Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

Objective: The clinical clerkship and practice stage plays a pivotal role in the transition of medical students from theoretical knowledge to practical application, bridging the gap between classroom learning and real-life clinical experience. In order to improve the teaching quality of interns and probationers, we try to let them practice the skills of laparoscopic surgery in the early stage, and summed up a set of evaluation methods that can be widely used in medical education. Methods: From September 2019 to December 2019, a total of 54 interns and 72 trainees were selected as research objects. They were assigned to training sessions and their proficiency was assessed before and after the training. The change in proficiency is compared to determine whether the training course is valuable. Results: Before the operation training, the interns scores were BP 17.3 3.1, CC 17.9 3.4, KT 16.4 3.4, LS 16.7 3.3. The results of probationers were BP 16.9 2.7, CC 16.8 2.8, KT 15.2 1.6, and LS 14.8 2.2. After completing the operations training, the results of interns were BP 21.1 1.9, CC 20.6 2.7, KT 19.6 3.0, and LS 20.9 1.4. The probationers scores were BP 19.3 3.2, CC 19.6 3.5, KT 19.6 2.6, and LS 20.0 2.4. After the operation training, the performance of the intern group was better than that before the training (P < 0.05). The same is true of the probationer group. The time-consuming intern examinations were BP 147.9 38.5 s, CC 123.2 28.7 s, KT 82.6 24.1 s and LS 162.5 31.1 s. The examination time of probationers were BP 179.9 46.4 s, CC 132.1 24.3 s, KT 109.3 27.5 s and LS 210.0 58.8 s. Conclusion: Simulation training for laparoscopic surgery can improve minimally invasive surgical techniques for interns and probationers.

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.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

DYNAMIC MODEL AND SIMULATION OF A NOVEL ELECTRO-HYDRAULIC FULLY VARIABLE VALVE SYSTEM FOR FOUR-STROKE AUTOMOTIVE ENGINES

In modem four-stroke engine technology, variable valve timing and lift control offers potential benefits for making a high-performance engine. A novel electro-hydraulic fully variable valve train for four-stroke automotive engines is introduced. The construction of the nonlinear mathematic model of the valve train system and its dynamic analysis are also presented. Experimental and simulation results show that the novel electro-hydraulic valve train can achieve fully variable valve timing and lift control. Consequently the engine performance on different loads and speeds will be significantly increased. The technology also permits the elimination of the traditional throttle valve in the gasoline engines and increases engine design flexibility.

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.

A POWER SYSTEM INTELLIGENT TRAINING SIMULATOR BASED ON TRANSPUTER

The simulator is a combination of computational functions describing physical system, distributed rule and knowledge bases, and a reasoning machine, all executing in parallel. The hardware,comprising two levels of multiprocessor network-- a T800 transputer and STD--BUS computer systems--and analogue and I/O boards, has been used successfully to train and simulate a 100 MW power system at a low cost. The system has wide applications in industry.

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.

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.

Multiple Purpose Simulation for Electric Vehicles

Aim Toshorten integral design period of electric vehicles Methods The electric vehicle simulation program(EVSP), a modular user-friendly program which is written in Borland C++ OWL for Windows was developed. Results EVSP allows simulating the dynamic and the economy performance of electric vehicles.EVSP provides many kinds of data input module,a large components library of electric vehicles and several kinds of speed cycle with these library,it is easily to develop a new concept of different drive trains or even to compare or improve the existing electric vehicles. The paper simulated the performance of YW6120DD Electric Bus, and analyzed the test results comparing with simulation results Conclusion The simulation results indicate that the EVSP may contribute to the developments of electric vehicles in general and the definition of the optimal match management in the drive train in particular.

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.

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.

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.

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.

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

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.

An Improved Underwater Confrontation Simulation Method of Naval Amphibious Operational Training System

This paper described an improved underwater confrontation simulation method of naval amphibious operational training system. The initial position of submarine forces on the enemy is generated automatically, and the attacking distance model of torpedoes is established based on the kinematics theory, which is more flexible and reasonable to judge the launch condition compared to traditional method. The two kinds of confrontation behavior models on the enemy submarine are created to depict its tactical action from the defensive to the offensive as well as the contrary, ensuring that operational style is simulated more comprehensively and properly. The existing motion trajectory estimation and collision detection algorithms on operational platforms are also improved to reduce the iteration error and further enhance the detection accuracy of target hit.

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.

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.

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.

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.