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

Mid-Holocene monsoons: a multi-model analysis of the inter-hemispheric differences in the responses to orbital forcing and ocean feedbacks

The response of monsoon circulation in the northern and southern hemisphere to 6 ka orbital forcing has been examined in 17 atmospheric general circulation models and 11 coupled ocean–atmosphere general circulation models. The atmospheric response to increased summer insolation at 6 ka in the northern subtropics strengthens the northern-hemisphere summer monsoons and leads to increased monsoonal precipitation in western North America, northern Africa and China; ocean feedbacks amplify this response and lead to further increase in monsoon precipitation in these three regions. The atmospheric response to reduced summer insolation at 6 ka in the southern subtropics weakens the southern-hemisphere summer monsoons and leads to decreased monsoonal precipitation in northern South America, southern Africa and northern Australia; ocean feedbacks weaken this response so that the decrease in rainfall is smaller than might otherwise be expected. The role of the ocean in monsoonal circulation in other regions is more complex. There is no discernable impact of orbital forcing in the monsoon region of North America in the atmosphere-only simulations but a strong increase in precipitation in the ocean–atmosphere simulations. In contrast, there is a strong atmospheric response to orbital forcing over northern India but ocean feedback reduces the strength of the change in the monsoon although it still remains stronger than today. Although there are differences in magnitude and exact location of regional precipitation changes from model to model, the same basic mechanisms are involved in the oceanic modulation of the response to orbital forcing and this gives rise to a robust ensemble response for each of the monsoon systems. Comparison of simulated and reconstructed changes in regional climate suggest that the coupled ocean–atmosphere simulations produce more realistic changes in the northern-hemisphere monsoons than atmosphere-only simulations, though they underestimate the observed changes in precipitation in all regions. Evaluation of the southern-hemisphere monsoons is limited by lack of quantitative reconstructions, but suggest that model skill in simulating these monsoons is limited.

Self-ratings and observer-ratings of social skill: a manipulation of state social anxiety in anxious and non-anxious children

The role of state and trait anxiety on observer ratings of social skill and negatively biased self-perception of social skill was examined. Participants were aged between 7 and 13 years (mean=9.65; sd=1.77; N=102), 47 had a current anxiety diagnosis and 55 were non-anxious controls. Participants were randomly allocated to a high or low anxiety condition and asked to complete social tasks. Task instructions were adjusted across conditions to manipulate participants’ state anxiety. Observers rated anxious participants as having poorer social skills than non-anxious controls but there was no evidence that anxious participants exhibited a negative self-perception bias, relative to controls. However, as participants’ ratings of state anxiety increased, their perception of their performance became more negatively biased. The results suggest that anxious children may exhibit real impairments in social skill and that high levels of state anxiety can lead to biased judgements of social skills in anxious and non-anxious children.

The dependent variable problem in quantitative studies of Active Labour Market Programmes: uncovering hidden dynamics?

The question of what explains variation in expenditures on Active Labour Market Programs (ALMPs) has attracted significant scholarship in recent years. Significant insights have been gained with respect to the role of employers, unions and dual labour markets, openness, and partisanship. However, there remain significant disagreements with respects to key explanatory variables such the role of unions or the impact of partisanship. Qualitative studies have shown that there are both good conceptual reasons as well as historical evidence that different ALMPs are driven by different dynamics. There is little reason to believe that vastly different programs such as training and employment subsidies are driven by similar structural, interest group or indeed partisan dynamics. The question is therefore whether different ALMPs have the same correlation with different key explanatory variables identified in the literature? Using regression analysis, this paper shows that the explanatory variables identified by the literature have different relation to distinct ALMPs. This refinement adds significant analytical value and shows that disagreements are at least partly due to a dependent variable problem of ‘over-aggregation’.

Bollène-2002 experiment: radar quantitative precipitation estimation in the Cévennes–Vivarais region, France

The Bollène-2002 Experiment was aimed at developing the use of a radar volume-scanning strategy for conducting radar rainfall estimations in the mountainous regions of France. A developmental radar processing system, called Traitements Régionalisés et Adaptatifs de Données Radar pour l’Hydrologie (Regionalized and Adaptive Radar Data Processing for Hydrological Applications), has been built and several algorithms were specifically produced as part of this project. These algorithms include 1) a clutter identification technique based on the pulse-to-pulse variability of reflectivity Z for noncoherent radar, 2) a coupled procedure for determining a rain partition between convective and widespread rainfall R and the associated normalized vertical profiles of reflectivity, and 3) a method for calculating reflectivity at ground level from reflectivities measured aloft. Several radar processing strategies, including nonadaptive, time-adaptive, and space–time-adaptive variants, have been implemented to assess the performance of these new algorithms. Reference rainfall data were derived from a careful analysis of rain gauge datasets furnished by the Cévennes–Vivarais Mediterranean Hydrometeorological Observatory. The assessment criteria for five intense and long-lasting Mediterranean rain events have proven that good quantitative precipitation estimates can be obtained from radar data alone within 100-km range by using well-sited, well-maintained radar systems and sophisticated, physically based data-processing systems. The basic requirements entail performing accurate electronic calibration and stability verification, determining the radar detection domain, achieving efficient clutter elimination, and capturing the vertical structure(s) of reflectivity for the target event. Radar performance was shown to depend on type of rainfall, with better results obtained with deep convective rain systems (Nash coefficients of roughly 0.90 for point radar–rain gauge comparisons at the event time step), as opposed to shallow convective and frontal rain systems (Nash coefficients in the 0.6–0.8 range). In comparison with time-adaptive strategies, the space–time-adaptive strategy yields a very significant reduction in the radar–rain gauge bias while the level of scatter remains basically unchanged. Because the Z–R relationships have not been optimized in this study, results are attributed to an improved processing of spatial variations in the vertical profile of reflectivity. The two main recommendations for future work consist of adapting the rain separation method for radar network operations and documenting Z–R relationships conditional on rainfall type.

Rapid qualitative and quantitative analysis of proanthocyanidin oligomers and polymers by UPLC-MS/MS.

This paper presents the development of a rapid method with ultraperformance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) for the qualitative and quantitative analyses of plant proanthocyanidins directly from crude plant extracts. The method utilizes a range of cone voltages to achieve the depolymerization step in the ion source of both smaller oligomers and larger polymers. The formed depolymerization products are further fragmented in the collision cell to enable their selective detection. This UPLC-MS/MS method is able to separately quantitate the terminal and extension units of the most common proanthocyanidin subclasses, that is, procyanidins and prodelphinidins. The resulting data enable (1) quantitation of the total proanthocyanidin content, (2) quantitation of total procyanidins and prodelphinidins including the procyanidin/prodelphinidin ratio, (3) estimation of the mean degree of polymerization for the oligomers and polymers, and (4) estimation of how the different procyanidin and prodelphinidin types are distributed along the chromatographic hump typically produced by large proanthocyanidins. All of this is achieved within the 10 min period of analysis, which makes the presented method a significant addition to the chemistry tools currently available for the qualitative and quantitative analyses of complex proanthocyanidin mixtures from plant extracts.

Quantitative ventilation assessments of idealized urban canopy layers with various urban layouts and the same building packing density

This paper investigates urban canopy layers (UCL) ventilation under neutral atmospheric condition with the same building area density (λp=0.25) and frontal area density (λf=0.25) but various urban sizes, building height variations, overall urban forms and wind directions. Turbulent airflows are first predicted by CFD simulations with standard k-ε model evaluated by wind tunnel data. Then air change rates per hour (ACH) and canopy purging flow rate (PFR) are numerically analyzed to quantify the rate of air exchange and the net ventilation capacity induced by mean flows and turbulence. With a parallel approaching wind (θ=0o), the velocity ratio first decreases in the adjustment region, followed by the fully-developed region where the flow reaches a balance. Although the flow quantities macroscopically keep constant, however ACH decreases and overall UCL ventilation becomes worse if urban size rises from 390m to 5km. Theoretically if urban size is infinite, ACH may reach a minimum value depending on local roof ventilation, and it rises from 1.7 to 7.5 if the standard deviation of building height variations increases (0% to 83.3%). Overall UCL ventilation capacity (PFR) with a square overall urban form (Lx=Ly=390m) is better as θ=0o than oblique winds (θ=15o, 30o, 45o), and it exceeds that of a staggered urban form under all wind directions (θ=0o to 45o), but is less than that of a rectangular urban form (Lx=570m, Ly=270m) under most wind directions (θ=30o to 90o). Further investigations are still required to quantify the net ventilation efficiency induced by mean flows and turbulence.

Review: the predictability of the extra-tropical stratosphere on monthly timescales and its impact on the skill of tropospheric forecasts

Extreme variability of the winter- and spring-time stratospheric polar vortex has been shown to affect extratropical tropospheric weather. Therefore, reducing stratospheric forecast error may be one way to improve the skill of tropospheric weather forecasts. In this review, the basis for this idea is examined. A range of studies of different stratospheric extreme vortex events shows that they can be skilfully forecasted beyond five days and into the sub-seasonal range (0-30 days) in some cases. Separate studies show that typical errors in forecasting a stratospheric extreme vortex event can alter tropospheric forecasts skill by 5-7% in the extratropics on sub-seasonal timescales. Thus understanding what limits stratospheric predictability is of significant interest to operational forecasting centres. Both limitations in forecasting tropospheric planetary waves and stratospheric model biases have been shown to be important in this context.

Interpolation of Hilbert and Sobolev spaces: quantitative estimates and counterexamples

This paper provides an overview of interpolation of Banach and Hilbert spaces, with a focus on establishing when equivalence of norms is in fact equality of norms in the key results of the theory. (In brief, our conclusion for the Hilbert space case is that, with the right normalisations, all the key results hold with equality of norms.) In the final section we apply the Hilbert space results to the Sobolev spaces Hs(Ω) and tildeHs(Ω), for s in R and an open Ω in R^n. We exhibit examples in one and two dimensions of sets Ω for which these scales of Sobolev spaces are not interpolation scales. In the cases when they are interpolation scales (in particular, if Ω is Lipschitz) we exhibit examples that show that, in general, the interpolation norm does not coincide with the intrinsic Sobolev norm and, in fact, the ratio of these two norms can be arbitrarily large.

Global forecasting of thermal health hazards: the skill of probabilistic predictions of the Universal Thermal Climate Index (UTCI)

Although over a hundred thermal indices can be used for assessing thermal health hazards, many ignore the human heat budget, physiology and clothing. The Universal Thermal Climate Index (UTCI) addresses these shortcomings by using an advanced thermo-physiological model. This paper assesses the potential of using the UTCI for forecasting thermal health hazards. Traditionally, such hazard forecasting has had two further limitations: it has been narrowly focused on a particular region or nation and has relied on the use of single ‘deterministic’ forecasts. Here, the UTCI is computed on a global scale,which is essential for international health-hazard warnings and disaster preparedness, and it is provided as a probabilistic forecast. It is shown that probabilistic UTCI forecasts are superior in skill to deterministic forecasts and that despite global variations, the UTCI forecast is skilful for lead times up to 10 days. The paper also demonstrates the utility of probabilistic UTCI forecasts on the example of the 2010 heat wave in Russia.

Will Arctic sea ice thickness initialization improve seasonal forecast skill?

Arctic sea ice thickness is thought to be an important predictor of Arctic sea ice extent. However, coupled seasonal forecast systems do not generally use sea ice thickness observations in their initialization and are therefore missing a potentially important source of additional skill. To investigate how large this source is, a set of ensemble potential predictability experiments with a global climate model, initialized with and without knowledge of the sea ice thickness initial state, have been run. These experiments show that accurate knowledge of the sea ice thickness field is crucially important for sea ice concentration and extent forecasts up to 8 months ahead, especially in summer. Perturbing sea ice thickness also has a significant impact on the forecast error in Arctic 2 m temperature a few months ahead. These results suggest that advancing capabilities to observe and assimilate sea ice thickness into coupled forecast systems could significantly increase skill.

Probabilistic skill in ensemble seasonal forecasts

Simulation models are widely employed to make probability forecasts of future conditions on seasonal to annual lead times. Added value in such forecasts is reflected in the information they add, either to purely empirical statistical models or to simpler simulation models. An evaluation of seasonal probability forecasts from the Development of a European Multimodel Ensemble system for seasonal to inTERannual prediction (DEMETER) and ENSEMBLES multi-model ensemble experiments is presented. Two particular regions are considered: Nino3.4 in the Pacific and the Main Development Region in the Atlantic; these regions were chosen before any spatial distribution of skill was examined. The ENSEMBLES models are found to have skill against the climatological distribution on seasonal time-scales. For models in ENSEMBLES that have a clearly defined predecessor model in DEMETER, the improvement from DEMETER to ENSEMBLES is discussed. Due to the long lead times of the forecasts and the evolution of observation technology, the forecast-outcome archive for seasonal forecast evaluation is small; arguably, evaluation data for seasonal forecasting will always be precious. Issues of information contamination from in-sample evaluation are discussed and impacts (both positive and negative) of variations in cross-validation protocol are demonstrated. Other difficulties due to the small forecast-outcome archive are identified. The claim that the multi-model ensemble provides a ‘better’ probability forecast than the best single model is examined and challenged. Significant forecast information beyond the climatological distribution is also demonstrated in a persistence probability forecast. The ENSEMBLES probability forecasts add significantly more information to empirical probability forecasts on seasonal time-scales than on decadal scales. Current operational forecasts might be enhanced by melding information from both simulation models and empirical models. Simulation models based on physical principles are sometimes expected, in principle, to outperform empirical models; direct comparison of their forecast skill provides information on progress toward that goal.

A comparative review of skill assessment: performance, prediction and profiling

The assessment of chess players is an increasingly attractive opportunity and an unfortunate necessity. The chess community needs to limit potential reputational damage by inhibiting cheating and unjustified accusations of cheating: there has been a recent rise in both. A number of counter-intuitive discoveries have been made by benchmarking the intrinsic merit of players’ moves: these call for further investigation. Is Capablanca actually, objectively the most accurate World Champion? Has ELO rating inflation not taken place? Stimulated by FIDE/ACP, we revisit the fundamentals of the subject to advance a framework suitable for improved standards of computational experiment and more precise results. Other domains look to chess as the demonstrator of good practice, including the rating of professionals making high-value decisions under pressure, personnel evaluation by Multichoice Assessment and the organization of crowd-sourcing in citizen science projects. The ‘3P’ themes of performance, prediction and profiling pervade all these domains.

Quantitative single-molecule localization microscopy combined with rule-based modeling reveals ligand-induced TNF-R1 reorganization toward higher-order oligomers

We report on the assembly of tumor necrosis factor receptor 1 (TNF-R1) prior to ligand activation and its ligand-induced reorganization at the cell membrane. We apply single-molecule localization microscopy to obtain quantitative information on receptor cluster sizes and copy numbers. Our data suggest a dimeric pre-assembly of TNF-R1, as well as receptor reorganization toward higher oligomeric states with stable populations comprising three to six TNF-R1. Our experimental results directly serve as input parameters for computational modeling of the ligand-receptor interaction. Simulations corroborate the experimental finding of higher-order oligomeric states. This work is a first demonstration how quantitative, super-resolution and advanced microscopy can be used for systems biology approaches at the single-molecule and single-cell level.