A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition

Objectives: To evaluate virtual reality as a laparoscopic training device in helping surgeons to automate to the “fulcrum effect” by comparing it to time-matched training programs using randomly alternating images (ie, y-axis inverted and normal laparoscopic) and normal laparoscopic viewing conditions.

Methods: Twenty-four participants (16 females and 8 males), were randomly assigned to minimally invasive surgery virtual reality (MIST VR), randomly alternating (between y-axis inverted and normal laparoscopic images), and normal laparoscopic imaging condition. Participants were requested to perform a 2-minute laparoscopic cutting task before and after training.

Results: In the test trial participants who trained on the MIST VR performed significantly better than those in the normal laparoscopic and randomly alternating imaging conditions.

Conclusion: The results show that virtual reality training may provide faster skill acquisition with particular reference to automation of the fulcrum effect. MIST VR provides a new way of training laparoscopic psychomotor surgical skills.

Does the level of graphical detail of a virtual handball thrower influence a goal-keeper's motor response?

The authors investigated how different levels of detail (LODs) of a virtual throwing action can influence a handball goalkeeper's motor response. Goalkeepers attempted to stop a virtual ball emanating from five different graphical LODs of the same virtual throwing action. The five levels of detail were: a textured reference level (L0), a non-textured level (L1), a wire-frame level (L2), a point-light-display (PLD) representation (L3) and a PLD level with reduced ball size (L4). For each motor response made by the goalkeeper we measured and analyzed the time to respond (TTR), the percentage of successful motor responses, the distance between the ball and the closest limb (when the stopping motion was incorrect) and the kinematics of the motion. Results showed that TTR, percentage of successful motor responses and distance with the closest limb were not significantly different for any of the five different graphical LODs. However the kinematics of the motion revealed that the trajectory of the stopping limb was significantly different when comparing the L1 and L3 levels, and when comparing the L1 and L4 levels. These differences in the control of the goalkeeper's actions suggests that the different level of information available in the PLD representations ( L3 and L4) are causing the goalkeeper to adopt different motor strategies to control the approach of their limb to stop the ball.

Influence of the Graphical Levels of Detail of a Virtual Thrower on the Perception of the Movement

Virtual reality has a number of advantages for analyzing sports interactions such as the standardization of experimental conditions, stereoscopic vision, and complete control of animated humanoid movement. Nevertheless, in order to be useful for sports applications, accurate perception of simulated movement in the virtual sports environment is essential. This perception depends on parameters of the synthetic character such as the number of degrees of freedom of its skeleton or the levels of detail (LOD) of its graphical representation. This study focuses on the influence of this latter parameter on the perception of the movement. In order to evaluate it, this study analyzes the judgments of immersed handball goalkeepers that play against a graphically modified virtual thrower. Five graphical representations of the throwing action were defined: a textured reference level (L0), a nontextured level (L1), a wire-frame level (L2), a moving point light display (MLD) level with a normal-sized ball (L3), and a MLD level where the ball is represented by a point of light (L4). The results show that judgments made by goalkeepers in the L4 condition are significantly less accurate than in all the other conditions (p

Improving signal reliability for indoor off–body communications using spatial diversity at the base station

In this paper, we investigate the potential improvement in signal reliability for indoor off-body communications when using spatial diversity at the base station. In particular, we utilize two hypothetical indoor base stations operating at 5.8 GHz each featuring four antennas which are spaced at either half- or one-wavelength apart. Three on-body locations are considered along with four types of user movement. The cross-correlation between the received signal envelopes observed at each base station antenna element was calculated and found to be always less than 0.5. Selection, maximal ratio, and equal gain combining of the received signal has shown that the greatest improvement is obtained when the user is mobile, with a maximum diversity gain of 11.34 dB achievable when using a four branch receiver. To model the fading envelope obtained at the output of the virtual combiners, we use diversity specific, theoretical probability density functions for multi-branch receivers operating in Nakagami-m fading channels. It is shown that these equations provide an excellent fit to the measured channel data.

Thermography-based virtual MPPT scheme for improving PV energy efficiency under partial shading conditions

This paper proposes a new thermography-based maximum power point tracking (MPPT) scheme to address photovoltaic (PV) partial shading faults. Solar power generation utilizes a large number of PV cells connected in series and in parallel in an array, and that are physically distributed across a large field. When a PV module is faulted or partial shading occurs, the PV system sees a nonuniform distribution of generated electrical power and thermal profile, and the generation of multiple maximum power points (MPPs). If left untreated, this reduces the overall power generation and severe faults may propagate, resulting in damage to the system. In this paper, a thermal camera is employed for fault detection and a new MPPT scheme is developed to alter the operating point to match an optimized MPP. Extensive data mining is conducted on the images from the thermal camera in order to locate global MPPs. Based on this, a virtual MPPT is set out to find the global MPP. This can reduce MPPT time and be used to calculate the MPP reference voltage. Finally, the proposed methodology is experimentally implemented and validated by tests on a 600-W PV array. 

Effectiveness of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual non-inferiority trial

OBJECTIVES: To compare the ability of ophthalmologists versus optometrists to correctly classify retinal lesions due to neovascular age-related macular degeneration (nAMD).

DESIGN: Randomised balanced incomplete block trial. Optometrists in the community and ophthalmologists in the Hospital Eye Service classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomographic images. Participants' classifications were validated against experts' classifications (reference standard).

SETTING: Internet-based application.

PARTICIPANTS: Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care.

INTERVENTIONS: The trial emulated a conventional trial comparing optometrists' and ophthalmologists' decision-making, but vignettes, not patients, were assessed. Therefore, there were no interventions and the trial was virtual. Participants received training before assessing vignettes.

MAIN OUTCOME MEASURES: Primary outcome-correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes-potentially sight-threatening errors, judgements about specific lesion components and participants' confidence in their decisions.

RESULTS: In total, 155 participants registered for the trial; 96 (48 in each group) completed all assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702/2016 (84.4%) and 1722/2016 (85.4%) correct classifications, respectively (OR 0.91, 95% CI 0.66 to 1.25; p=0.543). Optometrists' decision-making was non-inferior to ophthalmologists' with respect to the prespecified limit of 10% absolute difference (0.298 on the odds scale). Optometrists and ophthalmologists made similar numbers of sight-threatening errors (57/994 (5.7%) vs 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57; p=0.789). Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their classifications than optometrists.

CONCLUSIONS: Optometrists' ability to make nAMD retreatment decisions from vignettes is not inferior to ophthalmologists' ability. Shared care with optometrists monitoring quiescent nAMD lesions has the potential to reduce workload in hospitals.

TRIAL REGISTRATION NUMBER: ISRCTN07479761; pre-results registration.