Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling.

BACKGROUND: Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention. DESIGN AND METHODS: We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective. RESULTS: The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio. CONCLUSIONS: Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.

The future of patient safety: Surgical trainees accept virtual reality as a new training tool.

BACKGROUND: The use of virtual reality (VR) has gained increasing interest to acquire laparoscopic skills outside the operating theatre and thus increasing patients' safety. The aim of this study was to evaluate trainees' acceptance of VR for assessment and training during a skills course and at their institution. METHODS: All 735 surgical trainees of the International Gastrointestinal Surgery Workshop 2006-2008, held in Davos, Switzerland, were given a minimum of 45 minutes for VR training during the course. Participants' opinion on VR was analyzed with a standardized questionnaire. RESULTS: Fivehundred-twenty-seven participants (72%) from 28 countries attended the VR sessions and answered the questionnaires. The possibility of using VR at the course was estimated as excellent or good in 68%, useful in 21%, reasonable in 9% and unsuitable or useless in 2%. If such VR simulators were available at their institution, most course participants would train at least one hour per week (46%), two or more hours (42%) and only 12% wouldn't use VR. Similarly, 63% of the participants would accept to operate on patients only after VR training and 55% to have VR as part of their assessment. CONCLUSION: Residents accept and appreciate VR simulation for surgical assessment and training. The majority of the trainees are motivated to regularly spend time for VR training if accessible.

USER'S GUIDE FOR ADVANCED PROCESS SIMULATION SOFTWARE APROS 5

Tässä diplomityössä tehtiin käyttäjän opas kehittyneelle prosessisimulointiohjelmistolle APROS 5. Opas on osa VTT Energialle tehtävää APROS 5 käyttäjän koulutuspakettia, joka julkaistaan myöhemmin CD-ROM -muotoisena. Prosessisimulointiohjelmistoa AAPROS 5 voidaan käyttää termohydraulisten prosessien, automaatiopiirien ja sähköjärjestelmien mallinnuksessa. Ohjelma sisältää myös neutroniikkamallin ydinreaktorin käyttäytymisen mallintamiseksi. APROS:in aikaisemmilla UNIX-ympäristössä toimivilla versioilla on toteutettu useita ydinvoimalaitosten turvallisuustutkimukseen liittyviä analyysejä ja sekä ydinvoimalaitosten että konventionaalisten voimalaitosten koulutussimulaattoreita. APROS 5 toimii Windows NT -ympäristössä ja on oleellisesti erilainen käyttää kuin aikaisemmat versiot. Tämän myötä syntyi tarve uudelle käyttäjän oppaalle. Käyttäjän oppaassa esitetään APROS 5:n tärkeimmät toiminnot, mallinnuksen periaatteet ja termohydraulisten ja neutroniikan ratkaisumallit. Lisäksi oppaassa esitetään esimerkki, jossa mallinnetaan yksinkertaistettu VVER-440 -tyyppisen ydinvoimalaitoksen primääripiiri. Yksityiskohtaisempaa tietoa ohjelmistosta on saatavilla APROS 5 -dokumentaatiosta.

Real-Time Simulation of Mobile and Industrial Machines Using the Multibody Simulation Approach

This thesis introduces a real-time simulation environment based on the multibody simulation approach. The environment consists of components that are used in conventional product development, including computer aided drawing, visualization, dynamic simulation and finite element software architecture, data transfer and haptics. These components are combined to perform as a coupled system on one platform. The environment is used to simulate mobile and industrial machines at different stages of a product life time. Consequently, the demands of the simulated scenarios vary. In this thesis, a real-time simulation environment based on the multibody approach is used to study a reel mechanism of a paper machine and a gantry crane. These case systems are used to demonstrate the usability of the real-time simulation environment for fault detection purposes and in the context of a training simulator. In order to describe the dynamical performance of a mobile or industrial machine, the nonlinear equations of motion must be defined. In this thesis, the dynamical behaviour of machines is modelled using the multibody simulation approach. A multibody system may consist of rigid and flexible bodies which are joined using kinematic joint constraints while force components are used to describe the actuators. The strength of multibody dynamics relies upon its ability to describe nonlinearities arising from wearing of the components, friction, large rotations or contact forces in a systematic manner. For this reason, the interfaces between subsystems such as mechanics, hydraulics and control systems of the mechatronic machine can be defined and analyzed in a straightforward manner.

Playing to Learn: Business Simulation Games as Leadership Learning Environments

The aim of this dissertation is to investigate if participation in business simulation gaming sessions can make different leadership styles visible and provide students with experiences beneficial for the development of leadership skills. Particularly, the focus is to describe the development of leadership styles when leading virtual teams in computer-­supported collaborative game settings and to identify the outcomes of using computer simulation games as leadership training tools. To answer to the objectives of the study, three empirical experiments were conducted to explore if participation in business simulation gaming sessions (Study I and II), which integrate face-­to-­face and virtual communication (Study III and IV), can make different leadership styles visible and provide students with experiences beneficial for the development of leadership skills. In the first experiment, a group of multicultural graduate business students (N=41) participated in gaming sessions with a computerized business simulation game (Study III). In the second experiment, a group of graduate students (N=9) participated in the training with a ‘real estate’ computer game (Study I and II). In the third experiment, a business simulation gaming session was organized for graduate students group (N=26) and the participants played the simulation game in virtual teams, which were organizationally and geographically dispersed but connected via technology (Study IV). Each team in all experiments had three to four students and students were between 22 and 25 years old. The business computer games used for the empirical experiments presented an enormous number of complex operations in which a team leader needed to make the final decisions involved in leading the team to win the game. These gaming environments were interactive;; participants interacted by solving the given tasks in the game. Thus, strategy and appropriate leadership were needed to be successful. The training was competition-­based and required implementation of leadership skills. The data of these studies consist of observations, participants’ reflective essays written after the gaming sessions, pre-­ and post-­tests questionnaires and participants’ answers to open-­ ended questions. Participants’ interactions and collaboration were observed when they played the computer games. The transcripts of notes from observations and students dialogs were coded in terms of transactional, transformational, heroic and post-­heroic leadership styles. For the data analysis of the transcribed notes from observations, content analysis and discourse analysis was implemented. The Multifactor Leadership Questionnaire (MLQ) was also utilized in the study to measure transformational and transactional leadership styles;; in addition, quantitative (one-­way repeated measures ANOVA) and qualitative data analyses have been performed. The results of this study indicate that in the business simulation gaming environment, certain leadership characteristics emerged spontaneously. Experiences about leadership varied between the teams and were dependent on the role individual students had in their team. These four studies showed that simulation gaming environment has the potential to be used in higher education to exercise the leadership styles relevant in real-­world work contexts. Further, the study indicated that given debriefing sessions, the simulation game context has much potential to benefit learning. The participants who showed interest in leadership roles were given the opportunity of developing leadership skills in practice. The study also provides evidence of unpredictable situations that participants can experience and learn from during the gaming sessions. The study illustrates the complex nature of experiences from the gaming environments and the need for the team leader and role divisions during the gaming sessions. It could be concluded that the experience of simulation game training illustrated the complexity of real life situations and provided participants with the challenges of virtual leadership experiences and the difficulties of using leadership styles in practice. As a result, the study offers playing computer simulation games in small teams as one way to exercise leadership styles in practice.

Genetic programming for the RoboCup Rescue Simulation System

The Robocup Rescue Simulation System (RCRSS) is a dynamic system of multi-agent interaction, simulating a large-scale urban disaster scenario. Teams of rescue agents are charged with the tasks of minimizing civilian casualties and infrastructure damage while competing against limitations on time, communication, and awareness. This thesis provides the first known attempt of applying Genetic Programming (GP) to the development of behaviours necessary to perform well in the RCRSS. Specifically, this thesis studies the suitability of GP to evolve the operational behaviours required of each type of rescue agent in the RCRSS. The system developed is evaluated in terms of the consistency with which expected solutions are the target of convergence as well as by comparison to previous competition results. The results indicate that GP is capable of converging to some forms of expected behaviour, but that additional evolution in strategizing behaviours must be performed in order to become competitive. An enhancement to the standard GP algorithm is proposed which is shown to simplify the initial search space allowing evolution to occur much quicker. In addition, two forms of population are employed and compared in terms of their apparent effects on the evolution of control structures for intelligent rescue agents. The first is a single population in which each individual is comprised of three distinct trees for the respective control of three types of agents, the second is a set of three co-evolving subpopulations one for each type of agent. Multiple populations of cooperating individuals appear to achieve higher proficiencies in training, but testing on unseen instances raises the issue of overfitting.

Simulation de radiographies à partir d'images tomodensitométriques pour l'enseignement de l'anatomie radiographique en médecine vétérinaire

L'un des principaux défis de l'interprétation radiographique réside dans la compréhension de l’anatomie radiographique, laquelle est intrinsèquement liée à la disposition tridimensionnelle des structures anatomiques et à l’impact du positionnement du tube radiogène vis-à-vis de ces structures lors de l'acquisition de l'image. Traditionnellement, des radiographies obtenues selon des projections standard sont employées pour enseigner l'anatomie radiographique en médecine vétérinaire. La tomodensitométrie − ou communément appelée CT (Computed Tomography) − partage plusieurs des caractéristiques de la radiographie en ce qui a trait à la génération des images. À l’aide d'un plug-in spécialement développé (ORS Visual ©), la matrice contenant les images CT est déformée pour reproduire les effets géométriques propres au positionnement du tube et du détecteur vis-à-vis du patient radiographié, tout particulièrement les effets de magnification et de distorsion. Afin d'évaluer le rendu des images simulées, différentes régions corporelles ont été imagées au CT chez deux chiens, un chat et un cheval, avant d'être radiographiées suivant des protocoles d'examens standards. Pour valider le potentiel éducatif des simulations, dix radiologistes certifiés ont comparé à l'aveugle neuf séries d'images radiographiques simulées aux séries radiographiques standard. Plusieurs critères ont été évalués, soient le grade de visualisation des marqueurs anatomiques, le réalisme et la qualité radiographique des images, le positionnement du patient et le potentiel éducatif de celles-ci pour différents niveaux de formation vétérinaire. Les résultats généraux indiquent que les images radiographiques simulées à partir de ce modèle sont suffisamment représentatives de la réalité pour être employées dans l’enseignement de l’anatomie radiographique en médecine vétérinaire.

Beyond Doing Good: An Interview with Dr. Kirsten Johnson on the Canadian Disaster and Humanitarian Response Training Program

Compte-rendu / Review

Verfahren zur echtzeitfähigen Simulation dynamischer Emissionsverläufe ausgewählter Schadstoffe von Ottomotoren

Im Rahmen dieser Arbeit werden Modellbildungsverfahren zur echtzeitfähigen Simulation wichtiger Schadstoffkomponenten im Abgasstrom von Verbrennungsmotoren vorgestellt. Es wird ein ganzheitlicher Entwicklungsablauf dargestellt, dessen einzelne Schritte, beginnend bei der Ver-suchsplanung über die Erstellung einer geeigneten Modellstruktur bis hin zur Modellvalidierung, detailliert beschrieben werden. Diese Methoden werden zur Nachbildung der dynamischen Emissi-onsverläufe relevanter Schadstoffe des Ottomotors angewendet. Die abgeleiteten Emissionsmodelle dienen zusammen mit einer Gesamtmotorsimulation zur Optimierung von Betriebstrategien in Hybridfahrzeugen. Im ersten Abschnitt der Arbeit wird eine systematische Vorgehensweise zur Planung und Erstellung von komplexen, dynamischen und echtzeitfähigen Modellstrukturen aufgezeigt. Es beginnt mit einer physikalisch motivierten Strukturierung, die eine geeignete Unterteilung eines Prozessmodells in einzelne überschaubare Elemente vorsieht. Diese Teilmodelle werden dann, jeweils ausgehend von einem möglichst einfachen nominalen Modellkern, schrittweise erweitert und ermöglichen zum Abschluss eine robuste Nachbildung auch komplexen, dynamischen Verhaltens bei hinreichender Genauigkeit. Da einige Teilmodelle als neuronale Netze realisiert werden, wurde eigens ein Verfah-ren zur sogenannten diskreten evidenten Interpolation (DEI) entwickelt, das beim Training einge-setzt, und bei minimaler Messdatenanzahl ein plausibles, also evidentes Verhalten experimenteller Modelle sicherstellen kann. Zum Abgleich der einzelnen Teilmodelle wurden statistische Versuchs-pläne erstellt, die sowohl mit klassischen DoE-Methoden als auch mittels einer iterativen Versuchs-planung (iDoE ) generiert wurden. Im zweiten Teil der Arbeit werden, nach Ermittlung der wichtigsten Einflussparameter, die Model-strukturen zur Nachbildung dynamischer Emissionsverläufe ausgewählter Abgaskomponenten vor-gestellt, wie unverbrannte Kohlenwasserstoffe (HC), Stickstoffmonoxid (NO) sowie Kohlenmono-xid (CO). Die vorgestellten Simulationsmodelle bilden die Schadstoffkonzentrationen eines Ver-brennungsmotors im Kaltstart sowie in der anschließenden Warmlaufphase in Echtzeit nach. Im Vergleich zur obligatorischen Nachbildung des stationären Verhaltens wird hier auch das dynami-sche Verhalten des Verbrennungsmotors in transienten Betriebsphasen ausreichend korrekt darge-stellt. Eine konsequente Anwendung der im ersten Teil der Arbeit vorgestellten Methodik erlaubt, trotz einer Vielzahl von Prozesseinflussgrößen, auch hier eine hohe Simulationsqualität und Ro-bustheit. Die Modelle der Schadstoffemissionen, eingebettet in das dynamische Gesamtmodell eines Ver-brennungsmotors, werden zur Ableitung einer optimalen Betriebsstrategie im Hybridfahrzeug ein-gesetzt. Zur Lösung solcher Optimierungsaufgaben bieten sich modellbasierte Verfahren in beson-derer Weise an, wobei insbesondere unter Verwendung dynamischer als auch kaltstartfähiger Mo-delle und der damit verbundenen Realitätsnähe eine hohe Ausgabequalität erreicht werden kann.

Immersive open surgery simulation

Realistic medical simulation has great potential for augmenting or complimenting traditional medical training or surgery planning, and Virtual Reality (VR) is a key enabling technology for delivering this goal. Although, medical simulators are now widely used in medical institutions, the majority of them are still reliant on desktop monitor displays, and many are restricted in their modelling capability to minimally invasive or endoscopic surgery scenarios. Whilst useful, such models lack the realism and interaction of the operating theatre. In this paper, we describe how we are advancing the technology by simulating open surgery procedures in an Immersive Projection Display CAVE environment thereby enabling medical practitioners to interact with their virtual patients in a more realistic manner.

Neural networks training using the constructivism paradigms

The Backpropagation Algorithm (BA) is the standard method for training multilayer Artificial Neural Networks (ANN), although it converges very slowly and can stop in a local minimum. We present a new method for neural network training using the BA inspired on constructivism, an alphabetization method proposed by Emilia Ferreiro based on Piaget philosophy. Simulation results show that the proposed configuration usually obtains a lower final mean square error, when compared with the standard BA and with the BA with momentum factor.

Energy demands in taekwondo athletes during combat simulation

The purpose of this study was to investigate energy system contributions and energy costs in combat situations. The sample consisted of 10 male taekwondo athletes (age: 21 +/- 6 years old; height: 176.2 +/- 5.3 cm; body mass: 67.2 +/- 8.9 kg) who compete at the national or international level. To estimate the energy contributions, and total energy cost of the fights, athletes performed a simulated competition consisting of three 2 min rounds with a 1 min recovery between each round. The combats were filmed to quantify the actual time spent fighting in each round. The contribution of the aerobic (WAER), anaerobic alactic (W-PCR), and anaerobic lactic (Wleft perpendicularLA-right perpendicular) energy systems was estimated through the measurement of oxygen consumption during the activity, the fast component of excess post-exercise oxygen consumption, and the change in blood lactate concentration in each round, respectively. The mean ratio of high intensity actions to moments of low intensity (steps and pauses) was similar to 1:7. The W-AER, W-PCR and (Wleft perpendicularLA-right perpendicular) system contributions were estimated as 120 +/- 22 kJ (66 +/- 6%), 54 +/- 21 kJ (30 +/- 6%), 8.5 kJ (4 +/- 2%), respectively. Thus, training sessions should be directed mainly to the improvement of the anaerobic alactic system (responsible by the highintensity actions), and of the aerobic system (responsible by the recovery process between high- intensity actions).

Simulation of titration experiments

Nowadays computer simulation is used in various fields, particularly in laboratories where it is used for the exploration data which are sometimes experimentally inaccessible. In less developed countries where there is a need for up to date laboratories for the realization of practical lessons in chemistry, especially in secondary schools and some higher institutions of learning, it may permit learners to carryout experiments such as titrations without the use of laboratory materials and equipments. Computer simulations may also permit teachers to better explain the realities of practical lessons, given that computers have now become very accessible and less expensive compared to the acquisition of laboratory materials and equipments. This work is aimed at coming out with a virtual laboratory that shall permit the simulation of an acid-base titration and an oxidation-reduction titration with the use of synthetic images. To this effect, an appropriate numerical method was used to obtain appropriate organigram, which were further transcribed into source codes with the help of a programming language so as to come out with the software.