mannequin-based simulation was used to simulate a patient with hemorrhagic shock and congestive heart failure to demonstrate the Frank-Starling force and cardiac function curve. Before and after the medical simulation, students completed a questionnaire as a self-assessment. A knowledge test was also delivered after the simulation. Our study demonstrated a significant improvement in student confidence in understanding congestive heart failure, hemorrhagic shock, and the Frank-Starling curve after the simulation. Medical simulation may be an effective way to enhance basic science learning experiences for students and an ideal supplement to traditional, lecture-based teaching in PA education.

  9. Large-Scale Testing and High-Fidelity Simulation Capabilities at Sandia National Laboratories to Support Space Power and Propulsion

    International Nuclear Information System (INIS)

    Dobranich, Dean; Blanchat, Thomas K.

    2008-01-01

    Sandia National Laboratories, as a Department of Energy, National Nuclear Security Agency, has major responsibility to ensure the safety and security needs of nuclear weapons. As such, with an experienced research staff, Sandia maintains a spectrum of modeling and simulation capabilities integrated with experimental and large-scale test capabilities. This expertise and these capabilities offer considerable resources for addressing issues of interest to the space power and propulsion communities. This paper presents Sandia's capability to perform thermal qualification (analysis, test, modeling and simulation) using a representative weapon system as an example demonstrating the potential to support NASA's Lunar Reactor System

  10. A Novel Approach to Medical Student Peer-assisted Learning Through Case-based Simulations.

    Science.gov (United States)

    Jauregui, Joshua; Bright, Steven; Strote, Jared; Shandro, Jamie

    2018-01-01

    Peer-assisted learning (PAL) is the development of new knowledge and skills through active learning support from peers. Benefits of PAL include introduction of teaching skills for students, creation of a safe learning environment, and efficient use of faculty time. We present a novel approach to PAL in an emergency medicine (EM) clerkship curriculum using an inexpensive, tablet-based app for students to cooperatively present and perform low-fidelity, case-based simulations that promotes accountability for student learning, fosters teaching skills, and economizes faculty presence. We developed five clinical cases in the style of EM oral boards. Fourth-year medical students were each assigned a unique case one week in advance. Students also received an instructional document and a video example detailing how to lead a case. During the 90-minute session, students were placed in small groups of 3-5 students and rotated between facilitating their assigned cases and participating as a team for the cases presented by their fellow students. Cases were supplemented with a half-mannequin that can be intubated, airway supplies, and a tablet-based app (SimMon, $22.99) to remotely display and update vital signs. One faculty member rotated among groups to provide additional assistance and clarification. Three EM faculty members iteratively developed a survey, based on the literature and pilot tested it with fourth-year medical students, to evaluate the course. 135 medical students completed the course and course evaluation survey. Learner satisfaction was high with an overall score of 4.6 on a 5-point Likert scale. In written comments, students reported that small groups with minimal faculty involvement provided a safe learning environment and a unique opportunity to lead a group of peers. They felt that PAL was more effective than traditional simulations for learning. Faculty reported that students remained engaged and required minimal oversight. Unlike other simulations, our

  11. Randomized Crossover Study of Training Benefits of High Fidelity ECMO Simulation versus Porcine Animal Model An Interim Report

    Science.gov (United States)

    2017-02-25

    59 MDW/SGVU SUBJECT: Professional Presentation Approval 24 FEB 2017 1. Your paper, entitled Randomized C rossover Study of T raining Benefits of...have been the gold -standard for ECMO training due to their ability to replicate complex physiology and anatomic variation . Recently ECMO simulation

  12. Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents.

    Science.gov (United States)

    Mannella, Paolo; Palla, Giulia; Cuttano, Armando; Boldrini, Antonio; Simoncini, Tommaso

    2016-12-01

    To determine the effect of a simulation training program for residents in obstetrics and gynecology in terms of technical and nontechnical skills for the management of shoulder dystocia. A prospective study was performed at a center in Italy in April-May 2015. Thirty-two obstetrics and gynecology residents were divided into two groups. Residents in the control group were immediately exposed to an emergency shoulder dystocia scenario, whereas those in the simulation group completed a 2-hour training session with the simulator before being exposed to the scenario. After 8weeks, the residents were again exposed to the shoulder dystocia scenario and reassessed. Participants were scored on their demonstration of technical and nontechnical skills. In the first set of scenarios, the mean score was higher in the simulation group than the control group in terms of both technical skills (P=0.008) and nontechnical skills (Pdystocia. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Inspiring careers in STEM and healthcare fields through medical simulation embedded in high school science education.

    Science.gov (United States)

    Berk, Louis J; Muret-Wagstaff, Sharon L; Goyal, Riya; Joyal, Julie A; Gordon, James A; Faux, Russell; Oriol, Nancy E

    2014-09-01

    The most effective ways to promote learning and inspire careers related to science, technology, engineering, and mathematics (STEM) remain elusive. To address this gap, we reviewed the literature and designed and implemented a high-fidelity, medical simulation-based Harvard Medical School MEDscience course, which was integrated into high school science classes through collaboration between medical school and K-12 faculty. The design was based largely on the literature on concepts and mechanisms of self-efficacy. A structured telephone survey was conducted with 30 program alumni from the inaugural school who were no longer in high school. Near-term effects, enduring effects, contextual considerations, and diffusion and dissemination were queried. Students reported high incoming attitudes toward STEM education and careers, and these attitudes showed before versus after gains (P science or healthcare-related career to the program. Additionally, 63% subsequently took additional science or health courses, 73% participated in a job or educational experience that was science related during high school, and 97% went on to college. Four of every five program graduates cited a health-related college major, and 83% offered their strongest recommendation of the program to others. Further study and evaluation of simulation-based experiences that capitalize on informal, naturalistic learning and promote self-efficacy are warranted. Copyright © 2014 The American Physiological Society.

  14. High-fidelity simulation of lung isolation with double-lumen endotracheal tubes and bronchial blockers in anesthesiology resident training.

    Science.gov (United States)

    Failor, Erin; Bowdle, Andrew; Jelacic, Srdjan; Togashi, Kei

    2014-08-01

    Demonstrate the feasibility of using the AirSim Bronchi airway simulator to teach residents how to manage lung isolation with double-lumen endotracheal tubes and bronchial blockers and evaluate their performance with a detailed checklist. Prospective observational study. University anesthesiology residency training program. Anesthesiology residents taking a cardiothoracic anesthesiology rotation. Residents were instructed in 7 tasks using the AirSim Bronchi: The use of the fiberoptic bronchoscope, methods for placing left and right double-lumen endotracheal tubes and 3 bronchial blockers (Univent, Arndt, and Cohen), and application of continuous positive airway pressure (CPAP) to the unventilated lung. Two to 3 weeks later, checklists and a detailed scoring system were used to assess performance. Residents rated the curriculum and their own confidence in performing the tasks using a 5-point Likert scale. Thirteen residents completed the curriculum. Their median Likert scale ratings of the curriculum based on a questionnaire with 6 items ranged from 4 to 5 of 5. Resident confidence scores for each lung isolation technique improved after the simulation training, with the median gain ranging from 0.5 to 1.5 Likert levels depending on the task. The largest improvement occurred with the bronchial blockers (psimulator in a novel simulation curriculum to teach lung-isolation techniques to anesthesiology residents and evaluated performance using a detailed checklist scoring system. This curriculum is a promising educational tool. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Medical simulation technology: educational overview, industry leaders, and what's missing.

    Science.gov (United States)

    Spooner, Nicholas; Hurst, Stephen; Khadra, Mohamed

    2012-01-01

    Modern medical simulation technology (MST) debuted in 1960 with the development of Resusci Annie (Laerdal 2007), which assisted students in the acquisition of proper ventilation and compression techniques used during basic life support. Following a steady stream of subsequent technological advances and innovations, MST manufacturers are now able to offer training aids capable of facilitating innovative learning in such diverse areas as human patient simulators, simulated clinical environments, virtual procedure stations, virtual medical environments, electronic tutors, and performance recording. The authors list a number of the most popular MSTs presently available while citing evaluative efforts undertaken to date regarding the efficacy of MST to the medical profession. They conclude by proposing a variety of simulation innovations of prospective interest to both medical and technology personnel while offering healthcare administrators a series of recommended considerations when planning to integrate MST into existing medical systems.

  16. Semiclassical approach to fidelity amplitude

    International Nuclear Information System (INIS)

    García-Mata, Ignacio; Vallejos, Raúl O; Wisniacki, Diego A

    2011-01-01

    The fidelity amplitude (FA) is a quantity of paramount importance in echo-type experiments. We use semiclassical theory to study the average FA for quantum chaotic systems under external perturbation. We explain analytically two extreme cases: the random dynamics limit - attained approximately by strongly chaotic systems - and the random perturbation limit, which shows a Lyapunov decay. Numerical simulations help us to bridge the gap between both the extreme cases. (paper)

  17. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

    NARCIS (Netherlands)

    Sorensen, J.L.; Ostergaard, D.; Leblanc, V.; Ottesen, B.; Konge, L.; Dieckmann, P.; Vleuten, C. van der

    2017-01-01

    BACKGROUND: Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities

  18. Assessment of synthetic image fidelity

    Science.gov (United States)

    Mitchell, Kevin D.; Moorhead, Ian R.; Gilmore, Marilyn A.; Watson, Graham H.; Thomson, Mitch; Yates, T.; Troscianko, Tomasz; Tolhurst, David J.

    2000-07-01

    Computer generated imagery is increasingly used for a wide variety of purposes ranging from computer games to flight simulators to camouflage and sensor assessment. The fidelity required for this imagery is dependent on the anticipated use - for example when used for camouflage design it must be physically correct spectrally and spatially. The rendering techniques used will also depend upon the waveband being simulated, spatial resolution of the sensor and the required frame rate. Rendering of natural outdoor scenes is particularly demanding, because of the statistical variation in materials and illumination, atmospheric effects and the complex geometric structures of objects such as trees. The accuracy of the simulated imagery has tended to be assessed subjectively in the past. First and second order statistics do not capture many of the essential characteristics of natural scenes. Direct pixel comparison would impose an unachievable demand on the synthetic imagery. For many applications, such as camouflage design, it is important that nay metrics used will work in both visible and infrared wavebands. We are investigating a variety of different methods of comparing real and synthetic imagery and comparing synthetic imagery rendered to different levels of fidelity. These techniques will include neural networks (ICA), higher order statistics and models of human contrast perception. This paper will present an overview of the analyses we have carried out and some initial results along with some preliminary conclusions regarding the fidelity of synthetic imagery.

  19. Fidelity imaging for atomic force microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Ghosal, Sayan, E-mail: ghos0087@umn.edu; Salapaka, Murti, E-mail: murtis@umn.edu [Nanodynamics Systems Laboratory, Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota 55455 (United States)

    2015-01-05

    Atomic force microscopy is widely employed for imaging material at the nanoscale. However, real-time measures on image reliability are lacking in contemporary atomic force microscopy literature. In this article, we present a real-time technique that provides an image of fidelity for a high bandwidth dynamic mode imaging scheme. The fidelity images define channels that allow the user to have additional authority over the choice of decision threshold that facilitates where the emphasis is desired, on discovering most true features on the sample with the possible detection of high number of false features, or emphasizing minimizing instances of false detections. Simulation and experimental results demonstrate the effectiveness of fidelity imaging.

  20. Millennium conference 2005 on medical simulation: a summary report.

    Science.gov (United States)

    Huang, Grace C; Gordon, James A; Schwartzstein, Richard M

    2007-01-01

    Medical simulation takes advantage of contextual and experiential learning by allowing trainees to practice in realistic environments prior to actual patient care. Although proponents argue that patient simulation can fundamentally enhance both medical education and patient safety, large-scale experience with advanced simulation technologies is limited. To explore expert opinion on the topic, we convened a conference of educational leaders and simulation experts to provide recommendations for how this field should be directed on a broad scale to improve the training of future health professionals. This document summarizes the proceedings of that conference. We issued a request for applications to all U.S. and Canadian medical schools within the Association of American Medical Colleges (AAMC), seeking a diverse group of institutional teams committed to an in-depth exploration of the topic. Of 33 applications, nine medical schools were selected to participate. Once on site, eight working groups were formed, each comprised of representatives across sites and roles, including deans, clerkship and program directors, content experts, and trainees. We addressed four key topics, which are subsequently summarized for presentation in this report: 1) education (How can medical simulation contribute to the education of trainees?), 2) assessment (What is the role of simulation in evaluating trainees in the context of general competencies?), 3) research (How should we develop a research agenda to evaluate simulation?), and 4) implementation (How should simulation technologies be developed and managed within and across institutions?). Participants in the conference generally agreed that simulation offers a conducive environment for focused reflection and critical thought. Although there was consensus that medical simulation can provide a robust platform for performance assessment, most participants thought that the research basis for high-stakes assessment was still too immature

  1. Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

    Directory of Open Access Journals (Sweden)

    Evelyn Porter

    2014-07-01

    Full Text Available Introduction: The objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child. Methods: The results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables. Results: We reviewed 49 simulated resuscitations . The final medication error rate for the simulation was 26.5% (95% CI 13.7% - 39.3%. On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 - 0.64. Conclusion: Our results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

  2. Integrated Variable-Fidelity Tool Set For Modeling and Simulation of Aeroservothermoelasticity -Propulsion (ASTE-P) Effects For Aerospace Vehicles Ranging From Subsonic to Hypersonic Flight, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed research program aims at developing a variable-fidelity software tool set for aeroservothermoelastic-propulsive (ASTE-P) modeling that can be routinely...

  3. Simulation-based medical education: time for a pedagogical shift.

    Science.gov (United States)

    Kalaniti, Kaarthigeyan; Campbell, Douglas M

    2015-01-01

    The purpose of medical education at all levels is to prepare physicians with the knowledge and comprehensive skills, required to deliver safe and effective patient care. The traditional 'apprentice' learning model in medical education is undergoing a pedagogical shift to a 'simulation-based' learning model. Experiential learning, deliberate practice and the ability to provide immediate feedback are the primary advantages of simulation-based medical education. It is an effective way to develop new skills, identify knowledge gaps, reduce medical errors, and maintain infrequently used clinical skills even among experienced clinical teams, with the overall goal of improving patient care. Although simulation cannot replace clinical exposure as a form of experiential learning, it promotes learning without compromising patient safety. This new paradigm shift is revolutionizing medical education in the Western world. It is time that the developing countries embrace this new pedagogical shift.

  4. An information theoretic approach to use high-fidelity codes to calibrate low-fidelity codes

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Allison, E-mail: lewis.allison10@gmail.com [Department of Mathematics, North Carolina State University, Raleigh, NC 27695 (United States); Smith, Ralph [Department of Mathematics, North Carolina State University, Raleigh, NC 27695 (United States); Williams, Brian [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Figueroa, Victor [Sandia National Laboratories, Albuquerque, NM 87185 (United States)

    2016-11-01

    For many simulation models, it can be prohibitively expensive or physically infeasible to obtain a complete set of experimental data to calibrate model parameters. In such cases, one can alternatively employ validated higher-fidelity codes to generate simulated data, which can be used to calibrate the lower-fidelity code. In this paper, we employ an information-theoretic framework to determine the reduction in parameter uncertainty that is obtained by evaluating the high-fidelity code at a specific set of design conditions. These conditions are chosen sequentially, based on the amount of information that they contribute to the low-fidelity model parameters. The goal is to employ Bayesian experimental design techniques to minimize the number of high-fidelity code evaluations required to accurately calibrate the low-fidelity model. We illustrate the performance of this framework using heat and diffusion examples, a 1-D kinetic neutron diffusion equation, and a particle transport model, and include initial results from the integration of the high-fidelity thermal-hydraulics code Hydra-TH with a low-fidelity exponential model for the friction correlation factor.

  5. Simulation-Based Medical Education: An Ethical Imperative.

    Science.gov (United States)

    Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D.; Glick, Shimon

    2003-01-01

    Describes simulation-based learning in medical education and presents four these that make a framework for simulations: (1) best standards of care and training; (2) error management and patient safety; (3) patient autonomy; and (4) social justice and resource allocation. (SLD)

  6. Medical simulation-based education improves medicos' clinical skills.

    Science.gov (United States)

    Wang, Zhaoming; Liu, Qiaoyu; Wang, Hai

    2013-03-01

    Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos' clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.

  7. Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation.

    Science.gov (United States)

    Yang, Chris P; Hunt, Elizabeth A; Shilkofski, Nicole; Dudas, Robert; Egbuta, Chinyere; Schwartz, Jamie M

    2017-07-01

    Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial. In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia. The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07. This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at

  8. Development of the McGill simulator for endoscopic sinus surgery: a new high-fidelity virtual reality simulator for endoscopic sinus surgery.

    Science.gov (United States)

    Varshney, Rickul; Frenkiel, Saul; Nguyen, Lily H P; Young, Meredith; Del Maestro, Rolando; Zeitouni, Anthony; Tewfik, Marc A

    2014-01-01

    The technical challenges of endoscopic sinus surgery (ESS) and the high risk of complications support the development of alternative modalities to train residents in these procedures. Virtual reality simulation is becoming a useful tool for training the skills necessary for minimally invasive surgery; however, there are currently no ESS virtual reality simulators available with valid evidence supporting their use in resident education. Our aim was to develop a new rhinology simulator, as well as to define potential performance metrics for trainee assessment. The McGill simulator for endoscopic sinus surgery (MSESS), a new sinus surgery virtual reality simulator with haptic feedback, was developed (a collaboration between the McGill University Department of Otolaryngology-Head and Neck Surgery, the Montreal Neurologic Institute Simulation Lab, and the National Research Council of Canada). A panel of experts in education, performance assessment, rhinology, and skull base surgery convened to identify core technical abilities that would need to be taught by the simulator, as well as performance metrics to be developed and captured. The MSESS allows the user to perform basic sinus surgery skills, such as an ethmoidectomy and sphenoidotomy, through the use of endoscopic tools in a virtual nasal model. The performance metrics were developed by an expert panel and include measurements of safety, quality, and efficiency of the procedure. The MSESS incorporates novel technological advancements to create a realistic platform for trainees. To our knowledge, this is the first simulator to combine novel tools such as the endonasal wash and elaborate anatomic deformity with advanced performance metrics for ESS.

  9. Improvement of the NSSS T/H Module ARTS for Enhancing the Simulation Fidelity of YGN no 1/2 Simulator

    International Nuclear Information System (INIS)

    Seo, In Yong; Lee, Myung Soo; Lee, Yong Kwan; Suh, Jae Seung; Jeun, Gyoo Dong

    2006-01-01

    KEPRI(Korea Electric Power Research Institute) and KAERI(Korea Atomic Energy Research Institute) developed a NSSS (Nuclear Steam Supply System) T/H (Thermal-Hydraulic) module (named ARTS) based on the best-estimate code RETRAN-3D for the KNPEC-2 full-scope simulator in 2001. Although ARTS can simulate the most transients in real-time, and its robustness is ensured, real-time calculation and robustness can fail for large break loss-of-coolant accident (LBLOCA) and long term, two-phase transients. In order to improve its robustness, ARTS equipped with the backup calculation module to be used whenever a regular ARTS module fails to calculate. When the symptom for the failure of T/H module is detected, the main ARTS module is replaced with the backup module for the calculation of primary and secondary reactor system although most failures of ARTS occur in the calculation of the primary system especially for LBLOCA simulation. The sudden transition from the main ARTS module to the backup module can exhibit the discontinuity of simulation of secondary system on rare occasions. To mitigate the simulation discontinuity, we have improved the backup module of ARTS. The performance of a new approach has been illustrated by the non-integrated standalone test. The improved ARTS module will be incorporated into YGN no. 1/2 simulator and evaluated its performance in the real simulator environment. This paper presents the brief description of a new backup calculation strategy and the simulation results of LOCA to evaluate the performance of a new backup strategy in standalone test environment

  10. Simulator Fidelity: A Concept Paper

    Science.gov (United States)

    1980-11-01

    training programs, it should be possible to screen out those trainees who do not possess the required abilities to benefit from a given training program...PTZ!L-CAC-IM I USACAC ýITN:Z ArIL-CA(.-IA I IJSAC&%CUA ArrIN’ AT?D.--CAC-A 1 UiSA i.LICTHONIC WAqFAHk LAd CHILI INTLLLIGENCE MAYER nEVEL SUPP OFF I

  11. Learning in Technology-Enhanced Medical Simulation: Locations and Knowings

    Directory of Open Access Journals (Sweden)

    Song-ee Ahn

    2015-06-01

    Full Text Available This qualitative study focuses on how knowings and learning take place in full-scale simulation training of medical and nursing students, by drawing upon actor-network theory (ANT. ANT situates materiality as a part of the social practices. Knowing and learning, according to ANT, are not simply cognitive or social phenomena, but are seen as emerging as effects of the relation between material assemblages and human actors being performed into being in particular locations. Data consists of observations of simulations performed by ten groups of students. The analysis focuses on the emerging knowings in the socio-material—arrangements of three locations involved in the simulation—the simulation room, the observation room and the reflection room. The findings indicate that medical knowing, affective knowing and communicative knowing are produced in different ways in the different locations and material arrangements of the simulation cycle.Keywords: simulation, locations, knowings, actor-network theory, collaborate learning, multiprofessional learning.

  12. High-fidelity simulation-based team training in urology: evaluation of technical and nontechnical skills of urology residents during laparoscopic partial nephrectomy.

    Science.gov (United States)

    Abdelshehid, Corollos S; Quach, Stephen; Nelson, Corey; Graversen, Joseph; Lusch, Achim; Zarraga, Jerome; Alipanah, Reza; Landman, Jaime; McDougall, Elspeth M

    2013-01-01

    The use of low-risk simulation training for resident education is rapidly expanding as teaching centers integrate simulation-based team training (SBTT) sessions into their education curriculum. SBTT is a valuable tool in technical and communication skills training and assessment for residents. We created a unique SBTT scenario for urology residents involving a laparoscopic partial nephrectomy procedure. Urology residents were randomly paired with a certified registered nurse anesthetists or an anesthesia resident. The scenario incorporated a laparoscopic right partial nephrectomy utilizing a unique polyvinyl alcohol kidney model with an embedded 3cm lower pole exophytic tumor and the high-fidelity SimMan3G mannequin. The Urology residents were instructed to pay particular attention to the patient's identifying information provided at the beginning of the case. Two scripted events occurred, the patient had an anaphylactic reaction to a drug and, after tumor specimen was sent for a frozen section, the confederate pathologist called into the operating room (OR) twice, first with the wrong patient name and subsequently with the wrong specimen. After the scenario was complete, technical performance and nontechnical performance were evaluated and assessed. A debriefing session followed the scenario to discuss and assess technical performance and interdisciplinary nontechnical communication between the team. All Urology residents (n = 9) rated the SBTT scenario as a useful tool in developing communication skills among the OR team and 88% rated the model as useful for technical skills training. Despite cuing to note patient identification, only 3 of 9 (33%) participants identified that the wrong patient information was presented when the confederate "pathologist" called in to report pathology results. All urology residents rated SBTT sessions as useful for the development of communication skills between different team members and making residents aware of unlikely but

  13. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

    DEFF Research Database (Denmark)

    Sørensen, Jette Led; Østergaard, Doris; LeBlanc, Vicki

    2017-01-01

    that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors......BACKGROUND: Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities...... simulations. DISCUSSION: Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence...

  14. A Randomized Trial Comparing Didactics, Demonstration, and Simulation for Teaching Teamwork to Medical Residents

    Science.gov (United States)

    Keriwala, Raj D.; Clune, Jennifer K.; Rice, Todd W.; Pugh, Meredith E.; Wheeler, Arthur P.; Miller, Alison N.; Banerjee, Arna; Terhune, Kyla; Bastarache, Julie A.

    2015-01-01

    Rationale: Effective teamwork is fundamental to the management of medical emergencies, and yet the best method to teach teamwork skills to trainees remains unknown. Objectives: In a cohort of incoming internal medicine interns, we tested the hypothesis that expert demonstration of teamwork principles and participation in high-fidelity simulation would each result in objectively assessed teamwork behavior superior to traditional didactics. Methods: This was a randomized, controlled, parallel-group trial comparing three teamwork teaching modalities for incoming internal medicine interns. Participants in a single-day orientation at the Vanderbilt University Center for Experiential Learning and Assessment were randomized 1:1:1 to didactic, demonstration-based, or simulation-based instruction and then evaluated in their management of a simulated crisis by five independent, blinded observers using the Teamwork Behavioral Rater score. Clinical performance was assessed using the American Heart Association Advanced Cardiac Life Support algorithm and a novel “Recognize, Respond, Reassess” score. Measurements and Main Results: Participants randomized to didactics (n = 18), demonstration (n = 17), and simulation (n = 17) were similar at baseline. The primary outcome of average overall Teamwork Behavioral Rater score for those who received demonstration-based training was similar to simulation participation (4.40 ± 1.15 vs. 4.10 ± 0.95, P = 0.917) and significantly higher than didactic instruction (4.40 ± 1.15 vs. 3.10 ± 0.51, P = 0.045). Clinical performance scores were similar between the three groups and correlated only weakly with teamwork behavior (coefficient of determination [Rs2] = 0.267, P didactics. Clinical performance was largely independent of teamwork behavior and did not differ between training modalities. PMID:25730661

  15. Medical Simulation: Utilize, Inspire, Embrace , Verify

    Directory of Open Access Journals (Sweden)

    Frederic McKENZIE

    2014-06-01

    Full Text Available (ExtractI too have experienced the enthusiasm of an individual seeking to learn a new task. More years ago than I care to elaborate and before the proliferation of health care simulators, I visited the ER with a painful ache and had an interesting training experience with a youthful ER nurse. She looked around possibly to see if anyone could help or oversee her and noting that everyone else was busy and my veins were attractively prominent, she promptly asked if I would mind if she practiced drawing blood. Under duress due to pain perhaps, I agreed. I am not sure if the art and science of phlebotomy includes the part of chasing the vein with the needle under the epidermis or whether it is at the 3rd or 4th stick that phlebotomy starts to become something akin to torture but thankfully after the 4th stick, I received an apology and a surrender from the novice nurse and we waited for a more experienced practitioner.  That day I wished for a better way and hoped that no one else would need to endure the painful or even perilous results of such inexperience.... 

  16. Nuclear Energy Advanced Modeling and Simulation (NEAMS) waste Integrated Performance and Safety Codes (IPSC): gap analysis for high fidelity and performance assessment code development

    International Nuclear Information System (INIS)

    Lee, Joon H.; Siegel, Malcolm Dean; Arguello, Jose Guadalupe Jr.; Webb, Stephen Walter; Dewers, Thomas A.; Mariner, Paul E.; Edwards, Harold Carter; Fuller, Timothy J.; Freeze, Geoffrey A.; Jove-Colon, Carlos F.; Wang, Yifeng

    2011-01-01

    needed for repository modeling are severely lacking. In addition, most of existing reactive transport codes were developed for non-radioactive contaminants, and they need to be adapted to account for radionuclide decay and in-growth. The accessibility to the source codes is generally limited. Because the problems of interest for the Waste IPSC are likely to result in relatively large computational models, a compact memory-usage footprint and a fast/robust solution procedure will be needed. A robust massively parallel processing (MPP) capability will also be required to provide reasonable turnaround times on the analyses that will be performed with the code. A performance assessment (PA) calculation for a waste disposal system generally requires a large number (hundreds to thousands) of model simulations to quantify the effect of model parameter uncertainties on the predicted repository performance. A set of codes for a PA calculation must be sufficiently robust and fast in terms of code execution. A PA system as a whole must be able to provide multiple alternative models for a specific set of physical/chemical processes, so that the users can choose various levels of modeling complexity based on their modeling needs. This requires PA codes, preferably, to be highly modularized. Most of the existing codes have difficulties meeting these requirements. Based on the gap analysis results, we have made the following recommendations for the code selection and code development for the NEAMS waste IPSC: (1) build fully coupled high-fidelity THCMBR codes using the existing SIERRA codes (e.g., ARIA and ADAGIO) and platform, (2) use DAKOTA to build an enhanced performance assessment system (EPAS), and build a modular code architecture and key code modules for performance assessments. The key chemical calculation modules will be built by expanding the existing CANTERA capabilities as well as by extracting useful components from other existing codes.

  17. Nuclear Energy Advanced Modeling and Simulation (NEAMS) waste Integrated Performance and Safety Codes (IPSC) : gap analysis for high fidelity and performance assessment code development.

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon H.; Siegel, Malcolm Dean; Arguello, Jose Guadalupe, Jr.; Webb, Stephen Walter; Dewers, Thomas A.; Mariner, Paul E.; Edwards, Harold Carter; Fuller, Timothy J.; Freeze, Geoffrey A.; Jove-Colon, Carlos F.; Wang, Yifeng

    2011-03-01

    needed for repository modeling are severely lacking. In addition, most of existing reactive transport codes were developed for non-radioactive contaminants, and they need to be adapted to account for radionuclide decay and in-growth. The accessibility to the source codes is generally limited. Because the problems of interest for the Waste IPSC are likely to result in relatively large computational models, a compact memory-usage footprint and a fast/robust solution procedure will be needed. A robust massively parallel processing (MPP) capability will also be required to provide reasonable turnaround times on the analyses that will be performed with the code. A performance assessment (PA) calculation for a waste disposal system generally requires a large number (hundreds to thousands) of model simulations to quantify the effect of model parameter uncertainties on the predicted repository performance. A set of codes for a PA calculation must be sufficiently robust and fast in terms of code execution. A PA system as a whole must be able to provide multiple alternative models for a specific set of physical/chemical processes, so that the users can choose various levels of modeling complexity based on their modeling needs. This requires PA codes, preferably, to be highly modularized. Most of the existing codes have difficulties meeting these requirements. Based on the gap analysis results, we have made the following recommendations for the code selection and code development for the NEAMS waste IPSC: (1) build fully coupled high-fidelity THCMBR codes using the existing SIERRA codes (e.g., ARIA and ADAGIO) and platform, (2) use DAKOTA to build an enhanced performance assessment system (EPAS), and build a modular code architecture and key code modules for performance assessments. The key chemical calculation modules will be built by expanding the existing CANTERA capabilities as well as by extracting useful components from other existing codes.

  18. Fidelity deviation in quantum teleportation

    OpenAIRE

    Bang, Jeongho; Ryu, Junghee; Kaszlikowski, Dagomir

    2018-01-01

    We analyze the performance of quantum teleportation in terms of average fidelity and fidelity deviation. The average fidelity is defined as the average value of the fidelities over all possible input states and the fidelity deviation is their standard deviation, which is referred to as a concept of fluctuation or universality. In the analysis, we find the condition to optimize both measures under a noisy quantum channel---we here consider the so-called Werner channel. To characterize our resu...

  19. Application of Computer Simulation Modeling to Medication Administration Process Redesign

    OpenAIRE

    Huynh, Nathan; Snyder, Rita; Vidal, Jose M.; Tavakoli, Abbas S.; Cai, Bo

    2012-01-01

    The medication administration process (MAP) is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess...

  20. A New Design for Airway Management Training with Mixed Reality and High Fidelity Modeling.

    Science.gov (United States)

    Shen, Yunhe; Hananel, David; Zhao, Zichen; Burke, Daniel; Ballas, Crist; Norfleet, Jack; Reihsen, Troy; Sweet, Robert

    2016-01-01

    Restoring airway function is a vital task in many medical scenarios. Although various simulation tools have been available for learning such skills, recent research indicated that fidelity in simulating airway management deserves further improvements. In this study, we designed and implemented a new prototype for practicing relevant tasks including laryngoscopy, intubation and cricothyrotomy. A large amount of anatomical details or landmarks were meticulously selected and reconstructed from medical scans, and 3D-printed or molded to the airway intervention model. This training model was augmented by virtually and physically presented interactive modules, which are interoperable with motion tracking and sensor data feedback. Implementation results showed that this design is a feasible approach to develop higher fidelity airway models that can be integrated with mixed reality interfaces.

  1. Bronchoscopy Simulation Training as a Tool in Medical School Education.

    Science.gov (United States)

    Gopal, Mallika; Skobodzinski, Alexus A; Sterbling, Helene M; Rao, Sowmya R; LaChapelle, Christopher; Suzuki, Kei; Litle, Virginia R

    2018-07-01

    Procedural simulation training is rare at the medical school level and little is known about its usefulness in improving anatomic understanding and procedural confidence in students. Our aim is to assess the impact of bronchoscopy simulation training on bronchial anatomy knowledge and technical skills in medical students. Medical students were recruited by email, consented, and asked to fill out a survey regarding their baseline experience. Two thoracic surgeons measured their knowledge of bronchoscopy on a virtual reality bronchoscopy simulator using the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT), a validated 65-point checklist (46 for anatomy, 19 for simulation). Students performed four self-directed training sessions of 15 minutes per week. A posttraining survey and BSTAT were completed afterward. Differences between pretraining and posttraining scores were analyzed with paired Student's t tests and random intercept linear regression models accounting for baseline BSTAT score, total training time, and training year. The study was completed by 47 medical students with a mean training time of 81.5 ± 26.8 minutes. Mean total BSTAT score increased significantly from 12.3 ± 5.9 to 48.0 ± 12.9 (p training time and frequency of training did not have a significant impact on level of improvement. Self-driven bronchoscopy simulation training in medical students led to improvements in bronchial anatomy knowledge and bronchoscopy skills. Further investigation is under way to determine the impact of bronchoscopy simulation training on future specialty interest and long-term skills retention. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Fidelity of quantum interferometers

    International Nuclear Information System (INIS)

    Bahder, Thomas B.; Lopata, Paul A.

    2006-01-01

    For a generic interferometer, the conditional probability density distribution p(φ|m), for the phase φ given measurement outcome m will generally have multiple peaks. Therefore, the phase sensitivity of an interferometer cannot be adequately characterized by the standard deviation, such as Δφ∼1/√(N) (the standard limit), or Δφ∼1/N (the Heisenberg limit). We propose an alternative measure of phase sensitivity--the fidelity of an interferometer--defined as the Shannon mutual information between the phase shift φ and the measurement outcomes m. As an example application of interferometer fidelity, we consider a generic optical Mach-Zehnder interferometer, used as a sensor of a classical field. For the case where there exists no a priori information on the phase shift, we find the surprising result that maximally entangled state input leads to a lower fidelity than Fock state input, for the same photon number

  3. Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students.

    Science.gov (United States)

    Nassif, Joseph; Sleiman, Abdul-Karim; Nassar, Anwar H; Naamani, Sima; Sharara-Chami, Rana

    2017-10-10

    Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N = 82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p = 0.889). Hybrid simulation improved lesion identification grades (p simulation relieved the fear of missing a lesion on CBE (p = 0.043) and increased satisfaction with the teaching method among students (p = 0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.

  4. Medical Robotic and Telesurgical Simulation and Education Research

    Science.gov (United States)

    2016-09-01

    they cannot correct or control the 109 variation caused by human input. 110 Medical simulation often looks to the military as a front runner in...more resilient to mistakes made during the learning process. These tools not only allow hands-on practice in a safe environment, but also provide

  5. The effect of an interprofessional clinical simulation on medical ...

    African Journals Online (AJOL)

    Five themes emerged from the reflections: (i) difficulties with implementing knowledge and skills; (ii) importance of teamwork; (iii) skills necessary for teamwork; (iv) effect of being observed by peers; and (v) IPE in the curriculum. Conclusions. Medical students gained clinical knowledge during the simulation and became ...

  6. Students' Emotions in Simulation-Based Medical Education

    Science.gov (United States)

    Keskitalo, Tuulikki; Ruokamo, Heli

    2017-01-01

    Medical education is emotionally charged for many reasons, especially the fact that simulation-based learning is designed to generate emotional experiences. However, there are very few studies that concentrate on learning and emotions, despite widespread interest in the topic, especially within healthcare education. The aim of this research is to…

  7. Simulation of a medical linear accelerator for teaching purposes.

    Science.gov (United States)

    Anderson, Rhys; Lamey, Michael; MacPherson, Miller; Carlone, Marco

    2015-05-08

    Simulation software for medical linear accelerators that can be used in a teaching environment was developed. The components of linear accelerators were modeled to first order accuracy using analytical expressions taken from the literature. The expressions used constants that were empirically set such that realistic response could be expected. These expressions were programmed in a MATLAB environment with a graphical user interface in order to produce an environment similar to that of linear accelerator service mode. The program was evaluated in a systematic fashion, where parameters affecting the clinical properties of medical linear accelerator beams were adjusted independently, and the effects on beam energy and dose rate recorded. These results confirmed that beam tuning adjustments could be simulated in a simple environment. Further, adjustment of service parameters over a large range was possible, and this allows the demonstration of linear accelerator physics in an environment accessible to both medical physicists and linear accelerator service engineers. In conclusion, a software tool, named SIMAC, was developed to improve the teaching of linear accelerator physics in a simulated environment. SIMAC performed in a similar manner to medical linear accelerators. The authors hope that this tool will be valuable as a teaching tool for medical physicists and linear accelerator service engineers.

  8. A medical platform for simulation of surgical procedures.

    Science.gov (United States)

    Thurfjell, L; Lundin, A; McLaughlin, J

    2001-01-01

    Surgery simulation is a promising technique for training of surgical procedures. The overall goal for any surgical simulator is to allow for efficient training of the skills required and to improve learning by giving the user proper feedback. This goal is easier achieved if the training is performed in a realistic environment. Therefore functionality such as soft tissue deformation, tearing and cutting, penetration of soft tissue etc. is necessary. Furthermore, a realistic simulator must provide haptic feedback so that all senses match, that is, there should be a correspondence between what you see and what you feel with your hands. In this paper we describe a medical platform that provides all this functionality. It is based on the Reachln Magma API, which has been extended for surgery simulation. We describe the development of the platform and illustrate the use of it for the development of two different types of surgical simulators, both of which represents work in progress.

  9. The masked educator-innovative simulation in an Australian undergraduate Medical Sonography and Medical Imaging program.

    Science.gov (United States)

    Reid-Searl, Kerry; Bowman, Anita; McAllister, Margaret; Cowling, Cynthia; Spuur, Kelly

    2014-12-01

    Clinical learning experiences for sonography and medical imaging students can sometimes involve the practice of technical procedures with less of a focus on developing communication skills with patients. Whilst patient-based simulation scenarios have been widely reported in other health education programmes, there is a paucity of research in sonography and medical imaging. The aim of this study was to explore the effectiveness of Mask-Ed™ (KRS Simulation) in the learning and teaching of clinical communication skills to undergraduate medical sonography and medical imaging students. Mask-Ed™ (KRS Simulation) is a simulation technique where the educator is hidden behind wearable realistic silicone body props including masks. Focus group interviews were conducted with 11 undergraduate medical sonography and medical imaging students at CQUniversity, Australia. The number of participants was limited to the size of the cohort of students enrolled in the course. Prior to these interviews participants were engaged in learning activities that featured the use of the Mask-Ed™ (KRS Simulation) method. Thematic analysis was employed to explore how the introduction of Mask-Ed™ (KRS Simulation) contributed to students' learning in relation to clinical communication skills. Key themes included: benefits of interacting with someone real rather than another student, learning made fun, awareness of empathy, therapeutic communication skills, engaged problem solving and purposeful reflection. Mask-Ed™ (KRS Simulation) combined with interactive sessions with an expert facilitator, contributed positively to students' learning in relation to clinical communication skills. Participants believed that interacting with someone real, as in the Mask-Ed characters was beneficial. In addition to the learning being described as fun, participants gained an awareness of empathy, therapeutic communication skills, engaged problem solving and purposeful reflection.

  10. Users' Perception of Medical Simulation Training: A Framework for Adopting Simulator Technology

    Science.gov (United States)

    Green, Leili Hayati

    2014-01-01

    Users play a key role in many training strategies, yet some organizations often fail to understand the users' perception after a simulation training implementation, their attitude about acceptance or rejection of and integration of emerging simulation technology in medical training (Gaba, 2007, and Topol, 2012). Several factors are considered to…

  11. Simulation based virtual learning environment in medical genetics counseling

    DEFF Research Database (Denmark)

    Makransky, Guido; Bonde, Mads T.; Wulff, Julie S. G.

    2016-01-01

    BACKGROUND: Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based...... the perceived relevance of medical educational activities. The results suggest that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice....... learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making. METHODS: An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major...

  12. The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

    Science.gov (United States)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

  13. The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

    Science.gov (United States)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

  14. Medical teachers' perception towards simulation-based medical education: A multicenter study in Saudi Arabia.

    Science.gov (United States)

    Ahmed, Shabnam; Al-Mously, Najwa; Al-Senani, Fahmi; Zafar, Muhammad; Ahmed, Muhammad

    2016-01-01

    This study aims to evaluate the perception of medical teachers toward the integration of simulation-based medical education (SBME) in undergraduate curriculum and also identify contextual barriers faced by medical teachers. This cross-sectional observational study included medical teachers from three universities. A questionnaire was used to report teachers' perception. SBME was perceived by medical teachers (basic sciences/clinical, respectively) as enjoyable (71.1%/75.4%), effective assessment tool to evaluate students' learning (60%/73.9%) and can improve learning outcome (88.8%/79.7%). Similarly, (91.1%/71%) of teachers think that simulation should be part of the curriculum and not stand alone one time activity. Teachers' training for SBME has created a significant difference in perception (p medical curriculum are major perceived barriers for effective SBME. Results highlight the positive perception and attitude of medical teachers toward the integration of SBME in undergraduate curriculum. Prior formal training of teachers created a different perception. Top perceived barriers for effective SBME include teachers' formal training supported with time and resources and the early integration into the curriculum. These critical challenges need to be addressed by medical schools in order to enhance the integration SBME in undergraduate curricula.

  15. Simulation in Medical Education: Focus on Anesthesiology and Critical Care Medicine

    Directory of Open Access Journals (Sweden)

    D. John Doyle

    2002-12-01

    Full Text Available Simulation refers to the artificial representation of a complex real-world process with sufficient fidelity to achieve a particular objective, usually for the purposes of training or performance testing. While simulation has been important from early times (as in the rehearsal of animal hunting activities or preparing for warfare, the needs of World War II greatly accelerated simulation technology for use in flight training. With the available of inexpensive computer technology in recent years, simulation technology has blossomed again, especially in the field of medicine, where applications range from scientific modeling to clinical performance appraisal in the setting of crisis management.

  16. Comparison of High-Fidelity Simulation Versus Didactic Instruction as a Reinforcement Intervention in a Comprehensive Curriculum for Radiology Trainees in Learning Contrast Reaction Management: Does It Matter How We Refresh?

    Science.gov (United States)

    Picard, Melissa; Curry, Nancy; Collins, Heather; Soma, LaShonda; Hill, Jeanne

    2015-10-01

    Simulation-based training has been shown to be a useful adjunct to standard didactic lecture in teaching residents appropriate management of adverse contrast reactions. In addition, it has been suggested that a biannual refresher is needed; however, the type of refresher education has not been assessed. This was a prospective study involving 31 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by high-fidelity simulation-based training. At approximately 6 months, residents were randomized into a didactic versus simulation group for a refresher. At approximately 9 months, all residents returned to the simulation center for performance testing. Knowledge and confidence assessments were obtained from all participants before and after each phase. Performance testing was obtained at each simulation session and scored based on predefined critical actions. There was significant improvement in knowledge (P didactic and simulation-based training. There was no statistical difference between the simulation and didactic groups in knowledge or confidence at any phase of the study. There was no significant difference in tested performance between the groups in either performance testing session. This study suggests that a curriculum consisting of an annual didactic lecture combined with simulation-based training followed by a didactic refresher at 6 months is an effective and efficient (both cost-effective and time-effective) method of educating radiology residents in the management of adverse contrast reactions. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  17. Simulation of scintillating fiber gamma ray detectors for medical imaging

    International Nuclear Information System (INIS)

    Chaney, R.C.; Fenyves, E.J.; Antich, P.P.

    1990-01-01

    This paper reports on plastic scintillating fibers which have been shown to be effective for high spatial and time resolution of gamma rays. They may be expected to significantly improve the resolution of current medical imaging systems such as PET and SPECT. Monte Carlo simulation of imaging systems using these detectors, provides a means to optimize their performance in this application, as well as demonstrate their resolution and efficiency. Monte Carlo results are presented for PET and SPECT systems constructed using these detectors

  18. The National Center for Collaboration in Medical Modeling and Simulation

    Science.gov (United States)

    2005-05-01

    being developed that addressed specific procedures including knee surgery, ophthalmology , and sinus surgery (Satava, 2001). One of the important factors...Nirona, 1990). In fact, the general picture for Vietnam data suggested that the prevalence of some types of disease may decrease during wartime...physical models with limited functionality. However, the current breed of medical simulators is quite sophisticated and many have impressive levels

  19. Multi-fidelity stochastic collocation method for computation of statistical moments

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Xueyu, E-mail: xueyu-zhu@uiowa.edu [Department of Mathematics, University of Iowa, Iowa City, IA 52242 (United States); Linebarger, Erin M., E-mail: aerinline@sci.utah.edu [Department of Mathematics, University of Utah, Salt Lake City, UT 84112 (United States); Xiu, Dongbin, E-mail: xiu.16@osu.edu [Department of Mathematics, The Ohio State University, Columbus, OH 43210 (United States)

    2017-07-15

    We present an efficient numerical algorithm to approximate the statistical moments of stochastic problems, in the presence of models with different fidelities. The method extends the multi-fidelity approximation method developed in . By combining the efficiency of low-fidelity models and the accuracy of high-fidelity models, our method exhibits fast convergence with a limited number of high-fidelity simulations. We establish an error bound of the method and present several numerical examples to demonstrate the efficiency and applicability of the multi-fidelity algorithm.

  20. PSYCHE: An Object-Oriented Approach to Simulating Medical Education

    Science.gov (United States)

    Mullen, Jamie A.

    1990-01-01

    Traditional approaches to computer-assisted instruction (CAI) do not provide realistic simulations of medical education, in part because they do not utilize heterogeneous knowledge bases for their source of domain knowledge. PSYCHE, a CAI program designed to teach hypothetico-deductive psychiatric decision-making to medical students, uses an object-oriented implementation of an intelligent tutoring system (ITS) to model the student, domain expert, and tutor. It models the transactions between the participants in complex transaction chains, and uses heterogeneous knowledge bases to represent both domain and procedural knowledge in clinical medicine. This object-oriented approach is a flexible and dynamic approach to modeling, and represents a potentially valuable tool for the investigation of medical education and decision-making.

  1. Application of Computer Simulation Modeling to Medication Administration Process Redesign

    Directory of Open Access Journals (Sweden)

    Nathan Huynh

    2012-01-01

    Full Text Available The medication administration process (MAP is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess the impact of MAP workflow redesign on MAP performance. The agent-based approach is adopted in order to capture Registered Nurse medication administration performance. The process of designing, developing, validating, and testing such a model is explained. Work is underway to collect MAP data in a hospital setting to provide more complex MAP observations to extend development of the model to better represent the complexity of MAP.

  2. IMPROVING MEDICAL EDUCATION: SIMULATING CHANGES IN PATIENT ANATOMY USING DYNAMIC HAPTIC FEEDBACK

    OpenAIRE

    Yovanoff, Mary; Pepley, David; Mirkin, Katelin; Moore, Jason; Han, David; Miller, Scarlett

    2016-01-01

    Virtual simulation is an emerging field in medical education. Research suggests that simulation reduces complication rates and improves learning gains for medical residents. One benefit of simulators is their allowance for more realistic and dynamic patient anatomies. While potentially useful throughout medical education, few studies have explored the impact of dynamic haptic simulators on medical training. In light of this research void, this study was developed to examine how a Dynamic-Hapt...

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

    Science.gov (United States)

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

    2012-07-01

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

  4. Live defibrillation in simulation-based medical education--a survey of simulation center practices and attitudes.

    Science.gov (United States)

    Turban, Joseph W; Peters, Deborah P; Berg, Benjamin W

    2010-02-01

    Resuscitation from cardiac arrhythmia, requiring cardioversion/defibrillation is a common simulation training scenario. Use of live defibrillation enhances simulation fidelity but is not without risk. This survey was conducted to describe the prevalence of live defibrillation use during training scenarios in healthcare simulation centers, and when used, if safety training was required before using live defibrillation. A convenience sample of attendees at the 7th annual International Meeting on Simulation in Healthcare (January 2007) was surveyed using a closed-ended 23-item survey instrument. Survey domains included responder and simulation center demographics, simulation center defibrillation safety policies, and attitudes toward defibrillation practices in simulation training environments. Fifty-seven individuals representing 39 simulation centers returned surveys, 29 of which were in the United States. Live defibrillation was used in 35 of the 39 centers (90%). A defibrillation safety training policy was in effect at 14 of 39 centers (36%). Formal training before using live defibrillation was considered necessary by 48 of 55 responders (87%). Forty-eight of 54 responders (89%) strongly agreed or agreed with the statement, "I feel using live defibrillation plays an important role in simulation-based education." Although most responders consider use of live defibrillation important and believe formal defibrillator safety training should be conducted before use, only about one third of the centers had a training policy in effect. It remains to be determined whether safety training before the use of live defibrillation during simulation-based education increases user safety.

  5. Procedural wound geometry and blood flow generation for medical training simulators

    Science.gov (United States)

    Aras, Rifat; Shen, Yuzhong; Li, Jiang

    2012-02-01

    Efficient application of wound treatment procedures is vital in both emergency room and battle zone scenes. In order to train first responders for such situations, physical casualty simulation kits, which are composed of tens of individual items, are commonly used. Similar to any other training scenarios, computer simulations can be effective means for wound treatment training purposes. For immersive and high fidelity virtual reality applications, realistic 3D models are key components. However, creation of such models is a labor intensive process. In this paper, we propose a procedural wound geometry generation technique that parameterizes key simulation inputs to establish the variability of the training scenarios without the need of labor intensive remodeling of the 3D geometry. The procedural techniques described in this work are entirely handled by the graphics processing unit (GPU) to enable interactive real-time operation of the simulation and to relieve the CPU for other computational tasks. The visible human dataset is processed and used as a volumetric texture for the internal visualization of the wound geometry. To further enhance the fidelity of the simulation, we also employ a surface flow model for blood visualization. This model is realized as a dynamic texture that is composed of a height field and a normal map and animated at each simulation step on the GPU. The procedural wound geometry and the blood flow model are applied to a thigh model and the efficiency of the technique is demonstrated in a virtual surgery scene.

  6. Multi-Fidelity Uncertainty Propagation for Cardiovascular Modeling

    Science.gov (United States)

    Fleeter, Casey; Geraci, Gianluca; Schiavazzi, Daniele; Kahn, Andrew; Marsden, Alison

    2017-11-01

    Hemodynamic models are successfully employed in the diagnosis and treatment of cardiovascular disease with increasing frequency. However, their widespread adoption is hindered by our inability to account for uncertainty stemming from multiple sources, including boundary conditions, vessel material properties, and model geometry. In this study, we propose a stochastic framework which leverages three cardiovascular model fidelities: 3D, 1D and 0D models. 3D models are generated from patient-specific medical imaging (CT and MRI) of aortic and coronary anatomies using the SimVascular open-source platform, with fluid structure interaction simulations and Windkessel boundary conditions. 1D models consist of a simplified geometry automatically extracted from the 3D model, while 0D models are obtained from equivalent circuit representations of blood flow in deformable vessels. Multi-level and multi-fidelity estimators from Sandia's open-source DAKOTA toolkit are leveraged to reduce the variance in our estimated output quantities of interest while maintaining a reasonable computational cost. The performance of these estimators in terms of computational cost reductions is investigated for a variety of output quantities of interest, including global and local hemodynamic indicators. Sandia National Labs is a multimission laboratory managed and operated by NTESS, LLC, for the U.S. DOE under contract DE-NA0003525. Funding for this project provided by NIH-NIBIB R01 EB018302.

  7. Mock ECHO: A Simulation-Based Medical Education Method.

    Science.gov (United States)

    Fowler, Rebecca C; Katzman, Joanna G; Comerci, George D; Shelley, Brian M; Duhigg, Daniel; Olivas, Cynthia; Arnold, Thomas; Kalishman, Summers; Monnette, Rebecca; Arora, Sanjeev

    2018-04-16

    This study was designed to develop a deeper understanding of the learning and social processes that take place during the simulation-based medical education for practicing providers as part of the Project ECHO® model, known as Mock ECHO training. The ECHO model is utilized to expand access to care of common and complex diseases by supporting the education of primary care providers with an interprofessional team of specialists via videoconferencing networks. Mock ECHO trainings are conducted through a train the trainer model targeted at leaders replicating the ECHO model at their organizations. Trainers conduct simulated teleECHO clinics while participants gain skills to improve communication and self-efficacy. Three focus groups, conducted between May 2015 and January 2016 with a total of 26 participants, were deductively analyzed to identify common themes related to simulation-based medical education and interdisciplinary education. Principal themes generated from the analysis included (a) the role of empathy in community development, (b) the value of training tools as guides for learning, (c) Mock ECHO design components to optimize learning, (d) the role of interdisciplinary education to build community and improve care delivery, (e) improving care integration through collaboration, and (f) development of soft skills to facilitate learning. Mock ECHO trainings offer clinicians the freedom to learn in a noncritical environment while emphasizing real-time multidirectional feedback and encouraging knowledge and skill transfer. The success of the ECHO model depends on training interprofessional healthcare providers in behaviors needed to lead a teleECHO clinic and to collaborate in the educational process. While building a community of practice, Mock ECHO provides a safe opportunity for a diverse group of clinician experts to practice learned skills and receive feedback from coparticipants and facilitators.

  8. The medical simulation markup language - simplifying the biomechanical modeling workflow.

    Science.gov (United States)

    Suwelack, Stefan; Stoll, Markus; Schalck, Sebastian; Schoch, Nicolai; Dillmann, Rüdiger; Bendl, Rolf; Heuveline, Vincent; Speidel, Stefanie

    2014-01-01

    Modeling and simulation of the human body by means of continuum mechanics has become an important tool in diagnostics, computer-assisted interventions and training. This modeling approach seeks to construct patient-specific biomechanical models from tomographic data. Usually many different tools such as segmentation and meshing algorithms are involved in this workflow. In this paper we present a generalized and flexible description for biomechanical models. The unique feature of the new modeling language is that it not only describes the final biomechanical simulation, but also the workflow how the biomechanical model is constructed from tomographic data. In this way, the MSML can act as a middleware between all tools used in the modeling pipeline. The MSML thus greatly facilitates the prototyping of medical simulation workflows for clinical and research purposes. In this paper, we not only detail the XML-based modeling scheme, but also present a concrete implementation. Different examples highlight the flexibility, robustness and ease-of-use of the approach.

  9. Fidelity deviation in quantum teleportation

    Science.gov (United States)

    Bang, Jeongho; Ryu, Junghee; Kaszlikowski, Dagomir

    2018-04-01

    We analyze the performance of quantum teleportation in terms of average fidelity and fidelity deviation. The average fidelity is defined as the average value of the fidelities over all possible input states and the fidelity deviation is their standard deviation, which is referred to as a concept of fluctuation or universality. In the analysis, we find the condition to optimize both measures under a noisy quantum channel—we here consider the so-called Werner channel. To characterize our results, we introduce a 2D space defined by the aforementioned measures, in which the performance of the teleportation is represented as a point with the channel noise parameter. Through further analysis, we specify some regions drawn for different channel conditions, establishing the connection to the dissimilar contributions of the entanglement to the teleportation and the Bell inequality violation.

  10. Simulation of medical irradiation and X-ray detector signals

    Energy Technology Data Exchange (ETDEWEB)

    Kreisler, Bjoern

    2010-02-08

    This thesis aims for an improved understanding of medical irradiation. Two major parts are investigated: the beam shaping components of a medical linear accelerator, i.e. the source of the radiation, and the signal generation inside semiconductor sensors, i.e. the detection of the radiation. The direct measurement of the spatial and spectral particle distribution in the irradiation beam is not possible with state of the art detectors due to the high particle flux. The development of new advanced detectors is the goal of the first part of this thesis. The focus is set on the signal generation inside the sensor volume of a semiconductor detector. Incoming particles interact with the sensor material and generate clouds of electron hole pairs. These pairs get separated by an applied bias voltage. The motion of the charge clouds is simulated with a finite element programme taking into account the drift and diffusion. Mirror charges are induced on the electrodes which move due to the motion of the charge cloud. The motion of the induced mirror charges leads to the signal that is detected. The transient calculation of the signals is based on Ramo's theorem. The efficient adjoint formulation of the induction solution is adjusted to doped materials, as for example the electric bias field and hence the motion of the charge cloud is changing with the doping level. The effect of the doping of the material on the signal shape is shown together with influences of different voltages and pixel geometries. Smaller pixels and higher bias voltages can lead to shorter signals which is preferable for high flux measurements. Possible count rate improvements are limited by electric break through, high dark current across the sensor layer and charge sharing. Another option to shorten the signals is the use of steering grid electrodes which modify the electric and the weighting field. This results in shorter signals and thus in a higher possible rate. The detailed Monte

  11. Simulation of medical irradiation and X-ray detector signals

    International Nuclear Information System (INIS)

    Kreisler, Bjoern

    2010-01-01

    This thesis aims for an improved understanding of medical irradiation. Two major parts are investigated: the beam shaping components of a medical linear accelerator, i.e. the source of the radiation, and the signal generation inside semiconductor sensors, i.e. the detection of the radiation. The direct measurement of the spatial and spectral particle distribution in the irradiation beam is not possible with state of the art detectors due to the high particle flux. The development of new advanced detectors is the goal of the first part of this thesis. The focus is set on the signal generation inside the sensor volume of a semiconductor detector. Incoming particles interact with the sensor material and generate clouds of electron hole pairs. These pairs get separated by an applied bias voltage. The motion of the charge clouds is simulated with a finite element programme taking into account the drift and diffusion. Mirror charges are induced on the electrodes which move due to the motion of the charge cloud. The motion of the induced mirror charges leads to the signal that is detected. The transient calculation of the signals is based on Ramo's theorem. The efficient adjoint formulation of the induction solution is adjusted to doped materials, as for example the electric bias field and hence the motion of the charge cloud is changing with the doping level. The effect of the doping of the material on the signal shape is shown together with influences of different voltages and pixel geometries. Smaller pixels and higher bias voltages can lead to shorter signals which is preferable for high flux measurements. Possible count rate improvements are limited by electric break through, high dark current across the sensor layer and charge sharing. Another option to shorten the signals is the use of steering grid electrodes which modify the electric and the weighting field. This results in shorter signals and thus in a higher possible rate. The detailed Monte-Carlo simulation of

  12. IMPROVING MEDICAL EDUCATION: SIMULATING CHANGES IN PATIENT ANATOMY USING DYNAMIC HAPTIC FEEDBACK.

    Science.gov (United States)

    Yovanoff, Mary; Pepley, David; Mirkin, Katelin; Moore, Jason; Han, David; Miller, Scarlett

    2016-09-01

    Virtual simulation is an emerging field in medical education. Research suggests that simulation reduces complication rates and improves learning gains for medical residents. One benefit of simulators is their allowance for more realistic and dynamic patient anatomies. While potentially useful throughout medical education, few studies have explored the impact of dynamic haptic simulators on medical training. In light of this research void, this study was developed to examine how a Dynamic-Haptic Robotic Trainer (DHRT) impacts medical student self-efficacy and skill gains compared to traditional simulators developed to train students in Internal Jugular Central Venous Catheter (IJ CVC) placement. The study was conducted with 18 third year medical students with no prior CVC insertion experience who underwent a pre-test, simulator training (manikin, robotic, or mixed) and post-test. The results revealed the DHRT as a useful method for training CVC skills and supports further research on dynamic haptic trainers in medical education.

  13. Using Simulation-Based Medical Education to Meet the Competency Requirements for the Single Accreditation System.

    Science.gov (United States)

    Riley, Bernadette

    2015-08-01

    Simulation-based medical education can provide medical training in a nonjudgmental, patient-safe, and effective environment. Although simulation has been a relatively new addition to medical education, the aeronautical, judicial, and military fields have used simulation training for hundreds of years, with positive outcomes. Simulation-based medical education can be used in a variety of settings, such as hospitals, outpatient clinics, medical schools, and simulation training centers. As the author describes in the present article, residencies currently accredited by the American Osteopathic Association can use a simulation-based medical education curriculum to meet training requirements of the 6 competencies identified by the Accreditation Council for Graduate Medical Education. The author also provides specific guidance on providing training and assessment in the professionalism competency.

  14. Monte Carlo simulation of medical linear accelerator using primo code

    International Nuclear Information System (INIS)

    Omer, Mohamed Osman Mohamed Elhasan

    2014-12-01

    The use of monte Carlo simulation has become very important in the medical field and especially in calculation in radiotherapy. Various Monte Carlo codes were developed simulating interactions of particles and photons with matter. One of these codes is PRIMO that performs simulation of radiation transport from the primary electron source of a linac to estimate the absorbed dose in a water phantom or computerized tomography (CT). PRIMO is based on Penelope Monte Carlo code. Measurements of 6 MV photon beam PDD and profile were done for Elekta precise linear accelerator at Radiation and Isotopes Center Khartoum using computerized Blue water phantom and CC13 Ionization Chamber. accept Software was used to control the phantom to measure and verify dose distribution. Elektalinac from the list of available linacs in PRIMO was tuned to model Elekta precise linear accelerator. Beam parameter of 6.0 MeV initial electron energy, 0.20 MeV FWHM, and 0.20 cm focal spot FWHM were used, and an error of 4% between calculated and measured curves was found. The buildup region Z max was 1.40 cm and homogenous profile in cross line and in line were acquired. A number of studies were done to verily the model usability one of them is the effect of the number of histories on accuracy of the simulation and the resulted profile for the same beam parameters. The effect was noticeable and inaccuracies in the profile were reduced by increasing the number of histories. Another study was the effect of Side-step errors on the calculated dose which was compared with the measured dose for the same setting.It was in range of 2% for 5 cm shift, but it was higher in the calculated dose because of the small difference between the tuned model and measured dose curves. Future developments include simulating asymmetrical fields, calculating the dose distribution in computerized tomographic (CT) volume, studying the effect of beam modifiers on beam profile for both electron and photon beams.(Author)

  15. Advanced Physical Models and Numerical Algorithms to Enable High-Fidelity Aerothermodynamic Simulations of Planetary Entry Vehicles on Emerging Distributed Heterogeneous Computing Architectures

    Data.gov (United States)

    National Aeronautics and Space Administration — The design and qualification of entry systems for planetary exploration largely rely on computational simulations. However, state-of-the-art modeling capabilities...

  16. The introduction and effectiveness of simulation-based learning in medical education.

    Science.gov (United States)

    Nara, Nobuo; Beppu, Masashi; Tohda, Shuji; Suzuki, Toshiya

    2009-01-01

    To contribute to reforming the medical education system in Japan, we visited overseas medical schools and observed the methods utilized in medical education. We visited 28 medical schools and five institutes in the United States, Europe, Australia and Asia in 2008. We met deans and specialists in medical affairs and observed the medical schools' facilities. Among the several effective educational methods used in overseas medical schools, simulation-based learning was being used in all that we visited. Simulation-based learning is used to promote medical students' mastery of communication skills, medical interviewing, physical examination and basic clinical procedures. Students and tutors both recognize the effectiveness of simulation-based learning in medical education. In contrast to overseas medical schools, simulation-based learning is not common in Japan. There remain many barriers to introduce simulation-based education in Japan, such as a shortage of medical tutors, staff, mannequins and budget. However, enhancing the motivation of tutors is likely the most important factor to facilitate simulation-based education in Japanese medical schools to become common place.

  17. Measuring third year undergraduate nursing students' reflective thinking skills and critical reflection self-efficacy following high fidelity simulation: A pilot study.

    Science.gov (United States)

    Tutticci, Naomi; Lewis, Peter A; Coyer, Fiona

    2016-05-01

    Critical reflection underpins critical thinking, a highly desirable generic nursing graduate capability. To improve the likelihood of critical thinking transferring to clinical practice, reflective thinking needs to be measured within the learning space of simulation. This study was divided into two phases to address the reliability and validity measures of previously untested surveys. Phase One data was collected from individuals (n = 6) using a 'think aloud' approach and an expert panel to review content validity, and verbatim comment analysis was undertaken. The Reflective Thinking Instrument and Critical Reflection Self-Efficacy Visual Analogue Scale items were contextualised to simulation. The expert review confirmed these instruments exhibited content validity. Phase Two data was collected through an online survey (n = 58). Cronbach's alpha measured internal consistency and was demonstrated by all subscales and the Instrument as a whole (.849). There was a small to medium positive correlation between critical reflection self-efficacy and general self-efficacy (r = .324, n = 56, p = .048). Participant responses were positive regarding the simulation experience. The research findings demonstrated that the Reflective Thinking and Simulation Satisfaction survey is reliable. Further development of this survey to establish validity is recommended to make it viable. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Fidelity for kicked atoms with gravity near a quantum resonance.

    Science.gov (United States)

    Dubertrand, Rémy; Guarneri, Italo; Wimberger, Sandro

    2012-03-01

    Kicked atoms under a constant Stark or gravity field are investigated for experimental setups with cold and ultracold atoms. The parametric stability of the quantum dynamics is studied using the fidelity. In the case of a quantum resonance, it is shown that the behavior of the fidelity depends on arithmetic properties of the gravity parameter. Close to a quantum resonance, the long-time asymptotics of the fidelity is studied by means of a pseudoclassical approximation introduced by Fishman et al. [J. Stat. Phys. 110, 911 (2003)]. The long-time decay of fidelity arises from the tunneling out of pseudoclassical stable islands, and a simple ansatz is proposed which satisfactorily reproduces the main features observed in numerical simulations.

  19. High-Fidelity RF Gun Simulations with the Parallel 3D Finite Element Particle-In-Cell Code Pic3P

    Energy Technology Data Exchange (ETDEWEB)

    Candel, A; Kabel, A.; Lee, L.; Li, Z.; Limborg, C.; Ng, C.; Schussman, G.; Ko, K.; /SLAC

    2009-06-19

    SLAC's Advanced Computations Department (ACD) has developed the first parallel Finite Element 3D Particle-In-Cell (PIC) code, Pic3P, for simulations of RF guns and other space-charge dominated beam-cavity interactions. Pic3P solves the complete set of Maxwell-Lorentz equations and thus includes space charge, retardation and wakefield effects from first principles. Pic3P uses higher-order Finite Elementmethods on unstructured conformal meshes. A novel scheme for causal adaptive refinement and dynamic load balancing enable unprecedented simulation accuracy, aiding the design and operation of the next generation of accelerator facilities. Application to the Linac Coherent Light Source (LCLS) RF gun is presented.

  20. Virtual patient simulator for distributed collaborative medical education.

    Science.gov (United States)

    Caudell, Thomas P; Summers, Kenneth L; Holten, Jim; Hakamata, Takeshi; Mowafi, Moad; Jacobs, Joshua; Lozanoff, Beth K; Lozanoff, Scott; Wilks, David; Keep, Marcus F; Saiki, Stanley; Alverson, Dale

    2003-01-01

    Project TOUCH (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) investigates the feasibility of using advanced technologies to enhance education in an innovative problem-based learning format currently being used in medical school curricula, applying specific clinical case models, and deploying to remote sites/workstations. The University of New Mexico's School of Medicine and the John A. Burns School of Medicine at the University of Hawai'i face similar health care challenges in providing and delivering services and training to remote and rural areas. Recognizing that health care needs are local and require local solutions, both states are committed to improving health care delivery to their unique populations by sharing information and experiences through emerging telehealth technologies by using high-performance computing and communications resources. The purpose of this study is to describe the deployment of a problem-based learning case distributed over the National Computational Science Alliance's Access Grid. Emphasis is placed on the underlying technical components of the TOUCH project, including the virtual reality development tool Flatland, the artificial intelligence-based simulation engine, the Access Grid, high-performance computing platforms, and the software that connects them all. In addition, educational and technical challenges for Project TOUCH are identified. Copyright 2003 Wiley-Liss, Inc.

  1. OB/GYN boot cAMP using high-fidelity human simulators: enhancing residents' perceived competency, confidence in taking a leadership role, and stress hardiness.

    Science.gov (United States)

    Pliego, Jose F; Wehbe-Janek, Hania; Rajab, M Hasan; Browning, Jeff L; Fothergill, Russell E

    2008-01-01

    To evaluate the effectiveness of an obstetrical and gynecologic (Ob/Gyn) Boot Camp simulation training on perceived technical competency, confidence in a leadership role, and stress hardiness of resident training. We conducted a prospective pilot study on the effectiveness of an Ob/Gyn Boot Camp on resident training. Residents participated in an intensive immersion in clinical simulation of common obstetrical emergencies including shoulder dystocia, neonatal resuscitation, postpartum hemorrhage, and ruptured ectopic pregnancy. After the training, residents completed a Web-based survey on their perceptions of how the Ob/Gyn Boot Camp affected their 1) technical competency in the assessment and management of their patients, 2) confidence in taking a leadership role, and 3) stress hardiness. Residents rated their perceptions on a Likert scale of 1 to 5, 1 = poor to 5 = excellent. Twenty-three (14 Ob/Gyn and 9 family medicine) residents participated in this pilot study. Eighteen (78%) residents completed the online survey; 4 Ob/Gyn and 1 family medicine resident did not complete the survey. The residents reported that the simulation training stimulated an interest in learning key skills for obstetrical and gynecologic emergencies. Ob/Gyn residents reported significant improvement in their perceived technical competence and stress hardiness after the Boot Camp. However both Ob/Gyn and family medicine residents reported no significant improvement of confidence in their leadership abilities during obstetrical emergencies after the Boot Camp. Boot Camp simulation training early in the curriculum has the potential for enhancing residents' self-assessments of confidence, competency, and stress hardiness in managing obstetrical emergencies.

  2. Clinical simulation training improves the clinical performance of Chinese medical students

    Directory of Open Access Journals (Sweden)

    Ming-ya Zhang

    2015-10-01

    Full Text Available Background: Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods: In the present study, we compared the mean scores of medical students (Jinan University who graduated in 2013 and 2014 on 16 stations between traditional training (control and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results: The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions: Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future.

  3. Nursing students' evaluation of a new feedback and reflection tool for use in high-fidelity simulation - Formative assessment of clinical skills. A descriptive quantitative research design.

    Science.gov (United States)

    Solheim, Elisabeth; Plathe, Hilde Syvertsen; Eide, Hilde

    2017-11-01

    Clinical skills training is an important part of nurses' education programmes. Clinical skills are complex. A common understanding of what characterizes clinical skills and learning outcomes needs to be established. The aim of the study was to develop and evaluate a new reflection and feedback tool for formative assessment. The study has a descriptive quantitative design. 129 students participated who were at the end of the first year of a Bachelor degree in nursing. After highfidelity simulation, data were collected using a questionnaire with 19 closed-ended and 2 open-ended questions. The tool stimulated peer assessment, and enabled students to be more thorough in what to assess as an observer in clinical skills. The tool provided a structure for selfassessment and made visible items that are important to be aware of in clinical skills. This article adds to simulation literature and provides a tool that is useful in enhancing peer learning, which is essential for nurses in practice. The tool has potential for enabling students to learn about reflection and developing skills for guiding others in practice after they have graduated. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Medical Team Training: Using Simulation as a Teaching Strategy for Group Work

    Science.gov (United States)

    Moyer, Michael R.; Brown, Rhonda Douglas

    2011-01-01

    Described is an innovative approach currently being used to inspire group work, specifically a medical team training model, referred to as The Simulation Model, which includes as its major components: (1) Prior Training in Group Work of Medical Team Members; (2) Simulation in Teams or Groups; (3) Multidisciplinary Teamwork; (4) Team Leader…

  5. Training Tomorrow's Doctors to Safeguard the Patients of Today: Using Medical Student Simulation Training to Explore Barriers to Recognition of Elder Abuse.

    Science.gov (United States)

    Fisher, James M; Rudd, Matthew P; Walker, Richard W; Stewart, Jane

    2016-01-01

    In recognition of the fact that elder abuse is a global problem that doctors underrecognize and underreport, a simulation training session for undergraduate medical students was developed. The primary objective of this qualitative study was to examine barriers to and drivers of medical students making a diagnosis of elder abuse in simulated practice, with the goal of refining teaching methods and informing future teaching sessions for other clinical teachers. Third-year medical students (Newcastle University, United Kingdom) undertook a simulation scenario with a high-fidelity mannequin representing an elder abuse victim. After the simulation scenario, students underwent a semistructured debriefing. A tripartite approach to data collection was employed that included audio recordings of the simulation, data sheets capturing students' thoughts during the scenario, and postscenario debriefing. A different researcher analyzed each data set in isolation before discussions were held to triangulate findings from the data sets. Forty-six students undertook the scenario; none declined to participate. A number of barriers to students diagnosing elder abuse were identified. Students held a low index of suspicion for elder abuse and were overly optimistic regarding the etiology of the individual's injuries. Students lacked the confidence to raise concerns about possible elder abuse, believing that certainty was required before doing so. There was widespread confusion about nomenclature. These findings provide clinical teachers with important topic areas to address in future teaching sessions. Simulation, as a method to teach about elder abuse in a reproducible and immersive fashion, is recommended to clinical teachers. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  6. International Meeting on Medical Simulation (6th), "The World of Simulation" Held in San Diego, California on January 14-17, 2006

    National Research Council Canada - National Science Library

    Sinz, Elizabeth H

    2006-01-01

    Partial contents: Medical Education, Nursing and Allied Health Education, Simulation in Military and Hazardous Environments, Serious Games/3-Dimensional Interactive Environments, Virtual patients, Simulation Center Readiness...

  7. Driving Simulator Development and Performance Study

    OpenAIRE

    Juto, Erik

    2010-01-01

    The driving simulator is a vital tool for much of the research performed at theSwedish National Road and Transport Institute (VTI). Currently VTI posses three driving simulators, two high fidelity simulators developed and constructed by VTI, and a medium fidelity simulator from the German company Dr.-Ing. Reiner Foerst GmbH. The two high fidelity simulators run the same simulation software, developed at VTI. The medium fidelity simulator runs a proprietary simulation software. At VTI there is...

  8. Integrated Variable-Fidelity Tool Set for Modeling and Simulation of Aeroservothermoelasticity-Propulsion (ASTE-P) Effects for Aerospace Vehicles Ranging From Subsonic to Hypersonic Flight, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed research program aims at developing a variable-fidelity software tool set for aeroservothermoelastic-propulsive (ASTE-P) modeling that can be routinely...

  9. A report on the piloting of a novel computer-based medical case simulation for teaching and formative assessment of diagnostic laboratory testing

    Directory of Open Access Journals (Sweden)

    Clarence D. Kreiter

    2011-01-01

    Full Text Available Objectives: Insufficient attention has been given to how information from computer-based clinical case simulations is presented, collected, and scored. Research is needed on how best to design such simulations to acquire valid performance assessment data that can act as useful feedback for educational applications. This report describes a study of a new simulation format with design features aimed at improving both its formative assessment feedback and educational function. Methods: Case simulation software (LabCAPS was developed to target a highly focused and well-defined measurement goal with a response format that allowed objective scoring. Data from an eight-case computer-based performance assessment administered in a pilot study to 13 second-year medical students was analyzed using classical test theory and generalizability analysis. In addition, a similar analysis was conducted on an administration in a less controlled setting, but to a much large sample (n=143, within a clinical course that utilized two random case subsets from a library of 18 cases. Results: Classical test theory case-level item analysis of the pilot assessment yielded an average case discrimination of 0.37, and all eight cases were positively discriminating (range=0.11–0.56. Classical test theory coefficient alpha and the decision study showed the eight-case performance assessment to have an observed reliability of σ=G=0.70. The decision study further demonstrated that a G=0.80 could be attained with approximately 3 h and 15 min of testing. The less-controlled educational application within a large medical class produced a somewhat lower reliability for eight cases (G=0.53. Students gave high ratings to the logic of the simulation interface, its educational value, and to the fidelity of the tasks. Conclusions: LabCAPS software shows the potential to provide formative assessment of medical students’ skill at diagnostic test ordering and to provide valid feedback to

  10. Statistics of strain rates and surface density function in a flame-resolved high-fidelity simulation of a turbulent premixed bluff body burner

    Science.gov (United States)

    Sandeep, Anurag; Proch, Fabian; Kempf, Andreas M.; Chakraborty, Nilanjan

    2018-06-01

    The statistical behavior of the surface density function (SDF, the magnitude of the reaction progress variable gradient) and the strain rates, which govern the evolution of the SDF, have been analyzed using a three-dimensional flame-resolved simulation database of a turbulent lean premixed methane-air flame in a bluff-body configuration. It has been found that the turbulence intensity increases with the distance from the burner, changing the flame curvature distribution and increasing the probability of the negative curvature in the downstream direction. The curvature dependences of dilatation rate ∇ṡu → and displacement speed Sd give rise to variations of these quantities in the axial direction. These variations affect the nature of the alignment between the progress variable gradient and the local principal strain rates, which in turn affects the mean flame normal strain rate, which assumes positive values close to the burner but increasingly becomes negative as the effect of turbulence increases with the axial distance from the burner exit. The axial distance dependences of the curvature and displacement speed also induce a considerable variation in the mean value of the curvature stretch. The axial distance dependences of the dilatation rate and flame normal strain rate govern the behavior of the flame tangential strain rate, and its mean value increases in the downstream direction. The current analysis indicates that the statistical behaviors of different strain rates and displacement speed and their curvature dependences need to be included in the modeling of flame surface density and scalar dissipation rate in order to accurately capture their local behaviors.

  11. Current Status of Simulation-Based Training in Graduate Medical Education.

    Science.gov (United States)

    Willis, Ross E; Van Sickle, Kent R

    2015-08-01

    The use of simulation in Graduate Medical Education has evolved significantly over time, particularly during the past decade. The applications of simulation include introductory and basic technical skills, more advanced technical skills, and nontechnical skills, and simulation is gaining acceptance in high-stakes assessments. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and has borne new and exciting national and local consortia that will ensure that the scope and impact of simulation will continue to broaden. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. High-fidelity quantum driving

    DEFF Research Database (Denmark)

    Bason, Mark George; Viteau, Matthieu; Malossi, Nicola

    2011-01-01

    Accurately controlling a quantum system is a fundamental requirement in quantum information processing and the coherent manipulation of molecular systems. The ultimate goal in quantum control is to prepare a desired state with the highest fidelity allowed by the available resources...... and the experimental constraints. Here we experimentally implement two optimal high-fidelity control protocols using a two-level quantum system comprising Bose–Einstein condensates in optical lattices. The first is a short-cut protocol that reaches the maximum quantum-transformation speed compatible...

  13. The Evolution of Medical Training Simulation in the U.S. Military.

    Science.gov (United States)

    Linde, Amber S; Kunkler, Kevin

    2016-01-01

    The United States has been at war since 2003. During that time, training using Medical Simulation technology has been developed and integrated into military medical training for combat medics, nurses and surgeons. Efforts stemming from the Joint Programmatic Committee-1 (JPC-1) Medical Simulation and Training Portfolio has allowed for the improvement and advancement in military medical training by focusing on research in simulation training technology in order to achieve this. Based upon lessons learned capability gaps have been identified concerning the necessity to validate and enhance combat medial training simulators. These capability gaps include 1) Open Source/Open Architecture; 2) Modularity and Interoperability; and 3) Material and Virtual Reality (VR) Models. Using the capability gaps, JPC-1 has identified important research endeavors that need to be explored.

  14. Site fidelity, mate fidelity, and breeding dispersal in American kestrels

    Science.gov (United States)

    Steenhof, K.; Peterson, B.E.

    2009-01-01

    We assessed mate fidelity, nest-box fidelity, and breeding dispersal distances of American Kestrels (falco sparverius) nesting in boxes in southwestern Idaho from 1990 through 2006. Seventy-seven percent of boxes had different males and 87% had different females where nest-box occupants were identified in consecutive years. High turnover rates were partly a result of box-switching. Forty-eight percent of males and 58% of females that nested within the study area in successive years used different boxes. The probability of changing boxes was unrelated to gender, nesting success in the prior year, or years of nesting experience. Breeding dispersal distances for birds that moved to different boxes averaged 2.2 km for males (max = 22 km) and 3.2 km for females (max = 32 km). Approximately 70% of birds that nested in consecutive years on the study area had a different mate in the second year. Mate fidelity was related to box fidelity but not to prior nesting success or years of nesting experience. Mate changes occurred 32% of the time when the previous mate was known to be alive and nesting in the area. Kestrels that switched mates and boxes did not improve or decrease their subsequent nesting success. Kestrels usually switched to mates with less experience and lower lifetime productivity than their previous mates. The costs of switching boxes and mates were low, and there were no obvious benefits to fidelity. The cost of "waiting" for a previous mate that might have died could be high in species with high annual mortality.

  15. Medical Robotic and Telesurgical Simulation and Education Research

    Science.gov (United States)

    2012-09-01

    an expert - Gladwell “There is no excuse for the surgeon to learn on the patient.” – William Mayo, 1927 32 Outliers l"n r: · oRY or l l E s MALCOLM ...10,000 hours to become an expert - Gladwell “There is no excuse for the surgeon to learn on the patient.” – William Mayo, 1927 100 Outliers l"n r...oRY or l l E s MALCOLM GLADW Medical Education – Explosion of Information • Medical procedures are becoming more numerous and more complex – medical

  16. Training in trauma management: the role of simulation-based medical education.

    Science.gov (United States)

    Berkenstadt, Haim; Ben-Menachem, Erez; Simon, Daniel; Ziv, Amitai

    2013-03-01

    Simulation-based medical education (SBME) offers a safe and "mistake-forgiving" environment to teach and train medical professionals. The diverse range of medical-simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. Further research is needed to better learn the role of simulation-based learning in trauma management and education. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study.

    Science.gov (United States)

    Nakanishi, Taizo; Shiga, Takashi; Homma, Yosuke; Koyama, Yasuaki; Goto, Tadahiro

    2016-05-23

    We examined whether the use of Airway Scope (AWS) and C-MAC PM (C-MAC) decreased the force applied on oral structures during intubation attempts as compared with the force applied with the use of Macintosh direct laryngoscope (DL). Prospective cross-over study. A total of 35 novice physicians participated. We used 6 simulation scenarios based on the difficulty of intubation and intubation devices. Our primary outcome measures were the maximum force applied on the maxillary incisors and tongue during intubation attempts, measured by a high-fidelity simulator. The maximum force applied on maxillary incisors was higher with the use of the C-MAC than with the DL and AWS in the normal airway scenario (DL, 26 Newton (N); AWS, 18 N; C-MAC, 52 N; p<0.01) and the difficult airway scenario (DL, 42 N; AWS, 24 N; C-MAC, 68 N; p<0.01). In contrast, the maximum force applied on the tongue was higher with the use of the DL than with the AWS and C-MAC in both airway scenarios (DL, 16 N; AWS, 1 N; C-MAC, 7 N; p<0.01 in the normal airway scenario; DL, 12 N; AWS, 4 N; C-MAC, 7 N; p<0.01 in the difficult airway scenario). The use of C-MAC, compared with the DL and AWS, was associated with the higher maximum force applied on maxillary incisors during intubation attempts. In contrast, the use of video laryngoscopes was associated with the lower force applied on the tongue in both airway scenarios, compared with the DL. Our study was a simulation-based study, and further research on living patients would be warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Laparoscopic skill improvement after virtual reality simulator training in medical students as assessed by augmented reality simulator.

    Science.gov (United States)

    Nomura, Tsutomu; Mamada, Yasuhiro; Nakamura, Yoshiharu; Matsutani, Takeshi; Hagiwara, Nobutoshi; Fujita, Isturo; Mizuguchi, Yoshiaki; Fujikura, Terumichi; Miyashita, Masao; Uchida, Eiji

    2015-11-01

    Definitive assessment of laparoscopic skill improvement after virtual reality simulator training is best obtained during an actual operation. However, this is impossible in medical students. Therefore, we developed an alternative assessment technique using an augmented reality simulator. Nineteen medical students completed a 6-week training program using a virtual reality simulator (LapSim). The pretest and post-test were performed using an object-positioning module and cholecystectomy on an augmented reality simulator(ProMIS). The mean performance measures between pre- and post-training on the LapSim were compared with a paired t-test. In the object-positioning module, the execution time of the task (P virtual reality simulator improved the operative skills of medical students as objectively evaluated by assessment using an augmented reality simulator instead of an actual operation. We hope that these findings help to establish an effective training program for medical students. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  19. Simulation training for medical emergencies in the dental setting using an inexpensive software application.

    Science.gov (United States)

    Kishimoto, N; Mukai, N; Honda, Y; Hirata, Y; Tanaka, M; Momota, Y

    2017-11-09

    Every dental provider needs to be educated about medical emergencies to provide safe dental care. Simulation training is available with simulators such as advanced life support manikins and robot patients. However, the purchase and development costs of these simulators are high. We have developed a simulation training course on medical emergencies using an inexpensive software application. The purpose of this study was to evaluate the educational effectiveness of this course. Fifty-one dental providers participated in this study from December 2014 to March 2015. Medical simulation software was used to simulate a patient's vital signs. We evaluated participants' ability to diagnose and treat vasovagal syncope or anaphylaxis with an evaluation sheet and conducted a questionnaire before and after the scenario-based simulation training. The median evaluation sheet score for vasovagal syncope increased significantly from 7/9 before to 9/9 after simulation training. The median score for anaphylaxis also increased significantly from 8/12 to 12/12 (P simulation training. This simulation course improved participants' ability to diagnose and treat medical emergencies and improved their confidence. This course can be offered inexpensively using a software application. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

    Science.gov (United States)

    2011-01-01

    Background Simulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures. Methods Fifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator. Results Significant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice. PMID:21696584

  1. Toward Improved Fidelity of Thermal Explosion Simulations

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, A L; Becker, R; Howard, W M; Wemhoff, A

    2009-07-17

    We will present results of an effort to improve the thermal/chemical/mechanical modeling of HMX based explosive like LX04 and LX10 for thermal cook-off. The original HMX model and analysis scheme were developed by Yoh et.al. for use in the ALE3D modeling framework. The current results were built to remedy the deficiencies of that original model. We concentrated our efforts in four areas. The first area was addition of porosity to the chemical material model framework in ALE3D that is used to model the HMX explosive formulation. This is needed to handle the roughly 2% porosity in solid explosives. The second area was the improvement of the HMX reaction network, which included the inclusion of a reactive phase change model base on work by Henson et.al. The third area required adding early decomposition gas species to the CHEETAH material database to develop more accurate equations of state for gaseous intermediates and products. Finally, it was necessary to improve the implicit mechanics module in ALE3D to more naturally handle the long time scales associated with thermal cook-off. The application of the resulting framework to the analysis of the Scaled Thermal Explosion (STEX) experiments will be discussed.

  2. Fidelity Optimization of Microprocessor System Simulations.

    Science.gov (United States)

    1981-03-01

    effort feasible in terms of required CPU time would be to employ a separate clock with an artificially compressed time base in the serial...RETURN ILINCR -NU𔃾OPS D.% PROt.ESSING 900 IF IIERP2.NF.41 GO TO 1000 IFRCOD - L CALL VAIRCO 1A(61,NUMVALLEPCOOl IEPRZ -IEACCO IF hEARR .GT. 01 RETURN I

  3. Performance of technology-driven simulators for medical students--a systematic review.

    Science.gov (United States)

    Michael, Michael; Abboudi, Hamid; Ker, Jean; Shamim Khan, Mohammed; Dasgupta, Prokar; Ahmed, Kamran

    2014-12-01

    Simulation-based education has evolved as a key training tool in high-risk industries such as aviation and the military. In parallel with these industries, the benefits of incorporating specialty-oriented simulation training within medical schools are vast. Adoption of simulators into medical school education programs has shown great promise and has the potential to revolutionize modern undergraduate education. An English literature search was carried out using MEDLINE, EMBASE, and psychINFO databases to identify all randomized controlled studies pertaining to "technology-driven" simulators used in undergraduate medical education. A validity framework incorporating the "framework for technology enhanced learning" report by the Department of Health, United Kingdom, was used to evaluate the capabilities of each technology-driven simulator. Information was collected regarding the simulator type, characteristics, and brand name. Where possible, we extracted information from the studies on the simulators' performance with respect to validity status, reliability, feasibility, education impact, acceptability, and cost effectiveness. We identified 19 studies, analyzing simulators for medical students across a variety of procedure-based specialities including; cardiovascular (n = 2), endoscopy (n = 3), laparoscopic surgery (n = 8), vascular access (n = 2), ophthalmology (n = 1), obstetrics and gynecology (n = 1), anesthesia (n = 1), and pediatrics (n = 1). Incorporation of simulators has so far been on an institutional level; no national or international trends have yet emerged. Simulators are capable of providing a highly educational and realistic experience for the medical students within a variety of speciality-oriented teaching sessions. Further research is needed to establish how best to incorporate simulators into a more primary stage of medical education; preclinical and clinical undergraduate medicine. Copyright © 2014 Elsevier Inc. All rights

  4. The Central Simulation Committee (CSC): a model for centralization and standardization of simulation-based medical education in the U.S. Army healthcare system.

    Science.gov (United States)

    Deering, Shad; Sawyer, Taylor; Mikita, Jeffrey; Maurer, Douglas; Roth, Bernard J

    2012-07-01

    In this report, we describe the organizational framework, operations and current status of the Central Simulation Committee (CSC). The CSC was established in 2007 with the goals of standardizing simulation-based training in Army graduate medical education programs, assisting in redeployment training of physicians returning from war, and improving patient safety within the Army Medical Department. Presently, the CSC oversees 10 Simulation Centers, controls over 21,000 sq ft of simulation center space, and provides specialty-specific training in 14 medical specialties. In the past 2 years, CSC Simulation Centers have trained over 50,000 Army medical students, residents, physician assistants, nurses, Soldiers and DoD civilian medical personnel. We hope this report provides simulation educators within the military, and our civilian simulation colleagues, with insight into the workings of our organization and provides an example of centralized support and oversight of simulation-based medical education.

  5. Team Regulation in a Simulated Medical Emergency: An In-Depth Analysis of Cognitive, Metacognitive, and Affective Processes

    Science.gov (United States)

    Duffy, Melissa C.; Azevedo, Roger; Sun, Ning-Zi; Griscom, Sophia E.; Stead, Victoria; Crelinsten, Linda; Wiseman, Jeffrey; Maniatis, Thomas; Lachapelle, Kevin

    2015-01-01

    This study examined the nature of cognitive, metacognitive, and affective processes among a medical team experiencing difficulty managing a challenging simulated medical emergency case by conducting in-depth analysis of process data. Medical residents participated in a simulation exercise designed to help trainees to develop medical expertise,…

  6. A social cybernetic analysis of simulation-based, remotely delivered medical skills training in an austere environment: developing a test bed for spaceflight medicine.

    Science.gov (United States)

    Musson, David M; Doyle, Thomas E

    2012-01-01

    This paper describes analysis of medical skills training exercises that were conducted at an arctic research station. These were conducted as part of an ongoing effort to establish high fidelity medical simulation test bed capabilities in remote and extreme "space analogue" environments for the purpose studying medical care in spaceflight. The methodological orientation followed by the authors is that of "second order cybernetics," or the science of studying human systems where the observer is involved within the system in question. Analyses presented include the identification of three distinct phases of the training activity, and two distinct levels of work groups-- termed "first-order teams" and "second-order teams." Depending on the phase of activity, first-order and second-order teams are identified, each having it own unique structure, composition, communications, goals, and challenges. Several specific teams are highlighted as case examples. Limitations of this approach are discussed, as are potential benefits to ongoing and planned research activity in this area.

  7. Medical Visualization and Simulation for Customizable Surgical Guides

    NARCIS (Netherlands)

    Kroes, T.

    2015-01-01

    This thesis revolves around the development of medical visualization tools for the planning of CSG-based surgery. To this end, we performed an extensive computerassisted surgery (CAS) literature study, developed a novel optimization technique for customizable surgical guides (CSG), and introduce

  8. Tolerance of centrifuge-simulated suborbital spaceflight by medical condition.

    Science.gov (United States)

    Blue, Rebecca S; Pattarini, James M; Reyes, David P; Mulcahy, Robert A; Garbino, Alejandro; Mathers, Charles H; Vardiman, Johnené L; Castleberry, Tarah L; Vanderploeg, James M

    2014-07-01

    We examined responses of volunteers with known medical disease to G forces in a centrifuge to evaluate how potential commercial spaceflight participants (SFPs) might tolerate the forces of spaceflight despite significant medical history. Volunteers were recruited based upon suitability for each of five disease categories (hypertension, cardiovascular disease, diabetes, lung disease, back or neck problems) or a control group. Subjects underwent seven centrifuge runs over 2 d. Day 1 consisted of two +G(z) runs (peak = +3.5 G(z), Run 2) and two +G(x), runs (peak = +6.0 G(x), Run 4). Day 2 consisted of three runs approximating suborbital spaceflight profiles (combined +G(x) and +G(z), peak = +6.0 G(x)/+4.0 G(z)). Data collected included blood pressure, electrocardiogram, pulse oximetry, neurovestibular exams, and post-run questionnaires regarding motion sickness, disorientation, grayout, and other symptoms. A total of 335 subjects registered for participation, of which 86 (63 men, 23 women, age 20-78 yr) participated in centrifuge trials. The most common causes for disqualification were weight and severe and uncontrolled medical or psychiatric disease. Five subjects voluntarily withdrew from the second day of testing: three for anxiety reasons, one for back strain, and one for time constraints. Maximum hemodynamic values recorded included HR of 192 bpm, systolic BP of 217 mmHg, and diastolic BP of 144 mmHg. Common subjective complaints included grayout (69%), nausea (20%), and chest discomfort (6%). Despite their medical history, no subject experienced significant adverse physiological responses to centrifuge profiles. These results suggest that most individuals with well-controlled medical conditions can withstand acceleration forces of launch and re-entry profiles of current commercial spaceflight vehicles.

  9. Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists

    Directory of Open Access Journals (Sweden)

    Ricci LH

    2017-06-01

    Full Text Available Lucas Holderegger Ricci,1 Caroline Amaral Ferraz2 1Department of Ophthalmology, School of Medicine, Laureate International Universities, São Paulo (SP, Brazil; 2Department of Ophthalmology, Federal University of São Paulo (UNIFESP, São Paulo (SP, Brazil Objective: To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. Methods: The present review was conducted using four national and international databases – PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002–2017.Results: Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included.Conclusion: Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training. Keywords: direct ophthalmoscopy, indirect ophthalmoscopy, skills, simulator, simulation models

  10. Medical Robotic and Telesurgical Simulation and Education Research

    Science.gov (United States)

    2015-09-01

    consideration would be the loss of revenue from physicians, nurses , and other medical professionals during training sessions. Supplies...occurs in postponing or rescheduling an operation because the robot is no longer operable. Inexperienced surgeons can also damage the surgical...and nursing in addition to physician training may decrease these times and costs. Upper Limit There are upper limits to the improvements that can

  11. Virtual worlds are an innovative tool for medical device training in a simulated environment.

    Science.gov (United States)

    Patel, Vishal; Lee, Henry; Taylor, Dave; Aggarwal, Rajesh; Kinross, James; Darzi, Ara

    2012-01-01

    Medical infusion devices are an integral component within the delivery of healthcare management. The aim of this study was to develop a training simulation in the virtual world of Second Life for the management of adverse events associated with infusion devices. Forty nurses were subsequently recruited to participate within the simulation and assess its feasibility.

  12. Internet-based system for simulation-based medical planning for cardiovascular disease.

    Science.gov (United States)

    Steele, Brooke N; Draney, Mary T; Ku, Joy P; Taylor, Charles A

    2003-06-01

    Current practice in vascular surgery utilizes only diagnostic and empirical data to plan treatments, which does not enable quantitative a priori prediction of the outcomes of interventions. We have previously described simulation-based medical planning methods to model blood flow in arteries and plan medical treatments based on physiologic models. An important consideration for the design of these patient-specific modeling systems is the accessibility to physicians with modest computational resources. We describe a simulation-based medical planning environment developed for the World Wide Web (WWW) using the Virtual Reality Modeling Language (VRML) and the Java programming language.

  13. Aproximación a la obra científica del Comandante médico Fidel Pagés Miravé Approach to the scientific work of medical Commander Fidel Pagés Miravé

    OpenAIRE

    I. Velázquez Rivera

    2011-01-01

    A. Faulconer en su libro "Foundations of Anesthesiology" refiriéndose a Pagés afirma: "No se encuentran apenas datos sobre la vida de este importante cirujano español". Esta concluyente afirmación unida a imperdonables omisiones de la figura de Pagés por historiógrafos de la anestesia o de la cirugía, y a graves errores en datos sobre su vida u obra, nos movió a realizar una aproximación, lo más exacta posible, a la obra científica del Comandante Médico Fidel Pagés Miravé. Escasas han sido la...

  14. Simulation based virtual learning environment in medical genetics counseling

    DEFF Research Database (Denmark)

    Makransky, Guido; Bonde, Mads T; Wulff, Julie S G

    2016-01-01

    learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making. METHODS: An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major...... in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical...... practice were demonstrated. RESULTS: Knowledge (Cohen's d = 0.73), intrinsic motivation (d = 0.24), and self-efficacy (d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge (d = 3.35) and self-efficacy (d = 0.61), but a non...

  15. Virtual reality aided visualization of fluid flow simulations with application in medical education and diagnostics.

    Science.gov (United States)

    Djukic, Tijana; Mandic, Vesna; Filipovic, Nenad

    2013-12-01

    Medical education, training and preoperative diagnostics can be drastically improved with advanced technologies, such as virtual reality. The method proposed in this paper enables medical doctors and students to visualize and manipulate three-dimensional models created from CT or MRI scans, and also to analyze the results of fluid flow simulations. Simulation of fluid flow using the finite element method is performed, in order to compute the shear stress on the artery walls. The simulation of motion through the artery is also enabled. The virtual reality system proposed here could shorten the length of training programs and make the education process more effective. © 2013 Published by Elsevier Ltd.

  16. Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.

    Science.gov (United States)

    Lichtenberger, John P; Tatum, Peter S; Gada, Satyen; Wyn, Mark; Ho, Vincent B; Liacouras, Peter

    2018-03-01

    This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

  17. Unexpected collateral effects of simulation-based medical education.

    Science.gov (United States)

    Barsuk, Jeffrey H; Cohen, Elaine R; Feinglass, Joe; McGaghie, William C; Wayne, Diane B

    2011-12-01

    Internal medicine residents who complete simulation-based education (SBE) in central venous catheter (CVC) insertion acquire improved skills that yield better patient care outcomes. The collateral effects of SBE on the skills of residents who have not yet experienced SBE are unknown. In this retrospective, observational study, the authors used a checklist to test the internal jugular and subclavian CVC insertion skills of 102 Northwestern University second- and third-year internal medicine residents before they received simulation training. The authors compared, across consecutive academic years (2007-2008, 2008-2009, 2009-2010), mean pretraining scores and the percent of trainees who met or surpassed a minimum passing score (MPS). Mean internal jugular pretest scores improved from 46.7% (standard deviation = 20.8%) in 2007 to 55.7% (±22.5%) in 2008 and 70.8% (±22.4%) in 2009 (P < .001). Mean subclavian pretest scores changed from 48.3% (±25.5%) in 2007 to 45.6% (±31.0%) in 2008 and 63.6% (±27.3%) in 2009 (P = .04). The percentage of residents who met or surpassed the MPS before training for internal jugular insertion was 7% in 2007, 16% in 2008, and 38% in 2009 (P = .004); for subclavian insertion, the percentage was 11% in 2007, 19% in 2008, and 38% in 2009 (P = .028). SBE for senior residents had an effect on junior trainees, as evidenced by pretraining CVC insertion skill improvement across three consecutive years. SBE for a targeted group of residents has implications for skill acquisition among other trainees.

  18. THE CONCEPT OF FIDELITY IN COMICS TRANSLATION

    Directory of Open Access Journals (Sweden)

    Erico Assis

    2016-11-01

    Full Text Available The long-discussed – and frequently dismissed – concept of translation faithfulness or translation fidelity, though usually applied to literary texts, has its fair share of applications when considered for comics translation. In literary translation, non-linguistic portions such as illustrations are often considered addenda or “paratexts” relative to the main, linguistic text. Comics, by its turn, present a certain set of features which single them out as a form that demands a new concept of “text” and, therefore, of translation fidelity. The comic-reading process, as pertaining to cognitive apprehension, implies interpretative accords that differ from the ones in purely linguistic texts: each and every element of the comics page – non-linguistic (mainly imagetic signs, linguistic signs, panel borders, typography and such – are intertwined and should be perceived in regards to its spatial and topological relations. This approach to understanding comics is based on Groensteen (1999 and his concepts of arthrology, spatio-topia, page layout, breakdown and braiding. As for translation fidelity, we rely on authors such as Berman (1984, Guidere (2010 and Aubert (1993. On comics translation, Zanettin (2008, Rota (2008 and Yuste Frías (2010, 2011 are of particular interest. Based on various concepts of fidelity – supported by samples of translated comics with varied degrees of fidelity to the source text – we discuss the different grounds of source-text fidelity, target-reader fidelity and source-author fidelity in the following instances: linguistic sign fidelity, imagetic sign fidelity, spatio-topia fidelity, typographic fidelity and format fidelity.

  19. Investigating a self-scoring interview simulation for learning and assessment in the medical consultation

    Directory of Open Access Journals (Sweden)

    Bruen C

    2017-05-01

    Full Text Available Catherine Bruen,1 Clarence Kreiter,2 Vincent Wade,3 Teresa Pawlikowska1 1Health Professions Education Centre, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA; 3School of Computer Science and Statistics, Faculty of Engineering, Mathematics and Science, Trinity College Dublin, Dublin, Ireland Abstract: Experience with simulated patients supports undergraduate learning of medical consultation skills. Adaptive simulations are being introduced into this environment. The authors investigate whether it can underpin valid and reliable assessment by conducting a generalizability analysis using IT data analytics from the interaction of medical students (in psychiatry with adaptive simulations to explore the feasibility of adaptive simulations for supporting automated learning and assessment. The generalizability (G study was focused on two clinically relevant variables: clinical decision points and communication skills. While the G study on the communication skills score yielded low levels of true score variance, the results produced by the decision points, indicating clinical decision-making and confirming user knowledge of the process of the Calgary–Cambridge model of consultation, produced reliability levels similar to what might be expected with rater-based scoring. The findings indicate that adaptive simulations have potential as a teaching and assessment tool for medical consultations. Keywords: medical education, simulation technology, competency assessment, generalizability theory

  20. Cellular Scanning Strategy for Selective Laser Melting: Capturing Thermal Trends with a Low-Fidelity, Pseudo-Analytical Model

    DEFF Research Database (Denmark)

    Mohanty, Sankhya; Hattel, Jesper Henri

    2014-01-01

    Simulations of additivemanufacturing processes are known to be computationally expensive.The resulting large runtimes prohibit their application in secondary analysis requiring several complete simulations such as optimization studies, and sensitivity analysis. In this paper, a low-fidelity pseud...

  1. Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill: A Randomized Controlled Trial.

    Science.gov (United States)

    Banaszek, Daniel; You, Daniel; Chang, Justues; Pickell, Michael; Hesse, Daniel; Hopman, Wilma M; Borschneck, Daniel; Bardana, Davide

    2017-04-05

    Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions. Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis. Trainees on both simulators demonstrated a significant improvement (p virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task. Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality

  2. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Combescure, Christophe; Lacroix, Laurence; Haddad, Kevin; Sanchez, Oliver; Gervaix, Alain; Lovis, Christian; Manzano, Sergio

    2017-02-01

    During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and

  3. Speed-accuracy trade-offs in computing spatial impulse responses for simulating medical ultrasound imaging

    DEFF Research Database (Denmark)

    Jensen, Jørgen Arendt

    2001-01-01

    sampling frequency is unnecessary in the final signals, since the transducers used in medical ultrasound are band limited. Approaches to reduce the sampling frequency are, thus, needed to make efficient simulation programs. Field II uses time integration of the spatial impulse responses using a continuous......Medical ultrasound imaging can be simulated realistically using linear acoustics. One of the most powerful approaches is to employ spatial impulse responses. Hereby both emitted fields and pulse-echo responses from point scatterers can be determined. Also any kind of dynamic focusing...

  4. Using mixed reality, force feedback and tactile augmentation to improve the realism of medical simulation.

    Science.gov (United States)

    Fisher, J Brian; Porter, Susan M

    2002-01-01

    This paper describes an application of a display approach which uses chromakey techniques to composite real and computer-generated images allowing a user to see his hands and medical instruments collocated with the display of virtual objects during a medical training simulation. Haptic feedback is provided through the use of a PHANTOM force feedback device in addition to tactile augmentation, which allows the user to touch virtual objects by introducing corresponding real objects in the workspace. A simplified catheter introducer insertion simulation was developed to demonstrate the capabilities of this approach.

  5. Translating medical documents improves students' communication skills in simulated physician-patient encounters.

    Science.gov (United States)

    Bittner, Anja; Bittner, Johannes; Jonietz, Ansgar; Dybowski, Christoph; Harendza, Sigrid

    2016-02-27

    Patient-physician communication should be based on plain and simple language. Despite communication skill trainings in undergraduate medical curricula medical students and physicians are often still not aware of using medical jargon when communicating with patients. The aim of this study was to compare linguistic communication skills of undergraduate medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task. Fifty-nine undergraduate medical students participated in this study. Twenty-nine participants were actively involved in voluntarily translating medical documents for real patients into plain language on the online-platform https://washabich.de (WHI group) and 30 participants were not (non-WHI group). The assessment resembled a virtual consultation hour, where participants were connected via skype to six simulated patients (SPs). The SPs assessed participants' communication skills. All conversations were transcribed and assessed for communication skills and medical correctness by a blinded expert. All participants completed a self-assessment questionnaire on their communication skills. Across all raters, the WHI group was assessed significantly (p = .007) better than the non-WHI group regarding the use of plain language. The blinded expert assessed the WHI group significantly (p = .018) better regarding the use of stylistic devices of communication. The SPs would choose participants from the WHI group significantly (p = .041) more frequently as their personal physician. No significant differences between the two groups were observed with respect to the medical correctness of the consultations. Written translation of medical documents is associated with significantly more frequent use of plain language in simulated physician-patient encounters. Similar extracurricular exercises might be a useful tool for medical students to enhance their communication skills with

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

    Science.gov (United States)

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

    2017-03-29

    The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (ptechnical 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.

  7. Simulation Technology for Skills Training and Competency Assessment in Medical Education

    Science.gov (United States)

    Obeso, Vivian T.; Issenberg, S. Barry

    2007-01-01

    Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and academic environments that limit patient availability as educational opportunities; worldwide attention focused on the problem of medical errors and the need to improve patient safety; and the paradigm shift to outcomes-based education with its requirements for assessment and demonstration of competence. The use of simulators addresses many of these issues: they can be readily available at any time and can reproduce a wide variety of clinical conditions on demand. In lieu of the customary (and arguably unethical) system, whereby novices carry out the practice required to master various techniques—including invasive procedures—on real patients, simulation-based education allows trainees to hone their skills in a risk-free environment. Evaluators can also use simulators for reliable assessments of competence in multiple domains. For those readers less familiar with medical simulators, this article aims to provide a brief overview of these educational innovations and their uses; for decision makers in medical education, we hope to broaden awareness of the significant potential of these new technologies for improving physician training and assessment, with a resultant positive impact on patient safety and health care outcomes. PMID:18095044

  8. MBRRACE in simulation: an evaluation of a multi-disciplinary simulation training for medical emergencies in obstetrics (MEmO).

    Science.gov (United States)

    Lavelle, Mary; Abthorpe, Jennifer; Simpson, Thomas; Reedy, Gabriel; Little, Fiona; Banerjee, Anita

    2018-03-21

    The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49). The training improved participants' clinical management of medical deterioration in pregnancy (p=.003) alongside improving their human factors skills (p=.004). Furthermore, participants reported the translation of these skills to their routine clinical practice. This flexible training is responsive to the changing national needs and contextualises the MBRRACE findings for healthcare staff. It is a promising avenue for reducing the rates of in-direct death in pregnancy. Impact statement What is already known on this subject? The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions. The management of medical conditions in pregnancy relies on a multi-professional approach. However, serious gaps in clinicians' human factors skills, highlighted by the MBRRACE report, may contribute to maternal death. What do the results of this study add? This study evaluated the first multi-disciplinary, simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Training significantly improved participants' management of medical deterioration in pregnancy and human factors skills, particularly in the areas of leadership, communication and teamwork. Moreover, the participants learning translated into their clinical practice. What are the implications of

  9. Simulation-based trauma education for medical students: A review of literature.

    Science.gov (United States)

    Borggreve, Alicia S; Meijer, Joost M R; Schreuder, Henk W R; Ten Cate, Olle

    2017-06-01

    Medical students often do not feel prepared to manage emergency situations after graduation. They experience a lack of practical skills and show significant deficits in cognitive performance to assess and stabilize trauma patients. Most reports in the literature about simulation-based education pertain to postgraduate training. Simulation-based trauma education (SBTE) in undergraduate medical education could improve confidence and performance of recently graduated doctors in trauma resuscitation. We reviewed the literature in search of SBTE effectiveness for medical students. A PubMed, Embase and CINAHL literature search was performed to identify all studies that reported on the effectiveness of SBTE for medical students, on student perception on SBTE or on the effectiveness of different simulation modalities. Eight studies were included. Three out of four studies reporting on the effectiveness of SBTE demonstrated an increase in performance of students after SBTE. SBTE is generally highly appreciated by medical students. Only one study directly compared two modalities of SBTE and reported favorable results for the mechanical model rather than the standardized live patient model. SBTE appears to be an effective method to prepare medical students for trauma resuscitation. Furthermore, students enjoy SBTE and they perceive SBTE as a very useful learning method.

  10. High-fidelity simulation of turbofan engine. ; Verification and improvement of model's dynamical characteristics in linear operating range. Turbofan engine no koseito simulation. ; Senkei sado han'i ni okeru model dotokusei no kensho to seido kojo ni tsuite

    Energy Technology Data Exchange (ETDEWEB)

    Yamane, H; Kagiyama, S [Defence Agency, Tokyo (Japan)

    1993-09-25

    This paper describes providing pulse inputs to a fuel supply in trial operation of a turbofan engine, measurement of its response, and calculation of the frequency characteristics and time constants to acquire dynamic characteristics of the engine on the ground. The resultant engine characteristics were compared with the model characteristics of numerically analyzing a mathematical simulation model, and corrected to develop a high-accuracy simulation model. An element model and a dynamics model were prepared in detail on the main engine components, such as fans, a compressor, a combustor, and a turbine, along a flow diagram from the air intake opening to the exhaust nozzle. The pulses were inputted into the fuel supply by opening and closing an electromagnetic valve. Closing of the illustrated electromagnetic valve for about 0.7 second caused a difference (of phase and trend) in both characteristics of high and low frequencies as a result of pulse-like change in the flow rate. To correct the model characteristics, the combustion delay tie was set to 0.02 second upon considering the combustion delay time relative to the heat capacity of the combustor. Improvement in the model was verified as the phase characteristics was approximated to the engine characteristics. 13 refs., 17 figs., 2 tabs.

  11. Five Questions Critical Care Educators Should Ask About Simulation-Based Medical Education.

    Science.gov (United States)

    Piquette, Dominique; LeBlanc, Vicki R

    2015-09-01

    Simulation is now commonly used in health care education, and a growing body of evidence supports its positive impact on learning. However, simulation-based medical education (SBME) involves a range of modalities, instructional methods, and presentations associated with different advantages and limitations. This review aims at better understanding the nature of SBME, its theoretic and proven benefits, its delivery, and the challenges posed by SBME. Areas requiring further research and development are also discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Human-simulation-based learning to prevent medication error: A systematic review.

    Science.gov (United States)

    Sarfati, Laura; Ranchon, Florence; Vantard, Nicolas; Schwiertz, Vérane; Larbre, Virginie; Parat, Stéphanie; Faudel, Amélie; Rioufol, Catherine

    2018-01-31

    In the past 2 decades, there has been an increasing interest in simulation-based learning programs to prevent medication error (ME). To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients. However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME. A systematic review was conducted on Medline from 2000 to June 2015, associating the terms "Patient Simulation," "Medication Errors," and "Simulation Healthcare." Reports of technology-based simulation were excluded, to focus exclusively on human simulation in nontechnical skills learning. Twenty-one studies assessing simulation-based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals. The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples. These various experiences, however, help in identifying the key elements required for an effective human simulation-based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment. The performance of these programs depends on their ability to reflect reality and on professional guidance. Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities. By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is

  13. Aprendizaje de la historia clínica con pacientes simulados en el grado de Medicina Learning to take medical histories through patients simulation in undergraduate Medical School students

    Directory of Open Access Journals (Sweden)

    M. Cristina Rodríguez-Díez

    2012-03-01

    methods have been proposed: virtual patients, high fidelity devices and standard patients. We propose the use of 5th-6th year Medical School students acting as patients when teaching history taking to their 1st year colleagues. Subjects and methods. A total of 207 students from 1st year Medical School underwent training in history taking at the Simulation Center, with senior students acting as actors. The quality of the written medical records was evaluated by two medical doctors. The satisfaction of all students involved in the course was evaluated through an anonymous voluntary questionnaire. Results. The average score of the written medical histories was 8.2/10, more than satisfactory for our goals. Students' satisfaction rate was high. Mean score on questions inquiring the usefulness of patient simulation in learning how to perform a clinical history was 9/10 and 9.2/10 for first and fifth-sixth year students respectively. Questions on improvement of communication skills scored 8.6/10 and 8.6/10 respectively. The fruitfulness of training with simulated patients before practicing with real patients was 9.3/10 and 9.3/10 respectively. Finally, the assessment of the whole course with simulated patients was of 9.3/10. Conclusion. Learning history taking in first year Medical School with simulated patients acted by senior students was beneficial and user-friendly for both students and actors. An early contact with the clinical practice through simulated patients could improve performance and safety.

  14. Positive Affect Is Associated With Reduced Fixation in a Realistic Medical Simulation.

    Science.gov (United States)

    Crane, Monique F; Brouwers, Sue; Forrest, Kirsty; Tan, Suyin; Loveday, Thomas; Wiggins, Mark W; Munday, Chris; David, Leila

    2017-08-01

    This study extends previous research by exploring the association between mood states (i.e., positive and negative affect) and fixation in practicing anesthetists using a realistic medical simulation. The impact of practitioner emotional states on fixation is a neglected area of research. Emerging evidence is demonstrating the role of positive affect in facilitating problem solving and innovation, with demonstrated implications for practitioner fixation. Twelve practicing anesthetists (4 females; M age = 39 years; SD = 6.71) were involved in a medical simulation. Prior to the simulation, practitioners rated the frequency they had experienced various positive and negative emotions in the previous three days. During the simulation, the patient deteriorated rapidly, and anesthetists were observed for their degree of fixation. After the simulation, practitioners indicated the frequency of these same emotions during the simulation. Nonparametric correlations were used to explore the independent relationships between positive and negative affect and the behavioral measures. Only positive affect impacted the likelihood of fixation. Anesthetists who reported more frequent recent positive affect in the three days prior to the simulation and during the simulation tended to be less fixated as judged by independent raters, identified a decline in patient oxygen saturation more quickly, and more rapidly implemented the necessary intervention (surgical cricothyroidotomy). These findings have some real-world implications for positive affect in patient safety. This research has broad implications for professions where fixation may impair practice. This research suggests that professional training should teach practitioners to identify their emotions and understand the role of these emotions in fixation.

  15. The Effectiveness of Remote Facilitation in Simulation-Based Pediatric Resuscitation Training for Medical Students.

    Science.gov (United States)

    Ohta, Kunio; Kurosawa, Hiroshi; Shiima, Yuko; Ikeyama, Takanari; Scott, James; Hayes, Scott; Gould, Michael; Buchanan, Newton; Nadkarni, Vinay; Nishisaki, Akira

    2017-08-01

    To assess the effectiveness of pediatric simulation by remote facilitation. We hypothesized that simulation by remote facilitation is more effective compared to simulation by an on-site facilitator. We defined remote facilitation as a facilitator remotely (1) introduces simulation-based learning and simulation environment, (2) runs scenarios, and (3) performs debriefing with an on-site facilitator. A remote simulation program for medical students during pediatric rotation was implemented. Groups were allocated to either remote or on-site facilitation depending on the availability of telemedicine technology. Both groups had identical 1-hour simulation sessions with 2 scenarios and debriefing. Their team performance was assessed with behavioral assessment tool by a trained rater. Perception by students was evaluated with Likert scale (1-7). Fifteen groups with 89 students participated in a simulation by remote facilitation, and 8 groups with 47 students participated in a simulation by on-site facilitation. Participant demographics and previous simulation experience were similar. Both groups improved their performance from first to second scenario: groups by remote simulation (first [8.5 ± 4.2] vs second [13.2 ± 6.2], P = 0.003), and groups by on-site simulation (first [6.9 ± 4.1] vs second [12.4 ± 6.4], P = 0.056). The performance improvement was not significantly different between the 2 groups (P = 0.94). Faculty evaluation by students was equally high in both groups (7 vs 7; P = 0.65). A pediatric acute care simulation by remote facilitation significantly improved students' performance. In this pilot study, remote facilitation seems as effective as a traditional, locally facilitated simulation. The remote simulation can be a strong alternative method, especially where experienced facilitators are limited.

  16. Implementing economic evaluation in simulation-based medical education: challenges and opportunities.

    Science.gov (United States)

    Lin, Yiqun; Cheng, Adam; Hecker, Kent; Grant, Vincent; Currie, Gillian R

    2018-02-01

    Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives. Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation. A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  17. Experiences with a simulated learning environment - the SimuScape©: Virtual environments in medical education

    Directory of Open Access Journals (Sweden)

    Anna-Lena Thies

    2014-03-01

    Full Text Available INTRODUCTION: Simulation as a tool for medical education has gained considerable importance in the past years. Various studies have shown that the mastering of basic skills happens best if taught in a realistic and workplace-based context. It is necessary that simulation itself takes place in the realistic background of a genuine clinical or in an accordingly simulated learning environment. METHODS: A panoramic projection system that allows the simulation of different scenarios has been created at the medical school of the Westphalian Wilhelms-University  Muenster/Germany. The SimuScape© is a circular training room of six meters in diameter and has the capacity to generate pictures or moving images as well as the corresponding background noises for medical students, who are then able to interact with simulated patients inside a realistic environment. RESULTS: About 1,000 students have been instructed using the SimuScape© in the courses of emergency medicine, family medicine and anesthesia. The SimuScape©, with its 270°-panoramic projection, gives the students the impression “of being right in the center of action”.  It is a flexible learning environment that can be easily integrated into curricular teaching and which is in full operation for 10 days per semester. CONCLUSION: The SimuScape© allows the establishment of new medical areas outside the hospital and surgery for simulation and it is an extremely adaptable and cost-effective utilization of a lecture room. In this simulated environment it is possible to teach objectives like self-protection and patient care during disturbing environmental influences in practice.

  18. Otoscopy simulation training in a classroom setting: a novel approach to teaching otoscopy to medical students.

    Science.gov (United States)

    Davies, Joel; Djelic, Lucas; Campisi, Paolo; Forte, Vito; Chiodo, Albino

    2014-11-01

    To determine the effectiveness of using of an otoscopy stimulator to teach medical students the primary principles of otoscopy in large group training sessions and improve their confidence in making otologic diagnoses. Cross-sectional survey design. In March 2013, the Department of Otolaryngology-Head and Neck Surgery held a large-scale otoscopy simulator teaching session at the MaRS Innovation Center for 92 first and second year University of Toronto medical students. Following the training session, students were provided with an optional electronic, nine-question survey related to their experience with learning otoscopy using the simulators alone, and in comparison to traditional methods of teaching. Thirty-four medical students completed the survey. Ninety-one percent of the respondents indicated that the overall quality of the event was either very good or excellent. A total of 71% of respondents either agreed, or strongly agreed, that the otoscopy simulator training session improved their confidence in diagnosing pathologies of the ear. The majority (70%) of students indicated that the training session had stimulated their interest in otolaryngology-head and neck surgery as a medical specialty. Organizing large-group otoscopy simulator training sessions is one method whereby students can become familiar with a wide variety of pathologies of the ear and improve both their diagnostic accuracy and their confidence in making otologic diagnoses. NA © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  19. The impact of assessing simulated bad news consultations on medical students' stress response and communication performance.

    NARCIS (Netherlands)

    Dulmen, S. van; Tromp, F.; Grosfeld, F.; Cate, O. ten; Bensing, J.M.

    2007-01-01

    Seventy second-year medical students volunteered to participate in a study with the aim of evaluating the impact of the assessment of simulated bad news consultations on their physiological and psychological stress and communication performance. Measurements were taken of salivary cortisol, systolic

  20. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    Science.gov (United States)

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  1. Simulation-based trauma education for medical students : A review of literature

    NARCIS (Netherlands)

    Borggreve, Alicia S.; Meijer, Joost M.R.; Schreuder, Henk W.R.; ten Cate, Olle

    2017-01-01

    Background: Medical students often do not feel prepared to manage emergency situations after graduation. They experience a lack of practical skills and show significant deficits in cognitive performance to assess and stabilize trauma patients. Most reports in the literature about simulation-based

  2. Design and simulation of a totally digital image system for medical image applications

    International Nuclear Information System (INIS)

    Archwamety, C.

    1987-01-01

    The Totally Digital Imaging System (TDIS) is based on system requirements information from the Radiology Department, University of Arizona Health Science Center. This dissertation presents the design of this complex system, the TDIS specification, the system performance requirements, and the evaluation of the system using the computer-simulation programs. Discrete-event simulation models were developed for the TDIS subsystems, including an image network, imaging equipment, storage migration algorithm, data base archive system, and a control and management network. The simulation system uses empirical data generation and retrieval rates measured at the University Medical Center hospital. The entire TDIS system was simulated in Simscript II.5 using a VAX 8600 computer system. Simulation results show the fiber-optical-image network to be suitable; however, the optical-disk-storage system represents a performance bottleneck

  3. Physiological and psychological effects of delivering medical news using a simulated physician-patient scenario.

    Science.gov (United States)

    Cohen, Lorenzo; Baile, Walter F; Henninger, Evelyn; Agarwal, Sandeep K; Kudelka, Andrzej P; Lenzi, Renato; Sterner, Janet; Marshall, Gailen D

    2003-10-01

    We examined the acute stress response associated with having to deliver either bad or good medical news using a simulated physician-patient scenario. Twenty-five healthy medical students were randomly assigned to a bad medical news (BN), a good medical news (GN), or a control group that read magazines during the session. Self-report measures were obtained before and after the task. Blood pressure and heart rate were measured throughout the task period. Four blood samples were obtained across the task period. The BN and GN tasks produced significant increases in self-reported distress and cardiovascular responses compared with the control group. There was also a significant increase in natural killer cell function 10 min into the task in the BN group compared with the control group. The BN task was also somewhat more stressful than the GN task, as shown by the self-report and cardiovascular data. These findings suggest that a simulated physician-patient scenario produces an acute stress response in the "physician," with the delivery of bad medical news more stressful than the delivery of good medical news.

  4. SIMulation of Medication Error induced by Clinical Trial drug labeling: the SIMME-CT study.

    Science.gov (United States)

    Dollinger, Cecile; Schwiertz, Vérane; Sarfati, Laura; Gourc-Berthod, Chloé; Guédat, Marie-Gabrielle; Alloux, Céline; Vantard, Nicolas; Gauthier, Noémie; He, Sophie; Kiouris, Elena; Caffin, Anne-Gaelle; Bernard, Delphine; Ranchon, Florence; Rioufol, Catherine

    2016-06-01

    To assess the impact of investigational drug labels on the risk of medication error in drug dispensing. A simulation-based learning program focusing on investigational drug dispensing was conducted. The study was undertaken in an Investigational Drugs Dispensing Unit of a University Hospital of Lyon, France. Sixty-three pharmacy workers (pharmacists, residents, technicians or students) were enrolled. Ten risk factors were selected concerning label information or the risk of confusion with another clinical trial. Each risk factor was scored independently out of 5: the higher the score, the greater the risk of error. From 400 labels analyzed, two groups were selected for the dispensing simulation: 27 labels with high risk (score ≥3) and 27 with low risk (score ≤2). Each question in the learning program was displayed as a simulated clinical trial prescription. Medication error was defined as at least one erroneous answer (i.e. error in drug dispensing). For each question, response times were collected. High-risk investigational drug labels correlated with medication error and slower response time. Error rates were significantly 5.5-fold higher for high-risk series. Error frequency was not significantly affected by occupational category or experience in clinical trials. SIMME-CT is the first simulation-based learning tool to focus on investigational drug labels as a risk factor for medication error. SIMME-CT was also used as a training tool for staff involved in clinical research, to develop medication error risk awareness and to validate competence in continuing medical education. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  5. Simulations of X-ray synchrotron beams using the EGS4 code system in medical applications

    International Nuclear Information System (INIS)

    Orion, I.; Henn, A.; Sagi, I.; Dilmanian, F.A.; Pena, L.; Rosenfeld, A.B.

    2001-01-01

    X-ray synchrotron beams are commonly used in biological and medical research. The availability of intense, polarized low-energy photons from the synchrotron beams provides a high dose transfer to biological materials. The EGS4 code system, which includes the photoelectron angular distribution, electron motion inside a magnetic field, and the LSCAT package, found to be the appropriate Monte Carlo code for synchrotron-produced X-ray simulations. The LSCAT package was developed in 1995 for the EGS4 code to contain the routines to simulate the linear polarization, the bound Compton, and the incoherent scattering functions. Three medical applications were demonstrated using the EGS4 Monte Carlo code as a proficient simulation code system for the synchrotron low-energy X-ray source. (orig.)

  6. Prioritization in medical school simulation curriculum development using survey tools and desirability function: a pilot experiment.

    Science.gov (United States)

    Ingrassia, Pier Luigi; Barozza, Ludovico Giovanni; Franc, Jeffrey Michael

    2018-01-01

    In Italy, there is no framework of procedural skills that all medical students should be able to perform autonomously at graduation. The study aims at identifying (1) a set of essential procedural skills and (2) which abilities could be potentially taught with simulation. Desirability score was calculated for each procedure to determine the most effective manner to proceed with simulation curriculum development. A web poll was conducted at the School of Medicine in Novara, looking at the level of expected and self-perceived competency for common medical procedures. Three groups were enrolled: (1) faculty, (2) junior doctors in their first years of practice, and (3) recently graduated medical students. Level of importance of procedural skills for independent practice expressed by teachers, level of mastery self-perceived by learners (students and junior doctors) and suitability of simulation training for the given technical skills were measured. Desirability function was used to set priorities for future learning. The overall mean expected level of competency for the procedural skills was 7.9/9. Mean level of self reported competency was 4.7/9 for junior doctors and 4.4/9 for recently graduated students. The highest priority skills according to the desirability function were urinary catheter placement, nasogastric tube insertion, and incision and drainage of superficial abscesses. This study identifies those technical competencies thought by faculty to be important and assessed the junior doctors and recent graduates level of self-perceived confidence in performing these skills. The study also identifies the perceived utility of teaching these skills by simulation. The study prioritizes those skills that have a gap between expected and observed competency and are also thought to be amenable to teaching by simulation. This allows immediate priorities for simulation curriculum development in the most effective manner. This methodology may be useful to researchers in

  7. Designing and using computer simulations in medical education and training: an introduction.

    Science.gov (United States)

    Friedl, Karl E; O'Neil, Harold F

    2013-10-01

    Computer-based technologies informed by the science of learning are becoming increasingly prevalent in education and training. For the Department of Defense (DoD), this presents a great potential advantage to the effective preparation of a new generation of technologically enabled service members. Military medicine has broad education and training challenges ranging from first aid and personal protective skills for every service member to specialized combat medic training; many of these challenges can be met with gaming and simulation technologies that this new generation has embraced. However, comprehensive use of medical games and simulation to augment expert mentorship is still limited to elite medical provider training programs, but can be expected to become broadly used in the training of first responders and allied health care providers. The purpose of this supplement is to review the use of computer games and simulation to teach and assess medical knowledge and skills. This review and other DoD research policy sources will form the basis for development of a research and development road map and guidelines for use of this technology in military medicine. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  8. DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

    Directory of Open Access Journals (Sweden)

    I. V. Tolmachyov

    2014-01-01

    Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

  9. Manned Flight Simulator (MFS)

    Data.gov (United States)

    Federal Laboratory Consortium — The Aircraft Simulation Division, home to the Manned Flight Simulator (MFS), provides real-time, high fidelity, hardware-in-the-loop flight simulation capabilities...

  10. Interprofessional simulation training improves knowledge and teamwork in nursing and medical students during internal medicine clerkship.

    Science.gov (United States)

    Tofil, Nancy M; Morris, Jason L; Peterson, Dawn Taylor; Watts, Penni; Epps, Chad; Harrington, Kathy F; Leon, Kevin; Pierce, Caleb; White, Marjorie Lee

    2014-03-01

    Simulation is effective at improving healthcare students' knowledge and communication. Despite increasingly interprofessional approaches to medicine, most studies demonstrate these effects in isolation. We enhanced an existing internal medicine curriculum with immersive interprofessional simulations. For ten months, third-year medical students and senior nursing students were recruited for four, 1-hour simulations. Scenarios included myocardial infarction, pancreatitis/hyperkalemia, upper gastrointestinal bleed, and chronic obstructive pulmonary disease exacerbation. After each scenario, experts in medicine, nursing, simulation, and adult learning facilitated a debriefing. Study measures included pre- and post-tests assessing self-efficacy, communication skills, and understanding of each profession's role. Seventy-two medical students and 30 nursing students participated. Self-efficacy communication scores improved for both (medicine, 18.9 ± 3.3 pretest vs 23.7 ± 3.7 post-test; nursing, 19.6 ± 2.7 pretest vs 24.5 ± 2.5 post-test). Both groups showed improvement in "confidence to correct another healthcare provider in a collaborative manner" (Δ = .97 medicine, Δ = 1.2 nursing). Medical students showed the most improvement in "confidence to close the loop in patient care" (Δ = .93). Nursing students showed the most improvement in "confidence to figure out roles" (Δ = 1.1). This study supports the hypothesis that interdisciplinary simulation improves each discipline's self-efficacy communication skills and understanding of each profession's role. Despite many barriers to interprofessional simulation, this model is being sustained. © 2014 Society of Hospital Medicine.

  11. Research opportunities in simulation-based medical education using deliberate practice.

    Science.gov (United States)

    McGaghie, William C

    2008-11-01

    There are many opportunities for the academic emergency medicine (EM) community to engage in simulation-based educational research using deliberate practice (DP). This article begins by defining and giving examples of two key concepts: deliberate practice and mastery learning. The article proceeds to report six lessons learned from a research legacy in simulation-based medical education (SBME). It concludes by listing and amplifying 10 DP research opportunities in academic EM. A coda states that the research agenda is rich and ambitious and should focus on the goal of educating superb, expert clinicians.

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

    Directory of Open Access Journals (Sweden)

    Alsaad AA

    2017-07-01

    Full Text Available Ali A Alsaad,1 Swetha Davuluri,2 Vandana Y Bhide,3 Amy M Lannen,4 Michael J Maniaci3 1Department of Internal Medicine, Mayo Clinic, 2University of Miami, Coral Gables, 3Division of Hospital Internal Medicine, 4J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA Background: Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective: To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs as compared to mannequin. Methods: Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis. Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score. Results: Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01. When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002. Conclusions: Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. Keywords: simulation, standardized patient, satisfaction, mannequin, assessment, resident education

  13. Introduction to the simulation with MCNP Monte Carlo code and its applications in Medical Physics

    International Nuclear Information System (INIS)

    Parreno Z, F.; Paucar J, R.; Picon C, C.

    1998-01-01

    The simulation by Monte Carlo is tool which Medical Physics counts with it for the development of its research, the interest by this tool is growing, as we may observe in the main scientific journals for the years 1995-1997 where more than 27 % of the papers treat over Monte Carlo and/or its applications in the radiation transport.In the Peruvian Institute of Nuclear Energy we are implementing and making use of the MCNP4 and EGS4 codes. In this work are presented the general features of the Monte Carlo method and its more useful applications in Medical Physics. Likewise, it is made a simulation of the calculation of isodose curves in an interstitial treatment with Ir-192 wires in a mammary gland carcinoma. (Author)

  14. Local Interaction Simulation Approach for Fault Detection in Medical Ultrasonic Transducers

    Directory of Open Access Journals (Sweden)

    Z. Hashemiyan

    2015-01-01

    Full Text Available A new approach is proposed for modelling medical ultrasonic transducers operating in air. The method is based on finite elements and the local interaction simulation approach. The latter leads to significant reductions of computational costs. Transmission and reception properties of the transducer are analysed using in-air reverberation patterns. The proposed approach can help to provide earlier detection of transducer faults and their identification, reducing the risk of misdiagnosis due to poor image quality.

  15. Efficient and Effective Use of Peer Teaching for Medical Student Simulation.

    Science.gov (United States)

    House, Joseph B; Choe, Carol H; Wourman, Heather L; Berg, Kristin M; Fischer, Jonathan P; Santen, Sally A

    2017-01-01

    Simulation is increasingly used in medical education, promoting active learning and retention; however, increasing use also requires considerable instructor resources. Simulation may provide a safe environment for students to teach each other, which many will need to do when they enter residency. Along with reinforcing learning and increasing retention, peer teaching could decrease instructor demands. Our objective was to determine the effectiveness of peer-taught simulation compared to physician-led simulation. We hypothesized that peer-taught simulation would lead to equivalent knowledge acquisition when compared to physician-taught sessions and would be viewed positively by participants. This was a quasi-experimental study in an emergency medicine clerkship. The control group was faculty taught. In the peer-taught intervention group, students were assigned to teach one of the three simulation-based medical emergency cases. Each student was instructed to master their topic and teach it to their peers using the provided objectives and resource materials. The students were assigned to groups of three, with all three cases represented; students took turns leading their case. Three groups ran simultaneously. During the intervention sessions, one physician was present to monitor the accuracy of learning and to answer questions, while three physicians were required for the control groups. Outcomes compared pre-test and post-test knowledge and student reaction between control and intervention groups. Both methods led to equally improved knowledge; mean score for the post-test was 75% for both groups (p=0.6) and were viewed positively. Students in the intervention group agreed that peer-directed learning was an effective way to learn. However, students in the control group scored their simulation experience more favorably. In general, students' response to peer teaching was positive, students learned equally well, and found peer-taught sessions to be interactive and

  16. Laser Welding Process Parameters Optimization Using Variable-Fidelity Metamodel and NSGA-II

    Directory of Open Access Journals (Sweden)

    Wang Chaochao

    2017-01-01

    Full Text Available An optimization methodology based on variable-fidelity (VF metamodels and nondominated sorting genetic algorithm II (NSGA-II for laser bead-on-plate welding of stainless steel 316L is presented. The relationships between input process parameters (laser power, welding speed and laser focal position and output responses (weld width and weld depth are constructed by VF metamodels. In VF metamodels, the information from two levels fidelity models are integrated, in which the low-fidelity model (LF is finite element simulation model that is used to capture the general trend of the metamodels, and high-fidelity (HF model which from physical experiments is used to ensure the accuracy of metamodels. The accuracy of the VF metamodel is verified by actual experiments. To slove the optimization problem, NSGA-II is used to search for multi-objective Pareto optimal solutions. The results of verification experiments show that the obtained optimal parameters are effective and reliable.

  17. Simulation training improves medical students' learning experiences when performing real vaginal deliveries.

    Science.gov (United States)

    Dayal, Ashlesha K; Fisher, Nelli; Magrane, Diane; Goffman, Dena; Bernstein, Peter S; Katz, Nadine T

    2009-01-01

    To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students' performance and confidence in vaginal delivery maneuvers with and without simulation training. Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1-5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs. Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 +/- 3.7 versus 6.2 +/- 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 +/- 0.83 versus 3.00 +/- 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 +/- 0.94 versus 2.07 +/- 1.22, respectively, P < 0.001) and week 5 (4.88 +/- 0.33 versus 4.31 +/- 0.63, P < 0.001) in the simulated environment. Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence

  18. Medical images of patients in voxel structures in high resolution for Monte Carlo simulation

    International Nuclear Information System (INIS)

    Boia, Leonardo S.; Menezes, Artur F.; Silva, Ademir X.

    2011-01-01

    This work aims to present a computational process of conversion of tomographic and MRI medical images from patients in voxel structures to an input file, which will be manipulated in Monte Carlo Simulation code for tumor's radiotherapic treatments. The problem's scenario inherent to the patient is simulated by such process, using the volume element (voxel) as a unit of computational tracing. The head's voxel structure geometry has voxels with volumetric dimensions around 1 mm 3 and a population of millions, which helps - in that way, for a realistic simulation and a decrease in image's digital process techniques for adjustments and equalizations. With such additional data from the code, a more critical analysis can be developed in order to determine the volume of the tumor, and the protection, beside the patients' medical images were borrowed by Clinicas Oncologicas Integradas (COI/RJ), joined to the previous performed planning. In order to execute this computational process, SAPDI computational system is used in a digital image process for optimization of data, conversion program Scan2MCNP, which manipulates, processes, and converts the medical images into voxel structures to input files and the graphic visualizer Moritz for the verification of image's geometry placing. (author)

  19. Improving advanced cardiovascular life support skills in medical students: simulation-based education approach

    Directory of Open Access Journals (Sweden)

    Hamidreza Reihani

    2015-01-01

    Full Text Available Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students. Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012 participated in this study. Advanced Cardiovascular Life Support (ACLS workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA guidelines. Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100. This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001. Also the mean score of each station had a significant improvement (P< 0.001. Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students.

  20. Medical images of patients in voxel structures in high resolution for Monte Carlo simulation

    Energy Technology Data Exchange (ETDEWEB)

    Boia, Leonardo S.; Menezes, Artur F.; Silva, Ademir X., E-mail: lboia@con.ufrj.b, E-mail: ademir@con.ufrj.b [Universidade Federal do Rio de Janeiro (PEN/COPPE/UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-Graduacao de Engenharia. Programa de Engenharia Nuclear; Salmon Junior, Helio A. [Clinicas Oncologicas Integradas (COI), Rio de Janeiro, RJ (Brazil)

    2011-07-01

    This work aims to present a computational process of conversion of tomographic and MRI medical images from patients in voxel structures to an input file, which will be manipulated in Monte Carlo Simulation code for tumor's radiotherapic treatments. The problem's scenario inherent to the patient is simulated by such process, using the volume element (voxel) as a unit of computational tracing. The head's voxel structure geometry has voxels with volumetric dimensions around 1 mm{sup 3} and a population of millions, which helps - in that way, for a realistic simulation and a decrease in image's digital process techniques for adjustments and equalizations. With such additional data from the code, a more critical analysis can be developed in order to determine the volume of the tumor, and the protection, beside the patients' medical images were borrowed by Clinicas Oncologicas Integradas (COI/RJ), joined to the previous performed planning. In order to execute this computational process, SAPDI computational system is used in a digital image process for optimization of data, conversion program Scan2MCNP, which manipulates, processes, and converts the medical images into voxel structures to input files and the graphic visualizer Moritz for the verification of image's geometry placing. (author)

  1. Simulation Modeling of a Check-in and Medication Reconciliation Ambulatory Clinic Kiosk

    Directory of Open Access Journals (Sweden)

    Blake Lesselroth

    2011-01-01

    Full Text Available Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.

  2. Fidelity induced distance measures for quantum states

    International Nuclear Information System (INIS)

    Ma Zhihao; Zhang Fulin; Chen Jingling

    2009-01-01

    Fidelity plays an important role in quantum information theory. In this Letter, we introduce new metric of quantum states induced by fidelity, and connect it with the well-known trace metric, Sine metric and Bures metric for the qubit case. The metric character is also presented for the qudit (i.e., d-dimensional system) case. The CPT contractive property and joint convex property of the metric are also studied.

  3. Integration of soft tissue model and open haptic device for medical training simulator

    Science.gov (United States)

    Akasum, G. F.; Ramdhania, L. N.; Suprijanto; Widyotriatmo, A.

    2016-03-01

    Minimally Invasive Surgery (MIS) has been widely used to perform any surgical procedures nowadays. Currently, MIS has been applied in some cases in Indonesia. Needle insertion is one of simple MIS procedure that can be used for some purposes. Before the needle insertion technique used in the real situation, it essential to train this type of medical student skills. The research has developed an open platform of needle insertion simulator with haptic feedback that providing the medical student a realistic feel encountered during the actual procedures. There are three main steps in build the training simulator, which are configure hardware system, develop a program to create soft tissue model and the integration of hardware and software. For evaluating its performance, haptic simulator was tested by 24 volunteers on a scenario of soft tissue model. Each volunteer must insert the needle on simulator until rearch the target point with visual feedback that visualized on the monitor. From the result it can concluded that the soft tissue model can bring the sensation of touch through the perceived force feedback on haptic actuator by looking at the different force in accordance with different stiffness in each layer.

  4. An investigation of the efficiency in simulating 6 MV medical accelerator using OMEGA/BEAM

    International Nuclear Information System (INIS)

    Dai Zhenhui; Wang Xuetao; Zhu Lin; Zhang Yu; Liu Xiaowei

    2013-01-01

    Background: Monte Carlo simulation techniques are presently considered to be the most reliable method for radiation therapy treatment planning. However, long simulation times involved when using the general-purpose Monte Carlo code systems have led to the development of special-purpose Monte Carlo programs. Purpose: This paper attempts to improve computing efficiency for dose calculation in the EGSnrc modeling of clinical linear accelerator by selecting proper parameters. Methods: Several variance reduction techniques including uniform bremsstrahlung splitting, selective bremsstrahlung splitting, directional bremsstrahlung splitting are applied in BEAMnrc simulating medical accelerator treatment head to generate phase-space file which is selected as a source for DOSXYZnrc simulation, both photon splitting and particle recycling are used to improve the efficiency in the calculation of dose profile in water phantom. Results: The splitting number for maximum efficiency in directional bremsstrahlung splitting (no electron splitting) is 2500 in the BEAMnrc simulation. The highest efficiency of DOSXYZnrc simulation is given when photon splitting number is set to 40. Conclusions: Efficiency can be significantly improved by setting appropriate bremsstrahlung splitting and optimized photon splitting number and particle recycling number. (authors)

  5. Virtual suturing simulation based on commodity physics engine for medical learning.

    Science.gov (United States)

    Choi, Kup-Sze; Chan, Sze-Ho; Pang, Wai-Man

    2012-06-01

    Development of virtual-reality medical applications is usually a complicated and labour intensive task. This paper explores the feasibility of using commodity physics engine to develop a suturing simulator prototype for manual skills training in the fields of nursing and medicine, so as to enjoy the benefits of rapid development and hardware-accelerated computation. In the prototype, spring-connected boxes of finite dimension are used to simulate soft tissues, whereas needle and thread are modelled with chained segments. Spherical joints are used to simulate suture's flexibility and to facilitate thread cutting. An algorithm is developed to simulate needle insertion and thread advancement through the tissue. Two-handed manipulations and force feedback are enabled with two haptic devices. Experiments on the closure of a wound show that the prototype is able to simulate suturing procedures at interactive rates. The simulator is also used to study a curvature-adaptive suture modelling technique. Issues and limitations of the proposed approach and future development are discussed.

  6. Experimental validation of neutron activation simulation of a varian medical linear accelerator.

    Science.gov (United States)

    Morato, S; Juste, B; Miro, R; Verdu, G; Diez, S

    2016-08-01

    This work presents a Monte Carlo simulation using the last version of MCNP, v. 6.1.1, of a Varian CLinAc emitting a 15MeV photon beam. The main objective of the work is to estimate the photoneutron production and activated products inside the medical linear accelerator head. To that, the Varian LinAc head was modelled in detail using the manufacturer information, and the model was generated with a CAD software and exported as a mesh to be included in the particle transport simulation. The model includes the transport of photoneutrons generated by primary photons and the (n, γ) reactions which can result in activation products. The validation of this study was done using experimental measures. Activation products have been identified by in situ gamma spectroscopy placed at the jaws exit of the LinAc shortly after termination of a high energy photon beam irradiation. Comparison between experimental and simulation results shows good agreement.

  7. EL USO DE LAS SIMULACIONES EN EDUCACIÓN MÉDICA SIMULATION IN MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Jorge L. Palés Argullós

    2010-06-01

    Full Text Available En los últimos 20 años estamos asistiendo de forma progresiva al uso generalizado de las simulaciones en la formación de los médicos y de otros profesionales de las ciencias de la salud, en las diferentes etapas de su continuum educativo (grado, postgrado y formación continua. Tanto es así que ha surgido el concepto de la educación médica basada en las simulaciones, reconocida actualmente como una ayuda fundamental para asegurar el aprendizaje del estudiante y del médico y para mejorar la seguridad del paciente. En este artículo describiremos las razones por las que surge y se desarrolla esta nueva metodología, sus ventajas, los diferentes modelos y recursos disponibles en la actualidad y las características de los denominados centros de simulación o de habilidades clínicas que se han ido desarrollando en todo el mundo, en los cuales se lleva a cabo esta nueva modalidad de enseñanza médica. Así mismo trataremos brevemente  la situación en nuestro país y finalmente nos referiremos a los principios en los que se basa un desarrollo adecuado de la educación médica basada en las simulaciones. In last twenty years, we are seeing increasingly widespread use of simulations in the training of doctors and other professionals of health sciences at the different stages of their educational continuum (undergraduate, postgraduate and continuing medical education. So much so that the concept of simulations-based medical education has emerged and it is now recognized as a vital tool to ensure the learning of medical students and doctors, and to improve patient safety. This article will describe the reasons for the introduction and development of this new methodology, its advantages and the different models and currently available resources. We will describe also the characteristics of so-called simulation centres or clinical skills laboratories that have been developed worldwide, where the simulation-based medical education take place

  8. Evaluating display fidelity and interaction fidelity in a virtual reality game.

    Science.gov (United States)

    McMahan, Ryan P; Bowman, Doug A; Zielinski, David J; Brady, Rachael B

    2012-04-01

    In recent years, consumers have witnessed a technological revolution that has delivered more-realistic experiences in their own homes through high-definition, stereoscopic televisions and natural, gesture-based video game consoles. Although these experiences are more realistic, offering higher levels of fidelity, it is not clear how the increased display and interaction aspects of fidelity impact the user experience. Since immersive virtual reality (VR) allows us to achieve very high levels of fidelity, we designed and conducted a study that used a six-sided CAVE to evaluate display fidelity and interaction fidelity independently, at extremely high and low levels, for a VR first-person shooter (FPS) game. Our goal was to gain a better understanding of the effects of fidelity on the user in a complex, performance-intensive context. The results of our study indicate that both display and interaction fidelity significantly affect strategy and performance, as well as subjective judgments of presence, engagement, and usability. In particular, performance results were strongly in favor of two conditions: low-display, low-interaction fidelity (representative of traditional FPS games) and high-display, high-interaction fidelity (similar to the real world).

  9. Simulation

    DEFF Research Database (Denmark)

    Gould, Derek A; Chalmers, Nicholas; Johnson, Sheena J

    2012-01-01

    Recognition of the many limitations of traditional apprenticeship training is driving new approaches to learning medical procedural skills. Among simulation technologies and methods available today, computer-based systems are topical and bring the benefits of automated, repeatable, and reliable p...... performance assessments. Human factors research is central to simulator model development that is relevant to real-world imaging-guided interventional tasks and to the credentialing programs in which it would be used....

  10. Benefits of computer screen-based simulation in learning cardiac arrest procedures.

    Science.gov (United States)

    Bonnetain, Elodie; Boucheix, Jean-Michel; Hamet, Maël; Freysz, Marc

    2010-07-01

    What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high-fidelity patient simulators, but have also demonstrated their limits. New computer screen-based multimedia simulators have fewer constraints than high-fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen-based simulator to more realistic situations such as those encountered with high-fidelity patient simulators. We tested the benefits of learning cardiac arrest procedures using a multimedia computer screen-based simulator in 28 Year 2 medical students. Just before the end of the traditional resuscitation course, we compared two groups. An experiment group (EG) was first asked to learn to perform the appropriate procedures in a cardiac arrest scenario (CA1) in the computer screen-based learning environment and was then tested on a high-fidelity patient simulator in another cardiac arrest simulation (CA2). While the EG was learning to perform CA1 procedures in the computer screen-based learning environment, a control group (CG) actively continued to learn cardiac arrest procedures using practical exercises in a traditional class environment. Both groups were given the same amount of practice, exercises and trials. The CG was then also tested on the high-fidelity patient simulator for CA2, after which it was asked to perform CA1 using the computer screen-based simulator. Performances with both simulators were scored on a precise 23-point scale. On the test on a high-fidelity patient simulator, the EG trained with a multimedia computer screen-based simulator performed significantly better than the CG trained with traditional exercises and practice (16.21 versus 11.13 of 23 possible points, respectively; p<0.001). Computer screen-based simulation appears to be effective in preparing learners to

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

    Science.gov (United States)

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

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

  12. Teaching emergency medical services management skills using a computer simulation exercise.

    Science.gov (United States)

    Hubble, Michael W; Richards, Michael E; Wilfong, Denise

    2011-02-01

    Simulation exercises have long been used to teach management skills in business schools. However, this pedagogical approach has not been reported in emergency medical services (EMS) management education. We sought to develop, deploy, and evaluate a computerized simulation exercise for teaching EMS management skills. Using historical data, a computer simulation model of a regional EMS system was developed. After validation, the simulation was used in an EMS management course. Using historical operational and financial data of the EMS system under study, students designed an EMS system and prepared a budget based on their design. The design of each group was entered into the model that simulated the performance of the EMS system. Students were evaluated on operational and financial performance of their system design and budget accuracy and then surveyed about their experiences with the exercise. The model accurately simulated the performance of the real-world EMS system on which it was based. The exercise helped students identify operational inefficiencies in their system designs and highlighted budget inaccuracies. Most students rated the exercise as moderately or very realistic in ambulance deployment scheduling, budgeting, personnel cost calculations, demand forecasting, system design, and revenue projections. All students indicated the exercise was helpful in gaining a top management perspective, and 89% stated the exercise was helpful in bridging the gap between theory and reality. Preliminary experience with a computer simulator to teach EMS management skills was well received by students in a baccalaureate paramedic program and seems to be a valuable teaching tool. Copyright © 2011 Society for Simulation in Healthcare

  13. The economics of improving medication adherence in osteoporosis: validation and application of a simulation model.

    Science.gov (United States)

    Patrick, Amanda R; Schousboe, John T; Losina, Elena; Solomon, Daniel H

    2011-09-01

    Adherence to osteoporosis treatment is low. Although new therapies and behavioral interventions may improve medication adherence, questions are likely to arise regarding their cost-effectiveness. Our objectives were to develop and validate a model to simulate the clinical outcomes and costs arising from various osteoporosis medication adherence patterns among women initiating bisphosphonate treatment and to estimate the cost-effectiveness of a hypothetical intervention to improve medication adherence. We constructed a computer simulation using estimates of fracture rates, bisphosphonate treatment effects, costs, and utilities for health states drawn from the published literature. Probabilities of transitioning on and off treatment were estimated from administrative claims data. Patients were women initiating bisphosphonate therapy from the general community. We evaluated a hypothetical behavioral intervention to improve medication adherence. Changes in 10-yr fracture rates and incremental cost-effectiveness ratios were evaluated. A hypothetical intervention with a one-time cost of $250 and reducing bisphosphonate discontinuation by 30% had an incremental cost-effectiveness ratio (ICER) of $29,571 per quality-adjusted life year in 65-yr-old women initiating bisphosphonates. Although the ICER depended on patient age, intervention effectiveness, and intervention cost, the ICERs were less than $50,000 per quality-adjusted life year for the majority of intervention cost and effectiveness scenarios evaluated. Results were sensitive to bisphosphonate cost and effectiveness and assumptions about the rate at which intervention and treatment effects decline over time. Our results suggests that behavioral interventions to improve osteoporosis medication adherence will likely have favorable ICERs if their efficacy can be sustained.

  14. Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

    Directory of Open Access Journals (Sweden)

    Serkan Toy

    2017-03-01

    Full Text Available Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001. Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t (23 = −2.92, P < .001, and arterial line placement, t (23 = −2.75, P < .001. Procedural performance scores for intubation ( t (23 = −17.29, P < .001, arterial line placement ( t (23 = −19.75, P < .001, lumbar puncture ( t (23 = −16.27, P < .001, and central line placement ( t (23 = −17.25, P < .001 showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

  15. The effect of degree of immersion upon learning performance in virtual reality simulations for medical education.

    Science.gov (United States)

    Gutiérrez, Fátima; Pierce, Jennifer; Vergara, Víctor M; Coulter, Robert; Saland, Linda; Caudell, Thomas P; Goldsmith, Timothy E; Alverson, Dale C

    2007-01-01

    Simulations are being used in education and training to enhance understanding, improve performance, and assess competence. However, it is important to measure the performance of these simulations as learning and training tools. This study examined and compared knowledge acquisition using a knowledge structure design. The subjects were first-year medical students at The University of New Mexico School of Medicine. One group used a fully immersed virtual reality (VR) environment using a head mounted display (HMD) and another group used a partially immersed (computer screen) VR environment. The study aims were to determine whether there were significant differences between the two groups as measured by changes in knowledge structure before and after the VR simulation experience. The results showed that both groups benefited from the VR simulation training as measured by the significant increased similarity to the expert knowledge network after the training experience. However, the immersed group showed a significantly higher gain than the partially immersed group. This study demonstrated a positive effect of VR simulation on learning as reflected by improvements in knowledge structure but an enhanced effect of full-immersion using a HMD vs. a screen-based VR system.

  16. Modeling and simulation of multi-physics multi-scale transport phenomenain bio-medical applications

    International Nuclear Information System (INIS)

    Kenjereš, Saša

    2014-01-01

    We present a short overview of some of our most recent work that combines the mathematical modeling, advanced computer simulations and state-of-the-art experimental techniques of physical transport phenomena in various bio-medical applications. In the first example, we tackle predictions of complex blood flow patterns in the patient-specific vascular system (carotid artery bifurcation) and transfer of the so-called 'bad' cholesterol (low-density lipoprotein, LDL) within the multi-layered artery wall. This two-way coupling between the blood flow and corresponding mass transfer of LDL within the artery wall is essential for predictions of regions where atherosclerosis can develop. It is demonstrated that a recently developed mathematical model, which takes into account the complex multi-layer arterial-wall structure, produced LDL profiles within the artery wall in good agreement with in-vivo experiments in rabbits, and it can be used for predictions of locations where the initial stage of development of atherosclerosis may take place. The second example includes a combination of pulsating blood flow and medical drug delivery and deposition controlled by external magnetic field gradients in the patient specific carotid artery bifurcation. The results of numerical simulations are compared with own PIV (Particle Image Velocimetry) and MRI (Magnetic Resonance Imaging) in the PDMS (silicon-based organic polymer) phantom. A very good agreement between simulations and experiments is obtained for different stages of the pulsating cycle. Application of the magnetic drug targeting resulted in an increase of up to ten fold in the efficiency of local deposition of the medical drug at desired locations. Finally, the LES (Large Eddy Simulation) of the aerosol distribution within the human respiratory system that includes up to eight bronchial generations is performed. A very good agreement between simulations and MRV (Magnetic Resonance Velocimetry) measurements is

  17. Modeling and simulation of multi-physics multi-scale transport phenomenain bio-medical applications

    Science.gov (United States)

    Kenjereš, Saša

    2014-08-01

    We present a short overview of some of our most recent work that combines the mathematical modeling, advanced computer simulations and state-of-the-art experimental techniques of physical transport phenomena in various bio-medical applications. In the first example, we tackle predictions of complex blood flow patterns in the patient-specific vascular system (carotid artery bifurcation) and transfer of the so-called "bad" cholesterol (low-density lipoprotein, LDL) within the multi-layered artery wall. This two-way coupling between the blood flow and corresponding mass transfer of LDL within the artery wall is essential for predictions of regions where atherosclerosis can develop. It is demonstrated that a recently developed mathematical model, which takes into account the complex multi-layer arterial-wall structure, produced LDL profiles within the artery wall in good agreement with in-vivo experiments in rabbits, and it can be used for predictions of locations where the initial stage of development of atherosclerosis may take place. The second example includes a combination of pulsating blood flow and medical drug delivery and deposition controlled by external magnetic field gradients in the patient specific carotid artery bifurcation. The results of numerical simulations are compared with own PIV (Particle Image Velocimetry) and MRI (Magnetic Resonance Imaging) in the PDMS (silicon-based organic polymer) phantom. A very good agreement between simulations and experiments is obtained for different stages of the pulsating cycle. Application of the magnetic drug targeting resulted in an increase of up to ten fold in the efficiency of local deposition of the medical drug at desired locations. Finally, the LES (Large Eddy Simulation) of the aerosol distribution within the human respiratory system that includes up to eight bronchial generations is performed. A very good agreement between simulations and MRV (Magnetic Resonance Velocimetry) measurements is obtained

  18. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

    Science.gov (United States)

    Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

    2013-01-01

    Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  19. MCNP6 simulation of reactions of interest to FRIB, medical, and space applications

    International Nuclear Information System (INIS)

    Mashnik, Stepan G.

    2015-01-01

    The latest production-version of the Los Alamos Monte Carlo N-Particle transport code MCNP6 has been used to simulate a variety of particle-nucleus and nucleus-nucleus reactions of academic and applied interest to research subjects at the Facility for Rare Isotope Beams (FRIB), medical isotope production, space-radiation shielding, cosmic-ray propagation, and accelerator applications, including several reactions induced by radioactive isotopes, analyzing production of both stable and radioactive residual nuclei. Here, we discuss examples of validation and verification of MCNP6 by comparing with recent neutron spectra measured at the Heavy Ion Medical Accelerator in Chiba, Japan; spectra of light fragments from several reactions measured recently at GANIL, France; INFN Laboratori Nazionali del Sud, Catania, Italy; COSY of the Jülich Research Center, Germany; and cross sections of products from several reactions measured lately at GSI, Darmstadt, Germany; ITEP, Moscow, Russia; and, LANSCE, LANL, Los Alamos, U.S.A. As a rule, MCNP6 provides quite good predictions for most of the reactions we analyzed so far, allowing us to conclude that it can be used as a reliable and useful simulation tool for various applications for FRIB, medical, and space applications involving stable and radioactive isotopes. (author)

  20. Laser-wakefield accelerators for medical phase contrast imaging: Monte Carlo simulations and experimental studies

    Science.gov (United States)

    Cipiccia, S.; Reboredo, D.; Vittoria, Fabio A.; Welsh, G. H.; Grant, P.; Grant, D. W.; Brunetti, E.; Wiggins, S. M.; Olivo, A.; Jaroszynski, D. A.

    2015-05-01

    X-ray phase contrast imaging (X-PCi) is a very promising method of dramatically enhancing the contrast of X-ray images of microscopic weakly absorbing objects and soft tissue, which may lead to significant advancement in medical imaging with high-resolution and low-dose. The interest in X-PCi is giving rise to a demand for effective simulation methods. Monte Carlo codes have been proved a valuable tool for studying X-PCi including coherent effects. The laser-plasma wakefield accelerators (LWFA) is a very compact particle accelerator that uses plasma as an accelerating medium. Accelerating gradient in excess of 1 GV/cm can be obtained, which makes them over a thousand times more compact than conventional accelerators. LWFA are also sources of brilliant betatron radiation, which are promising for applications including medical imaging. We present a study that explores the potential of LWFA-based betatron sources for medical X-PCi and investigate its resolution limit using numerical simulations based on the FLUKA Monte Carlo code, and present preliminary experimental results.

  1. Simulation of leakage current measurement on medical devices using helmholtz coil configuration with different current flow

    Science.gov (United States)

    Sutanto, E.; Chandra, F.; Dinata, R.

    2017-05-01

    Leakage current measurement which can follow IEC standard for medical device is one of many challenges to be answered. The IEC 60601-1 has defined that the limit for a leakage current for Medical Device can be as low as 10 µA and as high as 500 µA, depending on which type of contact (applied part) connected to the patient. Most people are using ELCB (Earth-leakage circuit breaker) for safety purpose as this is the most common and available safety device in market. One type of ELCB devices is RCD (Residual Current Device) and this RCD type can measure the leakage current directly. This work will show the possibility on how Helmholtz Coil Configuration can be made to be like the RCD. The possibility is explored by comparing the magnetic field formula from each device, then it proceeds with a simulation using software EJS (Easy Java Simulation). The simulation will make sure the concept of magnetic field current cancellation follows the RCD concept. Finally, the possibility of increasing the measurement’s sensitivity is also analyzed. The sensitivity is needed to see the possibility on reaching the minimum leakage current limit defined by IEC, 0.01mA.

  2. Simulation of leakage current measurement on medical devices using helmholtz coil configuration with different current flow

    International Nuclear Information System (INIS)

    Sutanto, E; Chandra, F; Dinata, R

    2017-01-01

    Leakage current measurement which can follow IEC standard for medical device is one of many challenges to be answered. The IEC 60601-1 has defined that the limit for a leakage current for Medical Device can be as low as 10 µA and as high as 500 µA, depending on which type of contact (applied part) connected to the patient. Most people are using ELCB (Earth-leakage circuit breaker) for safety purpose as this is the most common and available safety device in market. One type of ELCB devices is RCD (Residual Current Device) and this RCD type can measure the leakage current directly. This work will show the possibility on how Helmholtz Coil Configuration can be made to be like the RCD. The possibility is explored by comparing the magnetic field formula from each device, then it proceeds with a simulation using software EJS (Easy Java Simulation). The simulation will make sure the concept of magnetic field current cancellation follows the RCD concept. Finally, the possibility of increasing the measurement’s sensitivity is also analyzed. The sensitivity is needed to see the possibility on reaching the minimum leakage current limit defined by IEC, 0.01mA. (paper)

  3. Validity of Simulation-Based Assessment for Accreditation Council for Graduate Medical Education Milestone Achievement.

    Science.gov (United States)

    Isaak, Robert S; Chen, Fei; Martinelli, Susan M; Arora, Harendra; Zvara, David A; Hobbs, Gene; Stiegler, Marjorie P

    2018-01-25

    The Accreditation Council for Graduate Medical Education requires biannual evaluation of anesthesiology residents on 25 subcompetency milestones. Some milestone domains are particularly challenging to repeatedly and reliably observe during clinical care. Simulation-Based Milestones Assessment (SBMA) may help overcome these challenges. However, few studies have examined the external validation of simulation assessment scores (ie, the relationships between simulation-based assessment scores and other standard measures of ability) for milestones. This study analyzed whether SBMA scores (1) discriminate by postgraduate year, (2) improve over time, and (3) correlate with traditional measures of performance. This is a retrospective analysis of 55 residents' SBMA data from 30 scenarios for two academic years. Each scenario was evaluated for time-in-training discrimination. Scenarios were then analyzed for SBMA scoring trends over time, and SBMA scores were compared with residents' clinical evaluations. Twenty-four SBMA scenarios discriminated by postgraduate year. Repeated measure analysis of variance showed statistically significant between-session score improvements (F (3, 54) = 17.79, P Medical Education milestone competencies.

  4. Evaluation of a novel high-fidelity epistaxis task trainer.

    Science.gov (United States)

    Scott, Grace M; Roth, Kathryn; Rotenberg, Brian; Sommer, Doron D; Sowerby, Leigh; Fung, Kevin

    2016-07-01

    To assess the efficacy of a novel high-fidelity epistaxis simulator in teaching epistaxis management to junior otolaryngology head and neck surgery residents. Prospective cohort study. A novel high-fidelity epistaxis task trainer was developed using a cadaver head, intravenous tubing, and a food coloring-filled saline bag to emulate blood. Learners were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis using the task trainer. Learners were videotaped attempting to pack the nose of the task trainer pre- and postintervention (verbal instruction, and practice time with task trainer). Five board-certified otolaryngologists (blinded to pre- and postintervention status) evaluated the packing technique using standardized subjective outcome measures. There were 13 junior otolaryngology residents enrolled in the study. This cohort showed a statistically significant increase in global rating scores (P epistaxis simulator has been successful in teaching and the practical application of various skills in epistaxis management. This task trainer appears to confer an educational benefit in technical skills acquisition in novice learners. Further studies are needed to determine long-term skill retention. Simulation is a promising educational adjunct that effectively enhances epistaxis management skills acquisition while maximizing patient safety. NA. Laryngoscope, 126:1501-1503, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  5. [Clinical Simulation and Emotional Learning].

    Science.gov (United States)

    Afanador, Adalberto Amaya

    2012-01-01

    At present, the clinical simulation has been incorporated into medical school curriculum. It is considered that the simulation is useful to develop skills, and as such its diffusion. Within the acquisition of skills, meaningful learning is an essential emotional component for the student and this point is essential to optimize the results of the simulation experience. Narrative description on the subject of simulation and the degree of "emotionality." The taxonomy is described for the types of clinical simulation fidelity and correlates it with the degree of emotionality required to achieve significant and lasting learning by students. It is essential to take into account the student's level of emotion in the learning process through simulation strategy. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  6. From confident medical students to confident doctors through exposure to simulated and clinical resuscitation

    Directory of Open Access Journals (Sweden)

    Abdoolraheem MY

    2018-04-01

    Full Text Available Mohammad Yusuf Abdoolraheem,1 Mohammad Farwana2 1GKT School of Medical Education, King’s College London, UK; 2Frimley Health Foundation Trust, Camberley, UKWe read with great interest the research article published by Aggarwal and Khan1 concerning the experiences of final-year medical students in terms of both cardiopulmonary resuscitation (CPR and discussions of advanced directives during clinical placements. While we would agree with the concluding opinion that there should be standardized formal education concerning CPR and “Do Not Attempt CPR” (DNACPR; the knowledge and skills developed during theoretical and simulation based teaching should also be complemented by clinical exposure to various scenarios such that the students are more prepared prior to starting their Foundation year training. View the original paper by Aggarwal and Khan. 

  7. Supporting transitions in medical career pathways: the role of simulation-based education.

    Science.gov (United States)

    Cleland, Jennifer; Patey, Rona; Thomas, Ian; Walker, Kenneth; O'Connor, Paul; Russ, Stephanie

    2016-01-01

    Transitions, or periods of change, in medical career pathways can be challenging episodes, requiring the transitioning clinician to take on new roles and responsibilities, adapt to new cultural dynamics, change behaviour patterns, and successfully manage uncertainty. These intensive learning periods present risks to patient safety. Simulation-based education (SBE) is a pedagogic approach that allows clinicians to practise their technical and non-technical skills in a safe environment to increase preparedness for practice. In this commentary, we present the potential uses, strengths, and limitations of SBE for supporting transitions across medical career pathways, discussing educational utility, outcome and process evaluation, and cost and value, and introduce a new perspective on considering the gains from SBE. We provide case-study examples of the application of SBE to illustrate these points and stimulate discussion.

  8. Impact of current video game playing on robotic simulation skills among medical students.

    Science.gov (United States)

    Öge, Tufan; Borahay, Mostafa A; Achjian, Tamar; Kılıç, Sami Gökhan

    2015-01-01

    To evaluate the impact of current and prior video game playing on initial robotic simulation skill acquisition. This cross-sectional descriptive study (Canadian Task Force Classification II-1) was conducted at a medical university training center. The study subjects were medical students who currently played video games (Group I) and those who had not played video games in the last 2 years (Group II). The robotic skills of both groups were assessed using simulation. Twenty-two students enrolled in this study; however, only 21 completed it. The median age of the participants was 23 (22-24) years and 24 (23-26) years in Groups I and II, respectively. Among the participants, 15 (71.4%) were male and 6 (28.5%) were female, and 90.4% of the students started playing video games in primary school. When the 2 groups were compared according to the completion time of each exercise, Group I finished more quickly than Group II in the Peg Board-1 exercise (p>0.05), whereas Group II had better results in 3 exercises including Pick and Place, Ring and Rail, and Thread the Rings-1. However, none of the differences were found to be statistically significant (p>.05), and according to the overall scores based on the time to complete exercises, economy of motion, instrument collision, use of excessive instrument force, instruments out of view, and master workspace range, the scores were not statistically different between Groups I and II (p>.05). According to the basic robotic simulation exercise results, there was no difference between medical students who used to play video games and those who still played video games. Studies evaluating baseline visuospatial skills with larger sample sizes are needed.

  9. Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study.

    Science.gov (United States)

    McCoy, Lise; Pettit, Robin K; Lewis, Joy H; Allgood, J Aaron; Bay, Curt; Schwartz, Frederic N

    2016-01-16

    Student engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA. First year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach. Triangulation of findings between the four data sources indicate that VPS foster engagement in three facets: 1) Flow. In general, students enjoyed the activities, and were absorbed in the task at hand. 2) Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations. 3) Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions. Researchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.

  10. Teaching empathy to undergraduate medical students using a temporary tattoo simulating psoriasis.

    Science.gov (United States)

    Latham, Lesley; MacDonald, Aimee; Kimball, Alexa B; Langley, Richard G

    2012-07-01

    Psoriasis has a profound negative effect on quality of life that is often underappreciated by health care professionals and the public. We sought to assess the perception of the burden of psoriasis relative to other medical conditions in first-year medical students, and to determine if wearing a temporary tattoo simulating psoriasis during a teaching exercise would change their perceptions. Participants completed a questionnaire assessing their perception of the impact of psoriasis and other common medical conditions (visual analog scale). Participants then wore a temporary tattoo of a psoriatic lesion for 24 hours and completed the same questionnaire after this exercise. Of 91 students approached, 61 completed the study. At baseline, psoriasis (mean = 23.6) and eczema (mean = 23.3) were perceived as having the lowest physical burden of diseases queried (P mental impact of psoriasis was scored comparably with arthritis, heart disease, and diabetes (mean = 45.1-56.7), but lower than cancer (mean = 82.2) and depression (mean = 93.8). After the exercise, the perception of the impact of eczema (physical: mean = 37.3, P mental: mean = 66.6, P = .0005) and psoriasis (physical: mean = 37.8, P = .0014; mental: mean = 68.6, P = .0293) was significantly increased. The exercise did not simulate the chronic nature of psoriasis or the scaling and pruritic characteristics of psoriatic lesions. The survey instrument used to assess empathy has not been previously validated and statistical analysis was limited by small sample size and the absence of a control group. Temporary tattoos are a novel and effective method of teaching medical students about the psychological burden of psoriasis. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  11. Commissioning of a medical accelerator photon beam Monte Carlo simulation using wide-field profiles

    International Nuclear Information System (INIS)

    Pena, J; Franco, L; Gomez, F; Iglesias, A; Lobato, R; Mosquera, J; Pazos, A; Pardo, J; Pombar, M; RodrIguez, A; Sendon, J

    2004-01-01

    A method for commissioning an EGSnrc Monte Carlo simulation of medical linac photon beams through wide-field lateral profiles at moderate depth in a water phantom is presented. Although depth-dose profiles are commonly used for nominal energy determination, our study shows that they are quite insensitive to energy changes below 0.3 MeV (0.6 MeV) for a 6 MV (15 MV) photon beam. Also, the depth-dose profile dependence on beam radius adds an additional uncertainty in their use for tuning nominal energy. Simulated 40 cm x 40 cm lateral profiles at 5 cm depth in a water phantom show greater sensitivity to both nominal energy and radius. Beam parameters could be determined by comparing only these curves with measured data

  12. Commissioning of a medical accelerator photon beam Monte Carlo simulation using wide-field profiles

    Energy Technology Data Exchange (ETDEWEB)

    Pena, J [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Franco, L [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Gomez, F [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Iglesias, A [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Lobato, R [Hospital ClInico Universitario de Santiago, Santiago de Compostela (Spain); Mosquera, J [Hospital ClInico Universitario de Santiago, Santiago de Compostela (Spain); Pazos, A [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Pardo, J [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Pombar, M [Hospital ClInico Universitario de Santiago, Santiago de Compostela (Spain); RodrIguez, A [Departamento de Fisica de PartIculas, Facultade de Fisica, 15782 Santiago de Compostela (Spain); Sendon, J [Hospital ClInico Universitario de Santiago, Santiago de Compostela (Spain)

    2004-11-07

    A method for commissioning an EGSnrc Monte Carlo simulation of medical linac photon beams through wide-field lateral profiles at moderate depth in a water phantom is presented. Although depth-dose profiles are commonly used for nominal energy determination, our study shows that they are quite insensitive to energy changes below 0.3 MeV (0.6 MeV) for a 6 MV (15 MV) photon beam. Also, the depth-dose profile dependence on beam radius adds an additional uncertainty in their use for tuning nominal energy. Simulated 40 cm x 40 cm lateral profiles at 5 cm depth in a water phantom show greater sensitivity to both nominal energy and radius. Beam parameters could be determined by comparing only these curves with measured data.

  13. OntoVIP: an ontology for the annotation of object models used for medical image simulation.

    Science.gov (United States)

    Gibaud, Bernard; Forestier, Germain; Benoit-Cattin, Hugues; Cervenansky, Frédéric; Clarysse, Patrick; Friboulet, Denis; Gaignard, Alban; Hugonnard, Patrick; Lartizien, Carole; Liebgott, Hervé; Montagnat, Johan; Tabary, Joachim; Glatard, Tristan

    2014-12-01

    This paper describes the creation of a comprehensive conceptualization of object models used in medical image simulation, suitable for major imaging modalities and simulators. The goal is to create an application ontology that can be used to annotate the models in a repository integrated in the Virtual Imaging Platform (VIP), to facilitate their sharing and reuse. Annotations make the anatomical, physiological and pathophysiological content of the object models explicit. In such an interdisciplinary context we chose to rely on a common integration framework provided by a foundational ontology, that facilitates the consistent integration of the various modules extracted from several existing ontologies, i.e. FMA, PATO, MPATH, RadLex and ChEBI. Emphasis is put on methodology for achieving this extraction and integration. The most salient aspects of the ontology are presented, especially the organization in model layers, as well as its use to browse and query the model repository. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal?

    Science.gov (United States)

    Gordon, James A; Hayden, Emily M; Ahmed, Rami A; Pawlowski, John B; Khoury, Kimberly N; Oriol, Nancy E

    2010-02-01

    Flexner wanted medical students to study at the patient bedside-a remarkable innovation in his time-so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an "advanced" apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical-clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical-clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.

  15. Point-of-care ultrasound education: the increasing role of simulation and multimedia resources.

    Science.gov (United States)

    Lewiss, Resa E; Hoffmann, Beatrice; Beaulieu, Yanick; Phelan, Mary Beth

    2014-01-01

    This article reviews the current technology, literature, teaching models, and methods associated with simulation-based point-of-care ultrasound training. Patient simulation appears particularly well suited for learning point-of-care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low-fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High-fidelity simulators are usually high-tech and frequently consist of many computer-generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High-fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low- versus high-fidelity simulators are reviewed. An additional concept used in simulation-based ultrasound training is blended learning. Blended learning may include face-to-face or online learning often in combination with a learning management system. Increasingly, with simulation and Web-based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.

  16. A retrospective review of TATRC funding for medical modeling and simulation technologies.

    Science.gov (United States)

    Pugh, Carla M; Bevan, Matthew G; Duve, Rebecca J; White, Heather L; Magee, J Harvey; Wiehagen, Gene B

    2011-08-01

    In February 2000, the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC) and the U.S. Army's Simulation, Training, and Instrumentation Command cohosted an Integrated Research Team conference in Maryland. The goal of the conference was to enable end users, researchers, materiel developers, and other government agencies to present their conceptions of how modeling and simulation could and should be developed to meet military medical needs. During the past 9 years, TATRC has funded more than 175 projects relating to simulation. This study was a retrospective review of TATRC's Modeling and Simulation Training projects (N = 175). Our results show that most (>75%) of the funded projects in this study involved industry. More than 85% of the projects that involved industry focused on technology development. Industry development projects seemed to meet their deliverables in a timely fashion. However, academia projects using industry-developed technologies and prototypes were delayed largely because the technologies did not meet their needs. There seems to be a measurable gap between industry's definition of a completed product technology and academia's ability to implement and use the technology in interactive learning environments. Our findings support the need for a standardized strategic design process that involves a strong industry-academia collaboration and early end-user testing to better facilitate the development of sound requirements that guide technology development.

  17. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS

    Science.gov (United States)

    Chung, Kwangzoo; Kim, Jinsung; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-07-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles by using TOol for PArticle Simulation (TOPAS). At SMC proton therapy center, we have two gantry rooms with different types of nozzles: a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, the novel features of TOPAS, such as the time feature or the ridge filter class, have been used, and the appropriate physics models for proton nozzle simulation have been defined. Dosimetric properties, like percent depth dose curve, spreadout Bragg peak (SOBP), and beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported radiotherapy (RT) plan from the TPS is interpreted by using an interface and is then translated into the TOPAS input text. The developed Monte Carlo nozzle model can be used to estimate the non-beam performance, such as the neutron background, of the nozzles. Furthermore, the nozzle model can be used to study the mechanical optimization of the design of the nozzle.

  18. Fidelity approach in topological superconductors with disorders

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Wen-Chuan; Huang, Guang-Yao; Wang, Zhi, E-mail: physicswangzhi@gmail.com; Yao, Dao-Xin, E-mail: yaodaox@mail.sysu.edu.cn

    2015-03-20

    We apply the fidelity approach to study the topological superconductivity in spin–orbit coupling nanowire system. The wire is modeled as a one layer lattice chain with Zeeman energy and spin–orbit coupling, which is in proximity to a multi-layer superconductor. In particular, we study the effects of disorders and find that the fidelity susceptibility has multiple peaks. It is revealed that one peak indicates the topological quantum phase transition, while other peaks are signaling the pinning of the Majorana bound states by disorders. - Highlights: • We introduce fidelity approach to study the topological superconducting nanowire with disorders. • We study the quantum phase transition in the wire. • We investigate the disorder pinning of the Majorana bound states in the wire.

  19. Fidelity approach in topological superconductors with disorders

    International Nuclear Information System (INIS)

    Tian, Wen-Chuan; Huang, Guang-Yao; Wang, Zhi; Yao, Dao-Xin

    2015-01-01

    We apply the fidelity approach to study the topological superconductivity in spin–orbit coupling nanowire system. The wire is modeled as a one layer lattice chain with Zeeman energy and spin–orbit coupling, which is in proximity to a multi-layer superconductor. In particular, we study the effects of disorders and find that the fidelity susceptibility has multiple peaks. It is revealed that one peak indicates the topological quantum phase transition, while other peaks are signaling the pinning of the Majorana bound states by disorders. - Highlights: • We introduce fidelity approach to study the topological superconducting nanowire with disorders. • We study the quantum phase transition in the wire. • We investigate the disorder pinning of the Majorana bound states in the wire

  20. Unified universal quantum cloning machine and fidelities

    Energy Technology Data Exchange (ETDEWEB)

    Wang Yinan; Shi Handuo; Xiong Zhaoxi; Jing Li; Mu Liangzhu [School of Physics, Peking University, Beijing 100871 (China); Ren Xijun [School of Physics and Electronics, Henan University, Kaifeng 4750011 (China); Fan Heng [Institute of Physics, Chinese Academy of Sciences, Beijing 100190 (China)

    2011-09-15

    We present a unified universal quantum cloning machine, which combines several different existing universal cloning machines together, including the asymmetric case. In this unified framework, the identical pure states are projected equally into each copy initially constituted by input and one half of the maximally entangled states. We show explicitly that the output states of those universal cloning machines are the same. One importance of this unified cloning machine is that the cloning procession is always the symmetric projection, which reduces dramatically the difficulties for implementation. Also, it is found that this unified cloning machine can be directly modified to the general asymmetric case. Besides the global fidelity and the single-copy fidelity, we also present all possible arbitrary-copy fidelities.

  1. Fidelity susceptibility as holographic PV-criticality

    Energy Technology Data Exchange (ETDEWEB)

    Momeni, Davood, E-mail: davoodmomeni78@gmail.com [Eurasian International Center for Theoretical Physics and Department of General & Theoretical Physics, Eurasian National University, Astana 010008 (Kazakhstan); Faizal, Mir, E-mail: mirfaizalmir@googlemail.com [Department of Physics and Astronomy, University of Lethbridge, Lethbridge, Alberta T1K 3M4 (Canada); Irving K. Barber School of Arts and Sciences, University of British Columbia – Okanagan, 3333 University Way, Kelowna, British Columbia V1V 1V7 (Canada); Myrzakulov, Kairat, E-mail: kairatmyrzakul@gmail.com [Eurasian International Center for Theoretical Physics and Department of General & Theoretical Physics, Eurasian National University, Astana 010008 (Kazakhstan); Myrzakulov, Ratbay, E-mail: rmyrzakulov@gmail.com [Eurasian International Center for Theoretical Physics and Department of General & Theoretical Physics, Eurasian National University, Astana 010008 (Kazakhstan)

    2017-02-10

    It is well known that entropy can be used to holographically establish a connection among geometry, thermodynamics and information theory. In this paper, we will use complexity to holographically establish a connection among geometry, thermodynamics and information theory. Thus, we will analyze the relation among holographic complexity, fidelity susceptibility, and thermodynamics in extended phase space. We will demonstrate that fidelity susceptibility (which is the informational complexity dual to a maximum volume in AdS) can be related to the thermodynamical volume (which is conjugate to the cosmological constant in the extended thermodynamic phase space). Thus, this letter establishes a relation among geometry, thermodynamics, and information theory, using complexity.

  2. "More may mean less... " the role for simulation-based medical education in the cardiac catheterization laboratory.

    Science.gov (United States)

    Westerdahl, Daniel E; Henry, Timothy D

    2016-02-15

    Implementation of simulation-based medical education (SBME) can improve cardiovascular fellows' angiography skills and knowledge SBME focused on performing coronary angiography shortened procedure times and decreased the use of cine-fluoroscopy The ACGME mandate and SCAI's Simulation Committee recommendations suggest SBME will play an expanding and integral role in the field of cardiovascular medicine. © 2016 Wiley Periodicals, Inc.

  3. Simulation and virtual reality in medical education and therapy: a protocol.

    Science.gov (United States)

    Roy, Michael J; Sticha, Deborah L; Kraus, Patricia L; Olsen, Dale E

    2006-04-01

    Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.

  4. Accomplishments and challenges of surgical simulation.

    Science.gov (United States)

    Satava, R M

    2001-03-01

    For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.

  5. New hybrid voxelized/analytical primitive in Monte Carlo simulations for medical applications

    International Nuclear Information System (INIS)

    Bert, Julien; Lemaréchal, Yannick; Visvikis, Dimitris

    2016-01-01

    Monte Carlo simulations (MCS) applied in particle physics play a key role in medical imaging and particle therapy. In such simulations, particles are transported through voxelized phantoms derived from predominantly patient CT images. However, such voxelized object representation limits the incorporation of fine elements, such as artificial implants from CAD modeling or anatomical and functional details extracted from other imaging modalities. In this work we propose a new hYbrid Voxelized/ANalytical primitive (YVAN) that combines both voxelized and analytical object descriptions within the same MCS, without the need to simultaneously run two parallel simulations, which is the current gold standard methodology. Given that YVAN is simply a new primitive object, it does not require any modifications on the underlying MC navigation code. The new proposed primitive was assessed through a first simple MCS. Results from the YVAN primitive were compared against an MCS using a pure analytical geometry and the layer mass geometry concept. A perfect agreement was found between these simulations, leading to the conclusion that the new hybrid primitive is able to accurately and efficiently handle phantoms defined by a mixture of voxelized and analytical objects. In addition, two application-based evaluation studies in coronary angiography and intra-operative radiotherapy showed that the use of YVAN was 6.5% and 12.2% faster than the layered mass geometry method, respectively, without any associated loss of accuracy. However, the simplification advantages and differences in computational time improvements obtained with YVAN depend on the relative proportion of the analytical and voxelized structures used in the simulation as well as the size and number of triangles used in the description of the analytical object meshes. (paper)

  6. New hybrid voxelized/analytical primitive in Monte Carlo simulations for medical applications.

    Science.gov (United States)

    Bert, Julien; Lemaréchal, Yannick; Visvikis, Dimitris

    2016-05-07

    Monte Carlo simulations (MCS) applied in particle physics play a key role in medical imaging and particle therapy. In such simulations, particles are transported through voxelized phantoms derived from predominantly patient CT images. However, such voxelized object representation limits the incorporation of fine elements, such as artificial implants from CAD modeling or anatomical and functional details extracted from other imaging modalities. In this work we propose a new hYbrid Voxelized/ANalytical primitive (YVAN) that combines both voxelized and analytical object descriptions within the same MCS, without the need to simultaneously run two parallel simulations, which is the current gold standard methodology. Given that YVAN is simply a new primitive object, it does not require any modifications on the underlying MC navigation code. The new proposed primitive was assessed through a first simple MCS. Results from the YVAN primitive were compared against an MCS using a pure analytical geometry and the layer mass geometry concept. A perfect agreement was found between these simulations, leading to the conclusion that the new hybrid primitive is able to accurately and efficiently handle phantoms defined by a mixture of voxelized and analytical objects. In addition, two application-based evaluation studies in coronary angiography and intra-operative radiotherapy showed that the use of YVAN was 6.5% and 12.2% faster than the layered mass geometry method, respectively, without any associated loss of accuracy. However, the simplification advantages and differences in computational time improvements obtained with YVAN depend on the relative proportion of the analytical and voxelized structures used in the simulation as well as the size and number of triangles used in the description of the analytical object meshes.

  7. Monte Carlo simulation of a medical accelerator: application on a heterogeneous phantom

    International Nuclear Information System (INIS)

    Serrano, B.; Franchisseur, E.; Hachem, A.; Herault, J.; Marcie, S.; Bensadoun, R.J.

    2005-01-01

    The objective of this study is to seek an accurate and efficient method to calculate the dose distribution for small fields in high gradient heterogeneity, typical for Intensity Modulated Radiation Therapy (IMRT) technique on head and neck regions. This motivates a Monte Carlo (MC) simulation of the photon beam for the two nominal potential energies of 25 and 6 MV delivered by a medical linear electron accelerator (Linac) used at the Centre Antoine Lacassagne. These investigations were checked by means of an ionization chamber (IC). Some first adjustments on parameters given by the manufacturer for the 25 and the 6 MV data have been applied to optimize the adjustment between the IC and the MC simulation on the depth-dose and the dose profile distributions. The good agreement between the MC calculated and the measured data are only obtained when the mean energies of the electron beams are respectively 15 MeV and 5.2 MeV and the corresponding spot size diameter 2 and 3 mm. Once the validation of the MC simulation of the Linac is overcome, these results permit us in a second part to check the calculation data given by a treatment planning system (TPS) on a heterogeneous phantom. The result shows some discrepancies up to 7% between TPS and MC simulation. Those differences come from a bad approximation of the material density by the TPS. These encouraging results of the MC simulation will permit us afterwards to check the dose deposition given by the TPS on IMRT treatment. (authors)

  8. Cost: the missing outcome in simulation-based medical education research: a systematic review.

    Science.gov (United States)

    Zendejas, Benjamin; Wang, Amy T; Brydges, Ryan; Hamstra, Stanley J; Cook, David A

    2013-02-01

    The costs involved with technology-enhanced simulation remain unknown. Appraising the value of simulation-based medical education (SBME) requires complete accounting and reporting of cost. We sought to summarize the quantity and quality of studies that contain an economic analysis of SBME for the training of health professions learners. We performed a systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Articles reporting original research in any language evaluating the cost of simulation, in comparison with nonstimulation instruction or another simulation intervention, for training practicing and student physicians, nurses, and other health professionals were selected. Reviewers working in duplicate evaluated study quality and abstracted information on learners, instructional design, cost elements, and outcomes. From a pool of 10,903 articles we identified 967 comparative studies. Of these, 59 studies (6.1%) reported any cost elements and 15 (1.6%) provided information on cost compared with another instructional approach. We identified 11 cost components reported, most often the cost of the simulator (n = 42 studies; 71%) and training materials (n = 21; 36%). Ten potential cost components were never reported. The median number of cost components reported per study was 2 (range, 1-9). Only 12 studies (20%) reported cost in the Results section; most reported it in the Discussion (n = 34; 58%). Cost reporting in SBME research is infrequent and incomplete. We propose a comprehensive model for accounting and reporting costs in SBME. Copyright © 2013 Mosby, Inc. All rights reserved.

  9. Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing.

    Science.gov (United States)

    Harding, S R; D'Eon, M F

    2001-01-01

    Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

  10. Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.

    Science.gov (United States)

    Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

    2014-03-01

    Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p

  11. Electro-Quasistatic Simulations in Bio-Systems Engineering and Medical Engineering

    Directory of Open Access Journals (Sweden)

    U. van Rienen

    2005-01-01

    Full Text Available Slowly varying electromagnetic fields play a key role in various applications in bio-systems and medical engineering. Examples are the electric activity of neurons on neurochips used as biosensors, the stimulating electric fields of implanted electrodes used for deep brain stimulation in patients with Morbus Parkinson and the stimulation of the auditory nerves in deaf patients, respectively. In order to simulate the neuronal activity on a chip it is necessary to couple Maxwell's and Hodgkin-Huxley's equations. First numerical results for a neuron coupling to a single electrode are presented. They show a promising qualitative agreement with the experimentally recorded signals. Further, simulations are presented on electrodes for deep brain stimulation in animal experiments where the question of electrode ageing and energy deposition in the surrounding tissue are of major interest. As a last example, electric simulations for a simple cochlea model are presented comparing the field in the skull bones for different electrode types and stimulations in different positions.

  12. Applications of the Monte Carlo simulation in dosimetry and medical physics problems

    International Nuclear Information System (INIS)

    Rojas C, E. L.

    2010-01-01

    At the present time the computers use to solve important problems extends to all the areas. These areas can be of social, economic, of engineering, of basic and applied science, etc. With and appropriate handling of computation programs and information can be carried out calculations and simulations of real models, to study them and to solve theoretical or application problems. The processes that contain random variables are susceptible of being approached with the Monte Carlo method. This is a numeric method that, thanks to the improvements in the processors of the computers, it can apply in many tasks more than what was made in the principles of their practical application (at the beginning of the decade of 1950). In this work the application of the Monte Carlo method will be approached in the simulation of the radiation interaction with the matter, to investigate dosimetric aspects of some problems that exist in the medical physics area. Also, contain an introduction about some historical data and some general concepts related with the Monte Carlo simulation are revised. (Author)

  13. Negotiating frame ambiguity: a study of simulated encounters in medical education.

    Science.gov (United States)

    Seale, Clive; Butler, Christopher C; Hutchby, Ian; Kinnersley, Paul; Rollnick, Stephen

    2007-01-01

    We report an investigation of the sociolinguistic characteristics of simulated encounters (role plays) in medical education, focusing in particular on frame negotiation. The role played by context in influencing the nature of out-of-frame activity is noted through comparison with another published study of simulations (Linell and Thunqvist 2003). While in general sustaining a role-playing frame that involved an orientation to exact mimicry of clinical situations, the interactional work done to sustain this appearance of 'authenticity' at certain moments was revealed by out-of-frame utterances. One participating doctor in particular used humor to exploit the ambiguous realism of the role-playing frame. The success of this doctor in acquiring and applying new communication behaviors problematizes the view that 'realism', achieved through mimicry, is solely responsible for the success of training interventions. The implications for studying other kinds of simulated encounters, including an outline for a program of research into the sociolinguistics of acting tasks in general, are outlined. Sociolinguistic researchers involved in observational studies of talk would benefit from adopting the view that role-played, rehearsed, and even scripted talk of the sort used in dramatic performance is a variety of naturally occurring data and therefore worthy of study.

  14. High Fidelity Raman Chemical Imaging of Materials

    Science.gov (United States)

    Bobba, Venkata Nagamalli Koteswara Rao

    The development of high fidelity Raman imaging systems is important for a number of application areas including material science, bio-imaging, bioscience and healthcare, pharmaceutical analysis, and semiconductor characterization. The use of Raman imaging as a characterization tool for detecting the amorphous and crystalline regions in the biopolymer poly-L-lactic acid (PLLA) is the precis of my thesis. In the first chapter, a brief insight about the basics of Raman spectroscopy, Raman chemical imaging, Raman mapping, and Raman imaging techniques has been provided. The second chapter contains details about the successful development of tailored sample of PLLA. Biodegradable polymers are used in areas of tissue engineering, agriculture, packaging, and in medical field for drug delivery, implant devices, and surgical sutures. Detailed information about the sample preparation and characterization of these cold-drawn PLLA polymer substrates has been provided. Wide-field Raman hyperspectral imaging using an acousto-optic tunable filter (AOTF) was demonstrated in the early 1990s. The AOTF contributed challenges such as image walk, distortion, and image blur. A wide-field AOTF Raman imaging system has been developed as part of my research and methods to overcome some of the challenges in performing AOTF wide-field Raman imaging are discussed in the third chapter. This imaging system has been used for studying the crystalline and amorphous regions on the cold-drawn sample of PLLA. Of all the different modalities that are available for performing Raman imaging, Raman point-mapping is the most extensively used method. The ease of obtaining the Raman hyperspectral cube dataset with a high spectral and spatial resolution is the main motive of performing this technique. As a part of my research, I have constructed a Raman point-mapping system and used it for obtaining Raman hyperspectral image data of various minerals, pharmaceuticals, and polymers. Chapter four offers

  15. Information, entropy, and fidelity in visual communication

    Science.gov (United States)

    Huck, Friedrich O.; Fales, Carl L.; Alter-Gartenberg, Rachel; Rahman, Zia-ur

    1992-10-01

    This paper presents an assessment of visual communication that integrates the critical limiting factors of image gathering an display with the digital processing that is used to code and restore images. The approach focuses on two mathematical criteria, information and fidelity, and on their relationships to the entropy of the encoded data and to the visual quality of the restored image.

  16. A new universal colour image fidelity metric

    NARCIS (Netherlands)

    Toet, A.; Lucassen, M.P.

    2003-01-01

    We extend a recently introduced universal grayscale image quality index to a newly developed perceptually decorrelated colour space. The resulting colour image fidelity metric quantifies the distortion of a processed colour image relative to its original version. We evaluated the new colour image

  17. Information, entropy and fidelity in visual communication

    Science.gov (United States)

    Huck, Friedrich O.; Fales, Carl L.; Alter-Gartenberg, Rachel; Rahman, Zia-Ur

    1992-01-01

    This paper presents an assessment of visual communication that integrates the critical limiting factors of image gathering and display with the digital processing that is used to code and restore images. The approach focuses on two mathematical criteria, information and fidelity, and on their relationships to the entropy of the encoded data and to the visual quality of the restored image.

  18. Fixed versus variable practice for teaching medical students the management of pediatric asthma exacerbations using simulation.

    Science.gov (United States)

    Drummond, David; Truchot, Jennifer; Fabbro, Eleonora; Ceccaldi, Pierre-François; Plaisance, Patrick; Tesnière, Antoine; Hadchouel, Alice

    2018-02-01

    Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations (PAEs). In this study, we compared two pedagogical approaches, training students once on three different scenarios of PAEs versus training students three times on the same scenario of PAE. Eighty-five third-year medical students, novice learners for the management of PAEs, were randomized and trained. Students were assessed twice, 1 week and 4 months after the training, on a scenario of PAE new to both groups and on scenarios used during the training. The main outcome was the performance score on the new scenario of PAE at 1 week, assessed on a checklist custom-designed for the study. All students progressed rapidly and acquired excellent skills. One week after the training, there was no difference between the two groups on all the scenarios tested, including the new scenario of PAE (median performance score (IQR) of 8.3 (7.4-10.0) in the variation group versus 8.0 (6.0-10.0) in the repetition group (p = 0.16)). Four months later, the performance of the two groups remained similar. Varying practice with different scenarios was equivalent to repetitive practice on the same scenario for novice learners, with both methods leading to transfer and long-term retention of the skills acquired during the training. What is known: • Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations. • It is unclear whether students would benefit more from repetitive practice on the same scenario of asthma exacerbation or from practice on different scenarios in terms of transfer of skills. What is new: • An individual 30-min training on the management of pediatric asthma exacerbations using simulation allows transfer and long-term retention of the skills acquired. • Varying practice with different scenarios is equivalent to repetitive practice on the same

  19. Model-implementation fidelity in cyber physical system design

    CERN Document Server

    Fabre, Christian

    2017-01-01

    This book puts in focus various techniques for checking modeling fidelity of Cyber Physical Systems (CPS), with respect to the physical world they represent. The authors' present modeling and analysis techniques representing different communities, from very different angles, discuss their possible interactions, and discuss the commonalities and differences between their practices. Coverage includes model driven development, resource-driven development, statistical analysis, proofs of simulator implementation, compiler construction, power/temperature modeling of digital devices, high-level performance analysis, and code/device certification. Several industrial contexts are covered, including modeling of computing and communication, proof architectures models and statistical based validation techniques. Addresses CPS design problems such as cross-application interference, parsimonious modeling, and trustful code production Describes solutions, such as simulation for extra-functional properties, extension of cod...

  20. Use of simulation-based medical training in Swiss pediatric hospitals: a national survey.

    Science.gov (United States)

    Stocker, Martin; Laine, Kathryn; Ulmer, Francis

    2017-06-17

    Simulation-based medical training (SBMT) is a powerful tool for continuing medical education. In contrast to the Anglo-Saxon medical education community, up until recently, SBMT was scarce in continental Europe's pediatric health care education: In 2009, only 3 Swiss pediatric health care institutions used SBMT. The Swiss catalogue of objectives in Pediatrics does not acknowledge SBMT. The aim of this survey is to describe and analyze the current state of SBMT in Swiss pediatric hospitals and health care departments. A survey was carried out with medical education representatives of every institution. SBMT was defined as any kind of training with a mannequin excluding national and/or international standardized courses. The survey reference day was May 31st 2015. Thirty Swiss pediatric hospitals and health care departments answered our survey (response rate 96.8%) with 66.6% (20 out of 30) offering SBMT. Four of the 20 hospitals offering SMBT had two independently operating training simulation units, resulting in 24 educational units as the basis for our SBMT analysis. More than 90% of the educational units offering SBMT (22 out of 24 units) were conducting in-situ training and 62.5% (15 out of 24) were using high-technology mannequins. Technical skills, communication and leadership ranked among the top training priorities. All institutions catered to inter-professional participants. The vast majority conducted training that was neither embedded within a larger educational curriculum (19 out of 24: 79.2%) nor evaluated (16 out of 24: 66.6%) by its participants. Only 5 institutions (20.8%) extended their training to at least two thirds of their hospital staff. Two thirds of the Swiss pediatric hospitals and health care departments are offering SBMT. Swiss pediatric SBMT is inter-professional, mainly in-situ based, covering technical as well as non-technical skills, and often employing high-technology mannequins. The absence of a systematic approach and reaching only

  1. Medical Simulation as a Vital Adjunct to Identifying Clinical Life-Threatening Gaps in Austere Environments.

    Science.gov (United States)

    Chima, Adaora M; Koka, Rahul; Lee, Benjamin; Tran, Tina; Ogbuagu, Onyebuchi U; Nelson-Williams, Howard; Rosen, Michael; Koroma, Michael; Sampson, John B

    2018-04-01

    Maternal mortality and morbidity are major causes of death in low-resource countries, especially those in Sub-Saharan Africa. Healthcare workforce scarcities present in these locations result in poor perioperative care access and quality. These scarcities also limit the capacity for progressive development and enhancement of workforce training, and skills through continuing medical education. Newly available low-cost, in-situ simulation systems make it possible for a small cadre of trainers to use simulation to identify areas needing improvement and to rehearse best practice approaches, relevant to the context of target environments. Nurse anesthetists were recruited throughout Sierra Leone to participate in simulation-based obstetric anesthesia scenarios at the country's national referral maternity hospital. All subjects participated in a detailed computer assisted training program to familiarize themselves with the Universal Anesthesia Machine (UAM). An expert panel rated the morbidity/mortality risk of pre-identified critical incidents within the scenario via the Delphi process. Participant responses to critical incidents were observed during these scenarios. Participants had an obstetric anesthesia pretest and post-test as well as debrief sessions focused on reviewing the significance of critical incident responses observed during the scenario. 21 nurse anesthetists, (20% of anesthesia providers nationally) participated. Median age was 41 years and median experience practicing anesthesia was 3.5 years. Most participants (57.1%) were female, two-thirds (66.7%) performed obstetrics anesthesia daily but 57.1% had no experience using the UAM. During the simulation, participants were observed and assessed on critical incident responses for case preparation with a median score of 7 out of 13 points, anesthesia management with a median score of 10 out of 20 points and rapid sequence intubation with a median score of 3 out of 10 points. This study identified

  2. A physics based method for combining multiple anatomy models with application to medical simulation.

    Science.gov (United States)

    Zhu, Yanong; Magee, Derek; Ratnalingam, Rishya; Kessel, David

    2009-01-01

    We present a physics based approach to the construction of anatomy models by combining components from different sources; different image modalities, protocols, and patients. Given an initial anatomy, a mass-spring model is generated which mimics the physical properties of the solid anatomy components. This helps maintain valid spatial relationships between the components, as well as the validity of their shapes. Combination can be either replacing/modifying an existing component, or inserting a new component. The external forces that deform the model components to fit the new shape are estimated from Gradient Vector Flow and Distance Transform maps. We demonstrate the applicability and validity of the described approach in the area of medical simulation, by showing the processes of non-rigid surface alignment, component replacement, and component insertion.

  3. Monte Carlo simulation of a medical linear accelerator for radiotherapy use

    International Nuclear Information System (INIS)

    Serrano, B.; Hachem, A.; Franchisseur, E.; Herault, J.; Marcie, S.; Costa, A.; Bensadoun, R. J.; Barthe, J.; Gerard, J. P.

    2006-01-01

    A Monte Carlo code MCNPX (Monte Carlo N-particle) was used to model a 25 MV photon beam from a PRIMUS (KD2-Siemens) medical linear electron accelerator at the Centre Antoine Lacassagne in Nice. The entire geometry including the accelerator head and the water phantom was simulated to calculate the dose profile and the relative depth-dose distribution. The measurements were done using an ionisation chamber in water for different square field ranges. The first results show that the mean electron beam energy is not 19 MeV as mentioned by Siemens. The adjustment between the Monte Carlo calculated and measured data is obtained when the mean electron beam energy is ∼15 MeV. These encouraging results will permit to check calculation data given by the treatment planning system, especially for small fields in high gradient heterogeneous zones, typical for intensity modulated radiation therapy technique. (authors)

  4. Semi-automatic watershed medical image segmentation methods for customized cancer radiation treatment planning simulation

    International Nuclear Information System (INIS)

    Kum Oyeon; Kim Hye Kyung; Max, N.

    2007-01-01

    A cancer radiation treatment planning simulation requires image segmentation to define the gross tumor volume, clinical target volume, and planning target volume. Manual segmentation, which is usual in clinical settings, depends on the operator's experience and may, in addition, change for every trial by the same operator. To overcome this difficulty, we developed semi-automatic watershed medical image segmentation tools using both the top-down watershed algorithm in the insight segmentation and registration toolkit (ITK) and Vincent-Soille's bottom-up watershed algorithm with region merging. We applied our algorithms to segment two- and three-dimensional head phantom CT data and to find pixel (or voxel) numbers for each segmented area, which are needed for radiation treatment optimization. A semi-automatic method is useful to avoid errors incurred by both human and machine sources, and provide clear and visible information for pedagogical purpose. (orig.)

  5. A simulation-based curriculum to introduce key teamwork principles to entering medical students.

    Science.gov (United States)

    Banerjee, Arna; Slagle, Jason M; Mercaldo, Nathaniel D; Booker, Ray; Miller, Anne; France, Daniel J; Rawn, Lisa; Weinger, Matthew B

    2016-11-16

    Failures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams. As part of a new "Foundations" core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students' anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students' course evaluations, faculty reflection, and debriefing, the course changed and matured. Four hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their "Decision Making Abilities" (OR 1.69, 95% CI 1.07-2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28-3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises. This

  6. Some like it hot: medical student views on choosing the emotional level of a simulation.

    Science.gov (United States)

    Lefroy, Janet; Brosnan, Caragh; Creavin, Sam

    2011-04-01

    This study aimed to determine the impact of giving junior medical students control over the level of emotion expressed by a simulated patient (SP) in a teaching session designed to prepare students to handle emotions when interviewing real patients on placements.   Year 1 medical students at Keele University School of Medicine were allowed to set the degree of emotion to be displayed by the SP in their first 'emotional interview'. This innovation was evaluated by mixed methods in two consecutive academic years as part of an action research project, along with other developments in a new communications skills curriculum. Questionnaires were completed after the first and second iterations by students, tutors and SPs. Sixteen students also participated in evaluative focus group discussions at the end of Year 1. Most students found the 'emotion-setting switch' helpful, both when interviewing the SP and when observing. Student-interviewers were helped by the perception that they had control over the difficulty of the task. Student-observers found it helpful to see the different levels of emotion and to think about how they might empathise with patients. By contrast, some students found the 'control switch' unnecessary or even unhelpful. These students felt that challenge was good for them and preferred not to be given the option of reducing it. The emotional level control was a useful innovation for most students and may potentially be used in any first encounter with challenging simulation. We suggest that it addresses innate needs for competence and autonomy. The insights gained enable us to suggest ways of building the element of choice into such sessions. The disadvantages of choice highlighted by some students should be surmountable by tutor 'scaffolding' of the learning for both student-interviewers and student-observers. © Blackwell Publishing Ltd 2011.

  7. Route Fidelity during Marine Megafauna Migration

    Directory of Open Access Journals (Sweden)

    Travis W. Horton

    2017-12-01

    Full Text Available The conservation and protection of marine megafauna require robust knowledge of where and when animals are located. Yet, our ability to predict animal distributions in space and time remains limited due to difficulties associated with studying elusive animals with large home ranges. The widespread deployment of satellite telemetry technology creates unprecedented opportunities to remotely monitor animal movements and to analyse the spatial and temporal trajectories of these movements from a variety of geophysical perspectives. Reproducible patterns in movement trajectories can help elucidate the potential mechanisms by which marine megafauna navigate across vast expanses of open-ocean. Here, we present an empirical analysis of humpback whale (Megaptera novaeangliae, great white shark (Carcharodon carcharias, and northern elephant seal (Mirounga angustirostris satellite telemetry-derived route fidelity movements in magnetic and gravitational coordinates. Our analyses demonstrate that: (1 humpback whales, great white sharks and northern elephant seals are capable of performing route fidelity movements across millions of square kilometers of open ocean with a spatial accuracy of better than 150 km despite temporal separations as long as 7 years between individual movements; (2 route fidelity movements include significant (p < 0.05 periodicities that are comparable in duration to the lunar cycles and semi-cycles; (3 latitude and bedrock-dependent gravitational cues are stronger predictors of route fidelity movements than spherical magnetic coordinate cues when analyzed with respect to the temporally dependent moon illumination cycle. We further show that both route fidelity and non-route fidelity movement trajectories, for all three species, describe overlapping in-phase or antiphase sinusoids when individual movements are normalized to the gravitational acceleration present at migratory departure sites. Although these empirical results provide an

  8. Medical simulation: a tool for recognition of and response to risk

    International Nuclear Information System (INIS)

    Ruddy, Richard M.; Deffner Patterson, Mary

    2008-01-01

    The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children. (orig.)

  9. Medical simulation: a tool for recognition of and response to risk.

    Science.gov (United States)

    Ruddy, Richard M; Patterson, Mary Deffner

    2008-11-01

    The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children.

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

    Science.gov (United States)

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

    2012-07-01

    Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis. A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist. 98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8 ± 12.0% vs 65.4 ± 12.2%, pdidactic lectures followed by simulation experience.

  11. Evaluation of an interactive case simulation system in dermatology and venereology for medical students

    Directory of Open Access Journals (Sweden)

    Hindbeck Hans

    2006-08-01

    Full Text Available Abstract Background Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. Methods Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85 or conventional teaching plus NUDOV (n = 31 and comparing the results of the two groups in a final written examination. Results The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. Conclusion We created a computerised case simulation program allowing students to manage patients in a non

  12. Simulated disclosure of a medical error by residents: development of a course in specific communication skills.

    Science.gov (United States)

    Raper, Steven E; Resnick, Andrew S; Morris, Jon B

    2014-01-01

    Surgery residents are expected to demonstrate the ability to communicate with patients, families, and the public in a wide array of settings on a wide variety of issues. One important setting in which residents may be required to communicate with patients is in the disclosure of medical error. This article details one approach to developing a course in the disclosure of medical errors by residents. Before the development of this course, residents had no education in the skills necessary to disclose medical errors to patients. Residents viewed a Web-based video didactic session and associated slide deck and then were filmed disclosing a wrong-site surgery to a standardized patient (SP). The filmed encounter was reviewed by faculty, who then along with the SP scored each encounter (5-point Likert scale) over 10 domains of physician-patient communication. The residents received individualized written critique, the numerical analysis of their individual scenario, and an opportunity to provide feedback over a number of domains. A mean score of 4.00 or greater was considered satisfactory. Faculty and SP assessments were compared with Student t test. Residents were filmed in a one-on-one scenario in which they had to disclose a wrong-site surgery to a SP in a Simulation Center. A total of 12 residents, shortly to enter the clinical postgraduate year 4, were invited to participate, as they will assume service leadership roles. All were finishing their laboratory experiences, and all accepted the invitation. Residents demonstrated satisfactory competence in 4 of the 10 domains assessed by the course faculty. There were significant differences in the perceptions of the faculty and SP in 5 domains. The residents found this didactic, simulated experience of value (Likert score ≥4 in 5 of 7 domains assessed in a feedback tool). Qualitative feedback from the residents confirmed the realistic feel of the encounter and other impressions. We were able to quantitatively

  13. The "resident's dilemma"? Values and strategies of medical residents for education interactions: a cellular automata simulation.

    Science.gov (United States)

    Heckerling, P S; Gerber, B S; Weiner, S J

    2006-01-01

    Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work. Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions. Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value. Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.

  14. Fidel Castro: the word that unites

    Directory of Open Access Journals (Sweden)

    Grisel Veloz-Fernández

    2016-09-01

    Full Text Available The present work carries out a boarding of Fidel Castro's political speech, leaving of an understanding of its renovating character inside the most complex historical segment in the revolutionary process that is the period 1959 - 1961. It is during the same one that in Cuba a consent arms to the socialism. That achievement relapses fundamentally in Fidel's leadership and its capacity to negotiate the nucleus of ideas and values of that process through the political speech. Analyzed around 72 documents a characterization of that speech it has been achieved in benefit of their current utility. Presently work takes as starting point the conditions that existed in our country to the revolutionary victory that were the material base of an authentic revolution of the political speech in Cuba and the world like interaction form and transmission of political ideas as regards talkative resources.

  15. Fidelity, entanglement, and information complementarity relation

    International Nuclear Information System (INIS)

    Cai, Jian-Ming; Zhou, Zheng-Wei; Guo, Guang-Can

    2007-01-01

    We investigate the dynamics of information in isolated multi-qubit systems. It is shown that information is in not only local form but also nonlocal form. We apply a measure of local information based on fidelity, and demonstrate that nonlocal information can be directly related to some appropriate well defined entanglement measures. Under general unitary transformations, local and nonlocal information will exhibit unambiguous complementary behavior with the total information conserved

  16. Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education.

    Science.gov (United States)

    Makransky, Guido; Bonde, Mads T; Wulff, Julie S G; Wandall, Jakob; Hood, Michelle; Creed, Peter A; Bache, Iben; Silahtaroglu, Asli; Nørremølle, Anne

    2016-03-25

    Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making. An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical practice were demonstrated. Knowledge (Cohen's d = 0.73), intrinsic motivation (d = 0.24), and self-efficacy (d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge (d = 3.35) and self-efficacy (d = 0.61), but a non-significant increase in intrinsic motivation (d = 0.22). The medium and high knowledge students showed significant increases in knowledge (d = 1.45 and 0.36, respectively), motivation (d = 0.22 and 0.31), and self-efficacy (d = 0.36 and 0.52, respectively). Additionally, 90 % of students reported a greater understanding of medical genetics, 82 % thought that medical genetics was more interesting, 93 % indicated that they were more interested and motivated, and had gained confidence by having experienced working on a case story that resembled the real working situation of a doctor, and 78 % indicated that they would feel more confident counseling a patient after the simulation. The simulation based learning environment increased students' learning, intrinsic motivation, and

  17. Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance.

    Science.gov (United States)

    Bommer, Cassidy; Sullivan, Sarah; Campbell, Krystle; Ahola, Zachary; Agarwal, Suresh; O'Rourke, Ann; Jung, Hee Soo; Gibson, Angela; Leverson, Glen; Liepert, Amy E

    2018-02-01

    We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making. Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course. Scenarios were completed on day 2 and day 9. Prior to the first simulation, participants were randomly divided into two groups. Only one group received a pre-simulation orientation. Before the second simulation, all students received the same orientation. Learner anxiety was reported immediately preceding and following each simulation. Confidence was assessed post-simulation. Performance was evaluated by surgical faculty. The oriented group experienced decreased anxiety following the first simulation (p = 0.003); the control group did not. Compared to the control group, the oriented group reported less anxiety and greater confidence and received higher performance scores following all three simulations (all p simulation orientation reduces anxiety while increasing confidence and improving performance. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Simulation of an image network in a medical image information system

    International Nuclear Information System (INIS)

    Massar, A.D.A.; De Valk, J.P.J.; Reijns, G.L.; Bakker, A.R.

    1985-01-01

    The desirability of an integrated (digital) communication system for medical images is widely accepted. In the USA and in Europe several experimental projects are in progress to realize (a part of) such a system. Among these is the IMAGIS project in the Netherlands. From the conclusions of the preliminary studies performed, some requirements can be formulated such a system should meet in order to be accepted by its users. For example, the storage resolution of the images should match the maximum resolution of the presently acquired digital images. This determines the amount of data and therefore the storage requirements. Further, the desired images should be there when needed. This time constraint determines the speed requirements to be imposed on the system. As compared to current standards, very large storage capacities and very fast communication media are needed to meet these requirements. By employing cacheing techniques and suitable data compression schemes for the storage and by carefully choosing the network protocols, bare capacity demands can be alleviated. A communication network is needed to make the imaging system available over a larger area. As the network is very likely to become a major bottleneck for system performance, effects of variation of various attributes have to be carefully studied and analysed. After interesting results had been obtained (although preliminary) using a simulation model for a layered storage structure, it was decided to apply simulation also to this problem. Effects of network topology, access protocols and buffering strategies will be tested. Changes in performance resulting from changes in various network parameters will be studied. Results of this study at its present state are presented

  19. Evaluation of medical countermeasures against organophosphorus compounds: the value of experimental data and computer simulations.

    Science.gov (United States)

    Worek, Franz; Aurbek, Nadine; Herkert, Nadja M; John, Harald; Eddleston, Michael; Eyer, Peter; Thiermann, Horst

    2010-09-06

    Despite extensive research for more than six decades on medical countermeasures against poisoning by organophosphorus compounds (OP) the treatment options are meagre. The presently established acetylcholinesterase (AChE) reactivators (oximes), e.g. obidoxime and pralidoxime, are insufficient against a number of nerve agents and there is ongoing debate on the benefit of oxime treatment in human OP pesticide poisoning. Up to now, the therapeutic efficacy of oximes was mostly evaluated in animal models but substantial species differences prevent direct extrapolation of animal data to humans. Hence, it was considered essential to establish relevant experimental in vitro models for the investigation of oximes as antidotes and to develop computer models for the simulation of oxime efficacy in different scenarios of OP poisoning. Kinetic studies on the various interactions between erythrocyte AChE from various species, structurally different OP and different oximes provided a basis for the initial assessment of the ability of oximes to reactivate inhibited AChE. In the present study, in vitro enzyme-kinetic and pharmacokinetic data from a minipig model of dimethoate poisoning and oxime treatment were used to calculate dynamic changes of AChE activities. It could be shown that there is a close agreement between calculated and in vivo AChE activities. Moreover, computer simulations provided insight into the potential and limitations of oxime treatment. In the end, such data may be a versatile tool for the ongoing discussion of the pros and cons of oxime treatment in human OP pesticide poisoning. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  20. The effect of medical trainees on pediatric emergency department flow: a discrete event simulation modeling study.

    Science.gov (United States)

    Genuis, Emerson D; Doan, Quynh

    2013-11-01

    Providing patient care and medical education are both important missions of teaching hospital emergency departments (EDs). With medical school enrollment rising, and ED crowding becoming an increasing prevalent issue, it is important for both pediatric EDs (PEDs) and general EDs to find a balance between these two potentially competing goals. The objective was to determine how the number of trainees in a PED affects patient wait time, total ED length of stay (LOS), and rates of patients leaving without being seen (LWBS) for PED patients overall and stratified by acuity level as defined by the Pediatric Canadian Triage and Acuity Scale (CTAS) using discrete event simulation (DES) modeling. A DES model of an urban tertiary care PED, which receives approximately 40,000 visits annually, was created and validated. Thirteen different trainee schedules, which ranged from averaging zero to six trainees per shift, were input into the DES model and the outcome measures were determined using the combined output of five model iterations. An increase in LOS of approximately 7 minutes was noted to be associated with each additional trainee per attending emergency physician working in the PED. The relationship between the number of trainees and wait time varied with patients' level of acuity and with the degree of PED utilization. Patient wait time decreased as the number of trainees increased for low-acuity visits and when the PED was not operating at full capacity. With rising numbers of trainees, the PED LWBS rate decreased in the whole department and in the CTAS 4 and 5 patient groups, but it rose in patients triaged CTAS 3 or higher. A rising numbers of trainees was not associated with any change to flow outcomes for CTAS 1 patients. The results of this study demonstrate that trainees in PEDs have an impact mainly on patient LOS and that the effect on wait time differs between patients presenting with varying degrees of acuity. These findings will assist PEDs in finding a

  1. Simulation-Based Medical Education Is No Better than Problem-Based Discussions and Induces Misjudgment in Self-Assessment

    Science.gov (United States)

    Wenk, Manuel; Waurick, Rene; Schotes, David; Wenk, Melanie; Gerdes, Christina; Van Aken, Hugo K.; Popping, Daniel M.

    2009-01-01

    Simulation-based teaching (SBT) is increasingly used in medical education. As an alternative to other teaching methods there is a lack of evidence concerning its efficacy. The aim of this study was to evaluate the potency of SBT in anesthesia in comparison to problem-based discussion (PBD) with students in a randomized controlled setting.…

  2. National Clinical Skills Competition: an effective simulation-based method to improve undergraduate medical education in China

    Directory of Open Access Journals (Sweden)

    Guanchao Jiang

    2016-02-01

    Full Text Available Background: The National Clinical Skills Competition has been held in China for 5 consecutive years since 2010 to promote undergraduate education reform and improve the teaching quality. The effects of the simulation-based competition will be analyzed in this study. Methods: Participation in the competitions and the compilation of the questions used in the competition finals are summarized, and the influence and guidance quality are further analyzed. Through the nationwide distribution of questionnaires in medical colleges, the effects of the simulation-based competition on promoting undergraduate medical education reform were evaluated. Results: The results show that approximately 450 students from more than 110 colleges (accounting for 81% of colleges providing undergraduate clinical medical education in China participated in the competition each year. The knowledge, skills, and attitudes were comprehensively evaluated by simulation-based assessment. Eight hundred and eighty copies of the questionnaires were distributed to 110 participating medical schools in 2015. In total, 752 valid responses were received across 95 schools. The majority of the interviewees agreed or strongly agreed that competition promoted the adoption of advanced educational principles (76.8%, updated the curriculum model and instructional methods (79.8%, strengthened faculty development (84.0%, improved educational resources (82.1%, and benefited all students (53.4%. Conclusions: The National Clinical Skills Competition is widely accepted in China. It has effectively promoted the reform and development of undergraduate medical education in China.

  3. American College of Surgeons/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment.

    Science.gov (United States)

    Glass, Charity C; Acton, Robert D; Blair, Patrice G; Campbell, Andre R; Deutsch, Ellen S; Jones, Daniel B; Liscum, Kathleen R; Sachdeva, Ajit K; Scott, Daniel J; Yang, Stephen C

    2014-02-01

    Simulation can enhance learning effectiveness, efficiency, and patient safety and is engaging for learners. A survey was conducted of surgical clerkship directors nationally and medical students at 5 medical schools to rank and stratify simulation-based educational topics. Students applying to surgery were compared with others using Wilcoxon's rank-sum tests. Seventy-three of 163 clerkship directors (45%) and 231 of 872 students (26.5%) completed the survey. Of students, 28.6% were applying for surgical residency training. Clerkship directors and students generally agreed on the importance and timing of specific educational topics. Clerkship directors tended to rank basic skills, such as examination skills, higher than medical students. Students ranked procedural skills, such as lumbar puncture, more highly than clerkship directors. Surgery clerkship directors and 4th-year medical students agree substantially about the content of a simulation-based curriculum, although 4th-year medical students recommended that some topics be taught earlier than the clerkship directors recommended. Students planning to apply to surgical residencies did not differ significantly in their scoring from students pursuing nonsurgical specialties. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. National Clinical Skills Competition: an effective simulation-based method to improve undergraduate medical education in China.

    Science.gov (United States)

    Jiang, Guanchao; Chen, Hong; Wang, Qiming; Chi, Baorong; He, Qingnan; Xiao, Haipeng; Zhou, Qinghuan; Liu, Jing; Wang, Shan

    2016-01-01

    The National Clinical Skills Competition has been held in China for 5 consecutive years since 2010 to promote undergraduate education reform and improve the teaching quality. The effects of the simulation-based competition will be analyzed in this study. Participation in the competitions and the compilation of the questions used in the competition finals are summarized, and the influence and guidance quality are further analyzed. Through the nationwide distribution of questionnaires in medical colleges, the effects of the simulation-based competition on promoting undergraduate medical education reform were evaluated. The results show that approximately 450 students from more than 110 colleges (accounting for 81% of colleges providing undergraduate clinical medical education in China) participated in the competition each year. The knowledge, skills, and attitudes were comprehensively evaluated by simulation-based assessment. Eight hundred and eighty copies of the questionnaires were distributed to 110 participating medical schools in 2015. In total, 752 valid responses were received across 95 schools. The majority of the interviewees agreed or strongly agreed that competition promoted the adoption of advanced educational principles (76.8%), updated the curriculum model and instructional methods (79.8%), strengthened faculty development (84.0%), improved educational resources (82.1%), and benefited all students (53.4%). The National Clinical Skills Competition is widely accepted in China. It has effectively promoted the reform and development of undergraduate medical education in China.

  5. Assessment of the production of medical isotopes using the Monte Carlo code FLUKA: Simulations against experimental measurements

    Energy Technology Data Exchange (ETDEWEB)

    Infantino, Angelo, E-mail: angelo.infantino@unibo.it [Department of Industrial Engineering, Montecuccolino Laboratory, University of Bologna, Via dei Colli 16, 40136 Bologna (Italy); Oehlke, Elisabeth [TRIUMF, 4004 Wesbrook Mall, V6T 2A3 Vancouver, BC (Canada); Department of Radiation Science & Technology, Delft University of Technology, Postbus 5, 2600 AA Delft (Netherlands); Mostacci, Domiziano [Department of Industrial Engineering, Montecuccolino Laboratory, University of Bologna, Via dei Colli 16, 40136 Bologna (Italy); Schaffer, Paul; Trinczek, Michael; Hoehr, Cornelia [TRIUMF, 4004 Wesbrook Mall, V6T 2A3 Vancouver, BC (Canada)

    2016-01-01

    The Monte Carlo code FLUKA is used to simulate the production of a number of positron emitting radionuclides, {sup 18}F, {sup 13}N, {sup 94}Tc, {sup 44}Sc, {sup 68}Ga, {sup 86}Y, {sup 89}Zr, {sup 52}Mn, {sup 61}Cu and {sup 55}Co, on a small medical cyclotron with a proton beam energy of 13 MeV. Experimental data collected at the TR13 cyclotron at TRIUMF agree within a factor of 0.6 ± 0.4 with the directly simulated data, except for the production of {sup 55}Co, where the simulation underestimates the experiment by a factor of 3.4 ± 0.4. The experimental data also agree within a factor of 0.8 ± 0.6 with the convolution of simulated proton fluence and cross sections from literature. Overall, this confirms the applicability of FLUKA to simulate radionuclide production at 13 MeV proton beam energy.