Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a simulation-based staff educational program was developed and implemented by ICU staff (n=20). Following the implementation of the simulation-based program, adherence to CVC maintenance guidelines improved from 41.5% to 87.9%. A sample t-test showed that this improvement was statistically significant and the CLABSI rate declined to 1.24 per 1,000 catheter days in the 4-week period following implementation of the program. Findings show that introducing a simulation-based training program might help to reduce CLABSI rates in the ICU setting and contribute to positive social change by improving health outcomes in ICU patients with a CVC.

INTRODUCTION: According to current census projections, by the year 2050 racial and ethnic minority groups will make up over half of the United States population. With the rise of a more multicultural and diverse population, there has been growing concern with regards to the health disparities and how healthcare professionals can increase positive healthcare outcomes. In an effort to contend with the growing population, the subsequent disparities that will be faced by a more diverse population, and the difficulties many healthcare practitioner’s will encounter while communicating and working with this population group, many healthcare educators have turned their attention to training and educating the next generation of healthcare providers on the practice of cultural competence. For many institutions, however, there is still uncertainty over the most effective means for teaching cultural competence throughout the healthcare curriculum. Data collected from a 2017-2020 study conducted at Boston University in the M.S. in Oral Health Sciences Program, a credential enhancing program for predental students with the aim of providing students with admission into an accredited dental institution, evaluates an effective mechanism for training healthcare professionals in cultural competence skills. This study hypothesizes that one effective and powerful tool for teaching the next generation of health professionals to be culturally competent providers is through role-playing, case-based, simulated exercises which emphasize the importance of the provider patient relationship, holistic approaches to healthcare, and compassion when working with patients. METHODS: A course session was created in an Evidence Based Dentistry Course within the M.S. in Oral Health Sciences Program. From 2017-2019 the course session was composed of three parts: a role-playing enactment of two patient case-based encounters, a real-time class group discussion following both patient encounters, and a PowerPoint presentation emphasizing the key take-away points from the role-playing exercise. At the conclusion of the session, students were asked to participate in a post-session survey regarding the student’s feelings about the session. In 2020, due to the COVID-19 pandemic, a switch in course session modality in the Evidence Based Dentistry course to an online format, prompted a change in the session format. In 2020, students were asked to read both patient encounters on their own, reflect, discuss, and comment on the learning platform Blackboard Learn discussion board on their takeaways from the case, and participate in PowerPoint presentation presented by facilitators. At the conclusion of the 2020 session, students were asked to complete a post-session survey on the effectiveness of the session. In addition to qualitative data obtained from the post-session surveys, in 2020, student discussion board posts were coded and analyzed qualitatively using the coding software NVivo 12 to determine whether students understood the important takeaways from the discussion board portion of the session. RESULTS: According to results from the course session implemented from 2017-2019, overall, the role-playing exercise significantly improved participants understanding of key components of cultural competence. From 2017-2019 students were strongly able to identify the importance of communication in patient encounters, were able to understand the strategies such as communication and compassion in patient encounters, were better able to identify the importance of building a trusting patient -physician relationship, and most importantly, students were able to recognize their own cultural biases when treating patients. Results from 2020, revealed that even with a change in course modality and format to a discussion board format, students were still able to understand the key take-aways of cultural competence from the session. DISCUSSION: This study reveals that students were able to understand cultural competence after completion of both iterations of the course session from 2017-2019 & 2020 and that this session can be an effective method for training the next generation of healthcare professionals the practice of cultural competence. While this study provides insight into the future of cultural competence training, it is important to recognize that more studies must be conducted to provide additional answers to several questions about the most effective mechanism for teaching cultural competence, what to teach in cultural competence education, and when to begin training students the practice of cultural competence.

The U.S. Army Training and Doctrine Command*s Army Learning Concept 2015 and Army Training Concept 2025 are documents that discuss the need for an adaptive soldier learning model with a flexible training delivery methodology. The U.S. Army has been investing in serious gaming technology for the past two decades as a cost effective means to teach tactics and strategy. Today, the U.S. Army is seeking to expand its application of virtual environment training to areas such as cultural awareness and human network analysis for the infantry soldier. These new expanded applications will require a higher level of non-determinant behavior inside the virtual environment. To meet more of the training needs of the war fighter, the U.S. Army is looking beyond first person perspective games to the cooperative and social gaming experience offered by the MMOG (Massively Multiplayer Online Game) and the VWT (Virtual World Technology). Altogether, these classes of games have the potential to teach leadership skills, social acclimation skills, cultural awareness and practice skills, and critical thinking skills for problem solving in a cost effective manner. Unfortunately, even today there is a paucity of scientific research to support whether this potential may be realized or not. A literature review was performed which covers current concepts in the usage of virtual environments for military individual and team training in the U.S. Army infantry soldier domains. There are many variables involved with the lifecycle of the virtual training activity including the acquisition, information assurance and cyber security, deployment, proper employment, content development and maintenance, and retirement. This discussion goes beyond the traditional topics of graphics and game engine technology and delves deeper into concepts of the importance of proper usage of the environments by the trainees. This dissertation is composed of three studies with two subject pools: experienced soldiers and novice soldiers. The participants in the studies were randomly assigned to one of two training conditions. The training conditions were either a traditional slide-show in a classroom or a virtual environment based training system. The participants were then provided with training for a room clearing tasks in each of the conditions. The independent variables are training condition and soldier condition. The dependent variables are individual performance, team performance, stress questionnaire scores, and workload questionnaire scores. A number of relationships are explored in this dissertation. The first objective of these studies is to attempt to identify any effect the training conditions have on either individual performance or team performance. Lastly, these studies attempt to identify if there is any difference the training conditions have on novice versus experienced subjects* performance during a live assessment.

This document summarizes a research effort focused on improving live-to-virtual (L-V) communication systems. The purpose of this work is to address a significant challenge facing the tactical communications training community through the development of the Live-to-Virtual Relay Radio Prediction Algorithm and implementation of the algorithm into an Integrated Live-to-Virtual Communications Server prototype device. The motivation for the work and the challenges of integrating live and virtual communications are presented. Details surrounding the formulation of the prediction algorithm and a description of the prototype system, hardware, and software architectures are shared. Experimental results from discrete event simulation analysis and prototype functionality testing accompany recommendations for future investigation. If the methods and technologies summarized are implemented, an estimated equipment savings of 25%-53% and an estimated cost savings of $150,000.00 - $630,000.00 per site are anticipated. Thus, a solution to a critical tactical communications training problem is presented through the research discussed.

The U.S. Army desires to improve safety during Intelligence, Surveillance, Reconnaissance (ISR) operations by removing Warfighters from direct line-of-fire by enhancing ISR operational capabilities with unmanned systems, also known as Robot-Aided ISR (RAISR) (DOD, 2013). Additionally, RAISR presents an opportunity to fulfill ISR capability requirements of modern combat environments including: detection of High-Value Individuals (HVI) from safer distances, identification of baseline behavior, and interpretation of adversarial intent (U.S. Army, 2008). Along with the demand and projected acquisition of RAISR technology, there is the added need to design training requirements for system operation and task execution instruction. While documentation identifying specific training standards and objectives for ISR tasks utilizing unmanned systems is limited (DOD, 2013), simulation-based training has been identified as a critical training medium for RAISR (U.S. Army, 2008). ISR analysts will primarily conduct RAISR tasks via Indirect Vision Displays (IVD) which transition well into multimodal simulations (Salcedo, Lackey, & Maraj, 2014). However, simulation alone may not fulfill the complex training needs of RAISR tasks, therefore, incorporating instructional support may improve the effectiveness of training (Oser, Gualtieri, Cannon-Bowers, & Salas, 1999). One method to accomplish this is to utilize a Scenario-Based Training (SBT) framework enhanced with instructional strategies to target specific training objectives. The purpose for the present experiment was to assess the effectiveness of SBT enhanced with selected instructional strategies for a PC-based RAISR training simulation. The specific task type was the identification of HVIs within a group through behavior cue analysis. The instructional strategies assessed in this experiment, Highlighting and Massed Exposure, have shown to improve attentional weighting, visual search, and pattern recognition skills, which are critical for successful behavior cue analysis. Training effectiveness was evaluated by analyzing the impact of the instructional strategies on performance outcomes, including detection accuracy, classification accuracy, and median response time, and perceptions of the level of engagement, immersion, and presence during training exercises. Performance results revealed that the Massed Exposure strategy produced significantly faster response times for one subtle and one familiar target behavior cue. Perception results indicated that Highlighting was the least challenging instructional strategy and the Control offered the preferred level of challenge. The relationships between performance and perception measures revealed that higher levels of engagement, immersion, and presence were associated with better performance in the Control, but this trend did not always hold for Massed Exposure and Highlighting. Furthermore, presence emerged as the primary predictor of performance for select target behavior cues in the Control and Massed Exposure conditions, while immersion and engagement predicted performance of select cues in the Highlighting condition. The findings of the present experiment point to the potential benefit of SBT instructional strategies to improve effectiveness of simulation-based training for behavior cue analysis during RAISR operations. Specifically, the findings suggest that the Massed Exposure strategy has the potential to improve response time when detecting both familiar and novel targets. The results also highlight directions for future research to investigate methods to alter instructional strategy design and delivery in order to improve trainee perceptions of the instruction.

The DoD Modeling and Simulation Steering Committee (M&S SC) identified Modeling and Simulation (M&S) as an educational objective for the Acquisition, Technology and Logistics (AT&L) workforce. Notably, past usages of M&S in system acquisitions for both DoD and commercial industry have demonstrated improvements in efficiency and effectiveness over traditional acquisition techniques. However, to achieve expected and consistent performance by this workforce in these new techniques, the M&S essential skill requirements for this workforce may be extensive. This research aims to validate the content and level of competency in selected M&S tools and technology necessary for consistent workforce performance. The notion here is to achieve greater efficiency and effectiveness in the acquisition process through thresholds of competency that must be resident in or available to the acquisition workforce. This research proposes a matrix of training objectives and levels of competency for portions of the AT&L workforce that was validated through survey by individuals who are leading experts in both M&S and acquisition. This effort combines rigorously defined learning objectives and parameters by academia with practical learning insights from the military and industry ground perspectives. The resultant Joint Learning Model aims to identify the workforce educational foundations necessary to achieve more widespread efficiency and effectiveness in current and future DoD acquisitions.

Scenario based training (SBT) allows organizations to train the competencies necessary for effective performance in an environment that replicates critical aspects of the transfer or operational setting. One of the most salient training features that can be delivered during SBT is feedback. Task feedback may be provided to trainees either during a training scenario (immediately following actions) or between training scenarios (after action review). However, little is known regarding the effects of immediate versus delayed feedback given to teams. Prior research on training individuals suggests that immediate feedback improves performance as assessed immediately after training (acquisition performance), however delayed feedback improves performance after time has passed (retention performance). Moreover, several individual training studies have found that trainee goal orientation moderates the influence of instructional features such as goal difficulty and content organization. I hypothesized that team member goal orientation would also moderate the influence of feedback timing on team performance. Three facets of goal orientation were assessed. Learning goal orientation refers to the extent to which individuals strive towards the mastery of skills for the sake of continuous improvement. Prove goal orientation refers to the extent to which individuals strive to demonstrate their own competence to others. Finally, avoid goal orientation refers to the extent to which individuals seek to avoid demonstrating their incompetence to others. Participants were 160 undergraduate psychology students assigned to 80 two-person teams. These teams were trained and tested using a simulated military task called the Forward Observer Personal Computer-based Simulator. Teams received 36 minutes of training prior to performing a skill acquisition test on day one of the experiment. One week later teams returned to perform a skill retention test. Teams were randomly assigned to receive immediate feedback during their team training scenarios or delayed feedback following each training scenario. Results indicated that the timing of feedback had no impact on acquisition performance. As predicted, however, teams that had received delayed feedback outperformed those that had received immediate feedback on the retention test. Moreover, the positive impact of delayed feedback on retention performance was greatest for teams that scored higher on a measure of state learning goal orientation on the day of their training. This interaction was mediated by the team's perception of the instrumentality of the feedback provided to them. Theoretical and practical implications, as well as, limitations and directions for future research are discussed.

<p>Although decades of experience in human spaceflight have produced and refined a wealth of operational knowledge, the unique challenges posed to long-term extraterrestrial surface habitats will require new approaches to mission design. The key objectives of this thesis are to develop an understanding of 1) how to use simulation to study these habitats and 2) how to make contingency plans for these habitats under complex, changing conditions. In order to accurately represent the challenges posed, we identify the common qualities of mission architectures that are likely to be present in near-future habitats. These qualities are used to formulate sample crew schedules that contribute to developing realistic models for meaningful research. We discuss the development of such models and demonstrate the suitability of simulation to enable the design and study of resilient space habitats. Simulation can be used as a tool to understand the challenges and consequences associated with decision making, as well as the importance of resilient design choices in a hazard-prone environment. We then identify aspects of vulnerability in space habitat mission operations, the subfactors that influence changes in habitat vulnerability, and the effects of each identified category of vulnerability. These ‘vulnerability factors’ are subsystem availability, environmental conditions, safety control options, and recent events. Each vulnerability factor has several subfactors that influence its change during a mission.</p> <p><br></p> <p>The set of vulnerability factors is significant because each captures some category of behavior in surface habitats that changes over time and impacts the likelihood or consequences of risks to the habitat. We use these vulnerability factors to formulate six research questions which can be addressed via simulation-based research. A simulation set plan is developed to highlight the significant concepts at play in each research question. Finally, we conduct trials and analyses of these questions via simulation by injecting faults into a modular coupled virtual testbed for space habitats. The results of the simulations are used to develop lists of key implications for each vulnerability factor in practice. In addition, the lessons learned over the course of simulation set design and the usage of the simulation tool are discussed to support future simulation-based research efforts. We conclude by summarizing the major findings and potential for future work in the area.</p>

En undersökning om Simulation inom utbildningsområdet, med hjälp av medieteknik. I artikeln diskuteras bland annat hur erfarenhet-baserad undervisning, som en digitalsimulation med fysiska kontroller, kan vara ett utmärkt tillägg för hur man undervisar. Dessutom kan det vara ett sätt att ge en individ mer självförtroende och får hen att mer tänkaundermedvetet hur arbetet kan göras bättre. För att utreda detta har arbetet fokuserat på en typav simulation, nämligen inom truckkörning. Undersökningen har också samarbetat med Volvo Car Body Components för att se vad de upplever som risker inom truckkörning, och vad som då borde fokuseras på en sådan simulation.Simulation har sedan presenterats för deltagare med och utan kompetens i truckkörning, föratt sedan utreda om de känner att de skulle kunnat använda upplevelsen undermedvetet somerfarenhet för framtida strävanden. Det är diskuterbart om resultatet på undersökningen är användbar eller inte, då mängden avdeltagare kunde har varit större. Dock kan det argumenteras för att arbetet gjort ger chansenför flera undersökningar inom simulation-baserad undervisning att kunna visa att bara för ettsätt av utbildning funkar, betyder inte det att det finns det sätt att göra något bättre.

Nowadays, it has become crucial to transform company production processes in order to reduce carbon emissions. Therefore, the company LKAB is working to make the production process of iron ore pellets fossil-free. In particular, this thesis project focuses on the pellet induration stage and addresses the mathematical optimization of the process. In particular, the idea is to combine state-of-the-art optimization algorithms with simulation software. This thesis aims to address the problem of multi-objective optimization within the context of simulation-based scenarios, i.e., the aim is to study Simulation-Based Multi-Objective Optimization Problems. The primary focus of this thesis is to thoroughly investigate and compare three different algorithms applied to two distinct problem formulations. By doing so, we aim to gain valuable insights into the suitability of different approaches and evaluate the algorithms' performance in achieving the desired objectives. / Nuförtiden har det blivit mycket viktigt att förändra företagens produktionsprocesser för att minska koldioxidutsläppen. Företaget LKAB arbetar för att göra produktionsprocessen av järnmalmspellets fossilfri. Detta examensarbete fokuserar på pelletiseringsfasen och behandlar den matematiska optimeringen av processen. Mer specifikt, tanken är att kombinera toppmoderna optimeringsalgoritmer med simuleringsprogramvara. Syftet med examensarbetet är att studera problem med flermålsoptimering inom ramen för simuleringsbaserade scenarier, dvs. syftet är att studera ett simuleringsbaserat flermålsoptimeringsproblem. Det primära fokuset i examnesarbetet är att grundligt undersöka och jämföra tre olika algoritmer som tillämpas på två distinkta problemformuleringar. Genom att göra detta vill vi få värdefull insikt om lämpligheten av de olika strategierna och utvärdera algoritmernas prestanda för att uppnå de önskade målen.