High-fidelity Simulation Environment Research Articles

Articulated blade tip devices for load alleviation on wind turbines

Abstract. This paper investigates the load alleviation capabilities of an articulated tip device, where the outermost portion of the blade can rotate with respect to the rest of the blade. Passive, semi-passive and active solutions are developed for the tip rotation. In the passive and semi-passive configurations tip pitching is mainly driven by aerodynamic loads, while for the active case the rotation is obtained with an actuator commanded by a feedback control law. Each configuration is analyzed and tested using a high-fidelity aeroservoelastic simulation environment, by considering standard operative conditions as well as fault situations. The potential benefits of the proposed blade tip concepts are discussed in terms of performance and robustness.

One-Lung Ventilation: A Pediatric Simulation Case for Anesthesiology Residents.

This activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity. Our simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not. Learners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that "This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients" and "This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation." Comments were overall positive, including "I am better prepared to manage pediatric one lung ventilation cases." At the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.

Detection of rotor imbalance, including root cause, severity and location

This paper presents a new way of detecting imbalances on wind turbine rotors, by using a harmonic analysis of the rotor response in the fixed frame. The method is capable of distinguishing among different root causes of the imbalance. In addition, the imbalance severity and location, i.e. the affected blade, can be identified. The automatic classification of the imbalance problem is obtained by using a neural network. The performance of the method is illustrated with the help of different fault scenarios, within a high-fidelity simulation environment.

Verification of a Fully Numerical Entry Guidance Algorithm

The process, methodology, and results of a two year effort are presented in this paper on verification of an advanced entry guidance algorithm, called Fully Numerical Predictor-corrector Entry Guidance (FNPEG). FNPEG is a model-based numerical guidance algorithm capable of performing both direct (orbital or suborbital) entry and skip entry missions. Few vehicle-dependent adjustments are necessary, and no reference trajectory or mission-dependent planning is required. The algorithm is applicable to a wide range of vehicles with different lift-to-drag ratios and includes state-of-the-art capability to effectively control load and damp out phugoid oscillations, without adversely affecting the guidance precision. FNPEG has undergone extensive testing and evaluation in the high-fidelity simulation environment for the Orion spacecraft at NASA Johnson Space Center. In this paper, the verification methodology and process are described. The metrics for verification are defined. Extensive testing and simulation results on FNPEG and the comparison with the primary entry guidance algorithm for Orion, PredGuid, are provided. The outcome of this effort has clearly demonstrated the capability, strong robustness, and excellent performance of FNPEG, even in the presence of dispersions and uncertainties significantly higher than the design level.

A Hemodynamic Monitor as a Simulation Tool, a Novel Use of the PiCCO2: Technical Description of the Method and Its Application.

The PiCCO2 is a commonly used monitor, which education remains theoretical and demonstration based. Simulation allows active learning, which may help achieve a better understanding and handling of this device, hence a safer and more effective use. Because of the lack of availability of dedicated simulators and the uselessness of the demonstration mode of monitors for simulation purpose, simulation remains seldom used. We will describe a novel use of the PiCCO2 for simulation training and its experiment in high-fidelity simulation (HFS). A standard PiCCO2 was modified with software allowing its transformation into a simulator. The values displayed on the screen were managed in real time by an operator using a standard laptop linked to the monitor and using a standard disposable catheter set to execute simulated transpulmonary thermodilution. Nineteen volunteers were requested to assess the realism of the device during scenarios in which the PiCCO2S (simulator) was used in an HFS environment, with a mannequin reproducing a septic shock condition. Two experimental sessions were made. PiCCO2S was used in the contextualized setting of HFS, which allowed a good interactivity between the device and its users. Participants had a positive perception of the realism as well as the method's adequacy to achieve a better understanding of the PiCCO2. The PiCCO2S could be obtained from a serial device. Its integration in HFS provided a realistic handling of the device. A built-in simulation mode into serial medical devices may give users an easy access to training.

TF14 Development of the Open Access Airway Course

Emergency airway management is a crucial skill for emergency physicians. Easily accessible formal training for airway management is somewhat lacking. Many of the existing airway courses are not learner-focused and require the learner to travel to a central location at a specific time. Expert faculty time is then divided between lecturing and staffing task trainers. We created a modular curriculum to teach basic and advanced airway skills to a broad audience via asynchronous learning technologies. This should significantly decrease faculty time commitment and shift the teaching focus from conveying facts and methods to one-on-one instruction in a simulation environment. The primary learners for our curriculum are residents training in emergency medicine (PGY1-4). Our secondary learners include any personnel tasked with emergency airway management. This includes advanced practitioners, medical students, EMS providers, emergency medicine faculty, and critical care faculty. After completing this course learners will be able to assess airway anatomy, predict difficult airway issues, and demonstrate proficiency in securing the airway in multiple complex environments. In developing this curriculum, we began with a faculty-led resident focus group. This group consisted of six emergency medicine residents, PGY1-4, who are currently in training. We elicited feedback from residents regarding their current airway training. Using this feedback we developed a curriculum outline. The curriculum consists of two major components: asynchronous content development and delivery, and a hands-on high fidelity simulation environment. Content consists currently of twenty-two modules covering a variety of topics specific to airway management. Modules were designed using the ADDIE instructional design model (analysis, design, development, implementation, evaluation). Each module contains learning objectives, educational content, and an integrated knowledge assessment. Educational content for each module varies, but typically consist of short video segments demonstrating techniques or principles in detail. Modules are accessible via a publically accessible Web site and may be viewed in a non-linear fashion. Once a particular module is completed, the learner then schedules a time to meet with an expert provider in our simulation laboratory for deliberate practice. We have designed simulation scenarios to most closely represent complex practice scenarios including massive hematemesis, airway obstruction, and persistent hypoxemia. This allows learners to process events dynamically, rather than simply learning to perform a task. There is a checklist of critical events which was developed to objectively evaluate the learner. This is a simple two-column checklist which is marked as either requiring remediation or competent. We also utilize the ACGME Emergency Medicine Milestones to provide feedback to our learners. Emergency airway management is critical to the practice of emergency medicine. Teaching airway management is a time-consuming process. Development of this curriculum shifts the educational focus from the faculty to the learner, and maximizes the learner’s one-on-one time with expert faculty. This curriculum can be easily and rapidly modified or appended as new research is published or new devices are developed.

Simulation and experimental demonstration of model predictive control in a building HVAC system

This article presents the framework and results of implementing optimization-based control algorithm for building HVAC systems and demonstrates its benefits through reduced building energy consumption as well as improved thermal comfort along with lessons learned. In particular, a practically effective and computationally efficient model predictive control algorithm is proposed to optimize building energy usage while maintaining thermal comfort in a multi-zone medium-sized commercial building. This article has two themes. Driven by the challenge of fully evaluating the benefit of the proposed model predictive controller against baseline control, a model predictive control design framework is first presented with its performance benchmarked based on a high-fidelity building HVAC simulation environment to verify its effectiveness and feasibility. Following the same model predictive control design framework, the experimental results from the same building located at the Philadelphia Navy Yard are then presented. For the simulation study, the performance of the model predictive control algorithm was estimated relative to baseline days with exactly the same internal loads and outdoor conditions, and it was estimated that model predictive control reduced the total electrical energy consumption by around 17.5%. For the subsequent experimental demonstration, the performance of the model predictive control algorithm was estimated relative to baseline days with similar outdoor air temperature patterns during the cooling and shoulder seasons, and it was concluded that model predictive control reduced the total electrical energy consumption by more than 20% on average while improving thermal comfort in terms of zone air temperature.

Cognitive load, emotion, and performance in high-fidelity simulation among beginning nursing students: a pilot study.

Establishing the impact of the high-fidelity simulation environment on student performance, as well as identifying factors that could predict learning, would refine simulation outcome expectations among educators. The purpose of this quasi-experimental pilot study was to explore the impact of simulation on emotion and cognitive load among beginning nursing students. Forty baccalaureate nursing students participated in teaching simulations, rated their emotional state and cognitive load, and completed evaluation simulations. Two principal components of emotion were identified representing the pleasant activation and pleasant deactivation components of affect. Mean rating of cognitive load following simulation was high. Linear regression identiffed slight but statistically nonsignificant positive associations between principal components of emotion and cognitive load. Logistic regression identified a negative but statistically nonsignificant effect of cognitive load on assessment performance. Among lower ability students, a more pronounced effect of cognitive load on assessment performance was observed; this also was statistically non-significant.

Iterative Feedback Tuning of an LPV Feedforward Controller for Wind Turbine Load Alleviation

Modern wind turbines incorporate active control techniques such as Individual Pitch Control (IPC) to reduce lifetime dynamic loads. However, system identification and controller design are typically difficult for turbine load control on account of the LPV nature of the system and disturbance. This challenge is addressed by extending the data-based Iterative Feedback Tuning (IFT) technique to systems with LPV output matrices, controlled with a parameterised feedforward controller LPV in output matrices. In order to compensate for the parameter-varying nature of the plant, controller and disturbance, and to estimate the IFT cost gradients in an unbiased manner, an increased number of experiments is required. Such an LPV controller, tuned and tested in a high-fidelity simulation environment, is able to show enhanced load reductions as compared to an LTI controller.

Checklist for early recognition and treatment of acute illness: International collaboration to improve critical care practice.

Processes to ensure world-wide best-practice for critical care delivery are likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit (ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources (included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices (as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

Randomized clinical trial of the impact of surgical ward-care checklists on postoperative care in a simulated environment.

Complications are a common and accepted risk of surgery. Failure to optimize the management of patients who suffer postoperative morbidity may result in poorer surgical outcomes. This study aimed to evaluate a checklist-based tool to improve and standardize care of postoperative complications. Surgical trainees conducted baseline ward rounds of three patients with common postoperative complications in a high-fidelity simulated ward environment. Subjects were randomized to intervention or control groups, and final ward rounds were conducted with or without the aid of checklists for management of postoperative complications. Adherence to critical care processes was assessed, in addition to technical (Surgical Ward-care Assessment Tool, SWAT) and non-technical (Ward NOn-TECHnical Skills (W-NOTECHS) scale) performance. Subjects completed a feedback questionnaire regarding their perception of the checklists. Twenty trainees completed 120 patient assessments. All intervention group subjects opted to use the checklists, resulting in significantly fewer critical errors compared with controls (median (i.q.r.) 0 (0-0) versus 60 (40-73) per cent; P < 0·001). The intervention group demonstrated improved patient management (SWAT-M) (P < 0·001) and non-technical skills (P = 0·043) between baseline and final ward rounds, whereas controls did not (P = 0·571 and P = 0·809 respectively). A small learning effect was seen with improvement in patient assessment (SWAT-A) in both groups (P < 0·001). Intervention group subjects found checklists easy and effective to use, and would want them used for their own care if they were to experience postoperative complications. Checklist use resulted in significantly improved standardization, evidence-based management of postoperative complications, and quality of ward rounds. Simulation-based piloting aided appropriate use of checklists and staff engagement. Checklists represent a low-cost intervention to reduce rates of failure to rescue and to improve patient care.

174 Intubation Checklist Performance in a Simulation Model

174 Intubation Checklist Performance in a Simulation Model

Angles-Only Navigation to a Noncooperative Satellite Using Relative Orbital Elements

This work addresses the design and implementation of a prototype relative navigation tool that uses camera-based measurements collected by a servicer spacecraft to perform far-range rendezvous with a noncooperative client in low Earth orbit. The development serves the needs of future on-orbit servicing missions planned by the German Aerospace Center. The focus of the paper is on the design of the navigation algorithms and the assessment of the expected performance and robustness under real-world operational scenarios. The tool validation is accomplished through a high-fidelity simulation environment based on the Multi Satellite Simulator in combination with the experience gained from actual flight data from the GPS and camera systems onboard the Prototype Research Instruments and Space Mission Technology Advancement mission.

Board 519 - Technology Innovations Abstract Innovative Engineering to Increase Realism in High-Fidelity Simulation? Integration of the Laerdal Medium-Fidelity Airway Manikin in Airway Management Simulation (Submission #44)

Introduction/Background The goal of High Fidelity Simulation (HFS) is to convince the participant they are immersed in a real situation. To enable HFS, we employ “Realism” in three parts; first, we insure the problem being simulated is believable (conceptual); next, we take great pain to manipulate the simulation space to appear compellingly real (physical); and finally, we insure that the communication during simulation is reflective of the event being modeled (emotionally contextual).1 Fidelity is the degree to which simulation achieves the objective of “Realism”. Realism seems to be the critical quality that enables effectiveness of High Fidelity Simulation to enable episodic memory & transformational learning. 2-4 Hence, any contribution that enhances realism - be it conceptual, physical, or contextual - is of high value at increasing the probability of HFS event to occur. We present a novel approach to HFS, whereby the integration of the Laerdal Medium Fidelity Airway Management Trainer enables enhanced conceptual and physical realism in airway management scenarios such as the bleeding tonsil, the unexpected aspirating patient and a PA rupture. Methods In all three scenarios, the High Fidelity SimMan 3G manikin is moved down the OR table and fully draped, whereby the Medium Fidelity airway head is the visible part, giving the appearance of a continuous manikin. Case One - The Bleeding Tonsil: Using fake blood loaded in the injection apparatus (see picture), we carefully position the open tip of the suction catheter in the hypopharynx of the airway trainer’s mouth, behind the tonsillar pillar. Under full drapes, a confederate will forcefully inject the fluid into the direct view of the larygoscopist, mimicking a “bleeding tonsil”. Case Two - The Aspiration Scenario: Using the same injection apparatus and fake bile, we know change the catheter tip position to the corner of the mouth. Immediately after induction, a confederate forcefully injects the fluid into the airway, whereby “bile” comes rushing out of the side of the mouth, into the mask, imitating an aspiration event. Case Three - The PA Rupture: After intubating the manikin with a short 8.0 ETT (cut to 26cm), using the same injection apparatus described above, the suction tubing is inserted up the manikin trachea, with the open catheter tip resting just past the elbow of the breathing circuit. In our simulation, when the surgeon either begins to suture in the mitral valve or during a severe protamine reaction, the red tinged fluid is injected forcefully, whereby the breathing circuit is saturated with red “blood”, mimicking a PA rupture. Results: Conclusion The ability to train for airway complications is critical to mastery of the difficult airway. Given the sensitivity to damage of expensive high fidelity equipment, it is often unfeasible to imitate the physical conditions present in certain real life situations, such as pooling blood, projectile vomit or bile, or an ett full of blood. Introducing a medium fidelity head into the HFS environment offers more flexibility to faithfully simulate the characteristic features of these scenarios, thereby enhancing the conceptual and physical realism of the learner.

Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study

Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills. This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Mixed-method multi-centre study. High fidelity simulated acute clinical environment in three Australian universities. A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

Preparing the nursing student for internship in a pre-registration nursing program: Developing a problem based approach with the use of high fidelity simulation equipment

AimThis paper aims to explore the development and evaluation results of a simulated skills package designed using a problem based learning approach with general nursing students. BackgroundInternationally, the use of high fidelity simulated learning environments has escalated. This has occurred as a result of growing concerns relating to patient safety, patient litigation, lack of clinical opportunities for student nurses to gain experience and integration of new teaching methods into nursing curricula. There are however both proponents and opponents to the value of simulation and high fidelity simulation within nursing education. MethodsThis study was conducted in an Irish school of nursing. A simulated learning support package was developed by nurse educators and piloted with 134 third year nursing students. This was evaluated using a questionnaire in which 87 students responded. FindingsStudents generally found the simulation sessions realistic and useful in developing clinical skills, knowledge and confidence for clinical practice. However student issues regarding support with preparation for the session were highlighted. Also, the need for a more formalised structure for debriefing following the simulation sessions were identified. ConclusionIt is hoped that this paper will provide nurse educators with some guidance to aid future development of innovative and interactive teaching and learning strategies.

GPS-based relative navigation for the Proba-3 formation flying mission

The primary objective of the Proba-3 mission is to build a solar coronagraph composed of two satellites flying in close formation on a high elliptical orbit and tightly controlled at apogee. Both spacecraft will embark a low-cost GPS receiver, originally designed for low-Earth orbits, to support the mission operations and planning during the perigee passage, when the GPS constellation is visible. The paper demonstrates the possibility of extending the utilization range of the GPS-based navigation system to serve as sensor for formation acquisition and coarse formation keeping. The results presented in the paper aim at achieving an unprecedented degree of realism using a high-fidelity simulation environment with hardware-in-the-loop capabilities. A modified version of the flight-proven PRISMA navigation system, composed of two single-frequency Phoenix GPS receivers and an advanced real-time onboard navigation filter, has been retained for this analysis. For several-day long simulations, the GPS receivers are replaced by software emulation to accelerate the simulation process. Special attention has been paid to the receiver link budget and to the selection of a proper attitude profile. Overall the paper demonstrates that, despite a limited GPS tracking time, the onboard navigation filter gets enough measurements to perform a relative orbit determination accurate at the centimeter level at perigee. Afterwards, the orbit prediction performance depends mainly on the quality of the onboard modeling of the differential solar radiation pressure acting on the satellites. When not taken into account, this perturbation is responsible for relative navigation errors at apogee up to 50m. The errors can be reduced to only 10m if the navigation filter is able to model this disturbance with 70% fidelity.

The Effect of an Olfactory and Visual Cue on Realism and Engagement in a Health Care Simulation Experience

Fidelity has been identified as an important element in a subject's perception of realism and engagement in learning during a simulation experience. The purpose of this study was to determine whether an isolated visual and olfactory sensory change to the simulation environment affects the subjects' perceptions of realism during simulation cases. Using an electrosurgical unit applied to bovine muscle tissue, we created a model to simulate the characteristic operating room smoke and burning odor that occur during many procedures. Anesthesiologist subjects were randomly assigned to an intervention group that participated in a simulation involving the characteristic smoke and odor or a control group whose simulation involved no smoke or odor. Subjects completed a 7-question survey on the fidelity of the simulation, their perception of realism, and their learning engagement. We enrolled 103 subjects over 22 simulation courses in our study (intervention, n = 52; control, n = 51). The subjects' reactions to the physical (P = 0.73), conceptual (P = 0.34), and emotional (P = 0.12) fidelity and their perception of realism (P = 0.71) did not differ between the intervention and control groups. In a high-fidelity simulation environment, a visual and olfactory increment to physical fidelity did not affect subjects' overall ratings of fidelity, perceptions of realism, and engagement in the learning experience.

Measuring Team Performance in Complex and Dynamic Military Environments: The SPOTLITE Method

The Scenario-based Performance Observation Tool for Learning In Team Environments (SPOTLITE) provides a systematic method for developing team performance measurement instruments comprised of behaviorally anchored rating scales that are tied to observable behaviors that tap critical knowledge and skills and can be assessed at specific intervals during a training scenario. We developed a measurement instrument for four-person teams of F-16 pilots training for air-to-air combat in a high-fidelity simulation environment and implemented it in a handheld computer to support fast and accurate data entry as a team executes a scenario. An experiment demonstrated the sensitivity, reliability, and validity of the instrument.

Virtual Entity-Based Rapid Prototype for Design and Simulation of Humanoid Robots

This paper proposes a framework for a virtual entity-based rapid prototype (VERP) to facilitate the design and simulation of humanoid robots. The VERP framework consists of three components: virtual entities, a high-fidelity simulation environment with physical and rendering engines, and an interface between the physical and simulation environments. To study the effectiveness of the proposed framework, we present a complete prototype for a humanoid robot using virtual entity modelling, control algorithm design and simulation. The humanoid robot is mathematically modelled with adjustable physical parameters which determine the kinematic and dynamic behaviour of the virtual entity in the simulation environment. With the simulated model, a control scheme for the virtual entity and the actual humanoid robot are designed and implemented through the interface. The empirical experiments and numerical analysis show the effectiveness and preciseness of the proposed VERP in terms of simulation fidelity, dynamic performance, and control interface.