Low-cost Simulator Research Articles

Smartphone-based augmented reality patient education in radiation oncology

We built an augmented reality (AR) patient education application for portable iOS and Android devices that allows patients to view a virtual simulation of themselves receiving radiation treatment. We created software that reads data from the clinical treatment planning system and renders the patient’s actual radiotherapy plan in AR on a tablet or smartphone. The patient's CT simulation data are converted into a 3D translucent virtual human shown being treated with visible radiation beams from a virtual linear accelerator. We conducted a patient study to determine if showing patients this AR simulation improves patient understanding of radiotherapy and/or reduces anxiety about treatment. A total of 75 patients completed this study. The most common plans were 3D breast tangents and intensity modulated radiotherapy lung plans. Patients were administered questionnaires both before and after their AR viewing experience. After their AR viewing, 95% of patients indicated that they had a better understanding of how radiotherapy will be used to treat their cancer. Of the 35 patients who expressed anxiety about radiotherapy beforehand, 21 (60%) indicated that they had decreased anxiety after the AR session. In our single-arm prospective patient study, we found that this simplified low-cost tablet-based personalized AR simulation can be a helpful educational tool for cancer patients undergoing radiotherapy.

Development of a low-cost congenital abdominal wall defect simulator (wall-go) for undergraduate medical education: a validation study

BackgroundCongenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world’s top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication.MethodsMarket research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher’s Exact Test.ResultsGastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05).ConclusionsThe WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.

ANALISIS ALIRAN PADA BUCKET TURBIN PELTON 1 KW DENGAN VARIASI SPEAR NOZZLE MENGGUNAKAN METODE CFD

Pelton turbine have been used for harvesting renewable energy by extracting kineticenergy of water into mechanical energy for more than 100 years. This characteristic makes thissystem remains potential to achieve Goals #12 SDGs. During the operation, the performance ofPelton Turbine is affected by several parameters: hydraulic power, water flow rate, bucketdesign, and nozzle. Among others, nozzle design is the most challenging since this part isresponsible to drive the water direction strike the buckets, converting impulse. The performanceof existing 1 kW Pelton Turbine equipped with 15mm Spear Nozzle is believed can be improvedby varying the nozzle diameter by using low-cost CFD simulation procedure. Ansys Fluent fromAnsys Student 2021 R1 is used in this research. Represented by two-buckets facing spear nozzle,three dimensional CFD simulation is conducted. The nozzle diameter is varied to 15 mm, 14 mm,and 13 mm from two configurations. The first and second configuration is done with water flowrate 3,3 kg/s and 1,3 kg/s respectively. The results show that 15 mm nozzle diameter can producehigher power as high as 594,08 Watt with the first configuration. Even though at the secondconfiguration this 15mm nozzle diameter did not produce the highest power, other parameterssuch as splashing water and erosion effect still show that the 15mm nozzle diameter performedbetter than others. This simulation results also consistent with experimental results whichperformed by using first configuration and 15mm nozzle diameter. The results also show that thesistem performance is much higher at higher water flow rates. Therefore, the development of thesystem can be continued to by using spear nozzle with diameter higher than 15mm.

Mathematical analysis for simulation of incompressible fluid flow

The omnipresence and complexity of physical phenomena drive the strong search for tools capable of simulating them, since many applications require computationally viable, reliable and, preferably, low-cost simulations. Thus, a priori, this work has two objectives: i) understand the theoretical foundations of fluid dynamics with an important computational method aimed at simulating incompressible flows, called SPH (Smoothed Particle Hydrodynamic), which will subsequently be implemented; and ii) assist in the consolidation and application of key concepts in mathematical analysis for computer simulation. Our efforts in this work provide mathematical foundations, which in turn, describe the dynamics of fluid dynamic motion.

Development of a Low-Cost Simulator for Training in Hemorrhoidal Ligation

Abstract Introduction Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application.

Use of Low-Cost Task Trainer for Emergency Department Thoracotomy Training in General Surgery Residency Program

Emergency department thoracotomy (EDT) is an uncommon but potentially lifesaving procedure that warrants familiarity with anatomy, instruments, and indications necessary for completion. To address this need, we developed a low-cost EDT trainer. The primary objective of this study was to compare the effectiveness of a low-cost EDT trainer to teach emergency department thoracotomy with a discussion-based teaching session. Secondary objective was to study the face validity of the low-cost EDT trainer. A prospective 2-phase randomized control study was conducted. Participants were randomly divided into two groups. In phase one, baseline medical knowledge for both groups was assessed using a multiple-choice question pretest. In Group 1, each participant was taught EDT using a one-on-one discussion with a trauma surgeon, whereas Group 2 used the EDT trainer and debriefing for training. In phase 2 (1 month later), all participants completed a knowledge retention test and performed a videoed EDT using our EDT trainer, the video recordings were later reviewed by content experts blinded to the study participants using a checklist with a maximum score of 22. The participants also completed a reaction survey at the end of phase 2 of the study. OhioHealth Riverside Methodist Hospital, an urban tertiary care academic hospital in Columbus, Ohio. Nine senior surgery residents from training years 3 to 5. The mean score for the performance of the procedure for the simulation-based (Group 2) was significantly higher than that of the discussion-based (Group 1) (Rater 1: 21.2 ± 0.8 vs. 19.0 ± 2.0, p = 0.05, Rater 2: 20.4 ± 1.5 vs. 18.3±1.0, p = 0.04). Group 2 also was quicker than Group 1 in deciding to start the procedure by approximately 56 seconds. When comparing the mean pretest knowledge score to the mean knowledge retention score 30 days after training, the discussion-based group improved from 58.33% to 81.25% (p = 0.01); the simulation-trained group's scores remained at 68.33%. All the participants agreed or strongly agreed that the simulator provided a realistic opportunity to perform EDT and improved their confidence. The results of this pilot studysupport our hypothesis that using alow-cost EDT trainer effectively improves general surgery residents' confidence and procedural skills scores in a simulated environment. Further training with low-cost simulators may provide surgical residents with deliberate practice opportunities and improve performance when learning low-frequency procedures.

Closed Loop Vector Formulation in Eulers Complex Numbers for Multi Loop Planar Mechanisms With N bars A Novel Modeling Approach and Algorithm

This paper presents a novel iterative algorithm incorporated in a user-friendly GUI for modeling the kinematics of multiple looped N-bar closed-loop mechanisms. Past research works have used custom coding or expensive commercial software to analyze the mechanisms of specific applications. The proposed algorithm focuses on kinematics and offers a quick, easy-to-use, cost-effective solution to analyze a wide range of generic mechanisms, reducing the need for custom coding and lowering computational costs. The algorithm employs algebraic equations, such as solving complex closed-loop vector equations using the Euler form of complex numbers, to simulate and derive the unknowns necessary to characterise any generic closed-loop mechanism. The Python code implemented in the algorithm adapts to various scenarios by utilising available information on the position, velocity, and acceleration variables of the mechanisms. The simulation tool can display real-time color contour plots (RGB color scale) for linear and angular velocities and accelerations, simulate mechanisms with multiple loops and switch configurations, and find inverse mechanisms. The approach for solving multiple loop problems and the algorithm utilized to solve the configurations, methods, equations used and GUI features implementation are all described in this study. The case study considered for a four-bar mechanism indicates a strong agreement between the results obtained from the proposed kinematics-based simulator and ANSYS software. These results demonstrate the simulator’s effectiveness in providing low-cost and user-friendly simulation results for various generic mechanisms involving multiple interconnected loops.

A52Probing for Veins: A Cost-Effective, Reproducible Method for Teaching Ultrasound-Guided Peripheral Intravenous Access

Repeated attempts at peripheral intravenous (PIV) access cause increased discomfort and delays in treatment for patients in hospital. The use of ultrasound can improve success in PIV access, benefitting patient experience. Medical professionals are increasingly expected to use ultrasound when landmark techniques fail [1]. We sought to improve confidence using ultrasound for PIV cannulation with low-cost simulation models made from ADAMgel [2] or tofu in multiple teaching sessions. We organized teaching sessions with multiple specialties at St Richard’s Hospital. A total of 48 members of staff have been taught over four sessions. Prior to the teaching session learners were asked to complete a survey identifying previous ultrasound experience and rating confidence using ultrasound for PIV access. The teaching session consisted of an introductory multimedia presentation with a video demonstration, then practical experience. Models consisted of water-filled balloons placed in ADAMgel (Aqueous Dietary Fibre Antifreeze Mix gel) or tofu to simulate human tissue and veins, Models used to deliver teaching sessions. After ADAMgel became available this has been used exclusively due to it being more reusable compared to the tofu modelsA: tofu model with ultrasound image underneath.B: ADAMgel model with ultrasound image underneath The initial survey identified only 29% of staff had previously used ultrasound for PIV access, and half of these (15% overall) had only used it once or twice a year. Using a five-point Likert scale, 74% of respondents rated their confidence in using ultrasound as one or two out of five. All respondents thought they would benefit from further teaching in PIV access. Feedback after teaching sessions was favourable, with 95% of respondents finding the session very useful and 95% also believing it would increase their use of ultrasound in clinical practice. After the session, more than half rated their confidence in ultrasound cannulation as four or five out of five. We have demonstrated that there is a desire from medical staff to increase their competency in ultrasound-guided PIV cannulation. Using low-cost, high-fidelity simulation models with a blended learning method, we can deliver teaching sessions to a large number of medical staff. We hope to continue this teaching in collaboration with our sister sites throughout Sussex to increase confidence with ultrasound-guided PIV cannulation in this region. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

10505 Low-Cost Low-Fidelity Simulation Model for Minor Gynecologic Procedures

10505 Low-Cost Low-Fidelity Simulation Model for Minor Gynecologic Procedures

Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation.

To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.

An inexpensive foramen magnum decompression training tool: Feasibility and validation study.

Foramen magnum decompression (FMD) is a standard neurosurgical procedure, typically utilized to treat Chiari malformation. The aim of this educational project was to develop and validate a low-cost FMD simulation training model. Mold-based methods were used to develop a prototype. Feasibility was tested during an FMD training session for 17 neurosurgery trainees. Face and content validity were assessed through a Likert Scale. The perceived training benefit was determined using the Physician Performance Diagnostic Inventory Scale (PPDIS). A total of 87.5% successfully removed the C1 arch, 81.3% successfully performed an FMD, and 68.8% avoided injury to the underlying structures. The model scored highly for visual and tactile realism. The median confidence rating on PPDIS significantly improved from early learner to competent. We demonstrate feasibility, content, and face validity. Furthermore, this is a low-cost, portable model that can be easily replicated and used for simulation training.

A low-cost unity-based virtual training simulator for laparoscopic partial nephrectomy using HTC Vive.

Laparoscopic education and surgery assessments increase the success rates and lower the risks during actual surgeries. Hospital residents need a secure setting, and trainees require a safe and controlled environment with cost-effective resources where they may hone their laparoscopic abilities. Thus, we have modeled and developed a surgical simulator to provide the initial training in Laparoscopic Partial Nephrectomy (LPN-a procedure to treat kidney cancer or renal masses). To achieve this, we created a virtual simulator using an open-source game engine that can be used with a commercially available, reasonably priced virtual reality (VR) device providing visual and haptic feedback. In this study, the proposed simulator's design is presented, costs are contrasted, and the simulator's performance is assessed using face and content validity measures. CPU- and GPU-based computers can run the novel simulation with a soft body deformation based on simplex meshes. With a reasonable trade-off between price and performance, the HTC Vive's controlled soft body effect, physics-based deformation, and haptic rendering offer the advantages of an excellent surgical simulator. The trials show that the medical volunteers who performed the initial LPN procedures for newbie surgeons received positive feedback.

QES-Plume v1.0: a Lagrangian dispersion model

Abstract. Low-cost simulations providing accurate predictions of transport of airborne material in urban areas, vegetative canopies, and complex terrain are demanding because of the small-scale heterogeneity of the features influencing the mean flow and turbulence fields. Common models used to predict turbulent transport of passive scalars are based on the Lagrangian stochastic dispersion model. The Quick Environmental Simulation (QES) tool is a low-computational-cost framework developed to provide high-resolution wind and concentration fields in a variety of complex atmospheric-boundary-layer environments. Part of the framework, QES-Plume, is a Lagrangian dispersion code that uses a time-implicit integration scheme to solve the generalized Langevin equations which require mean flow and turbulence fields. Here, QES-Plume is driven by QES-Winds, a 3D fast-response model that computes mass-consistent wind fields around buildings, vegetation, and hills using empirical parameterizations, and QES-Turb, a local-mixing-length turbulence model. In this paper, the particle dispersion model is presented and validated against analytical solutions to examine QES-Plume’s performance under idealized conditions. In particular, QES-Plume is evaluated against a classical Gaussian plume model for an elevated continuous point-source release in uniform flow, the Lagrangian scaling of dispersion in isotropic turbulence, and a non-Gaussian plume model for an elevated continuous point-source release in a power-law boundary-layer flow. In these cases, QES-Plume yields a maximum relative error below 6 % when compared with analytical solutions. In addition, the model is tested against wind-tunnel data for a uniform array of cubical buildings. QES-Plume exhibits good agreement with the experiment with 99 % of matched zeros and 59 % of the predicted concentrations falling within a factor of 2 of the experimental concentrations. Furthermore, results also emphasize the importance of using high-quality turbulence models for particle dispersion in complex environments. Finally, QES-Plume demonstrates excellent computational performance.

Simulating infection prevention and control through virtual reality: a vehicle for equity, diversity, and inclusivity in Africa

Endemics in Africa are prominent, especially in countries with low income and inadequate infection prevention and control (IPC) measures. Additionally, poorly trained nurses negatively influence infection-related indicators, and these nurses may require re-training. Re-training is expensive, and due to limited resources, healthcare institutions in Africa may not have the opportunity for their nurses to be re-trained in a critical competence such as IPC. Simulation-based education, including virtual reality (VR), has shown numerous benefits in acquiring critical thinking, communication, and clinical skills. However, VR has been reserved for healthcare education in the global north. Also, no educational programmes currently exist that harness the power of VR in a low-resource context such as Africa. We argue that VR is a possible low-cost simulation modality that can create standardised training resulting in equitable, diverse, and inclusive IPC education for nursing students. However due to a lack of technological training and ongoing support, low to middle-income countries often end up failing to implement the interventions over a longer term than the initial investment. Authors like Hofstede identified dimensions causing problems between various cultures, which might restrict the implementation of newer technologies in a diverse, equitable, and inclusive manner. The design and implementation of an educational innovation must address and integrate the cultural dimensions of the targeted context. Embracing, understanding, and respecting the variations in local culture within African universities is essential to inclusive and diverse education practices and the subsequent designing and implementation of educational innovation such as VR.

Low-Cost Fishhook Removal Simulation.

The target audiences for this hands-on innovation are health care providers including medical students and emergency medicine residents. This simulation is also appropriate for small group sessions teaching the layperson. While generally not life-threating fishhook injuries are commonplace. They can end a day of recreation or an outdoor trip and possibly result in a visit to an emergency department or urgent care. Hands-on education on fishhook removal techniques that minimize tissue damage is rarely provided in wilderness first aid or traditional medical education. To the best of our knowledge, to date there are only two studies on fishhook removal simulations in medical and wilderness first aid education.1,2 The previously described simulation models are limited by accessibility of materials, realism, and cost. The goal of this small group session is to fill the gap in training on fishhook injuries. At the end of the session participants should be able to describe the parts of a fishhook, as well as demonstrate and have increased confidence in performing multiple fishhook removal techniques. Social learning theory is the conceptual framework for this small group session.3,4 This reflects the idea that students learn not only through repetition with trial and error, but through social interactions, observing and modeling successes of others. As a result, while this simulation requires a facilitator ensure the required items are available it does not necessitate a facilitator be present over the entire duration. Participants perform common fishhook removal techniques with hands-on skill development using commercially available silicone sponge injection pad trainers. Evaluating this small group session at a wilderness medicine training attended by medical and physician assistant students and their guests, self-reported confidence in fishhook removal before and after the simulation was assessed with a paired t-test. Survey results of perceived effectiveness and value of the simulation were also evaluated. The average confidence increased 58% after the simulation (p<0.005). The mean level of effectiveness was 87% and the participant perceived monetary value of the simulation materials was greater than actual cost. This innovation is a cost-friendly way to provide education and practice on fishhook removal. It requires minimal set up time and pre-learning can be easily modified to the expected knowledge and experience of participants. Understanding the fishhook removal techniques and increased levels of confidence has the potential to make participants more efficient when caring for patients. It may result in greater likelihood of success in removing fishhooks with minimal tissue damage. Fishhook injuries, medical simulation, emergency medical education, wilderness first aid, wound management, injection pad trainers.

ECMO simulation: How much, who to train, and a review of cost, fidelity and performance.

Extracorporeal Membrane Oxygenation (ECMO) is a high-risk, low-volume procedure requiring repetition, skill and multiple disciplines with fidelity of communication. Yet many barriers exist to maintain proficiency and skills with variable cost and fidelity. We designed and implemented a low-cost monthly ECMO simulation and hypothesized providers would have increased familiarity and improved teamwork. We also review some key elements of cost, fidelity and evaluation of effectiveness. A structured, 1-hour ECMO simulation was performed on a customized mannikin on a monthly basis in 2022. Qualitative surveys were administered to each member post-simulation. Answers were categorized by theme, including satisfaction of patient care, evaluation of self and team dynamics, and areas for improvement. Most participants were satisfied with their ability to take care of the patient, with common themes of communication and coordination of roles. Identified areas of improvement were mostly limited to technical skills, and soft skills such as communication and teamwork. We designed and implemented a low-cost, monthly and multi-disciplinary ECMO simulation program with overall positive feedback and identified areas for improvement. There remains variability in cost, fidelity and evaluation of performance and retention. There may be a need to create guidelines for ECMO simulation training that can be applied at all institutions utilizing ECMO for patient care.

705 Assessment of a Novel Low-Cost Abdominal Box Simulator for Laparoscopic Skills Training

Abstract Aim To create a low-cost abdominal box simulator and assess its validity for Hassan’s entry technique and visiport. Method A low-cost abdominal box simulator was created using a metal box skeleton. This was covered in a layer of cling-film simulating the peritoneum. Red and blue tubing was placed over this creating the inferior epigastric vessels. A posterior rectus sheath was created on either side using a white cotton sheet whilst thick red woollen socks were used to simulate the rectus abdominus muscles. The entire surface was then wrapped in a thick canvas to simulate the anterior rectus sheath. Finally, a commercial skin with subcutaneous tissue was affixed and the umbilicus demarcated using a pen. This simulator was used by 30 surgical trainees (ST3 to ST7) attending a laparoscopic skills course who were asked to provide feedback on the simulator for both Hassan’s entry technique, visiport entry and the introduction of secondary ports. Results The simulator was rated 10/10 for validity as well as ease of use for Hassan’s open entry technique, visiport and secondary port insertion by all 30 of the trainees. Feedback highlighted that using the simulator trainees were able to see all layers of the abdomen and gain excellent haptic feedback. The model was described as realistic as trainees were able to identify each layer of the abdomen as they performed open or visiport entry. Conclusions A low-cost abdominal box simulator can easily be reproduced using our technique and used to train trainees effectively.

911 How to Design a Low-Cost 3D Printed Laparoscopic Appendicectomy Simulation Model (LaApSi)?

Abstract Aim To develop a Low-cost Laparoscopic Appendicectomy Simulation (LaApSi) Model and to assess its application for surgical simulation in UK &amp; Lower Middle-Income Countries (LMICs). To ensure a realistic and accurate representation of the anatomy of the appendix and the laparoscopic appendicectomy procedure. Method Autodesk Fusion 360 software was used to design the appendix mould which was 3D printed using Ultimaker Tough PLA material. LaTeX material, Reschimica Shore 20 silicon was used &amp; Validity Testing following simulation by HST using Face Validity &amp; Likert 5-Point scale. LaApSi model has been recently used for the Laparoscopic workshop endorsed by RCSEd organised in LMICs and multiple times within the UK (Hull Suture Centre Laparoscopic Courses &amp; East of England Laparoscopic course for Core Surgery). Results Successful Development of a local low-cost Appendix model (under £5) vs expensive market models. Prototype testing results &amp; feedback from the users within and outside the UK are very positive and inspiring. The continuous evolvement of the LaApSi models based on the efficacy testing via face validity and Likert 5 Point Testing results has proved to be effective as evidenced by quantitative assessment where the users scored on Model specification shape, size and Texture: 90%, 96%, 92 % resemblance respectively. Conclusions The notion of creating low-cost LA simulation models provides a variety of potential benefits for surgical simulation in LMICs and the UK, and it warrants support from the industry and charity. These simulations aid in offering a standardised, affordable, and safe method for surgical training.

1267 Application of the Low-Cost Laparoscopic Appendicectomy Simulation (LaApSi) Model for Laparoscopic Training in Low-Middle-Income-Countries (LMIC) and Its Comparison with the Laparoscopic Skills Session in the UK

Abstract Aim To assess the LaApSi Model’s effectiveness in the surgical simulation within and outside the UK. To assess the delegates' expectations while simulating Laparoscopic Appendicectomy (LA) using LaApSi Model. Method LaApSi models were developed using 3D printed mould &amp; Silicon with a production cost under £5 pp. Within 6 months of model development, the quantitative assessment of LaApSi model was done by 18 trainees from LMICs (RCSEd endorsed Laparoscopic Course) and 29 within the UK, 2 Laparoscopic courses (LC) and 1 Intermediate Surgical Skills Course (ISS) evidenced by formal feedback which has further led to the production of the modified version. Results For LMICs Lap-courses, 88.9%, n = 16 delegates agreed that the LaApSi model was able to meet their learning objectives whereas it was around 80% for UK courses. Similarly, 90%, n = 16 delegates agreed they were able to understand the General Steps Involved in LA, were more confident with LA and felt the course was relevant whereas it was around 15% less in these domains during UK Lap courses. 80.3% n = 5 delegates responded that the LaApSi model was equally effective in simulating Open Appendicectomy (OA) in a recent ISS course. Conclusions There is an unmet need for the development of a Low-Cost simulation model in LMICs and these cost-effective LaApSi models can provide a safe and standardized method for simulation training before operating on real patients. Although the model expectations were found relatively higher among UK delegates, feedback establishes a positive impact of the model among the course delegates.

XPS™ Jensen lung as a low-cost, high-fidelity training adjunct to ex-vivo lung perfusion.

Ex vivo lung perfusion (EVLP) enables lung resuscitation before transplantation, and training is key, particularly in low-volume settings. To enable technique refinement and continuing education, we sought to demonstrate the value of a low-cost, high-fidelity EVLP simulator that would allow reproducible clinical scenarios. In partnership with our EVLP manufacturer, we utilized the XPS™ Jensen Lung with our clinical system. The Jensen Lung has two simulated lung bladders and an in-line polymethylpentene fiber oxygenator. It allows titration of ventilator support which aids in accurate clinical simulation. For simulations, blood gases (BGs) were obtained and compared with integrated in-line perfusate gas monitors (PGMs). PaO2 , PCO2 , and pH were measured and compared. The PGM and BG values were not significantly different throughout the range of FiO2 and sweep gas flow rates evaluated. The "delta" PaO2 was measured between LA and PA and did not show any change between approaches. The pH measurement between BG and PGM was not significantly different. The XPS™ Jensen Lung simulator allows for a high-fidelity simulator of clinical EVLP. The correlation of the PGM and the BG measurement of the PaO2 and pH allow for a low-cost simulation, as the PGMs are in line in the circuit, and enable real-time tracking of perfusate gas parameters with the PGM. Implementation of a standardized clinical EVLP training program allows the maintenance of technique and enables clinical simulation training without the need for costly animal perfusions and the use of multiple BG measurements.