Concurrent audio-visual feedback for supporting drivers at intersections: A study using two linked driving simulators.

A large portion of road traffic crashes occur at intersections for the reason that drivers lack necessary visual information. This research examined the effects of an audio-visual display that provides real-time sonification and visualization of the speed and direction of another car approaching the crossroads on an intersecting road. The location of red blinking lights (left vs. right on the speedometer) and the lateral input direction of beeps (left vs. right ear in headphones) corresponded to the direction from where the other car approached, and the blink and beep rates were a function of the approaching car's speed. Two driving simulators were linked so that the participant and the experimenter drove in the same virtual world. Participants (N = 25) completed four sessions (two with the audio-visual display on, two with the audio-visual display off), each session consisting of 22 intersections at which the experimenter approached from the left or right and either maintained speed or slowed down. Compared to driving with the display off, the audio-visual display resulted in enhanced traffic efficiency (i.e., greater mean speed, less coasting) while not compromising safety (i.e., the time gap between the two vehicles was equivalent). A post-experiment questionnaire showed that the beeps were regarded as more useful than the lights. It is argued that the audio-visual display is a promising means of supporting drivers until fully automated driving is technically feasible.

Evaluation of the Mediseus epidural simulator.

The demand for increased patient safety has led to greater use of simulation training of health professionals performing medical procedures. The study aim was to evaluate the usefulness of the Mediseus® Epidural Simulator in teaching basic epidural needle-handling skills. Three groups of 15 anaesthetists (Novice=zero to two year anaesthesia trainees; Intermediate=three- to five-year anaesthesia trainees; Expert=consultants and regional-specialist anaesthetists) from three different medical centres participated. Each participant performed 20 simulated epidural needle insertions and was scored on several parameters (e.g. time, success of the insertion, bone collisions). Following familiarisation with the simulator and the needle insertions, participants answered seven questions on the applicability of the simulator to the teaching of basic epidural needle-handling skills. There was a clear learning effect with regard to the simulation procedure time, this decreasing throughout the experiment (P=0.037). There was no significant influence of either group or experience with the simulator in the study on the number or type of errors made. The quality of the simulation was scored 2.3 out of 5.0 (for bone simulation) and 4.7 (for loss-of-resistance simulation). All groups considered that the simulator was best suited for training prospective anaesthetists. Each group rated the usefulness of the simulator for training novices at greater than 3.0 out of 5.0. The Mediseus® Epidural Simulator seems to be an appropriate training device for an introduction to epidural needle insertion. For medical professionals with procedural knowledge, the simulation is not realistic enough and the simulator did not distinguish between the groups based on the errors made.

Forces applied to the maxillary incisors by video laryngoscopes and the Macintosh laryngoscope.

BACKGROUND: Modern video laryngoscopes (VLSs) provide a superior view of the glottis, facilitating easier intubations. This study evaluates the forces applied to the maxillary incisors when using various VLSs and a Macintosh blade. METHODS: Fifty consecutive surgery patients were randomly assigned to receive laryngoscopy from a pair of four blades investigated in the study - the VLS GlideScope(®) (Verathon Inc., Bothell, WA, USA), V-Mac™ Storz(®) (Karl Storz, Tuttlingen, Germany), and McGrath™ (Aircraft Medical, Edinburgh, United Kingdom); and the classic Macintosh blade also from Storz(®) (Karl Storz). An endotracheal tube (ETT) was brought into position anterior to the vocal cords, with actual intubation carried out only with the second of the laryngoscopes. Sensors measured the forces directly applied to the patient's maxillary incisors while inserting the ETT. Other common metrics of intubation difficulty (e.g. Mallampati grade, Cormack-Lehane grade, and time) were also recorded. RESULTS: Only one patient was not intubated within the standard study parameters and was converted to the hospital protocols for difficult intubations. The forces applied to the maxillary incisors were significantly greater with the Macintosh blade compared with all VLSs. There were no differences between the VLSs with regard to the forces. Patient characteristics, including Mallampati grade, were not predictive of the forces applied. CONCLUSIONS: All VLSs considered were safer for the patient than was the Macintosh blade in terms of the forces applied to the maxillary teeth, time, number of insertion attempts, and view achieved of the glottic arch. There is a small, but significant, difference in the time and number of insertion attempts required during laryngoscopy with the different VLSs. There was no difference in the forces applied. The geometry of the respective blades may be an important component in the ease of laryngoscopy.

Bifurcating microchannels as a scaffold to induce separation of regenerating neurites.

Many neural interfacing strategies, such as the sieve electrode and the cultured probe, rely on neurite growth to establish neural contact. But this growth is subject to natural fasciculation, compromising the effectiveness of these interfacing strategies by reducing potential selectivity. This in vitro study shows that the fasciculation mechanism can be manipulated by providing an appropriate microchannel scaffold to guide and influence growth, thereby achieving a high degree of selectivity. The microchannels employed have a bifurcation from a primary channel into two secondary channels. This bifurcating microstructure was able to support and promote fasciculated growth over 70% of the time for microchannels widths of 2.5, 5, 10 and 20 microm. Fasciculation is shown to be a strong force during ingrowth, with the initiation of neurite separation related to random spatial exploration. Narrower microchannels initiate separated growth better. Once separated growth starts fasciculation results in an even distribution of neurite growth across the bifurcation. The reduction from 20 microm to 10 microm wide channels also resulted in a 3-fold decrease in ingrowing neurites performing 180 degrees turns to exit the microchannel via the entrance. No neurite turning was observed for both the 5 and 2.5 microm wide channels.

Micro-scale thermal tissue gripper.

During eye surgery translocating a graft of retinal tissue without damaging the vulnerable top layer is highly problematic using the currently available instruments. This study presents indirect Heat Induced Attachment and Detachment (HIAD) as a new concept for single side attachment of tissue to, and detachment from a heated metal wire. A small-scale prototype was built, having a 50 mum molybdenum wire that could be heated via an electric current. Tests (n = 60) were performed on submerged chicken meat to study the attachment and detachment properties of the prototype at different electric signal lengths. A 9V signal was applied to the prototype, with amplifier input signal lengths varying from 0.6-1.5 ms. Voltages and currents were sampled at 250 kHz to obtain energies. Both attachment and detachment occurred with 98% and 90% certainty, respectively, supplying 41 and 110 mJ of energy to the prototype in 0.7 and 1.5 ms. The attachment strength was estimated at 0.2 mN. Visible damage appeared to be approximately 0.005 mm(2). The concept of indirect heating of the instrument-tissue interface proved to be effective as the prototype could induce attachment and detachment of tissue. Indirect HIAD may be applicable in many different surgical applications.

Relationships between driving simulator performance and driving test results.

This article is considered relevant because: 1) car driving is an everyday and safety-critical task; 2) simulators are used to an increasing extent for driver training (related topics: training, virtual reality, human-machine interaction); 3) the article addresses relationships between performance in the simulator and driving test results--a relevant topic for those involved in driver training and the virtual reality industries; 4) this article provides new insights about individual differences in young drivers' behaviour. Simulators are being used to an increasing extent for driver training, allowing for the possibility of collecting objective data on driver proficiency under standardised conditions. However, relatively little is known about how learner drivers' simulator measures relate to on-road driving. This study proposes a theoretical framework that quantifies driver proficiency in terms of speed of task execution, violations and errors. This study investigated the relationships between these three measures of learner drivers' (n=804) proficiency during initial simulation-based training and the result of the driving test on the road, occurring an average of 6 months later. A higher chance of passing the driving test the first time was associated with making fewer steering errors on the simulator and could be predicted in regression analysis with a correlation of 0.18. Additionally, in accordance with the theoretical framework, a shorter duration of on-road training corresponded with faster task execution, fewer violations and fewer steering errors (predictive correlation 0.45). It is recommended that researchers conduct more large-scale studies into the reliability and validity of simulator measures and on-road driving tests.

Exploratory Factor Analysis With Small Sample Sizes.

Exploratory factor analysis (EFA) is generally regarded as a technique for large sample sizes (N), with N = 50 as a reasonable absolute minimum. This study offers a comprehensive overview of the conditions in which EFA can yield good quality results for N below 50. Simulations were carried out to estimate the minimum required N for different levels of loadings (λ), number of factors (f), and number of variables (p) and to examine the extent to which a small N solution can sustain the presence of small distortions such as interfactor correlations, model error, secondary loadings, unequal loadings, and unequal p/f. Factor recovery was assessed in terms of pattern congruence coefficients, factor score correlations, Heywood cases, and the gap size between eigenvalues. A subsampling study was also conducted on a psychological dataset of individuals who filled in a Big Five Inventory via the Internet. Results showed that when data are well conditioned (i.e., high λ, low f, high p), EFA can yield reliable results for N well below 50, even in the presence of small distortions. Such conditions may be uncommon but should certainly not be ruled out in behavioral research data. ∗ These authors contributed equally to this work.

Gender differences in driver's license theory test scores in the Netherlands.

INTRODUCTION: Gender differences were investigated in a sample of persons (N=34,755) who completed the driver's license theory test in the Netherlands. RESULTS: Contrary to recent findings from Sweden, no gender differences were found. IMPACT OF INDUSTRY: The present study signifies the importance of standardization in driver testing.

Mucoadhesive films inside the colonic tube: performance in a three-dimensional world.

A self-propelling colonoscopic device moving inside the colonic tube should be able to periodically grip safely to the colonic wall as well as to manipulate the generated friction. The feasibility of achieving high grip and friction manipulation by covering the device with mucoadhesive films is experimentally tested. More precisely, the frictional behaviour of mucoadhesive films inside the colonic tube is tested in vitro in porcine colon. It appears that mucoadhesive films generate significantly higher friction than conventional materials (ANOVA p=0, 95% CIs=-3.04, -2.14). The geometry of the film plays a role as well. When holes are, for instance, present in the film geometry and are large enough so that the colonic tissue can wrap their borders, friction can be significantly increased (ANOVA p=0, 95% CIs=-2.53, -1.26). By altering the contact area or the film geometry, friction manipulation can be achieved. Moreover, a simple theoretical model is developed and experimentally verified (R=0.92). The model can be used to estimate the level of the friction generated by three-dimensional configurations of mucoadhesive films as a function of their geometric characteristics and the material properties of the colon.

The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI).

BACKGROUND AND OBJECTIVES: Anesthesiologists are reluctant to consider higher levels for spinal anesthesia, largely due to direct threats to the spinal cord. The goal of this study is to investigate, with magnetic resonance imaging (MRI), the distances between the relevant structures of the spinal canal (spinal cord, thecal tissue, etc.) to determine modal anatomical positions for neuraxial anesthesia. METHOD: A group of 19 patients were imaged with an MRI scanner in supine position. Medial sagittal slices of the thoracic and lumbar spine were measured for the relative distances between anatomical structures, including epidural space, dura, and spinal cord. RESULTS: The posterior dura - spinal cord distance is significantly greater in the middle thoracic region than at upper and lower thoracic levels (e.g. T6 9.5 +/- 1.8 mm, T12 3.7 +/- 1.2 mm, p < 0.001, T1 4.7 +/- 1.7 mm, p < 0.001). There is variation in modal distances between the structures important for neuraxial anesthesia, at different levels of the spinal canal. CONCLUSIONS: The spinal cord tends to follow the straightest line through the imposed geometry of the spine. Considering the necessary angle of entry of the needle at mid-thoracic levels, there is relatively (more than at upper thoracic and lumbar levels) substantial separation of cord and surrounding thecal tissue. Anesthesiologists perform spinal blockades up to the L2-L3 interspace, but avoid higher levels for fear of neurological damage. The information that there is substantially more space in the dorsal subarachnoid space at thoracic level, might lead to potential applications in regional anesthesia. In contrast, the cauda equina sits more dorsally in the lumbar region.

Analysis of verbal communication during teaching in the operating room and the potentials for surgical training.

BACKGROUND: Verbal communication in the operating room during surgical procedures affects team performance, reflects individual skills, and is related to the complexity of the operation process. During the procedural training of surgeons (residents), feedback and guidance is given through verbal communication. A classification method based on structural analysis of the contents was developed to analyze verbal communication. This study aimed to evaluate whether a classification method for the contents of verbal communication in the operating room could provide insight into the teaching processes. METHODS: Eight laparoscopic cholecystectomies were videotaped. Two entire cholecystectomies and the dissection phase of six additional procedures were analyzed by categorization of the communication in terms of type (4 categories: commanding, explaining, questioning, and miscellaneous) and content (9 categories: operation method, location, direction, instrument handling, visualization, anatomy and pathology, general, private, undefinable). The operation was divided into six phases: start, dissection, clipping, separating, control, closing. RESULTS: Classification of the communication during two entire procedures showed that each phase of the operation was dominated by different kinds of communication. A high percentage of explaining anatomy and pathology was found throughout the whole procedure except for the control and closing phases. In the dissection phases, 60% of verbal communication concerned explaining. These explaining communication events were divided as follows: 27% operation method, 19% anatomy and pathology, 25% location (positioning of the instrument-tissue interaction), 15% direction (direction of tissue manipulation), 11% instrument handling, and 3% other nonclassified instructions. CONCLUSION: The proposed classification method is feasible for analyzing verbal communication during surgical procedures. Communication content objectively reflects the interaction between surgeon and resident. This information can potentially be used to specify training needs, and may contribute to the evaluation of different training methods.

Violations and errors during simulation-based driver training.

The effectiveness of virtual driving instruction can increase when techniques that automatically distinguish between violations and errors are available, two behaviours requiring different types of remediation. This study reports the analysis of the objectively measured performance of 520 participants completing a simulation-based training programme. Factor analysis of failure reasons showed that violations and errors were the primary underlying factors. Men committed more violations and women made more errors; the magnitude of sex differences corresponded to the factor loadings. Factor analysis of the mean task completion times yielded a factor that can be described as the extent to which motivation for speed resulted in quicker task execution. Quicker participants completed more tasks, committed more violations, but made fewer errors. Participants reduced errors during forced-paced driving and increased speed during self-paced driving. The authors would recommend exploiting the distinction between violations and errors by developing interfaces and feedback for both types of aberration.

A clearly visible endoscopic instrument shaft on the monitor facilitates hand-eye coordination.

BACKGROUND: Passing an instrument through a small incision alters the kinematics of the instrument, thus hampering hand-eye coordination. Nevertheless, the incision provides a stable, nearly invariant, point of rotation for instrument movements. Therefore, we set out to evaluate the effects of the altered kinematics on hand-eye coordination. In addition, we assessed the hypothesis that the hand-eye coordination of laparoscopic surgeons incorporates the incision as a point of reference. METHODS: Eight surgeons with experience in laparoscopy repeatedly performed a positioning task on a two-dimensional endoscopic manipulation simulator. Task time was measured. In the first experiment, normal endoscopic manipulation was compared to a condition in which the kinematic effects of the incision were compensated for. In the second experiment, the instrument shaft on the monitor was not visible during half of the trials, so that all visual information about the location of the incision was obscured. RESULTS: Task performance improved significantly when the kinematic effects of the incision were compensated for (p = 0.001). Task performance improved when the instrument shaft was clearly visible on the monitor (p <0.05). CONCLUSIONS: Compensating for the kinematic effects introduced by the incision improves hand-eye coordination. The results of this study indicate that the incision provides a point of reference for hand-eye coordination during endoscopic manipulation.

Quantitative evaluation of three advanced laparoscopic viewing technologies: a stereo endoscope, an image projection display, and a TFT display.

BACKGROUND: Compared to open surgery, minimally invasive surgery (MIS) relies heavily on advanced technology, such as endoscopic viewing systems and innovative instruments. The aim of the study was to objectively compare three technologically advanced laparoscopic viewing systems with the standard viewing system currently used in most Dutch hospitals. METHODS: We evaluated the following advanced laparoscopic viewing systems: a Thin Film Transistor (TFT) display, a stereo endoscope, and an image projection display. The standard viewing system was comprised of a monocular endoscope and a high-resolution monitor. Task completion time served as the measure of performance. Eight surgeons with laparoscopic experience participated in the experiment. RESULTS: The average task time was significantly greater (p <0.05) with the stereo viewing system than with the standard viewing system. The average task times with the TFT display and the image projection display did not differ significantly from the standard viewing system. CONCLUSION: Although the stereo viewing system promises improved depth perception and the TFT and image projection displays are supposed to improve hand-eye coordination, none of these systems provided better task performance than the standard viewing system in this pelvi-trainer experiment.

The perspective effect of wide-angle lenses in laparoscopes.

PURPOSE: To evaluate the effect of perspective distortion of wide-angle lenses in laparoscopes on hand-eye coordination during endoscopic manipulation. METHODS: Sixteen subjects repeatedly performed a standardized positioning task in a pelvi-trainer under two conditions. The subjects had no prior experience with endoscopic manipulation. In one condition, a wide-angle lens with considerable perspective distortion was used; in the other, a telephoto lens without perspective distortion was used. Task time and number of errors were measured. RESULTS: Task time and the number of errors did not significantly increase in the condition with a wide-angle lens. CONCLUSIONS: The perspective effect did not influence task performance in endoscopic manipulation in this experiment. Subjects indicated that they even preferred the wide-angle lens because its extreme perspective improved their perception of depth.

A quantitative measure for degree of automation and its relation to system performance and mental load.

In this paper we quantitatively model degree of automation (DofA) in supervisory control as a function of the number and nature of tasks to be performed by the operator and automation. This model uses a task weighting scheme in which weighting factors are obtained from task demand load, task mental load, and task effect on system performance. The computation of DofA is demonstrated using an experimental system. Based on controlled experiments using operators, analyses of the task effect on system performance, the prediction and assessment of task demand load, and the prediction of mental load were performed. Each experiment had a different DofA. The effect of a change in DofA on system performance and mental load was investigated. It was found that system performance became less sensitive to changes in DofA at higher levels of DofA. The experimental data showed that when the operator controlled a partly automated system, perceived mental load could be predicted from the task mental load for each task component, as calculated by analyzing a situation in which all tasks were manually controlled. Actual or potential applications of this research include a methodology to balance and optimize the automation of complex industrial systems.

Evidence that cell surface charge reduction modifes capillary red cell velocity-flux relationships in hamster cremaster muscle.

1. From capillary red cell velocity (V)-flux (F) relationships of hamster cremaster muscle a yield velocity (VF = 0) can be derived at which red cell flux is zero. Red cell velocity becomes intermittent and/or red blood cells come to a complete standstill for velocities close to this yield velocity, and, at the same time, capillary tube haematocrit becomes very low. 2. We have tested whether the net negative charge of red blood cells (RBCs) contributes to the magnitude of VF = 0. Velocity-flux relationships were measured for normal cells, normal cells labelled with the fluorescent dye calcein (LRBCs), and red cells treated with hexadimethrine to mask negative charge and labelled with calcein as well (HDM-LRBCs). Measurements were done in a hamster cremaster muscle preparation applying video in vivo microscopy. 3. Hexadimethrine treatment reduced the net negative surface charge of red cells to 20% of control as estimated from transmission electron microscopy using a ferritin tagging technique. The values of VF = 0 found for normal red cells and HDM-LRBCs were 86 +/- 15 and 31 +/- 17 microns s-1, +/- S.E.M., n = 12, respectively, which were significantly different (P < 0.05). For normal cells and cells labelled with calcein only, VF = 0 values were 63 +/- 14 and 65 +/- 13 microns s-1, n = 8, respectively, which were not significantly different. The effect of HDM treatment did not alter filterability of the red cells as estimated from transit times through 5 microns pores. 4. The present findings demonstrate that the net negative charge of RBCs contributes significantly to the yield velocity for red blood cells entering capillaries and flowing through them. HDM treatment reduced the net negative charge of red blood cells and may have caused cells to enter capillaries more easily owing to reduced electrostatic repulsion at the capillary entrance. In addition, HDM treatment may have lowered intracapillary flow resistance by a reduction in electrostatic repulsive forces between red blood cells and negatively charged (macromolecules on) capillary endothelial cells at sites of irregular capillary cross-sectional shape, without significantly affecting the lubricating properties of the capillary endothelial glycocalyx and/or associated plasma macromolecules.

Method to create small photo-bleached volumes to monitor blood plasma flow in capillaries.

A method has been developed to examine the movement of plasma in capillaries using intravital microscopy. Spatial transients in fluorescence properties are instantaneously induced by laser photo-bleach pulses after which the convective recovery can be monitored. The plasma is tagged with fluorescent dyes coupled to bovine serum albumin, which is injected well before the measurements and circulates with the blood stream. A laser beam from an argon laser source, set to emit light with a wavelength of 488 nm, is focused on the illumination field diaphragm and creates a spot in the object plane of the microscope. At low laser power, the laser spot is aimed at a blood plasma gap between red blood cells in a capillary segment, using a steerable mirror. Light sensors, coupled to photo-multipliers in the secondary image plane of the microscope, record the light intensity of the moving plasma/dye while the preparation is continuously illuminated with a xenon epi-illuminating set-up. The laser photo-bleach spot is then used to bleach the dye complex within a 5.4 microns segment of the capillary for less than 20 ms. The movement of the bleached plasma bolus is tracked by the photo-sensors, placed sequentially along the capillary. Both dye and red blood cell passage can be detected in the photo-multiplier signals, and the relative velocities of the two blood components can be measured. Measurements reveal that the ratio of transit times between blood plasma and red blood cells is 1.23 (SD = 0.22, N = 18), which is in good agreement with measurements by other techniques.

A technique for the estimation of plasma flow in single capillaries using photobleached dyes.

In order to estimate plasma flow in single capillaries, an "indicator bolus" was optically inserted into individual microvessels of the hamster cremaster muscle. This was accomplished using short-duration (200 msec), argon laser pulses to photobleach a 5-microns segment of fluorochrome circulating with the plasma. The subsequent motion of the bleached plasma bolus was then tracked using photomultipliers positioned at three sites along the capillary. The transient passage of the dye appeared as a steep fall in light intensity as the downstream edge of the bleached area entered the sensor field, followed by a steep rise in light intensity as trailing unbleached plasma flowed under the sensor. The behavior of light intensity as the photobleached bolus flowed past a sensor was analyzed using a theoretical model developed to predict the behavior of this type of plasma flow indicator in single capillaries. The characteristic time, tau, which equals the capillary segment volume divided by the plasma flow, was taken as an estimate of plasma flow. The model predicts that, for this system, tau of the capillary corresponds closely to the time at which 50% of the full sensor response to the bolus is attained, that is, the t50. The ratio between the t50 and the characteristic time is found to be a function of the relative sensor width and the flow velocity profile. A procedure is also described to assess the flow velocity profile from in vivo measurements. Using this technique, the ratio of the velocity of the red cell compared to that of plasma is found to be about 1.3.

Oxygen diffusion in a network model of the myocardial microcirculation.

Oxygen supply was studied in a three-dimensional capillary network model of the myocardial microcirculation. Capillary networks were generated using one common strategy to locate the capillary branchings and segments, arterioles and venules. Flow paths developed with different capillary flow velocities. All pressure-flow relationships were linear. The model includes free diffusion of oxygen within tissue slices that are perpendicular to the main capillary orientation. Oxygen pressure distributions were calculated and correlated to oxygen delivery by small capillary segments. It was shown that intercapillary diffusion is important for reducing PO2 heterogeneity. The absence of this feature leads to an oxygen distribution that has similar heterogeneity characteristics as the capillary flow heterogeneity. Such situations may also occur during simulated, elevated metabolic activity in a network model that allows intercapillary diffusion. On the basis of our simulations of metabolic vasoactivity we concluded that the venous PO2 is a misleading quantity to indicate tissue oxygenation. The venous PO2 in our model was not a good measure for the mean tissue or capillary PO2, and for the low oxygen pressures that exist at some locations in the network model. Moreover, the venous PO2 may remain constant despite considerable changes on the tissue PO2 distribution induced by metabolic activity.