Simulation-based mastery learning in gastrointestinal endoscopy training

Simulation-based mastery learning(SBML)is an emerging form of competencybased training that has been proposed as the next standard method for procedural task training,including that in gastr-ointestinal endoscopy.Current basic gastrointestinal endoscopy training relies on the number of procedures performed,and it has been criticized for its lack of objective standards that result in variable skills among trainees and its association with patient safety risk.Thus,incorporating simulators into a competency-based curriculum seems ideal for gastrointestinal endoscopy training.The curriculum for SBML in gastrointestinal endoscopy is currently being developed and has promising potential to translate into the clinical performance.Unlike the present apprenticeship model of“see one,do one,teach one,”SBML integrates a competency-based curriculum with specific learning objectives alongside simulation-based training.This allows trainees to practice essential skills repeatedly,receive feedback from experts,and gradually develop their abilities to achieve mastery.Moreover,trainees and trainers need to understand the learning targets of the program so that trainees can focus their learning on the necessary skills and trainers can provide structured feedback based on the expected outcomes.In addition to learning targets,an assessment plan is essential to provide trainees with future directions for their improvement and ensure patient safety by issuing a passing standard.Finally,the SBML program should be planned and managed by a specific team and conducted within a developed and tested curriculum.This review discusses the current state of gastr-ointestinal endoscopy training and the role of SBML in that field.

A DISPATCHER TRAINING SIMULATOR SYSTEM INTEGRATED WITH THE EXIST SCADA/EMS

To utilize exist SCADA(Supervisory Control and Data Acqui si tion)/EMS (Energy Management System) fully and economize capital, Henan Electric Power Dispatching and Communication Center in China established a set of Henan Dispatcher Training Simulator (HNDTS) base on its exist SCADA/EMS. In order to i ntegrated with exist SCADA/EMS, the integration method and technique are propose d. Graph data integration discussed with emphasis. After integration implemented , HNDTS can share all data with SCADA/EMS and dispatchers can be trained in same environment as real work situation, in the same time it can avoid amout of work of maintenance engineers. Both advantages and disadvantages of integration are analyzed. In the end of paper, the requirement for future DTS is put forward bas e on the experience of author.

Validity of virtual reality simulator in training of transurethral resection of prostate

Objective To assess the face and construct validity of a full procedural transurethral prostate resection simulator ( TURPSimTM ) in training of transurethral resection of prostate. Methods Ten experienced and thirteen inexperienced urologists ( TURP experience ≥ 30 and

Short lessons in basic life support improve self-assurance in performing cardiopulmonary resuscitation

BACKGROUND:There are several reasons why resuscitation measures may lead to inferior results:difficulties in team building,delayed realization of the emergency and interruption of chest compression.This study investigated the outcome of a new form of in-hospital cardiopulmonary resuscitation(CPR) training with special focus on changes in self-assurance of potential helpers when faced with emergency situations.METHODS:Following a 12-month period of CPR training,questionnaires were distributed to participants and non-participants.Those non-participants who intended to undergo the training at a later date served as control group.RESULTS:The study showed that participants experienced a significant improvement in selfassurance,compared with their remembered self-assurance before the training.Their self-assurance also was significantly greater than that of the control group of non-participants.CONCLUSION:Short lessons in CPR have an impact on the self-assurance of medical and non-medical personnel.

Longitudinal dynamics and energy analysis for heavy haul trains

Whole trip longitudinal dynamics and energy analysis of heavy haul trains are required by operators and manufacturers to enable optimisation of train controls and rolling stock components. A new technology named train dynamics and energy analyser/train simulator （TDEAS） has been developed by the State Key Laboratory of Traction Power in China to perform detailed whole trip longitudinal train dynamics and energy analyses. Facilitated by a controller user interface and a graphic user interface, the TDEAS can also be used as a train driving simulator. This paper elaborates the modelling of three primary parts in the TDEAS, namely wagon connection systems, air brake systems and train energy components. TDEAS uses advanced wedge-spring draft gear models that can simulate a wider spectrum of friction draft gear behaviour. An effective and efficient air brake model that can simulate air brake systems in various train configurations has been integrated. In addition, TDEAS simulates the train energy on the basis of a detailed longitudinal train dynamics simulation, which enables a further perspective of the train energy composition and the overall energy consumption. To demonstrate the validity of the TDEAS, a case study was carried out on a 120-km-long Chinese railway. The results show that the employment of electric locomotives with regenerative braking could bring considerable energy benefits. Nearly 40 % of the locomotive energy usage could be collected from the dynamic brake system. Most of tractive energy was dissipated by propulsion resistance that accounted for 42.48 % of the total energy. Only a small amount of tractive energy was dissipated by curving resistance, air brake and draft gear systems.

Feasibility of hydrogen fuel cell technology for railway intercity services:a case study for the Piedmont in North Carolina

Diesel fuel combustion results in exhaust containing air pollutants and greenhouse gas emissions.Many railway vehicles use diesel fuel as their energy source.Exhaust emissions,as well as concerns about economical,alternative power supply,have driven efforts to move to hydrogen motive power.Hydrogen fuel cell technology applied to railways offers the opportunity to eliminate harmful exhaust emissions and the potential for a low-or zero-emission energy supply chain.Currently,only multiple-unit trains with hydrail technology operate commercially.Development of an Integrated Hybrid Train Simulator for intercity railway is presented.The proposed tool incorporates the effect of powertrain components during the wheel-to-tank process.Compared to its predecessors,the proposed reconfigurable tool provides high fidelity with medium requirements and minimum computation time.Single train simulation and the federal government’s Greenhouse gases,Regulated Emissions,and Energy use in Transportation(GREET)model are used in combination to evaluate the feasibility of various train and powertrain configurations.The Piedmont intercity service operating in North Carolina is used as a case study.The study includes six train configurations and powertrain options as well as nine hydrogen supply options in addition to the diesel supply.The results show that a hydrail option is not only feasible,but a low-or zero-carbon hydrogen supply chain could be possible.

Dynamic simulation and safety evaluation of high-speed trains meeting in open air

Dynamic responses of a carriage under excitation with the German high-speed low-interference track spectrum together with the air pressure pulse generated as high-speed trains passing each other are investigated with a multi-body dynamics method.The variations of degrees of freedom（DOFs：horizontal movement,roll angle,and yaw angle）,the lateral wheel-rail force,the derailment coefficient and the rate of wheel load reduction with time when two carriages meet in open air are obtained and compared with the results of a single train travelling at specifie speeds.Results show that the rate of wheel load reduction increases with the increase of train speed and meets some safety standard at a certain speed,but exceeding the value of the rate of wheel load reduction does not necessarily mean derailment.The evaluation standard of the rate of wheel load reduction is somewhat conservative and may be loosened.The pressure pulse has significan effects on the train DOFs,and the evaluations of these safety indexes are strongly suggested in practice.The pressure pulse has a limited effect on the derailment coefficien and the lateral wheel-rail force,and,thus,their further evaluations may be not necessary.

Antiskid Control of Railway Train Braking Based on Adhesion Creep Behavior

In modern trains wheelset skidding leads to the deterioration of braking behavior,the degradation of comfort,as well as a boost in system hazards.Because of the nonlinearity and unknown characteristics of wheelset adhesion,simplifications are widely adopted in the modeling process of conventional antiskid controllers.Therefore,conventional antiskid controllers usually cannot perform satisfactorily.In this paper,systematic computer simulation and field tests for railway antiskid control system are introduced.The operating principal of antiskid control system is explained,which is fundamental to the simulation of antiskid brakes,and the simulation model is introduced,which incorporates both the adhesion creep curve and a pneumatic submodel of antiskid control system.In addition,the characteristics of adhesion curves and the simulation target are also provided.Using DHSplus,the pneumatic submodel is created to analyze the performance of the different control strategies of antiskid valves.Then the system simulation is realized by combining the kinematical characteristics of railway trains and the pneumatic submodel.The simulation is performed iteratively to obtain the optimized design of the antiskid control system.The design result is incorporated in the hardware design of the antiskid control system and is evaluated in the field tests in Shanghai Subway Line 1.Judging by the antiskid efficiency,the antiskid braking performance observed in the field tests shows the superiority of the optimized design.Therefore,the proposed simulation method,especially in view of its ease of application,appears to be a useful one for designing railway antiskid control systems.

Scheduling of high-speed rail traffic based on discrete-time movement model

In this paper, a new simulation approach for solving the mixed train scheduling problem on the high-speed double-track rail line is presented. Based on the discrete-time movement model, we propose control strategies for mixed train movement with different speeds on a high-speed double-track rail line, including braking strategy, priority rule, travelling strategy, and departing rule. A new detailed algorithm is also presented based on the proposed control strategies for mixed train movement. Moreover, we analyze the dynamic properties of rail traffic flow on a high-speed rail line. Using our proposed method, we can effectively simulate the mixed train schedule on a rail line. The numerical results demonstrate that an appropriate decrease of the departure interval can enhance the capacity, and a suitable increase of the distance between two adjacent stations can enhance the average speed. Meanwhile, the capacity and the average speed will be increased by appropriately enhancing the ratio of faster train number to slower train number from 1.

Review of simulation model for education of point-of-care ultrasound using easy-to-make tools

Point-of-care ultrasound(POCUS)is a powerful diagnostic tool and provides treatment guidelines in acute critical settings.However,the limitation of using POCUS is operator dependent.Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe.Simulation education models have been introduced as a way to solve and overcome these concerns.However,the commercial simulator with sufficiently secured fidelity is expensive and not always available.This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway,breathing,circulation,and disability.We introduced the simulators that used non-infectious materials,with easily transportable features,and that had a sonographic appearance reproducibility similar to human tissue.We also introduced the recipe of each simulator in two parts:Materials surrounding disease simulators(surrounding materials)and specific disease simulators themselves(target simulators).This review article covered the following:endotracheal or oesophageal intubation,lung(A-lines,B-lines,lung sliding,and pleural effusions such as hemothorax),central vein access,pericardial fluid(cardiac tamponade),the structure related to the eyes,soft tissue abscess,nerve(regional nerve block),and skull fracture simulators.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Objective:To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession.Simulation is an active learning strategy involving the use of various resources to assimilate the real situation.It enables learners to improve their skills and knowledge in a coordinated environment.Methods:Systematic literature search of original research ar ticles was carried out through Google Scholar,Medline,and Cochrane Cumulative Index to Nursing and Allied Health Literature(CINAHL)databases.Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019,and published in the English language,were included in this study.Methodological quality was assessed by Joanna Briggs Institute,and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies(ROBINS-I)checklists.Results:Initially,638 titles were obtained from 3 sources,and 24 original studies with 2209 study par ticipants were taken for the final analysis.Of the total studies,14(58.3%)used single group prep post design,7(29.1%)used high fidelity simulator(HFS),and 7(29.1%)used a virtual simulator(VS).Twenty(83.3%)studies reported improved skill performance following simulation-based teaching.Simulation-based teaching improves skill performance among types of groups(single or double),study regions,high fidelity(HF),low fidelity(LF),and standard patient(SP)users.But the effect over virtual and medium fidelity simulators was not statistically significant.Overall,simulation-based teaching improves the skill performance score among the experimental group(d=1.01,95%confidence interval[CI][0.69–1.33],Z=6.18,P<0.01,93.9%).Significant heterogeneity and publication bias were observed during the pooled analysis.Conclusions:Simulation did improve skill performance among the intervention groups,but the conclusion is uncer tain due to the significant heterogeneity.The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Coal mine fire and human escape simulation

Coal mine fire and human escape simulation system is developed based on 3D Max and EON software for the purpose of coal mine safety training.The models,such as miners,roadways,typical equipments,fire and smoke are all constructed in 3D Max.The roadway models derived from real data,functions of each part are determined for the roadway based on the data,and then corresponding tunnel typical equipments are added.Emergency refuge system model is not only an important system model,but also an important destination for fire simulation and human escape.The roaming of the miners through the roadways,the interactive functions between users and computer,the fire process of beginning,spreading,and destroying,the human escape interaction are simulated in EON virtual reality software after these models have been input into it.Besides,collision detection based on hierarchical bounding volumes is also utilized.Simulation results suggest that this strategy can produce realistic virtual state and fire effect.While as part of the coal mine safety simulation and training System(CMSSTS),this work is far from what we expected,and there is more intensive work that should be done.

A Feasible Partial Train Traffic Simulation Using Diagram Expressed in Network

Simulating large-scale and complex systems is commonly considered a difficult and time-consuming task. In this paper, we propose a partial simulation way to speed up the simulation with real time demands. It is based on the idea that a train traffic diagram is expressed in a network, and through calculating the maximal long path in the network the simulation is done, but only within a particular partial area.Upon this, we let it become a problem oriented simulation. The simulation could be started at any time,from any trains or at any stations and stopped as the same way according to the problem to be concerned.We can use this kind of simulation to analyse or confirm the correctness of traffic schedule at a high speed to meet the real time demands.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries

Purpose:To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees’performance for emergent and urgent thoracic surgeries.Methods:With a homemade machine,animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage,urgent sternotomy,and emergent thoracotomy.Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models.Five operation teams from basic-level hospitals(group A)and five operation teams from level III hospitals(group B)were included to be trained and tested.Testing standards for the operations were established after thorough literature review,and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Tests were carried out after the training.Pre-and post-training performances were compared.Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.Results:Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%.After literature review,testing standards were established,and expert questionnaire results showed that the scientific score was 7.30±1.49,and the feasibility score was 7.50±0.89.Post-training performance was significantly higher in both group A and group B than pre-training performance.Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.Conclusions:Animal model-based simulation training established in the current study could improve the trainees’performance for emergent and urgent thoracic surgeries,especially of the surgical teams from basic-level hospitals.

Study on Optimization of Urban Rail Train Operation Control Curve Based on Improved Multi-Objective Genetic Algorithm

A multi-objective improved genetic algorithm is constructed to solve the train operation simulation model of urban rail train and find the optimal operation curve.In the train control system,the conversion point of operating mode is the basic of gene encoding and the chromosome composed of multiple genes represents a control scheme,and the initial population can be formed by the way.The fitness function can be designed by the design requirements of the train control stop error,time error and energy consumption.the effectiveness of new individual can be ensured by checking the validity of the original individual when its in the process of selection,crossover and mutation,and the optimal algorithm will be joined all the operators to make the new group not eliminate on the best individual of the last generation.The simulation result shows that the proposed genetic algorithm comparing with the optimized multi-particle simulation model can reduce more than 10%energy consumption,it can provide a large amount of sub-optimal solution and has obvious optimization effect.

Novel Visualization Tool for Percutaneous Renal Puncture Training Using Augmented Reality Technology

We aim to develop a novel visualization tool for percutaneous renal puncture training based on augmented reality(AR)and compare the needle placement performance of this AR system with ultrasound-guidedfreehand navigation in phantoms.A head-mounted display-based AR navigation system was developed usingthe Unity3D software and Visual Studio to enable the overlay of the preoperative needle path and the complexanatomical structures onto a phantom in real time.The spatial location of the stationary phantom and the percutaneous instrument motion were traced by a Qualisys motion capture system.To evaluate the tracking accuracy,15 participants(7 males and 8 females)performed a single needle insertion using AR navigation(the number ofpunctures n=75)and ultrasound-guided freehand navigation(n=75).The needle placement error was measuredas the Euclidean distance between the actual needle tip and the virtual target by MicronTracker.All participantsdemonstrated a superior needle insertion efficiency when using the AR-assisted puncture method compared withthe ultrasound-guided freehand method.The needle insertion error of the ultrasound-guided method showed anincreased error compared with the AR method(5.54 mm±2.59 mm,4.34 mm±2.10 mm,respectively,p<0.05).The ultrasound-guided needle placements showed an increased time compared with the AR method(19.08 s±3.59 s,15.14 s±2.72 s,respectively,p<0.0001).Our AR training system facilitates the needle placement performance and solves hand-eye coordination problems.The system has the potential to increase efficiency andeffectiveness of percutaneous renal puncture training.

Lessons learned from requirements gathering for virtual reality simulators

Background This paper shows how current collaborative virtual environments(VEs)such as Mozilla Hubs and AltspaceVR can aid in the task of requirements gathering in VR for simulation and training.Methods We performed a qualitative study on our use of these technologies in the requirements gathering of two projects.Results Our results show that requirements gathering in virtual reality has an impact on the process of requirements identification.We report advantages and shortcomings that will be of interest to future practitioners.For example,we found that VR sessions for requirements gathering in current VEs could benefit from better pointers and better sound quality.Conclusion Current VEs are useful for the requirements gathering task in the development of VR simulators and VR training environments.

Simulation training in endoscopic skull base surgery: A scoping review

Objective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning.Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes.The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines,we systematically searched PubMed,Embase,CINAHL,and Cochrane databases.Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references,with 55 studies ultimately meeting inclusion criteria.Of these,19 studies described cadaveric dissection models,17 discussed three-dimensional(3D)printed models,14 examined virtual surgical planning and augmented reality-based models,and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery,including high-fidelity cadaveric,virtual reality,and 3D-printed models.These models are an asset for trainee development and preoperative surgical preparation.

A Communication Method of Distributed Tactical Training Simulation System Suitable for Remote Interconnection

The traditional distributed tactical training simulation system is limited by the availability and bandwidth of military network transmission channel and does not have the feasibility of remote interconnection and spatial sub-regional deployment.In this paper,a new communication method of distributed tactical training simulation system is proposed to solve the problem of strong business coupling between nodes and system availability under the condition of low bandwidth.The operator of federated exchange,federated queue and their concepts and design requirements are firstly proposed,and the inverted tree,triangle,ring exchange topology and circular queue structure are further constructed.Theoretically,the expected goal of high-speed interworking between nodes in the cluster and high reliable transmission between clusters is realized.The example also shows that this method can significantly improve the throughput of single switching node and federated node after using reliability confirmation mechanism.

Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries

Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.