The simulation of surgical procedures, in the case of hard tissues such as bone or teeth milling, using a haptic milling surgery simulator requires a haptic device which can provide high stiffness and transparency. To mimic a real milling process of hard tissue, such as for example creating a narrow channel or cavity, the simulator needs to provide force/torque feedback in 5–6 degrees of freedom (DOF). As described in this thesis, research has been performed to develop and optimize a haptic device that can provide high stiffness and force/torque capabilities to facilitate haptic interaction with stiff tissues.  The main contributions of this thesis are: (i) The use of a model-based design methodology for the design of haptic devices.  The proposed methodology is applied to a case study, i.e. the design and optimization of a haptic device based on parallel kinematics. Device requirements were elicited through dialogues with a prospective user from a neurosurgery clinic. In the conceptual design phase, different parallel concepts have been investigated and analyzed based on functional qualities such number of degrees of freedom, workspace size and force/torque capabilities. This analysis led to the selection of a specific 6 DOF kinematic structure for which dimension synthesis was performed including multi-objective optimization followed by control synthesis. Finally, a device prototype was realized and its performance verified. (ii) Optimization of the device for best kinematic and dynamic performance. For optimization, performance indices such as workspace-to-footprint ratio, kinematic isotropy and inertial indices were used. To cope with the problem of non-uniform units in the components of the Jacobian matrix, various normalization techniques were investigated. A new multi-objective optimization function is introduced to define the optimization problem, which is then resolved using multi-objective genetic algorithms. A sensitivity analysis of the performance indices against each design parameter is performed, as a basis for selecting a final set of design parameter values. (iii) A control strategy is investigated to achieve high transparency and stability of the device. The control strategy is based on careful analysis of the dynamics of the haptic device, computed torque feed-forward control and force control based on current feedback. (iv) Finally, experiments both separately in the lab and by using the device in a haptic milling surgery simulator were performed. Results from a face validity study performed in collaboration with orthopedists verify that the new haptic device enables high-performance force and torque feedback for stiff interactions. / QC 20120302

No description available.

Yes / Angiography is a minimally invasive diagnostic procedure in endovascular interventions. Training interventional procedures is a big challenge, due to the complexity of the procedures with the changes of measurement and visualization in blood flow rate, volume, and image contrast. In this paper, we present a novel virtual reality-based 3D interactive training platform for angiography procedure training. We propose a multi-fluid flow approach with a novel corresponding non-slip boundary condition to simulate the effect of diffusion between the blood and contrast media. A novel syringe device tool is also designed as an add-on hardware to the 3D software simulation system to model haptics through real physical interactions to enhance the realism of the simulation-based training. Experimental results show that the system can simulate realistic blood flow in complex blood vessel structures. The results are validated by visual comparisons between real angiography images and simulations. By combining the proposed software and hardware, our system is applicable and scalable to many interventional radiology procedures. Finally, we have tested the system with clinicians to assess its efficacy for virtual reality-based medical training. / National Natural Science Foundation of China grant number 61402278, the Shanghai Natural Science Foundation of China grant number 14ZR1415800, Research Program of Shanghai Engineering Research Center of Motion Picture Special Effects grant number 16dz2251300, Shanghai University Film Peak Discipline, and Shanxi Natural Science Technology Foundation grant number 2016JZ026.

Esta dissertação de mestrado propõe o estudo e a implementação de um método de deformação usando modelos tridimensionais sem o uso de malhas baseado na técnica Smoothed Particles Hydrodynamics (SPH), que consiste num sistema de resolução de equações diferenciais para aplicação de conceitos físicos para simular deformação de tecidos moles. A opção pelo método sem malha para processo de deformação é apresentado nesta dissertação como alternativa a um dos métodos mais comuns em simulação de deformação de tecidos, o método massa-mola, explorando questões referentes ao uso de recursos computacionais. Para chegada a definição do método foram analisados os temas envolvendo métodos de deformação, modelos baseados em pontos e o SPH como plataformas para alcançar o desenvolvimento do método proposto pela dissertação. Como forma de comprovar as propriedades do método desenvolvido foi realizada a implementação e testes levando em consideração os modelos de deformação e a interação em tempo real num ambiente de simulação que contempla a deformação de uma mama, levando em conta a comparação com o método massa-mola, o uso de recursos do próprio método em função do aumento de detalhe e do uso de objeto com múltiplas propriedades / This master thesis proposes a study and implementation of deformation method using tridimensional models without edge composed meshes based on Smoothed Particles Hydrodynamics (SPH) technique, that consists on diferential equation solving system to reproduce physical concepts to simulate soft tissue deformation. The option for a meshless method to deformation process is shown in this thesis as an alternative to a very common method in tissue deform simulation, the mass-spring method, reviewing a comparison based on computational resources. To achieve a method definition were analyzed fields of study involving deformation methods, point-based models and SPH as platforms to build and deploy the proposed method for this thesis. To show the characteristics for this developed deformation method was realized the implementation and tests based on deformation models and real time interaction on a simulation environment that includes a breast deformation, taking in account the comparison to mass-spring, number of points of the cloud model and multiple properties

Esta dissertação de mestrado propõe o estudo e a implementação de um método de deformação usando modelos tridimensionais sem o uso de malhas baseado na técnica Smoothed Particles Hydrodynamics (SPH), que consiste num sistema de resolução de equações diferenciais para aplicação de conceitos físicos para simular deformação de tecidos moles. A opção pelo método sem malha para processo de deformação é apresentado nesta dissertação como alternativa a um dos métodos mais comuns em simulação de deformação de tecidos, o método massa-mola, explorando questões referentes ao uso de recursos computacionais. Para chegada a definição do método foram analisados os temas envolvendo métodos de deformação, modelos baseados em pontos e o SPH como plataformas para alcançar o desenvolvimento do método proposto pela dissertação. Como forma de comprovar as propriedades do método desenvolvido foi realizada a implementação e testes levando em consideração os modelos de deformação e a interação em tempo real num ambiente de simulação que contempla a deformação de uma mama, levando em conta a comparação com o método massa-mola, o uso de recursos do próprio método em função do aumento de detalhe e do uso de objeto com múltiplas propriedades / This master thesis proposes a study and implementation of deformation method using tridimensional models without edge composed meshes based on Smoothed Particles Hydrodynamics (SPH) technique, that consists on diferential equation solving system to reproduce physical concepts to simulate soft tissue deformation. The option for a meshless method to deformation process is shown in this thesis as an alternative to a very common method in tissue deform simulation, the mass-spring method, reviewing a comparison based on computational resources. To achieve a method definition were analyzed fields of study involving deformation methods, point-based models and SPH as platforms to build and deploy the proposed method for this thesis. To show the characteristics for this developed deformation method was realized the implementation and tests based on deformation models and real time interaction on a simulation environment that includes a breast deformation, taking in account the comparison to mass-spring, number of points of the cloud model and multiple properties

Background: Medical student involvement in clinical care of obstetrical emergencies is limited. Wearable technology, namely Google Glass, has been used to enhance the simulation experience for trainees at our institution. We present a pilot study that examines the utility of this technology in medical students’ education through remotely-conducted exercises in obstetric emergencies. Materials & Methods: A total of thirteen medical students accepted the opportunity to participate in an obstetric emergencies training exercise with remote monitoring. Students wore the Google Glass device while participating in two simulated obstetrical emergencies: shoulder dystocia and vaginal breech delivery. A remote instructor monitored the students’ performance and gave verbal instructions during the simulation. Students then filled out a questionnaire grading the effectiveness of the exercise. Results: Of all participating students, 55% reported Glass extremely valuable for their education. None reported it as not being valuable. 15% reported that Glass distracted them in their simulation activity. 100% of participants reported it being more than “successful" in its potential to improve emergency obstetric care. 55% reported that Glass or a similar device is “extremely likely” to be incorporated into medicine. None reported that it is unlikely to be used in the future of medicine. Conclusions: Wearable technology has the potential to provide improved learner experience. This technology can be successfully used to provide student exposure to simulated emergencies. Further studies evaluating the participation of students and other learners in simulated obstetrical emergencies are needed to determine how effective wearable technology can become in medical education and ultimately patient care as well.

Army first responders, specifically Combat Medics and Combat Lifesavers, provide medical intervention while in the field. Didactic as well as hands-on training helps to prepare these first responders, and one module they receive involves bleeding control. First responders are taught to use the Combat Application Tourniquet® (CAT® ) to stop bleeding from limbs subjected to severe injury such as amputation, gunshot, or severe lacerations. A training aid like the Multiple Amputee Trauma Trainer™ (MATT™) simulator provides tourniquet training using a lifelike bilateral lower limb amputee. In addition, MATT™ combines movement and resistance while the first responder applies the tourniquet, mimicking conditions one would see in a real situation. This research describes tourniquet history, appropriate usage, field tourniquet review, surgical tourniquet, CAT® bleeding intervention procedures, bleeding physiology and complications, prehospital tourniquet use in recent conflicts, medical simulation fidelity, and a review of the value of animatronic movement during tourniquet simulation-based training. I then evaluate the effectiveness of animatronic movement during tourniquet training using the Advanced MATT in an experiment using Army first responders. The control group experienced no movement while the experimental group experienced movement when applying a tourniquet during the lab-training. Each group then alternately experienced Advanced MATT movement during an immersive scenario along with fog, strobe lights, and battle sounds. It was hypothesized that 1) In the immersive scenario, the experimental groups (i.e., those who were trained on a moving simulator) would have a faster reaction time as compared to those participants who did not receive training on the moving Advanced MATT simulator; 2) In the iv lab-based training, the experimental groups would have a slower reaction time; 3) In the immersive scenario, the experimental groups would have a faster tourniquet application time when subjected to movement while in the lab-based training, but the experimental groups would also have a slower tourniquet application time when initially subjected to movement in the laboratory-based training; finally, 4, 5, and 6) Participants who completed lab-based tourniquet training on the Advanced MATT simulation with animatronic movement would report higher perceived realism scores than participants who complete the training on a static version of the Advanced MATT and participants who completed a tourniquet training immersive scenario on the Advanced MATT simulation with movement would report higher perceived realism, presence, and self-efficacy scores than participants who complete the training on a static version of the Advanced MATT. The empirical results show a significant overall training effect of the Advanced MATT simulator (with or without movement). For reaction time and tourniquet application time, involving simulator movement was significant over varying scenarios. A small reduction in reaction and tourniquet application time on the battlefield may be extremely beneficial on the battlefield. Participants who received movement generally gave more positive reactions than those who did not received movement, although these results failed to reach statistical significance. Participants who received movement, followed by a scenario without movement rated the subjective ratings the lowest, suggestive of the lack of movement. Furthermore, despite the order movement was received, no large drops in performance occurred in any condition, indicating that negative training was avoided

Aims The aims of this study were to increase community pharmacists’ willingness and confidence to provide consultations for people with depression, and to enhance patients’ awareness of the pharmacists’ developing role. Research Design To observe pharmacist-patient consultations, the researcher developed a patient scenario. Pharmacist knowledge and attitude questionnaires were adapted, and a skills observation checklist was developed. Assessments of patient satisfaction levels took place before and after pharmacist training, which included a simulated consultation and action planning. The consultations were both video recorded and observed. Participants undertook a short interview with the researcher and each pharmacist developed his/her own plan for continuing professional development (CPD). An exploration of the interview transcripts was undertaken qualitatively. A University Ethics Panel approved the project. Results There were twenty-two pharmacists who took part in the study, comprising eighteen males and four females. MPharm students comprised one female and two males, and community pharmacists made up three females and sixteen males. The quantitative results: It was found that pharmacists possessed appropriate knowledge (the mean score was 75%, which showed that the pharmacists were aware of the safety and action of anti-depressants). The mean score for attitude was 54%, which tends towards the positive. When observing the simulated consultations, the mean score for initiating a consultation session was recorded at 28%. This indicates that the pharmacists were not very interested in initiating rapport with patients. However, the highest mean score calculated was 61%, which corresponded with closing a consultation. For data collection and action, the mean scores were 42% and 35%, respectively, and this indicates the need for improvement in these areas. The qualitative findings: The pharmacists demonstrated good knowledge about anti-depressants and held positive attitudes towards people with depression. However, the pharmacists were not very willing to exercise the responsibilities of their extended role or provide additional services for patients. The pharmacists lacked certain skills and opportunities to be able to enhance the patients’ satisfaction. The pharmacists in this study needed to improve their soft skills in some areas and engage in mutual discussion with patients in order to enhance patients’ expectations with the service provided. Conclusion/discussion The knowledge and attitude of pharmacists were good, but their consultation skills could be improved. Although simulated consultation allowed pharmacists to review their skills and practice the apparent impact on patient care was limited. This study has enable greater understanding of pharmacist strategies when consulting people with depression, and the findings could be used by those developing training programmes for enhancing pharmacists skills.

Les innovations technologiques et le déploiement du numérique se mettent au service de la santé et engagent les formations vers la simulation haute fidélité.La recherche effectuée dans le domaine de la maïeutique a pour but de mieux comprendre comment, dans un environnement simulé complexe, l'introduction d'outils informatiques perfectionnés agit sur les modalités de transmission de différents savoirs « scientifiques », « technologiques » et « professionnels ». Elle analyse l'activité déployée par une enseignante sage-femme lors de l'utilisation d'un « nouvel outil », un simulateur d'accouchement interactif et virtuel, pour des séances pédagogiques à destination d'étudiants en maïeutique de troisième année. L'objectif est de repérer les effets de cette innovation sur ses pratiques de formation, et de mesurer la nature de son développement professionnel avec le simulateur.La méthodologie utilisée est celle de l'analyse clinique. La recherche s'appuie sur les courants de la didactique professionnelle et de la théorie instrumentale. Elle intègre les concepts d'« imprévu » et de « gestes professionnels d'ajustement » visant à rendre compte des différents niveaux d'imbrication de l'activité de formation de l'enseignante, et elle est destinée à éclairer sa pratique dans la conceptualisation des situations de travail.Les résultats montrent que les pratiques se transforment au fil des séances faisant apparaître de nouvelles dynamiques d'apprentissage. Les premiers savoirs professionnels observés permettent d'identifier un répertoire de gestes professionnels utiles à l'enseignement avec ce simulateur d'accouchement interactif. Les conclusions débouchent sur des visées d'utilisation du simulateur non prévues par les concepteurs de l'outil et sur une proposition d'un dispositif de formation de formateurs adapté à l'enseignement avec ce simulateur. Ces quelques pistes, non exhaustives, sont une invitation à réfléchir sur de nouvelles modalités d'enseignement avec du matériel de simulation haute fidélité. / Technological innovations and the spread of digital technology help out public health and commit training towards high-fidelity simulation.The research made in the field of midwifery aims at a better understanding of how in a complex simulated environment the introduction of sophisticated computing tools plays on the modalities of transmission of various « scientific », « technological » and «professional » knowledge. It analyzes the activity displayed by a midwife teacher while using a « new tool », an interactive and virtual birth simulator, for educational sessions aimed at third-year students in midwifery. The objective is to spot the effects of this innovation on her practices of training, and to measure the nature of her professional development with the simulator.The methodology which is used is clinical analysis. The research is based on professional didactics and instrumental theory trends. It integrates the concepts of « the unpredictable » and of « professional gestures of adjustment » to report the various levels of interweaving of the teacher's activity in training, and it aims at clarifying her practice in the conceptualization of the working situations.The results show that the practices are transformed in the course of the sessions revealing new dynamics of learning. The first professional knowledge observed helps to identify a record of professional gestures that are useful for teaching with this interactive birth simulator. From the conclusions it turns out that the simulator is not used as it was planned by the designers of the tool and it leads to offer a device for trainers' training adapted to the teaching with this simulator. These few non-exhaustive tracks are an invitation to think about new modalities of teaching with high-fidelity of simulation devices.

<p>Simulation modeling has proven beneficial in gathering insights that may aid safety policy considerations for schools, offices, and outdoor events. This is especially true when conducting a drill that is not practical or possible, such as active shooter response. However, we can improve the current modeling practices with high-fidelity simulation logic reflecting a victim's well-being. Currently, victims are modeled either as “killed,” or they continue their normal movement. The binary approach is suitable for many simulations developed to understand course trends in an event space but does not allow for more fine-tuned insights that may be beneficial when developing a safety and response protocol for a specific facility or event. Additional victim characteristics, such as tracking the location of a victim's wound and the rate of physiological decline, may be added into a model that will improve the realism and lead to an improved response protocol. The increased fidelity will be helpful when simulating and assessing the effects of volunteer response, critical care transport for medical intervention, and other first-responder interventions.</p> <p>While some think it is not possible or necessary to simulate how fast gunshot victims would lose blood, we show that a high-fidelity simulation is possible. The main counterargument is that there is no sufficient data, and also it will be challenging to implement this process as it is occurring. However, we found enough data or were able to extrapolate the missing pieces and develop a consistent and realistic blood loss model. In addition, the state of current simulation packages, such as AnyLogic, has advanced to the point where we can model a liquid system dynamic within an agent-based model. Furthermore, there is an acute benefit to conducting this type of research as it can help us develop better response policies, which result in more saved lives.</p> <p>The research aims to improve emergency-response simulation fidelity by developing a model that simulates gunshot wounds and the subsequent blood loss while accounting for a victim's age, weight, gender, and the affected area. The model also accounts for the body's compensatory response and medical interventions, such as tourniquet application, wound packing, and direct pressure. The work presents an analytical model and its implementation using agent-based modeling in AnyLogic. This AnyLogic module can be inserted into active shooter simulations that easily integrate with the existing logic. This integration happens through a high-level application programming interface (API) exposed to the user. The API allows for automatic infliction of injury and mitigation. The extensive literature review and case studies provide a sound foundation for creating the model. AnyLogic was chosen due to its common usage and versatility with other systems and computer programming languages.</p>