Usefulness of driver's eye movement measurement to detect potential risks under combined conditions of taking second-generation antihistamines and calling tasks.

BACKGROUND: Concerns persist regarding the potential reduction in driving performance due to taking second-generation antihistamines or performing hands-free calling. Previous studies have indicated a potential risk to driving performance under an emergency event when these two factors are combined, whereas a non-emergency event was operated effectively. Currently, there is a lack of a discriminative index capable of detecting the potential risks of driving performance impairment. This study aims to investigate the relationship between driving performance and eye movements under combined conditions of taking second-generation antihistamines and a calling task, and to assess the usefulness of eye movement measurements as a discriminative index for detecting potential risks of driving performance impairment. METHODS: Participants engaged in a simulated driving task, which included a calling task, both under taking or not taking second-generation antihistamines. Driving performance and eye movements were monitored during both emergency and non-emergency events, assessing their correlation between driving performance and eye movements. The study further evaluated the usefulness of eye movement as a discriminative index for potential driving impairment risk through receiver operating characteristic (ROC) analysis. RESULTS: In the case of a non-emergency event, no correlation was observed between driving performance and eye movement under the combined conditions. Conversely, a correlation was observed during an emergency event. The ROC analysis, conducted to assess the discriminative index capability of eye movements in detecting the potential risk of driving performance impairment, demonstrated a high discriminative power, with an area under the curve of 0.833. CONCLUSIONS: The findings of this study show the correlation between driving performance and eye movements under the concurrent influence of second-generation antihistamines and a calling task, suggesting the usefulness of eye movement measurement as a discriminant index for detecting potential risks of driving performance impairment.

Ribosomal computing: implementation of the computational method.

BACKGROUND: Several computational and mathematical models of protein synthesis have been explored to accomplish the quantitative analysis of protein synthesis components and polysome structure. The effect of gene sequence (coding and non-coding region) in protein synthesis, mutation in gene sequence, and functional model of ribosome needs to be explored to investigate the relationship among protein synthesis components further. Ribosomal computing is implemented by imitating the functional property of protein synthesis. RESULT: In the proposed work, a general framework of ribosomal computing is demonstrated by developing a computational model to present the relationship between biological details of protein synthesis and computing principles. Here, mathematical abstractions are chosen carefully without probing into intricate chemical details of the micro-operations of protein synthesis for ease of understanding. This model demonstrates the cause and effect of ribosome stalling during protein synthesis and the relationship between functional protein and gene sequence. Moreover, it also reveals the computing nature of ribosome molecules and other protein synthesis components. The effect of gene mutation on protein synthesis is also explored in this model. CONCLUSION: The computational model for ribosomal computing is implemented in this work. The proposed model demonstrates the relationship among gene sequences and protein synthesis components. This model also helps to implement a simulation environment (a simulator) for generating protein chains from gene sequences and can spot the problem during protein synthesis. Thus, this simulator can identify a disease that can happen due to a protein synthesis problem and suggest precautions for it.

The effectiveness of simulation-based learning (SBL) on students' knowledge and skills in nursing programs: a systematic review.

BACKGROUND: Simulation-Based Learning (SBL) serves as a valuable pedagogical approach in nursing education, encompassing varying levels of fidelity. While previous reviews have highlighted the potential effectiveness of SBL in enhancing nursing students' competencies, a gap persists in the evidence-base addressing the long-term retention of these competencies. This systematic review aimed to evaluate the impact of SBL on nursing students' knowledge and skill acquisition and retention. METHOD: A comprehensive search of electronic databases, including CINAHL, PubMed, Embase, Scopus, and Eric, was conducted from 2017 to 2023 to identify relevant studies. The Joanna Briggs critical appraisal tools were used to assess the methodological quality of the included studies. A total of 33 studies (15 RCTs and 18 quasi-experimental) met the inclusion criteria and were included in the review. A descriptive narrative synthesis method was used to extract relevant data. RESULTS: The cumulative sample size of participants across the included studies was 3,670. Most of the studies focused on the impact of SBL on life-saving skills like cardiopulmonary resuscitation (CPR) or other life-support skills. The remaining studies examined the impact of SBL on critical care skills or clinical decision-making skills. The analysis highlighted consistent and significant improvements in knowledge and skills. However, the evidence base had several limitations, including the heterogeneity of study designs, risk of bias, and lack of long-term follow-up. CONCLUSION: This systematic review supports the use of SBL as a potent teaching strategy within nursing education and highlights the importance of the ongoing evaluation and refinement of this approach. While current evidence indicates enhancing knowledge and skill acquisition, limited studies evaluated the retention beyond five months, constraining generalisable claims regarding durability. Further research is essential to build on the current evidence and address gaps in knowledge related to the retention, optimal design, implementation, and evaluation of SBL interventions in nursing education.

Three-Dimensional Internal Voids and Marginal Adaptation in Deep Margin Elevation Technique: Efficiency of Highly Filled Flowable Composites.

PURPOSE: To evaluate interfacial three-dimensional adaptation and internal voids of different flowable materials before and after cyclic fatigue in a simulated deep-margin elevation scenario. METHODS: Eighty (n = 80) extracted premolars were selected and two Class II cavities were prepared. The mesial one with cervical margin 1 mm above the cementum-enamel junction (CEJ) and the distal one with cervical margin 1 mm below the CEJ. After performing adhesive procedures, specimens were divided into four groups according to the employed materials for 2 mm horizontal deep-margin relocation: nanohybrid composite (Clearfil ES2, Kuraray); conventional viscosity flowable composite (Tetric Flow, Ivoclar); medium viscosity flowable composite (Majesty ES2 Low Flow, Kuraray); high viscosity flowable composite (Majesty ES2 Super Low Flow, Kuraray). All restorations were finalized by oblique layering with nanohybrid composite (Clearfil ES2, Kuraray). To reveal interfacial and internal gap progression, specimens were scanned with a micro-CT (SkyScan 1172), before and after 500,000 cycles of mechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growing. Only the 2 mm margin relocation volumes were considered. Obtained masks were analyzed for noise removal and volume calculation. At baseline, interfacial gap progression and internal voids, expressed in mm3, were collected and statistically analyzed with two-way ANOVA (α 0.05) for the variables substrate and restorative materials followed by Tukey post-hoc test. An additional two-way ANOVA test, followed by Tukey post-hoc test, was performed to evaluate variation in interfacial gap progression after mechanical aging. RESULTS: At baseline, the ANOVA test showed a significant difference for the variable restorative materials (p = 0.01). More specifically, the Tukey post-hoc test revealed that the highly filled medium viscosity composite performed better than the conventional viscosity composite at baseline for the interfacial gap. The internal voids ANOVA test at baseline reported no significant differences for the variable tested. Analysis of variance for internal gap progression after thermocycling showed no differences for both substrate and restorative material employed. CONCLUSIONS: Highly filled medium viscosity composite performed significantly better than the conventional viscosity flowable composite for what concern baseline interfacial gaps. Artificial aging with a chewing simulator and thermocycling did not affect interfacial gap progression on enamel and dentin. The tested restorative materials performed equally after aging.

Realtime physical simulator for virtual reality sailing by patients with spinal cord injury: an innovative voyage.

Background: The aim of this study was to explore whether sail training using a VSail® simulator would allow people with spinal cord injuries (SCI) to learn to sail in a safe controlled environment and then sail competently on the water in wind of moderate strength (12 knots). A battery of physical tests and questionnaires was used to evaluate possible improvements in health and well-being as a consequence of participation in the trial. Methods: Twenty participants were recruited with the assistance of their physicians from The International Center for Spinal Cord Injury, Kennedy Krieger Institute. Inclusion criteria were SCI >6 months previously, medically stable, with no recent (1 month or less) inpatient admission for acute medical or surgical issues. All neurological SCI levels (C1-S1) were eligible. All subjects followed a programme of instruction leading to mastery of basic sailing techniques (steering predetermined courses, sail trimming, tacking, gybing and mark rounding). Results: Not all participants completed the study for various reasons. Those that did were seven males and six females, six with tetraplegia and seven with paraplegia. The mean age was 45 years (23 to 63) and the average time since injury was 14.7 years (2 to 38 years). At the end of the course subjects were able to perform the sailing maneuvers and navigate a triangular racecourse on the simulator's display in 12 knots of wind within a pre-set time. At 6 weeks post completion of training most subjects showed a decrease in depression, physical and social limitations, and an improvement in physical tests. These improvements were maintained or increased in most participants by 12 weeks, but not others. Conclusions: The primary objective of the trial was achieved as all participants who completed the VSail® training were able to sail on the water at the Downtown Sailing Center in Baltimore.

Activation of a Soft Robotic Left Ventricular Phantom Embedded in a Closed-Loop Cardiovascular Simulator: A Computational and Experimental Analysis.

PURPOSE: Cardiovascular simulators are used in the preclinical testing phase of medical devices. Their reliability increases the more they resemble clinically relevant scenarios. In this study, a physiologically actuated soft robotic left ventricle (SRLV) embedded in a hybrid (in silico- in vitro) simulator of the cardiovascular system is presented, along with its experimental and computational analysis. METHODS: A SRLV phantom, developed from a patient's CT scan using polyvinyl alcohol (PVA), is embedded in a hybrid cardiovascular simulator. We present an activation method in which the hydraulic pressure external ( P e ( t ) ) to the SRLV is continuously adapted to regulate the left ventricular volume ( V i ( t ) ), considering the geometry and material behavior of the SRLV and the left ventricular pressure ( P i ( t ) ). This activation method is verified using a finite element (FE) model of the SRLV and validated in the hybrid simulator. Different hemodynamic profiles are presented to test the flexibility of the method. RESULTS: Both the FE model and hybrid simulator could represent the desired in silico data ( P i ( t ) , V i ( t ) ) with the implemented activation method, with deviations below 8.09% in the FE model and mainly < 10% errors in the hybrid simulator. Only two measurements out of 32 exceeded the 10% threshold due to simulator setup limitations. CONCLUSION: The activation method effectively allows to represent various pressure-volume loops, as verified numerically, and validated experimentally in the hybrid simulator. This work presents a high-fidelity platform designed to simulate cardiovascular conditions, offering a robust foundation for future testing of cardiovascular medical devices under physiological conditions.

Cybersickness. A systematic literature review of adverse effects related to virtual reality.

BACKGROUND: Virtual Reality (VR) uses computer technology to create a simulated environment. VR is a growing technology with promising extensive applications in different areas such as Medicine, entertainment, sports, gaming, and simulation. However, information about VR side effects is still limited. We aimed to identify the most frequent physical side effects caused by VR therapeutic applications. METHODOLOGY: All available full-text articles evaluating VR as a therapeutic intervention and side effects using the Simulator Sickness Questionnaire (SSQ) between 2016 and 2021 were consulted across 4 electronic (Entrez Pubmed, Scopus, Science Direct, and Wiley databases). The methodological quality was assessed using the PEDro scale. RESULTS: Ten out of 55 reviewed articles (18%) met inclusion/exclusion criteria, including a sample of 416 patients, mean age of 24.54 (15-52.6)years old. According to the PEDro scale, two articles (20%) were considered good or excellent. Side effects were reported more frequently with head-mounted displays compared to desktop systems, especially disorientation, followed by nausea and oculomotor disturbances. CONCLUSIONS: Although VR might have positive effects as a therapeutic tool, VR can also cause side events. As in any other therapeutic intervention, it is important to understand the effectiveness and safety before planning a VR intervention using a well-designed scientific methodology.

Optimizing modern surgical simulation through instructor feedback - insights from a retrospective observational study in a tertiary hospital.

BACKGROUND: Laparoscopic surgery is associated with a prolonged learning curve for emerging surgeons, and simulation-based training (SBT) has become increasingly prominent in this context due to stringent working time regulations and heightened concerns regarding patient safety. While SBT offers a safe and ethical learning environment, the accuracy of simulators in the context of evaluating surgical skills remains uncertain. This study aims to assess the precision of a laparoscopic simulator with regard to evaluating surgical performance and to identify the instructor's role in SBT. MATERIALS AND METHODS: This retrospective study focused on surgical residents in their 1st through 5th years at the Department of Surgery of Linkou Chang Gung Memorial Hospital. The residents participated in a specially designed SBT program using the LapSim laparoscopic simulator. Following the training session, each resident was required to perform a laparoscopic procedure and received individualized feedback from an instructor. Both simulator and instructor evaluated trainees' performance on the LapSim, focusing on identifying correlations between the simulator's metrics and traditional assessments. RESULTS: Senior residents (n = 15), who employed more complex laparoscopic procedures, exhibited more significant improvements after receiving instructor feedback than did junior residents (n = 17). Notably, a stronger correlation between the simulator and instructor assessments was observed in the junior group (junior Global Operative Assessment of Laparoscopic Skills (GOALS) adjusted R2 = 0.285, p = 0.016), while no such correlations were observed among the senior group. CONCLUSION: A well-designed, step-by-step SBT can be a valuable tool in laparoscopic surgical training. LapSim simulator has demonstrated its potential in assessing surgical performances during the early stages of surgical training. However, instructors must provide intuitive feedback to ensure appropriate learning in later stages.

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study.

BACKGROUND: Humeral distalization is inherent to reverse total shoulder arthroplasty (rTSA) and is often produced with concomitant humeral lateralization via the level of the humeral head cut, implant positioning, implant neck shaft angle, and polymer insert thickness. Biomechanical data on the isolated effects of humeral distalization remain limited but could be important to consider when optimizing postoperative rTSA shoulder function. This study investigated the effects of isolated humeral distalization on shoulder biomechanics using a biorobotic shoulder simulator. METHODS: Eight fresh-frozen cadaveric shoulders were tested using custom polymer inserts that translated the bearing surface 0, +5, +10, and +15 mm along the humeral stem axis, producing isolated distalization without lateralization. Specimens underwent passive elevation in the scapular plane with a static scapula to assess glenohumeral range of motion. Scapular plane abduction motion trajectories were then performed, driven by previously collected scapulothoracic and glenohumeral kinematics from rTSA patients. The effect of isolated distalization on passive elevation was tested using mixed-effects linear regression and the effect on muscle force, joint reaction force, and muscle excursion during active scapular-plane abduction was tested using statistical parametric mapping random effects analysis. RESULTS: Maximum passive scapular plane elevation increased with humeral distalization (4° per 5 mm distalization). During active elevation, deltoid and rotator cuff muscle forces, and joint reaction forces, increased up to 37% per 5 mm of distalization. Simulated deltoid muscle excursion was altered with increasing distalization but amounted to no more than 0.8 mm change from baseline per 5 mm of distalization. Rotator cuff muscles were consistently lengthened throughout abduction, up to 1.6 mm per 5 mm of distalization. These trends were observed across various patient motions. CONCLUSIONS: Isolated humeral distalization caused dramatic increases in the muscle forces required to perform scapular-plane abduction. Joint reaction forces increased correspondingly. These results suggest that implant and surgical strategies to generate deltoid muscle tension without humeral distalization may promote better active range of motion and more durable long-term outcomes over approaches that rely on distalization.

Endovascular Simulator Training and Shadowing in Interventional Radiology: A Comparison of Two Teaching Methods in the Curricular Training of Medical Students.

PURPOSE: To identify the impact of endovascular simulator training and shadowing in interventional radiology on medical students' self-assessed IR knowledge. Moreover, the sequence of the teaching methods and its influence on the self-assessed IR knowledge is investigated. MATERIALS AND METHODS: A total of 19 fourth-year medical students participated in this study. Eleven students completed shadowing live cases first and endovascular simulator training the following day. Eight students completed the teaching in reversed order. Questionnaires were completed before and after each teaching method. The students assessed their knowledge of instruments and materials, steps of the Seldinger technique, and aortography on a Likert scale (1 = "I do not agree at all," 5 = "I fully agree"). RESULTS: After simulator training, the students stated a significant increase in perceived knowledge compared with baseline (p < 0.001). Shadowing led to a significant improvement regarding the items "knowledge of instruments and materials" (3.2 vs. 3.8, p = 0.008) and "steps of the Seldinger technique" (3.7 vs. 3.9, p = 0.046). Self-assessed knowledge after simulator training increased significantly more regarding Seldinger technique compared with shadowing (+ 1.2 vs. + 0.2, p < 0.001). Simulator training before shadowing was significantly more effective regarding the increase in "knowledge of the steps of aortography" compared with the reverse sequence (+ 2.0 vs. + 0.9, p = 0.041). CONCLUSION: Endovascular simulator training and shadowing are both feasible tools to improve medical students' perceived knowledge of interventional radiology. When organizing teaching, simulator training before shadowing can have a positive impact on self-assessed knowledge.

Examining the applicability of virtual battle space for stress management training in military personnel-A validation study.

Military personnel are often exposed to high levels of both physical and psychological challenges in their work environment and therefore it is important to be trained on how to handle stressful situations. The primary aim of this study was to examine whether military-specific virtual battle space (VBS) scenarios could elicit a physiological and subjective stress response in healthy military personnel, as compared to that of a virtual reality height exposure (VR-HE) stress task that has shown to reliably increase stress levels. Twenty participants engaged in two VBS scenarios and the VR-HE during separate sessions, while measurements of heart rate (HR), heart rate variability (HRV), respiration rate, and subjective stress levels were collected. Contrary to our initial expectations, analysis revealed that neither of the VBS scenarios induced a significant stress response, as indicated by stable HR, HRV, and low subjective stress levels. However, the VR-HE task did elicit a significant physiological stress response, evidenced by increased HR and HRV changes, aligning with previous research findings. Moreover, no discernible alterations were detected in cognitive performance subsequent to these stressors. These results suggest that the current VBS scenarios, despite their potential, may not be effective for stress-related training activities within military settings. The absence of a significant stress response in the VBS conditions points to the need for more immersive and engaging scenarios. By integrating interactive and demanding elements, as well as physical feedback systems and real-time communication, VBS training might better mimic real-world stressors and improve stress resilience in military personnel. The findings of this study have broader implications for stress research and training, suggesting the need for scenario design improvements in virtual training environments to effectively induce stress and improve stress management across various high-stress professions.

Realistic 3D Simulators for Automotive: A Review of Main Applications and Features.

Recent advancements in vehicle technology have stimulated innovation across the automotive sector, from Advanced Driver Assistance Systems (ADAS) to autonomous driving and motorsport applications. Modern vehicles, equipped with sensors for perception, localization, navigation, and actuators for autonomous driving, generate vast amounts of data used for training and evaluating autonomous systems. Real-world testing is essential for validation but is complex, expensive, and time-intensive, requiring multiple vehicles and reference systems. To address these challenges, computer graphics-based simulators offer a compelling solution by providing high-fidelity 3D environments to simulate vehicles and road users. These simulators are crucial for developing, validating, and testing ADAS, autonomous driving systems, and cooperative driving systems, and enhancing vehicle performance and driver training in motorsport. This paper reviews computer graphics-based simulators tailored for automotive applications. It begins with an overview of their applications and analyzes their key features. Additionally, this paper compares five open-source (CARLA, AirSim, LGSVL, AWSIM, and DeepDrive) and ten commercial simulators. Our findings indicate that open-source simulators are best for the research community, offering realistic 3D environments, multiple sensor support, APIs, co-simulation, and community support. Conversely, commercial simulators, while less extensible, provide a broader set of features and solutions.

Safety, Efficiency, and Mental Workload in Simulated Teledriving of a Vehicle as Functions of Camera Viewpoint.

Teleoperation services are expected to operate on-road and often in urban areas. In current teleoperation applications, teleoperators gain a higher viewpoint of the environment from a camera on the vehicle's roof. However, it is unclear how this viewpoint compares to a conventional viewpoint in terms of safety, efficiency, and mental workload. In the current study, teleoperators (n = 148) performed driving tasks in a simulated urban environment with a conventional viewpoint (i.e., the simulated camera was positioned inside the vehicle at the height of a driver's eyes) and a higher viewpoint (the simulated camera was positioned on the vehicle roof). The tasks required negotiating road geometry and other road users. At the end of the session, participants completed the NASA-TLX questionnaire. Results showed that participants completed most tasks faster with the higher viewpoint and reported lower frustration and mental demand. The camera position did not affect collision rates nor the probability of hard braking and steering events. We conclude that a viewpoint from the vehicle roof may improve teleoperation efficiency without compromising driving safety, while also lowering the teleoperators' mental workload.

Bacterial accumulation dynamics in runoff from extreme precipitation.

Extreme precipitation can significantly influence the water quality of surface waters. However, the total amount of bacteria carried by rainfall runoff is poorly understood. Here, thirty rainfall scenarios were simulated by artificial rainfall simulators, with designed rainfall intensity ranging from 19.3 to 250 mm/h. The instantaneous concentration ranges of R2A, nutrient agar (NA) culturable bacteria, and viable bacteria in runoff depended on the types of underlying surfaces. The instantaneous bacterial concentrations in runoff generated by forest lands, grasslands and bare soil were: R2A culturable bacteria = 104.5-6.3, 104.5-6.1, 104.0-5.3 colony-forming units (CFU)/mL, NA culturable bacteria = 104.0-6.0, 103.9-5.8, 103.2-4.9 CFU/mL, and viable bacteria = 106.4-8.0, 107.0-8.9, 106.4-7.6 cells/mL. Based on the measured bacterial instantaneous concentration in runoff, cumulative dynamic models were established, and the maximum amount of culturable bacteria and viable bacteria entering water sources were estimated to be 109.38-11.31 CFU/m2 and 1011.84-13.25 cells/m2, respectively. The model fitting and the bacterial accumulation dynamics were influenced by the rainfall types (p < 0.01). Surface runoff from the underlying surface of forest lands and grasslands had a high microbial risk that persisted even during the "Drought-to-Deluge Transition". Bacterial accumulation models provide valuable insight for predicting microbial risks in catchments during precipitation and can serve as theoretical support for further ensuring the safety of drinking water under the challenge of climate change.

Meta-analysis of set-based multiple phenotype association test based on GWAS summary statistics from different cohorts.

Genome-wide association studies (GWAS) have emerged as popular tools for identifying genetic variants that are associated with complex diseases. Standard analysis of a GWAS involves assessing the association between each variant and a disease. However, this approach suffers from limited reproducibility and difficulties in detecting multi-variant and pleiotropic effects. Although joint analysis of multiple phenotypes for GWAS can identify and interpret pleiotropic loci which are essential to understand pleiotropy in diseases and complex traits, most of the multiple phenotype association tests are designed for a single variant, resulting in much lower power, especially when their effect sizes are small and only their cumulative effect is associated with multiple phenotypes. To overcome these limitations, set-based multiple phenotype association tests have been developed to enhance statistical power and facilitate the identification and interpretation of pleiotropic regions. In this research, we propose a new method, named Meta-TOW-S, which conducts joint association tests between multiple phenotypes and a set of variants (such as variants in a gene) utilizing GWAS summary statistics from different cohorts. Our approach applies the set-based method that Tests for the effect of an Optimal Weighted combination of variants in a gene (TOW) and accounts for sample size differences across GWAS cohorts by employing the Cauchy combination method. Meta-TOW-S combines the advantages of set-based tests and multi-phenotype association tests, exhibiting computational efficiency and enabling analysis across multiple phenotypes while accommodating overlapping samples from different GWAS cohorts. To assess the performance of Meta-TOW-S, we develop a phenotype simulator package that encompasses a comprehensive simulation scheme capable of modeling multiple phenotypes and multiple variants, including noise structures and diverse correlation patterns among phenotypes. Simulation studies validate that Meta-TOW-S maintains a desirable Type I error rate. Further simulation under different scenarios shows that Meta-TOW-S can improve power compared with other existing meta-analysis methods. When applied to four psychiatric disorders summary data, Meta-TOW-S detects a greater number of significant genes.

Systematic review of subjective validation methods for computerized colonoscopy simulators.

Introduction: In recent years, different approaches have been used to conduct a subjective assessment of colonoscopy simulators. The purpose of this paper is to review these different approaches, specifically the ones used for computerized simulators, as the first step for the design of a standard validation procedure for this type of simulators. Methods: A systematic review was conducted by searching papers after 2010 in PubMed, Google Scholar, ScienceDirect, and IEEE Xplore databases. Papers were screened and reviewed for procedures regarding the subjective validation of computerized simulators for traditional colonoscopy with an endoscope. Results: An initial search in the databases identified 2094 papers, of which 7 remained after exhaustive review and application of exclusion criteria. All studies used questionnaires for subjective validation, with "face" being the most common validity type tested, while "content" validity and "usability" were less prominent. Conclusions: A classification of subscales for testing face validity was derived from the studies. The Colonoscopy Simulator Realism Questionnaire (CSRQ) was selected as the guide to follow for the development of future questionnaires related to subjective validation. Mislabeling of the validity tested in the studies due to ambiguous interpretations of the validity types was a common occurrence observed in the reviewed studies.

Investigation of the effectiveness of preoperative intubation simulation using a custom-made simulator for pediatric patients with difficult airway: a pilot study.

The purpose of this study is to investigate whether preoperative intubation simulation using custom-made simulator is useful during anesthesia induction for the children who have difficult airway. We included the children under 15 years of age who have difficult airway which had been already known. Prior to the scheduled surgery, CT imaging was performed and a 3D reconstruction of the face from the chest was performed. Then custom-made airway simulator was made. We tried to intubate custom-made simulator of patients preoperatively. We planned how to intubate the patient for anesthesia induction from the result of intubation simulation. The findings of direct laryngoscopy were compared with the findings during intubation. Three patients were included in this study. It took up to 3 weeks to create a simulator, which was difficult due to time constraints to accommodate emergency surgeries. Simulation findings correlated well with findings during anesthesia induction. There were no cases of severe hypotension or hypoxia during induction of anesthesia with the planned intubation method. In conclusion, preoperative intubation simulation using custom-made simulator may be useful for the patients who have difficult airway.

From simulation to surgery, advancements and challenges in robotic training for radical prostatectomy: a narrative review.

BACKGROUND AND OBJECTIVE: The landscape of surgical training is undergoing transformative changes, especially in the realm of robot-assisted procedures like radical prostatectomy (RARP). This narrative review explores the evolving methodologies and innovations in RARP training, emphasizing the shift from traditional training approaches, such as the Halsted method, to more scientific methods like proficiency-based progression (PBP). The rationale for the review stems from the increased adoption of robot-assisted surgery and the resulting increase in associated adverse events reported in the United States. The Patient Safety in Robotic Surgery (SAFROS) project initiated by the European Commission of the World Health Organization emphasized the importance of structured training programs for robotic surgeons. However, the review points out the limited availability of standardized curricula for RARP training, leading to non-homogeneous training worldwide. METHODS: PubMed was searched primarily for the following topics: training AND robotic AND prostatectomy; robotic training AND prostatectomy AND learning; simulator AND robotic AND prostatectomy. Literature was selected based on historical significance and landmark studies as well as publications published after 2000. References from select studies were additionally included. KEY CONTENT AND FINDINGS: The advent of robotic surgery, especially in RARP, demands unique skills necessitating specialized training. The review delves into the diverse stages of robotic surgery training, starting with e-learning and progressing through virtual reality simulators, dry and wet laboratories, culminating in modular console training. Each training stage plays a critical role, addressing the challenges posed by new technologies and tools. CONCLUSIONS: The ever-evolving landscape of surgical training underscores the critical need for globally standardized, effective, and accessible programs. PBP emerges as a promising methodology, and technological advancements open new possibilities for telementoring via platforms like 5G. This review emphasizes the imperative to equip surgeons with the requisite skills for intricate procedures like RARP, addressing current challenges while anticipating the future developments in this dynamic field.

Understanding the interaction between cyclists and motorized vehicles at unsignalized intersections: Results from a cycling simulator study.

INTRODUCTION: With cycling gaining more popularity in urban areas, it is vital to obtain accurate knowledge of cyclists' behavior to develop behavioral models that can predict the cyclist's intent. Most conflicts between cyclists and vehicles happen at crossings where the road users share the path, especially at unsignalized intersections. However, few studies have investigated and modeled the interaction between cyclists and vehicles at unsignalized intersections. METHOD: A bike simulator experiment was conducted to scrutinize cyclists' response process as they interacted with a passenger car at an unsignalized intersection. An existing unsignalized intersection in Gothenburg was simulated for test participants. Two independent variables were varied across trials: the difference in time to arrival at the intersection (DTA) and intersection visibility (IV). Subjective and quantitative data were analyzed to model the cyclists' behavior. RESULTS: When approaching the intersection, cyclists showed a clear sequence of actions (pedaling, braking, and head turning). The distance from the intersection at which cyclists started braking was significantly affected by the two independent variables. It was also found that DTA, looking duration, and pedaling behavior significantly affected cyclists' decisions to yield. Finally, the questionnaire outputs show that participants missed eye contact or communication with the motorized vehicle. CONCLUSIONS: The kinematic interaction between cyclists and vehicles, along with the cyclist's response process (visual and kinematic), can be utilized to predict cyclists' yielding decision at intersections. From the infrastructural perspective, enhancing visibility at intersections has the potential to reduce the severity of interactions between cyclists and vehicles. The analysis of the questionnaire emphasizes the significance of visual communication between cyclists and drivers to support the cyclist's decision-making process when yielding. PRACTICAL APPLICATIONS: The models can be used in threat assessment algorithms so that active safety systems and automated vehicles can react safely to the presence of cyclists in conflict scenarios.

What would affect drivers' stop-and-go decisions at yellow dilemma zones? A driving simulator study in Hong Kong.

Yellow dilemma, at which a driver can neither stop nor go safely after the onset of yellow signals, is one of the major crash contributory factors at the signal junctions. Studies have visited the yellow dilemma problem using observation surveys. Factors including road environment, traffic conditions, and driver characteristics that affect the driver behaviours are revealed. However, it is rare that the joint effects of situational and attitudinal factors on the driver behaviours at the yellow dilemma zone are considered. In this study, drivers' propensity to stop after the onset of yellow signals is examined using the driving simulator approach. For instances, the association between driver propensity, socio-demographics, safety perception, traffic signals, and traffic and weather conditions are measured using a binary logit model. Additionally, variations in the effect of influencing factors on driver behaviours are accommodated by adding the interaction terms for driver characteristics, traffic flow characteristics, traffic signals, and weather conditions. Results indicate that weather conditions, traffic volume, position of yellow dilemma in the sequence, driver age and safety perception significantly affect the drivers' propensity to stop after the onset of yellow signals. Furthermore, there are remarkable interactions for the effects of driver gender and location of yellow dilemma.