Haptics in medicine and clinical skill acquisition

THE clinical skills of medical professionals rely strongly on the sense of touch, combined with anatomical and diagnostic knowledge. Haptic exploratory procedures allow the expert to detect anomalies via gross and fine palpation, squeezing, and contour following. Haptic feedback is also key to medical interventions, for example when an anaesthetist inserts an epidural needle, a surgeon makes an incision, a dental surgeon drills into a carious lesion, or a veterinarian sutures a wound. Yet, current trends in medical technology and training methods involve less haptic feedback to clinicians and trainees. For example, minimally invasive surgery removes the direct contact between the patient and clinician that gives rise to natural haptic feedback, and furthermore introduces scaling and rotational transforms that confuse the relationship between movements of the hand and the surgical site. Similarly, it is thought that computer-based medical simulation and training systems require high-resolution and realistic haptic feedback to the trainee for significant training transfer to occur. The science and technology of haptics thus has great potential to affect the performance of medical procedures and learning of clinical skills. This special section is about understanding

A semi-distributed ntegrated itrogen model for multiple source assessment in tchments (INCA): Part I — model structure and process equations

A new model has been developed for assessing multiple sources of nitrogen in catchments. The model (INCA) is process based and uses reaction kinetic equations to simulate the principal mechanisms operating. The model allows for plant uptake, surface and sub-surface pathways and can simulate up to six land uses simultaneously. The model can be applied to catchment as a semi-distributed simulation and has an inbuilt multi-reach structure for river systems. Sources of nitrogen can be from atmospheric deposition, from the terrestrial environment (e.g. agriculture, leakage from forest systems etc.), from urban areas or from direct discharges via sewage or intensive farm units. The model is a daily simulation model and can provide information in the form of time series at key sites, or as profiles down river systems or as statistical distributions. The process model is described and in a companion paper the model is applied to the River Tywi catchment in South Wales and the Great Ouse in Bedfordshire.

Understanding and representing atmospheric convection across scales: recommendations from the meeting held at Dartington Hall, Devon, UK, 28–30 January 2013

As weather and climate models move toward higher resolution, there is growing excitement about potential future improvements in the understanding and prediction of atmospheric convection and its interaction with larger-scale phenomena. A meeting in January 2013 in Dartington, Devon was convened to address the best way to maximise these improvements, specifically in a UK context but with international relevance. Specific recommendations included increased convective-scale observations, high-resolution virtual laboratories, and a system of parameterization test beds with a range of complexities. The main recommendation was to facilitate the development of physically based convective parameterizations that are scale-aware, non-local, non-equilibrium, and stochastic.

On a resurgence of management simulations and games

The past few years have seen a significant resurgence of interest in ‘management games’ and ‘management flight simulators’, one particularly active source of such work being the system dynamics community. After proposing a distinction between games and simulations, this paper provides some background to these developments by briefly describing the historical roots of the field and the fundamental ideas of the system dynamics community, which are now giving rise to ‘microworlds’. The training advantages of management simulations and games are then discussed. The paper closes with a note on the research and findings of the system dynamics field and by offering some words of warning on the perils of simulation and game use. Two scenarios for how the use of simulations and games as management education devices might develop in the future are proposed. An Appendix describes five examples of very different types of management simulations and games.

Intercomparison of methods of coupling between convection and large-scale circulation: 1. Comparison over uniform surface conditions

As part of an international intercomparison project, a set of single column models (SCMs) and cloud-resolving models (CRMs) are run under the weak temperature gradient (WTG) method and the damped gravity wave (DGW) method. For each model, the implementation of the WTG or DGW method involves a simulated column which is coupled to a reference state defined with profiles obtained from the same model in radiative-convective equilibrium. The simulated column has the same surface conditions as the reference state and is initialized with profiles from the reference state. We performed systematic comparison of the behavior of different models under a consistent implementation of the WTG method and the DGW method and systematic comparison of the WTG and DGW methods in models with different physics and numerics. CRMs and SCMs produce a variety of behaviors under both WTG and DGW methods. Some of the models reproduce the reference state while others sustain a large-scale circulation which results in either substantially lower or higher precipitation compared to the value of the reference state. CRMs show a fairly linear relationship between precipitation and circulation strength. SCMs display a wider range of behaviors than CRMs. Some SCMs under the WTG method produce zero precipitation. Within an individual SCM, a DGW simulation and a corresponding WTG simulation can produce different signed circulation. When initialized with a dry troposphere, DGW simulations always result in a precipitating equilibrium state. The greatest sensitivities to the initial moisture conditions occur for multiple stable equilibria in some WTG simulations, corresponding to either a dry equilibrium state when initialized as dry or a precipitating equilibrium state when initialized as moist. Multiple equilibria are seen in more WTG simulations for higher SST. In some models, the existence of multiple equilibria is sensitive to some parameters in the WTG calculations.

Molecular insights of p47phox phosphorylation dynamics in the regulation of NADPH oxidase activation and superoxide production

Phagocyte superoxide production by a multicomponent NADPH oxidase is important in host defense against microbial invasion. However inappropriate NADPH oxidase activation causes inflammation. Endothelial cells express NADPH oxidase and endothelial oxidative stress due to prolonged NADPH oxidase activation predisposes many diseases. Discovering the mechanism of NADPH oxidase activation is essential for developing novel treatment of these diseases. The p47phox is a key regulatory subunit of NADPH oxidase; however, due to the lack of full protein structural information, the mechanistic insight of p47phox phosphorylation in NADPH oxidase activation remains incomplete. Based on crystal structures of three functional domains, we generated a computational structural model of the full p47phox protein. Using a combination of in silico phosphorylation, molecular dynamics simulation and protein/protein docking, we discovered that the C-terminal tail of p47phox is critical for stabilizing its autoinhibited structure. Ser-379 phosphorylation disrupts H-bonds that link the C-terminal tail to the autoinhibitory region (AIR) and the tandem Src homology 3 (SH3) domains, allowing the AIR to undergo phosphorylation to expose the SH3 pocket for p22phox binding. These findings were confirmed by site-directed mutagenesis and gene transfection of p47phox_/_ coronary microvascular cells. Compared with wild-type p47phoxcDNAtransfected cells, the single mutation of S379A completely blocked p47phox membrane translocation, binding to p22phox and endothelial O2 . production in response to acute stimulation of PKC. p47phox C-terminal tail plays a key role in stabilizing intramolecular interactions at rest. Ser-379 phosphorylation is a molecular switch which initiates p47phox conformational changes and NADPH oxidase-dependent superoxide production by cells.

Impact of cyclones on sea ice in the Fram Strait: numerical simulations and observations

The sea ice export from the Arctic is of global importance due to its fresh water which influences the oceanic stratification and, thus, the global thermohaline circulation. This study deals with the effect of cyclones on sea ice and sea ice transport in particular on the basis of observations from two field experiments FRAMZY 1999 and FRAMZY 2002 in April 1999 and March 2002 as well as on the basis of simulations with a numerical sea ice model. The simulations realised by a dynamic-thermodynamic sea ice model are forced with 6-hourly atmospheric ECMWF- analyses (European Centre for Medium-Range Weather Forecasts) and 6-hourly oceanic data of a MPI-OM-simulation (Max-Planck-Institute Ocean Model). Comparing the observed and simulated variability of the sea ice drift and of the position of the ice edge shows that the chosen configuration of the model is appropriate for the performed studies. The seven observed cyclones change the position of the ice edge up to 100 km and cause an extensive decrease of sea ice coverage by 2 % up to more than 10 %. The decrease is only simulated by the model if the ocean current is strongly divergent in the centre of the cyclone. The impact is remarkable of the ocean current on divergence and shear deformation of the ice drift. As shown by sensitivity studies the ocean current at a depth of 6 m – the sea ice model is forced with – is mainly responsible for the ascertained differences between simulation and observation. The simulated sea ice transport shows a strong variability on a time scale from hours to days. Local minima occur in the time series of the ice transport during periods with Fram Strait cyclones. These minima are not caused by the local effect of the cyclone’s wind field, but mainly by the large-scale pattern of surface pressure. A displacement of the areas of strongest cyclone activity in the Nordic Seas would considerably influence the ice transport.

Spatial patterns and environmental constraints on ecosystem services at a catchment scale

Improved understanding and prediction of the fundamental environmental controls on ecosystem service supply across the landscape will help to inform decisions made by policy makers and land-water managers. To evaluate this issue for a local catchment case study, we explored metrics and spatial patterns of service supply for water quality regulation, agriculture production, carbon storage, and biodiversity for the Macronutrient Conwy catchment. Methods included using ecosystem models such as LUCI and JULES, integration of national scale field survey datasets, earth observation products and plant trait databases, to produce finely resolved maps of species richness and primary production. Analyses were done with both 1x1 km gridded and subcatchment data. A common single gradient characterised catchment scale ecosystem services supply with agricultural production and carbon storage at opposing ends of the gradient as reported for a national-scale assessment. Species diversity was positively related to production due to the below national average productivity levels in the Conwy combined with the unimodal relationship between biodiversity and productivity at the national scale. In contrast to the national scale assessment, a strong reduction in water quality as production increased was observed in these low productive systems. Various soil variables were tested for their predictive power of ecosystem service supply. Soil carbon, nitrogen, their ratio and soil pH all had double the power of rainfall and altitude, each explaining around 45% of variation but soil pH is proposed as a potential metric for ecosystem service supply potential as it is a simple and practical metric which can be carried out in the field with crowd-sourcing technologies now available. The study emphasises the importance of considering multiple ecosystem services together due to the complexity of covariation at local and national scales, and the benefits of exploiting a wide range of metrics for each service to enhance data robustness.