610 Medizin und Gesundheit
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Background
Electrosurgical excisions are common procedures for treating cervical dysplasia and are often seen as minor surgeries. Yet, thorough training of this intervention is required, as there are considerable consequences of inadequate resections, e.g. preterm birth, the risk of recurrence, injuries and many more. Unfortunately, there is a lack of sufficiently validated possibilities of simulating electrosurgeries, which focus on high fidelity and patient safety.
Methods
A novel 3D printed simulator for examination and electrosurgical treatment of dysplastic areas of the cervix was compared with a conventional simulator. Sixty medical students experienced a seminar about cervical dysplasia. Group A underwent the seminar with the conventional and Group B with the novel simulator. After a theoretical introduction, the students were randomly assigned by picking a ticket from a box and went on to perform the hands-on training with their respective simulator. Each student first obtained colposcopic examination training. Then he or she performed five electrosurgical excisions (each). This was assessed with a validated score, to visualize their learning curve. Furthermore, adequate and inadequate resections and contacts between electrosurgical loop and vagina or speculum were counted. Both groups also assessed the seminar and their simulator with 18 questions (Likert-scales, 1–10, 1 = strongly agree / very good, 10 = strongly disagree / very bad). Group B additionally assessed the novel simulator with four questions (similar Likert-scales, 1–10).
Results
Nine of 18 questions showed statistically significant differences favoring Group B (p < 0.05). Group B also achieved more adequate R0-resections and less contacts between electrosurgical loop and vagina or speculum. The learning curves of the performed resections favored the novel simulator of Group B without statistically significant differences. The four questions focusing on certain aspects of the novel simulator indicate high appreciation of the students with a mean score of 1.6 points.
Conclusion
The presented novel simulator shows several advantages compared to the existing model. Thus, novice gynecologists can be supported with a higher quality of simulation to improve their training and thereby patient safety.
Most animals live in seasonal environments and experience very different conditions throughout the year. Behavioral strategies like migration, hibernation, and a life cycle adapted to the local seasonality help to cope with fluctuations in environmental conditions. Thus, how an individual utilizes the environment depends both on the current availability of habitat and the behavioral prerequisites of the individual at that time. While the increasing availability and richness of animal movement data has facilitated the development of algorithms that classify behavior by movement geometry, changes in the environmental correlates of animal movement have so far not been exploited for a behavioral annotation. Here, we suggest a method that uses these changes in individual–environment associations to divide animal location data into segments of higher ecological coherence, which we term niche segmentation. We use time series of random forest models to evaluate the transferability of habitat use over time to cluster observational data accordingly. We show that our method is able to identify relevant changes in habitat use corresponding to both changes in the availability of habitat and how it was used using simulated data, and apply our method to a tracking data set of common teal (Anas crecca). The niche segmentation proved to be robust, and segmented habitat suitability outperformed models neglecting the temporal dynamics of habitat use. Overall, we show that it is possible to classify animal trajectories based on changes of habitat use similar to geometric segmentation algorithms. We conclude that such an environmentally informed classification of animal trajectories can provide new insights into an individuals' behavior and enables us to make sensible predictions of how suitable areas might be connected by movement in space and time.
Many every-day life situations require two or more individuals to execute actions together. Assessing brain activation during naturalistic tasks to uncover relevant processes underlying such real-life joint action situations has remained a methodological challenge. In the present study, we introduce a novel joint action paradigm that enables the assessment of brain activation during real-life joint action tasks using functional near-infrared spectroscopy (fNIRS). We monitored brain activation of participants who coordinated complex actions with a partner sitting opposite them. Participants performed table setting tasks, either alone (solo action) or in cooperation with a partner (joint action), or they observed the partner performing the task (action observation). Comparing joint action and solo action revealed stronger activation (higher [oxy-Hb]-concentration) during joint action in a number of areas. Among these were areas in the inferior parietal lobule (IPL) that additionally showed an overlap of activation during action observation and solo action. Areas with such a close link between action observation and action execution have been associated with action simulation processes. The magnitude of activation in these IPL areas also varied according to joint action type and its respective demand on action simulation. The results validate fNIRS as an imaging technique for exploring the functional correlates of interindividual action coordination in real-life settings and suggest that coordinating actions in real-life situations requires simulating the actions of the partner.
Trypanosome Motion Represents an Adaptation to the Crowded Environment of the Vertebrate Bloodstream
(2012)
Blood is a remarkable habitat: it is highly viscous, contains a dense packaging of cells and perpetually flows at velocities varying over three orders of magnitude. Only few pathogens endure the harsh physical conditions within the vertebrate bloodstream and prosper despite being constantly attacked by host antibodies. African trypanosomes are strictly extracellular blood parasites, which evade the immune response through a system of antigenic variation and incessant motility. How the flagellates actually swim in blood remains to be elucidated. Here, we show that the mode and dynamics of trypanosome locomotion are a trait of life within a crowded environment. Using high-speed fluorescence microscopy and ordered micro-pillar arrays we show that the parasites mode of motility is adapted to the density of cells in blood. Trypanosomes are pulled forward by the planar beat of the single flagellum. Hydrodynamic flow across the asymmetrically shaped cell body translates into its rotational movement. Importantly, the presence of particles with the shape, size and spacing of blood cells is required and sufficient for trypanosomes to reach maximum forward velocity. If the density of obstacles, however, is further increased to resemble collagen networks or tissue spaces, the parasites reverse their flagellar beat and consequently swim backwards, in this way avoiding getting trapped. In the absence of obstacles, this flagellar beat reversal occurs randomly resulting in irregular waveforms and apparent cell tumbling. Thus, the swimming behavior of trypanosomes is a surprising example of micro-adaptation to life at low Reynolds numbers. For a precise physical interpretation, we compare our high-resolution microscopic data to results from a simulation technique that combines the method of multi-particle collision dynamics with a triangulated surface model. The simulation produces a rotating cell body and a helical swimming path, providing a functioning simulation method for a microorganism with a complex swimming strategy.
Background
Precise and complete documentation of in-hospital cardiopulmonary resuscitations is important but data quality can be poor. In the present study, we investigated the effect of a tablet-based application for real-time resuscitation documentation used by the emergency team leader on documentation quality and clinical performance of the emergency team.
Methods
Senior anaesthesiologists either used the tablet-based application during the simulated resuscitation for documentation and also used the application for the final documentation or conducted the full documentation at the end of the scenario using the local hospital information system. The latter procedure represents the current local documentation method. All scenarios were video recorded. To assess the documentation, we compared the precision of intervention delivery times, documentation completeness, and final documentation time. To assess clinical performance, we compared adherence to guidelines for defibrillation and adrenaline administration, the no-flow fraction, and the time to first defibrillation.
Results
The results showed significant benefits for the tablet-based application compared to the hospital information system for precision of the intervention delivery times, the final documentation time, and the no-flow fraction. We observed no differences between the groups for documentation completeness, adherence to guidelines for defibrillation and adrenaline administration, and the time to first defibrillation.
Discussion
In the presented study, we observed that a tablet-based application can improve documentation data quality. Furthermore, we demonstrated that a well-designed application can be used in real-time by a member of the emergency team with possible beneficial effects on clinical performance.
Conclusion
The present evaluation confirms the advantage of tablet-based documentation tools and also shows that the application can be used by an active member of an emergency team without compromising clinical performance.
Durch Fortschritte in der Technologie haben interventionelle Eingriffe am Herzen in den letzten Jahrzehnten einen herausragenden Stellenwert entwickelt und zu einer Reduktion von aufwendigen Operationen am Herzen geführt. Die Ausbildung im Herzkatheterlabor, die nach dem konservativen „appreticeship-model“ erfolgt, gerät in Anbetracht der sinkenden finanziellen Mittel, Zeitmangel und der ethischen Fragen bezüglich Patientensicherheit immer mehr in Diskussion. Die Entwicklung der Virtual-Reality-Simulatoren für Kathetereingriffe bietet hier durch die Realitätsnähe einen Ansatzpunkt für die Möglichkeit eines individuell angepassten, repetitiven Trainings ohne die Gefährdung eines Patienten. Standardsituationen als auch seltene Komplikationen können nachgestellt werden. Diese Studie weist nach, dass Training an den Virtual-Reality-Simulatoren CATHI und Immersion zu einer Risikoreduktioin bei der Durchführung einer perkutanen Coronarintervention führt. Zur Untersuchung der Effekte von Virtual-Reality-Training auf die Performance einer perkutanen Coronarintervention wurde an der medizinischen Klinik Wuerzburg eine kontrolliert-radnomisierte Studie mit 33 Anfängern in der interventionellen Kardiologie durchgeführt. 16 Teilnehmer (Simulationsgruppe) erhielten ein intensives acht-stuendiges Simulationstraining an zwei verschiedenen Virtual-Reality-Simulatoren (CATHI und Immersion), 17 Teilnehmer bildeten die Kontrollgruppe, die den konservativen Ausbildungsgang repräsentierte und kein Simulationstraining erhielt. Alle Teilnehmer mussten in Form einer Prä- und Postevaluation unter realitätsnahen Umständen im Herzkatheterlabor der Uniklinik Würzburg innerhalb von 30 Minuten eine perkutane Coronarintervention an einem pulsatilen Herzkreislaufmodell aus Silikon (CoroSim) eigenständig vornehmen. Dabei musste eine an einer Aufteilung lokalisierte hochgradige Stenose ohne Abgänge mit einer Länge von 10mm und einem Gefäßdurchmesser von 4mm eröffnet werden. Die Ergebnisse zeigten für die Präevaluation keine gruppenspezifischen Unterschiede. Nach dem Simulationstraining zeigte sich eine signifikante Verbesserung der Simulationsgruppe bei der Risikominimierung in Bezug auf Sicherheit bei der Anwendung des Führungskatheters, des Koronardrahts, des Ballon/Stents und bei der KM-Injektion, während sich die Kontrollgruppe in diesen Punkten nicht verbessern konnte. Die aktuelle Studie zeigt, dass Training an den Virtual-Reality-Simulatoren, als Ergänzung zur herkömmlichen Ausbildung, ein hohes Potential für die Optimierung von interventionellen Herzkathetereingriffen verfügt.