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

Noninvasive Evaluation of Oral Lesions Using Depth-sensitive Optical Spectroscopy

BACKGROUND: Optical spectroscopy is a noninvasive technique with potential applications for diagnosis of oral dysplasia and early cancer. In this study, we evaluated the diagnostic performance of a depth-sensitive optical spectroscopy (DSOS) system for distinguishing dysplasia and carcinoma from non-neoplastic oral mucosa. METHODS: Patients with oral lesions and volunteers without any oral abnormalities were recruited to participate. Autofluorescence and diffuse reflectance spectra of selected oral sites were measured using the DSOS system. A total of 424 oral sites in 124 subjects were measured and analyzed, including 154 sites in 60 patients with oral lesions and 270 sites in 64 normal volunteers. Measured optical spectra were used to develop computer-based algorithms to identify the presence of dysplasia or cancer. Sensitivity and specificity were calculated using a gold standard of histopathology for patient sites and clinical impression for normal volunteer sites. RESULTS: Differences in oral spectra were observed in: (1) neoplastic versus nonneoplastic sites, (2) keratinized versus nonkeratinized tissue, and (3) shallow versus deep depths within oral tissue. Algorithms based on spectra from 310 nonkeratinized anatomic sites (buccal, tongue, floor of mouth, and lip) yielded an area under the receiver operating characteristic curve of 0.96 in the training set and 0.93 in the validation set. CONCLUSIONS: The ability to selectively target epithelial and shallow stromal depth regions appeared to be diagnostically useful. For nonkeratinized oral sites, the sensitivity and specificity of this objective diagnostic technique were comparable to that of clinical diagnosis by expert observers. Thus, DSOS has potential to augment oral cancer screening efforts in community settings. Cancer 2009;115:1669-79. (C) 2009 American Cancer Society.

Coaches' perceptions of golf swing kinematics

Using a computer-based videotape analysis system, a randomized series of golf swings was presented to 10 professional and 10 amateur golf coaches in an attempt to determine differences m their internal model of golf swing kinematics. A global measure was obtained by having coaches independently inspect the swings of eight golfers and estimate their golf handicaps. A micro level of analysis was undertaken by requiring participants to indicate what they considered to be 'ideal' swing characteristics using 17 predetermined limb, club, and body position angles for various phases of the swing Videotaped swings for a highly skilled and beginner level golfer were used for this task. Although the training requirements for professional coaches are much more demanding and their playing ability higher, evidence of internal model differences was not found in the handicap estimation task. It was also established that a golfer's swing may be perceived to have deficiencies but still produce sufficient accuracy to engender a low handicap On the second task, only one of the 17 estimated swing angles showed a significant difference between the coach groups. When, however, the two coach groups indicated their preferred angles for the highly skilled golfer and the beginner, 6 of the 17 angles were significantly different. The implications of these findings are that the two coach groups had similar ability to identify fundamental characteristics of the golf swing, but their model of the ideal swing was influenced by the observed golfer's skill level.

A risk analysis model to reduce computer security risks among healthcare organizations

The paper describes the on-going development of a new computer-based security risk analysis methodology that may be used to determine the computer security requirements of medical computer systems. The methodology has been developed for use within healthcare, with particular emphasis placed upon protecting medical information systems. The paper goes on to describe some of the problems with existing automated risk analysis systems, and how the ODESSA system may overcome the majority of these problems. Examples of security scenarios are also presented.

Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?

The aim was to investigate whether the addition of supervised high intensity progressive resistance training to a moderate weight loss program (RT+WLoss) could maintain bone mineral density (BMD) and lean mass compared to moderate weight loss (WLoss) alone in older overweight adults with type 2 diabetes. We also investigated whether any benefits derived from a supervised RT program could be sustained through an additional home-based program. This was a 12-month trial in which 36 sedentary, overweight adults aged 60 to 80 years with type 2 diabetes were randomized to either a supervised gymnasium-based RT+WLoss or WLoss program for 6 months (phase 1). Thereafter, all participants completed an additional 6-month home-based training without further dietary modification (phase 2). Total body and regional BMD and bone mineral content (BMC), fat mass (FM) and lean mass (LM) were assessed by DXA every 6 months. Diet, muscle strength (1-RM) and serum total testosterone, estradiol, SHBG, insulin and IGF-1 were measured every 3 months. No between group differences were detected for changes in any of the hormonal parameters at any measurement point. In phase 1, after 6 months of gymnasium-based training, weight and FM decreased similarly in both groups (P<0.01), but LM tended to increase in the RT+WLoss (n=16) relative to the WLoss (n=13) group [net difference (95% CI), 1.8% (0.2, 3.5), P<0.05]. Total body BMD and BMC remained unchanged in the RT+WLoss group, but decreased by 0.9 and 1.5%, respectively, in the WLoss group (interaction, P<0.05). Similar, though non-significant, changes were detected at the femoral neck and lumbar spine (L2-L4). In phase 2, after a further 6 months of home-based training, weight and FM increased significantly in both the RT+WLoss (n=14) and WLoss (n=12) group, but there were no significant changes in LM or total body or regional BMD or BMC in either group from 6 to 12 months. These results indicate that in older, overweight adults with type 2 diabetes, dietary modification should be combined with progressive resistance training to optimize the effects on body composition without having a negative effect on bone health.

The Australasian triage scale: examining emergency department nurses' performance using computer and paper scenarios

Study objective: The purpose of this study is to examine emergency nurses' performance using triage scenarios characterized by type of patient population (adult versus pediatric) and mode of delivery (paper versus computer). Methods:   A combination of paper-based (script alone) and computer-based (script plus still photographs) triage scenarios were used. Of the 28 scenarios used, half were written and half were computer based. Within each subgroup, there were 7 adult and 7 pediatric scenarios. Participants were asked to allocate an Australasian Triage Scale category for each triage scenario. Results: One hundred sixty-seven participants completed a total of 2,349 adult scenarios, and 161 participants completed 2,265 pediatric scenarios. Sixty-one percent of the triage decisions made by the nurses were “expected” triage decisions, 18% were “undertriage,” decisions, and 21% were “overtriage” decisions. Nurse triage allocation decisions for the scenarios containing still photographs delivered by computer demonstrated a higher average agreement percentage of 66.2% (κ=0.56; τb=0.77; P<.0001) compared with the average agreement percentage of 55.4% (κ=0.42; τb=0.75; P<.0001) using paper-based (text-only) scenarios. Conclusion: The mode of delivery appeared to have an effect on the nurses' triage performance. It is unclear whether the use of simple still photographs used in the computer mode of delivery resulted in a higher incidence of expected triage decisions and, thus, improved performance. The use of cues such as photographs and video footage to enhance the fidelity of triage scenarios may be useful not only for the education of triage nurses but also the conduct of research into triage decisionmaking. However, further exploration and research in this area are warranted.

Usage of a computer conferencing system by on- and off-campus engineering students

This paper reports on the introduction of a computer conferencing  component into a first year study unit in Technology Management at Deakin University, Australia. It was found that significant variations in computer  usage were correlated to student study mode, including source of computer access, source of Internet access, hours per week computer usage, regular use of email, regular use of the Internet, and number of times the conference was accessed. Other moderate differences were also noted. Following  exposure to the computer conference, on-campus students were more likely to agree computers could assist their learning, and off-campus students  were less likely to agree that learning from computers would be better than classes/lectures.

Challenges in designing culturally-adaptive ICT-based learning environments

This paper argues that two of the major problems facing local courseware developers and educators in creating culturally-sensitive lCT-based learning environments are the difficulties of representing cultural artefacts in courseware and of having a model of 'culture' that can be implemented in lCT-based systems. A developing learning-object model is presented; one that can be adopted to address aspects of this problem by providing a systematic way to approach implementing and representing cultural artefacts in courseware. This also provides a basis for some aspects of computer-based cultural preservation initiatives. While this approach may have higher short term development costs, the potential long term cultural benefits to the society far outweigh short term considerations.

Effects of high-intensity progressive resistance training on self-reported health status in older persons with type 2 diabetes

Purpose: To evaluate the influence of high-intensity progressive resistance training (PRT) on self-reported physical and mental health in older persons with type 2 diabetes.

Methods: We performed a 12-month RCT with 36 overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to a moderate weight-loss diet plus PRT (PRT&WL) or a moderate weight-loss diet plus a control (stretching) program (WL). Gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. The SF-36 (v1) questionnaire was used to obtain physical (PCS) and mental (MCS) health component summary scores at baseline, 6 and 12 months.

Results: Subject retention was 81% and 72% after 6 and 12 months respectively. Exercise adherence during gymnasium- and home-based training was 88% and 73% for the PRT&WL group, and 85% and 78.1% for the WL group respectively. In a regression model adjusted for age and sex, PCS improved in the PRT&WL group compared to the WL group after 6 months of gymnasium-based training (2.3 versus -2.0, p = 0.05), which persisted after 12 months training (0.7 versus -4.1, p = 0.03). There were no between-group differences at 6 or 12 months for the MCS.

Conclusion: High-intensity PRT was effective in improving self-reported physical health, but not mental health. PRT provides an effective exercise alternative in lifestyle management for older adults with type 2 diabetes.

Haptically enabled interactive virtual reality prototype for general assembly

Desktop computers based virtual training systems are attracting paramount attention from manufacturing industries due to their potential advantages over the conventional training practices. Significant cost savings can be realized due to the shorter training-scenarios development times and reuse of existing engineering models. In addition, by using computer based virtual reality (VR) training systems, the time span from the product design to commercial production can be shortened due to non-reliance on hardware parts. Within the aforementioned conceptual framework, a haptically enabled interactive and immersive virtual reality (HIIVR) system is presented. Unlike existing VR systems, the presented idea tries to imitate real physical training scenarios by providing comprehensive user interaction, constrained within the physical limitations of the real world imposed by the haptics devices within the virtual environment. As a result, in contrast to the existing VR systems, capable of providing knowledge generally about assembly sequences only, the proposed system helps in procedural learning and procedural skill development as well, due to its high physically interactive nature.

A Foucauldian strategy for vocational education and training research

Vocational education and training (VET) is an area of research dominated by positivist approaches. Such approaches complement the behaviourist educational philosophy known as 'competency-based training' (CBT) that underpins Australia’s VET system. This paper reflects on a quandary encountered by researchers examining the history of competency based education at a TAFE institution in South Australia. The issue was how to account for a series of mutations in the way CBT was understood and practised that subverted the largely unquestioned expectation of progress. The researchers found that Foucault’s 'genealogical' approach allowed for the construction of a mode of intelligibility that lends the history a disturbing cogency. At the centre of this construction is an understanding of CBT as a highly permeable system whose configurability supports the reticulation of multiple forms of power.

Investigation of educator adoption of knowledge media

Human development has occurred against a timeline that has seen the creation of and diffusion of one innovation after another. These innovations range from language to complex computing and information technologies. The latter are assisting with the distribution of information, and extend to the distribution of the human species beyond the planet Earth. From early times, information has been published and mostly for a fee to the publisher. The absorption and use of information has had a high priority in most societies from early times, and has become institutionalised in universities and institutes of technical learning. For most in Western societies, education is now a matter of ‘lifelong learning’. Today, we see higher education institutions, worldwide, adapting their organisational structures and operating procedures and forming strategic alliances with communications content providers and carriers as well as with information technology companies. Modern educational institutes seek productivity and efficiency. Many also seek to differentiate themselves from competitors. Technological convergence is often seen by management to be a saviour in many educational organisations. It is hoped that lower capital and recurrent costs can be achieved, and that competitors in an increasingly globalised industry can be held at bay by strategic use of knowledge media (Eisenstadt, 1995) commonly associated with distance education in the campus setting. Knowledge media set up costs, intellectual property costs and training costs for staff and students are often so high as to make their use not viable for Australian institutes of higher education. Against this backdrop, one might expect greater educator and student use of publisher produced textbooks and digital enhancements to the textbook, particularly those involved in distance education. A major issue is whether or not the timing of instructor adoption of converging information technology and communications technologies aligns with the wishes of both higher education management and government, and with those who seek commercial gain from the diffusion and adoption of such technologies. Also at issue is whether or not it is possible to explain variance in stated intentions to recommend adoption of new learning technologies in higher education and implementation. Will there occur educator recommendation for adoption of individual knowledge media such as World Wide Web access to study materials by students? And what will be the form of this tool and others used in higher education? This thesis reports on more recent changes in the technological environment and seeks to contribute to an understanding of the factors that lead to a willingness, or unwillingness, on the part of higher education instructors, as influencers and content providers, to utilise these technologies. As such, it is a diffusion study which seeks to fill a gap in the literature. Diffusion studies typically focus on predicting adoption based on characteristics of the potential adopter. Few studies examine the relationship between characteristics of the innovation and adoption. Nearly all diffusion studies involve what is termed discontinuous innovation (Robertson, 1971). That is, the innovation involves adoptees in a major departure from previous practice. This study seeks to examine the relationship between previous experience of related technologies and adoption or rejection of dynamically continuous innovation. Continuous and dynamically continuous innovations are the most numerous in the real world, yet they are numerically the least scrutinised by way of academic research. Moreover, the three-year longitudinal study of educators in Australian and New Zealand meets important criteria laid down by researchers Tornatzky and Klein (1982) and Rogers (1995), that are often not met by similar studies. In particular the study examines diffusion as it is unfolding, rather than selectively examining a single innovation and after the fact, thus avoiding a possible pro-innovation bias. The study examines the situation for both ‘all educators’ and ‘marketing / management educators’ alone in seeking to meet the following aim: Establish if intended adopters of specific knowledge media have had more experience of other computer-based technologies than have those not intending to adopt said knowledge media. The analytical phase entails use of factor analysis and discriminant analysis to conclude that it is possible to discriminate adopters of selected knowledge media based on previous use of related technologies. The study does not find any generalised factor that enables such discrimination among educators. Thus the study supports the literature in part, but fails to find generalised factors that enable unambiguous prediction of knowledge media adoption or otherwise among each grouping of educators examined. The implications are that even in the case of related products and services (continuous or dynamically continuous innovation), there is not statistical certainty that prior usage of related products or technologies is related to intentions to use knowledge media in the future. In this regard, the present study might be said to confirm the view that Rogers and Shoemaker's (1971) conceptualisation of perceived innovation characteristics may only apply to discontinuous innovations (Stratton, Lumpkin & Vitell, 1997). The implications for stakeholders such as higher education management is that when seeking to appoint new educators or existing staff to knowledge media project teams, there is some support for the notion that those who already use World Wide Web based technologies are likely to take these technologies into teaching situations. The same claim cannot be made for computer software use in general, nor Internet use in general.

Telecommunication technology and the professional development of teachers : challenge and opportunity

The thesis explores an effective model for using the internet in a distance training program for secondary school teachers. The professional development program, the dissertation, titled The Virtual University: Professional development for teachers, was initiated based on aspects of telecommunication technology and the professional development for Thai school teachers. The question of this program was “How could information technology be used in developing an appropriate professional development model for Thai teachers?” Prior to the project, the four research studies were conducted to formulate the related base line information and supported framework for the program development. The four researches are: (1) Telecommunication Technology in Thai Schools, (2) The Role of University on Science Teachers Development, (3) Computer Education Curriculum for Student Teachers: Theory and Practice, and (4) Teachers’ Perceptions of the Academic Link Project Between Schools and Universities for Teacher Professional Development. The first research study provides the information about the necessary basic factors for change in Thai secondary schools and the new insights and understandings about change in Thai schooling. The major findings were the understandings about teachers’ need for professional development, the available support in Thai school for professional development, and the limitations of professional development of teachers. The second research study provides the information about the roles of university faculty on initiation and operation of science teacher development programs, science teaching and learning resources centers, science instructional media design and production services, science teaching clinics, and science teachers’ associations. The third research study provides the conceptual framework for both preservice and inservice curriculum development program for teacher development. The last research study provides a base of descriptive information about the perspectives of school teachers towards the academic link project between schools and universities and the partnership which can assist in its establishment. The findings of these four research tasks were used for the formation of the framework of the dissertation. The EDNET Project, an example of teachers’ professional development through the information technology based training, was developed and implemented with ten school teachers in Khon Kaen.

Evaluation of Australian undergraduate engineering management education for flexible delivery

This thesis examines issues in Australian undergraduate engineering management studies in the context of flexible learning delivery. It is proposed that, within an Australian context: a) the management skills and competencies required by graduate engineers can be determined and classified on a rational basis, permitting an educational focus on those elements most appropriate for graduates; and b) on-line and other computer-based technologies are a practical and effective method for the support of undergraduate engineering management studies. The doctoral project incorporates: • an examination of the nature of engineering management; • a review of the relevant literature establishing the importance of management studies in undergraduate engineering courses; • a review of historical and recent developments in Australian undergraduate engineering management studies; • an investigation of the management skills and competencies required by graduate engineers - based on original research; • an examination of flexible delivery of engineering education - based on professional practice experience; and • an evaluation of case studies of flexible delivery of engineering management education - based on original research and professional practice experience. A framework of ranked classified management skills is developed. Broadly, the ranking framework is generic professional skills, followed by general management skills and technical discipline specific management skills, followed by other professional discipline skills and theoretical skills. This framework provides a rational basis for design of undergraduate engineering management studies. This is supplemented by consideration of the management skills required for the future of engineering practice. It is concluded that undergraduate engineering management education is well suited to delivery and support by on-line and computer-based technology. Recent developments in improved access to the Internet, software systems for on-line collaboration and changes in copyright legislation to create a broad-based right to communication via on-line media have contributed to the facilitation of on-line delivery of teaching and learning. It is noted that though many on-line infrastructure issues have been satisfactorily resolved, higher level issues will emerge as being crucial, including the academic staff development and reward for operating in an online teaching environment and the financial sustainability of on-line development and delivery of courses.

Comparison of two modes of delivery of first aid training including basic life support

Aims: Flexible-learning first aid courses are increasingly common due to reduced classroom contact time. This study compared retention of first aid knowledge and basic life support (BLS) skills three months after a two-day, classroom-based first aid course (STD) to one utilizing on-line theory learning at home followed by one day of classroom training (FLEX).
Methods: In this prospective randomized controlled trial, 256 participants with internet access and no first aid related training for at least five years were randomly allocated to a STD or FLEX course. Assessment was conducted immediately after training and again three months later. Each participant was allocated a theory and a BLS score, which were summed and averaged to create an equally-weighted ‘combined score’
of first aid knowledge and skills.
Results: There was no significant difference in theory scores between the STD and FLEX groups immediately after training and after three months. STD participants had significantly higher BLS scores immediately after training (p = 0.001) and three months later (p = 0.046). Males had significantly higher BLS scores after training (p < 0.001), but not three months later (p = 0.02). Participants older than 46 years had significantly lower BLS scores than younger participants (p < 0.001). There was no significant difference in combined scores between the STD and FLEX groups or between genders, education or age groups either immediately after training or three months later.
Conclusion: After replacing one day of classroom-based training with on-line theory training, there was no significant difference in the first aid competencies of the study population, as measured by an equallyweighted
combined score of basic life support and first aid theory.