Simulated Room Research Articles

Framework for Integrating Large Language Models with a Robotic Health Attendant for Adaptive Task Execution in Patient Care

The development of intelligent medical service robots for patient care presents significant challenges, particularly in integrating diverse knowledge sources and enabling robots to autonomously perform tasks in dynamic and unpredictable healthcare environments. This study introduces a novel framework that combines large language models with healthcare-specific knowledge and robotic operations to enhance autonomous task execution for a Robotic Health Attendant. Utilizing OpenAI’s ChatGPT, the system processes structured information about patient care protocols and unstructured human inputs to generate context-aware robot actions. A prototype system was tested in a simulated patient room where the robot successfully performed both simple individual actions and complex tasks involving the execution of multiple actions, based on real-time dialogues with the language model and predefined task specifications. The results demonstrate the potential of language models to reduce the reliance on hardcoded logic and provide healthcare professionals with the ability to interact with robotic systems through natural language.

A cloud-based simulation framework for high-fidelity room impulse response dataset generation: case study, validation and computational performance

Increased cost-effective computational resources in the cloud in combination with state-of-the-art simulation algorithms has opened doors for generating large quantities of simulated high-fidelity room impulse responses. Such datasets can, e.g., be used for training machine learning based audio signal processing algorithms such as speech enhancement or dereverberation, as well as for carrying out virtual prototyping of audio devices in different acoustic conditions. The authors have previously presented a cloud-based simulation engine that is well suited for such large-scale dataset generation tasks. The simulation engine leverages a hybrid wave/geometrical solver, in combination with various geometry pre-processing technology and spatial audio post-processing technology. In this paper, we present a dataset generation case study using this simulation engine, as well as a novel validation study into certain aspects of the spatial audio post-processing. Finally, we present an analysis into computational performance when leveraging multi-node computational architectures to run extremely large wave-based simulations using the simulation framework. To the best of our knowledge, this is the first time a multi-node wave-based acoustics solver presented, enabling wave-based simulations with billions of degrees of freedom.

Latency-free real-time auralisation in hemi-anechoic chambers

Real-time auralisation allows users to interact with a simulated acoustical room, providing a more responsive way of evaluating acoustical performance than pre- recorded auralisation. Nevertheless, real-time auralisation is computationally intensive and, therefore, susceptible to latency. This paper presents a novel latency-free real-time auralisation method that enables users to auralise a simulated acoustical event with self-excitation more accurately than current methods. The method uses a loudspeaker system inside a hemi-anechoic chamber. By exploiting the inherent floor reflection of the hemi-anechoic chamber, the impulse response can be trimmed to compensate for the total latency of the loudspeaker system. The method's validity is demonstrated with measurements presenting virtual wall reflections arriving at the correct time at the listening position. The influence of the speaker placement regarding latency is discussed. This method enables users to evaluate a given response more accurately than conventionally possible.

Adaptation and evaluation of Pyroomacoustics for auralization purposes

An open-source room simulation software that relies on geometrical acoustics - Pyroomacoustics - was used to compute Binaural Room Impulse Responses (BRIRs) of existing rooms that are modeled in the Benchmark for Room Acoustical Simulation (BRAS). Modifications were made to the software to investigate the impact of the scattering model on the acoustic parameter values. A comparison with the acoustic parameter measurements showed that the values of EDT, C80 and D50 were found to be closer when using the Vector-Mixing method in comparison with the original scattering method. Overall, the alternative method reduced by 95% the mean squared error on the acoustic parameter values. The sound source directivity was also considered in the simulations to quantify its influence on the perceived auditory scenes. A listening test was then conducted to compare binaural renderings derived from measured and simulated BRIRs. Results showed that ratings of the modified versions of the software were either not significantly different or significantly higher than those of the original version depending on the room and sound source. Including the source directivity significantly improved the perceptual ratings, which is thought to be due to the reduction of spectral and loudness differences with the measured reference.

Wireless In-Ear Communication for Total Joint Arthroplasty: A Simulated Operating Room Evaluation

BackgroundEffective surgical team communication is a key component of patient safety. However, communication failure is common and has previously been identified as one of the leading causes of error. Nonetheless, there has been a lack of innovation in this domain. Contemporary communication technology may hamper loud noises frequently encountered during total joint arthroplasty surgery to allow the surgical team to communicate safely and effectively. The objective of this study was to assess whether the use of in-ear communication devices during simulated arthroplasty surgery could improve communication compared to standard of loud voice communication. MethodsThis was a randomized simulation study designed to evaluate differences in communication. Participants were recruited to engage in simulations of total joint arthroplasty with in-ear wireless communication devices and traditional methods. Data collected included participant demographics, sound level exposure, and communication effectiveness using a created list of phrases commonly involved in arthroplasty surgery. A System Usability Scale questionnaire and survey comparing participant experiences was given. ResultsFifteen participants were recruited. The median age was 29 years (standard deviation 2.9) and 66% were women. There were significant differences in the percent of correctly identified phrases (78.6% vs 44%), mean effectiveness (7.9/10 vs 4.9/10) and mean clarity (8/10 vs 4/10) in favor for the wireless in-ear communication simulation (P < .001 for all). Out of the 10 questions in the System Usability Scale questionnaire, 4 exhibited significant differences, favoring the use of in-ear communication, while the others showed no difference. The mean level of sound recorded was 86 dB in the in-ear device and 87.6 dB in the control group (P = .680). ConclusionsWireless in-ear communication appears to be safe and effective during total joint arthroplasty surgery which may promote efficiency and patient safety. Further, in-ear communication systems can dampen the loud and potentially damaging noise in orthopaedic procedures and may protect surgeons exposed to loud noises.

Exploring the Perceived Ease of Use of an Immersive VR Engine Room Simulator among Maritime Students: A Segmentation Approach

Exploring the Perceived Ease of Use of an Immersive VR Engine Room Simulator among Maritime Students: A Segmentation Approach

Impact of Reverberation on Speech Perception in Noise in Bimodal/Bilateral Cochlear Implant Users with and without Residual Hearing.

(1) Background: The aim of the present study was to assess the impact of reverberation on speech perception in noise and spatial release from masking (SRM) in bimodal or bilateral cochlear implant (CI) users and CI subjects with low-frequency residual hearing using combined electric-acoustic stimulation (EAS). (2) Methods: In total, 10 bimodal, 14 bilateral CI users and 14 EAS users, and 17 normal hearing (NH) controls, took part in the study. Speech reception thresholds (SRTs) in unmodulated noise were assessed in co-located masker condition (S0N0) with a spatial separation of speech and noise (S0N60) in both free-field and loudspeaker-based room simulation for two different reverberation times. (3) Results: There was a significant detrimental effect of reverberation on SRTs and SRM in all subject groups. A significant difference between the NH group and all the CI/EAS groups was found. There was no significant difference in SRTs between any CI and EAS group. Only NH subjects achieved spatial release from masking in reverberation, whereas no beneficial effect of spatial separation of speech and noise was found in any CI/EAS group. (4) Conclusions: The subject group with electric-acoustic stimulation did not yield a superior outcome in terms of speech perception in noise under reverberation when the noise was presented towards the better hearing ear.

Intelligent mobile robot for contagious disease treatments in hospitals

This paper provides a novel and applicable work that builds a real system for disinfecting the air and surfaces of the environment in a hospital room, with a non-contact measurement system for supporting contagious disease treatments in hospitals. The system is built on an intelligent mobile robot system that operates autonomously in a simulated real treatment room. The research team uses a new positioning algorithm. It is a combination of data from the Lidar sensor, encoder, and Extended Kalman filter. The program that applies segmentation and image feature extraction algorithms is developed to meet requirements of real-time environment mapping in the room. Control algorithms for moving and avoiding obstacles are also proposed. Next, techniques for collecting health data including patient identification, body temperature, and blood oxygen index via wireless sensor network are also mentioned in the article. Analysis and experimental results show qualified outcomes and promise. The main contribution of the paper can be listed as follows.•Design and build a new CEE-IMR, an intelligent mobile robot that can regconize patients, guide and lead them walking in hospitals, especially keep a safe distance avoiding contagious deseases.•A novel framework for controlling the robot is proposed. The robot can move flexible, avoid obstacles, etc. based on advanced control algorithms. A new control mechanism is also proposed.•Methods of collecting data and processing medical data to support either patients or doctors to improve the effecency in hospitals in contagious disease management.

Designing, Implementing, and Evaluating a Basic Surgical Skills Bootcamp: An Effective Approach to Enhance Competency in Surgical Residency Training

IntroductionRecent technological advances have facilitated the development of new educational methods, such as simulation-based learning, in specialized bootcamps to enhance the learning of surgical residents. This study aimed to design, implement, and evaluate a basic surgical skills bootcamp for residents in general surgery, orthopedics, neurosurgery, and gynecology based on the learning gap in the current educational program. MethodsThis intervention study focused on the design, implementation, and evaluation of a basic surgical skills bootcamp in a simulated operating room for first-year surgical residents in general surgery, orthopedics, neurosurgery, and gynecology. ResultsThe study resulted in the creation of a comprehensive course plan and the execution of a 6-day training program. Evaluation of educational outcomes confirmed high learner satisfaction, improvement in Multiple Choice Questions (MCQ) exam scores, and acceptable scores in the Objective Structured Clinical Examination (OSCE). ConclusionThe findings of this study suggest that surgical bootcamps, when designed based on needs assessment and in line with scientific bootcamp design principles, play a crucial role in enhancing the satisfaction, knowledge, and skills of surgical residents.

Beliefs, preferences, and acceptance of personal protective equipment for a shock room team in a tertiary care center.

During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality. The secondary objectives are to describe the expertise and difficulties faced while using PPE in the shock room care. Fifty-four HCW participated in a shock room simulation training at a large urban tertiary care hospital in Germany, utilizing a PPE comprising an FFP2 mask, gloves, goggles, and gown. Subsequently, participants completed an online questionnaire featuring 15 questions presented on a 5-point Likert scale or as multiple-choice questions with predefined answers. Sixty-eight point five percent of our participants voted for an established standard PPE in shock room care. The largest fraction of our participants (40.7%) favors a standard PPE consisting of FFP2 mask, gown, and gloves. Less HCW (31.5%) want to wear PPE in shock room simulation training. Except for goggles we could not detect relevant difficulties faced while using PPE in the shock room environment. Incorrect use of PPE was observed in 14.8%. A majority of our participants favored a standard PPE including a FFP2 respirator in shock room care. In addition, we recommend the use of PPE in shock room simulation training, while further awareness of and training in proper use of PPE seems to be necessary to reduce risk of infectious diseases for HCW.

Eye tracking during a simulated start of shift safety check: An observational analysis of gaze behavior of critical care nurses

Background: The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach. We hypothesized that specific gaze behavior during handover and shift start safety check correlates with error recognition. Methods: In our observational eye tracking study, we analyzed gaze behavior of critical care nurses during handover and shift start safety check in a simulation room with built-in errors. Four areas of interest (AOI) were pre-defined (patient, respirator, prescriptions, monitor). The primary outcome were different gaze metrics (time to first fixation, revisits, first visual intake duration, average visual intake duration, dwell time) on AOIs. Parameters were analyzed by taking all errors in account, and by dividing them into minor and critical. Results: Forty-three participants were included. All participants committed at least a minor error ( n = 43, 100%), at least one critical error occurred in 29 participants (67%). Taking all errors into account, longer time to first fixation and more revisits were associated with an increased risk of missing errors (Time to First Fixation: OR 1.099 (95% CI 1.023–1.191, p = 0.0002), Revisits: OR 1.080 (95% CI 1.025–1.143, p = 0.0055)). Conclusion: Error detection during shift start safety check was associated with distinct gaze behavior. Nurses who recognized more errors had a shorter time to first fixation and less revisits. These gaze characteristics might correspond to a more structured approach. Further research is necessary, for example by implementing a checklist, to reduce errors in the future and improve patient safety.

Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey

PurposeTo determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures. Methods and MaterialsA 27-item survey created with expertise from five brachytherapists was distributed electronically to 90 U.S. Radiation Oncology academic programs and publicized on social media and at two national meetings during June-October 2023. ResultsForty-one responses were received (46%). Fifty-four percent identified as female, 66% Caucasian and 85% non-Hispanic/Latino ethnicity. Forty nine percent utilize a BT suite +/- CT simulator alone, 39% the operating room +/- BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic exam room. Thirty four percent utilize general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone, and 28% combination. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, while 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to alleviate BT related emotional distress. ConclusionsMany U.S. brachytherapists report using GA, CS or epidural AS, yet 10% are using only OA and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe PTSD symptoms can occur after BT, but few offer any intervention. AS resources and clinician preference should be targeted for expansion of higher quality care.

Task reliability index for operator performance and failure probability assessment in control room simulators

Main control room simulators are an important information source for improving the empirical basis of human reliability analysis (HRA). Both quantitative and qualitative observations provide valuable insight on the operators’ ability to successfully perform their tasks. However, relevant portions of this evidence are not used in typical approaches for estimation of human error probabilities (HEP), which are based on failure counts. With small sample sizes and the operator performance levels representative for nuclear power plants, very little information enters the probability estimates. This paper presents a novel approach to formalize the collection and use of reliability-relevant evidence from simulators. The methodology treats task reliability with the plant-centred orientation characteristic of the systems or Probabilistic Safety Assessment (PSA) perspective as well as a human-centred view of task performance based in human factors engineering. These are combined to form a Task reliability index (TRI) able to distinguish finer performance variations and consider indications of potential failures. Bayesian updating of HEP distributions is suggested by translating the TRI data into pseudo-failures and trials, preserving the convenient coupling of Beta-Binomial distributions in the Bayesian analysis. The approach is demonstrated using data from the International HRA Empirical Study and is shown to produce results that are comparable to those obtained in the empirical study, which were based on comprehensive expert analyses.

The effect of information integration on team communication in a simulated submarine control room task

Submarine control rooms are characterised by dedicated individual roles for information types (e.g. Sonar operator processes sound energy), with individuals verbally reporting the information that they receive to other team members to help resolve uncertainty in the operational environment (low information integration). We compared this work design with one that ensured critical information was more readily available to all team members (high information integration). We used the Event Analysis of Systemic Teamwork (EAST) method to analyse task, information, and social networks for novice teams operating within a simulated submarine control room under low versus high information integration. Integration impacted team member centrality (importance relative to other operators) and the nature of information shared. Team members with greater centrality reported higher workload. Higher integration across consoles altered how team members interacted and their relative status, the information shared, and how workload was distributed. However, overall network structures remained intact.

An appreciation of the research of George Maling

No single individual has been more important to the formation, direction, and continuing work of the Institute of Noise Control Engineering (INCE/USA) than Dr. George Maling. Not only has he significantly shaped the trajectory of INCE-USA, but he contributed greatly to the field of acoustics and noise control. This paper will provide a concise overview of Dr. Maling's research contributions and numerous publications. Specifically, his contributions on modeling acoustic sources, characterization of air moving devices, and reverberation room simulation and measurements will be reviewed.

Sensitivity Response Analysis of Optical Surface Monitoring Systems Using the Fitzpatrick Scale: A Phantom Study

PurposeOptical Surface Monitoring systems (OSMS) have gained substantial attention in modern radiotherapy, specifically in the context of Surface Guided Radiation Therapy (SGRT) which offers real-time patient surface monitoring, ensuring accurate and effective radiotherapy treatments. The aim of this paper is to evaluate the OSMS camera sensitivity towards different skin tones, categorized according to the Fitzpatrick scale, a universal classification of human skin tones, using a phantom. Methods and MaterialThe study utilized Catalyst and SentinelTM OSMS systems (C-Rad, Uppsala, Sweden). The Alderson RANDO Female Pelvis phantom, located at the isocenter in CT simulation and treatment rooms, served as an experimental subject. Eighteen skin tone matching cotton cloths, selected based on Von Luschan's chromatic and Fitzpatrick scales, were wrapped around the phantom for sensitivity evaluation. Camera sensitivity was optimized by adjusting threshold/gain (100-600%) and integration time during individual scans in both rooms. Temporal response analysis spanned two months, with sixteen measurements for each OSMS taken in varying light conditions. ResultsThe OSMS systems successfully detected the surface of cloth-covered phantoms with varying mean (standard deviation) integration times: 550 (34) to 950 (43) μs for the Sentinel system and 2300 (71) to12000 (400) μs for the Catalyst system. The sensitivity parameters differed for each skin tone, with lighter skin requiring shorter integration times and gain/threshold values. Darker skin tones necessitated higher parameters for optimal surface images. The reliability of the systems declined with excessive parameters, leading to noise and compromised accuracy in patient positioning. ConclusionsOptimized sensitivity parameters tailored to individual skin tones are crucial for effective real-time patient surface monitoring in radiation therapy, as variations in skin colour can affect the accuracy of measurements. The precision of skin colour measurements in OSMS relies on carefully adjusting camera sensitivity parameters. However, careful consideration is essential, as larger values are required for darker skin tones, compromising reliability. This suggests the need for exploring alternative image guidance methods for patients with darker skin tones.

Virtual reality simulations to alleviate fear and anxiety in children awaiting MRI: a small-scale randomized controlled trial.

Up to 75% of paediatric patients experience anxiety and distress before undergoing new medical procedures. Virtual reality is an interesting avenue for alleviating the stress and fear of paediatric patients due to its ability to completely immerse the child in the virtual world and thus expose them to the sights and sounds of an MRI before undergoing the exam. We aimed to explore the impact of virtual reality exposure on reducing fear and anxiety in paediatric patients scheduled to undergo an MRI. We hypothesised that patient who had undergone VR exposure before the MRI would experience lower levels of fear and anxiety and subsequently have a higher MRI success rate. We conducted a prospective randomized control trial in a tertiary paediatric hospital over three weeks. Inclusion criteria comprised children aged 4 to 14 undergoing MRI without medical contraindications for VR use. Thirty patients (16 in VR, 14 in control) were included in the study. The VR room, created in-house by a researcher, that the VR group experienced, simulated MRI room with typical sounds for up to 5min before their actual MRI. Fear and anxiety were measured using the FACES scale before and after MRI for the control group as well as after VR exposure for the VR group. The VR group exhibited a significant reduction in anxiety post-VR exposure regarding the upcoming MRI (p = 0.009). There was no significant difference with regards to fear and anxiety between the VR and control groups before or after the MRI exam. There was no significant difference between the MRI exam success rates. VR exposure effectively reduces pre-MRI anxiety in paediatric patients who are about to undergo the exam, this is important as it alleviates the psychological burden on the child. This research is in line with previous findings, showing the validity of VR as a method of reducing pre-procedural paediatric anxiety and suggesting that complex VR experiences may not be necessary to have a significant impact. There is, however, a need for further investigation in this field using larger and MRI-naïve groups of patients.

The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies.

Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.

Environmental impact investigation of combined CCS and SCR on a ship by a case study

AbstractThe environmental and economic performance of a post‐combustion solvent‐based carbon capture system (CCS) combined with a selective catalytic reduction (SCR) system is investigated on a 48,600 kW engine container ship to meet the International Maritime Organization's emission reduction strategies through 2050. The proposed system uses aqueous ammonia to mitigate the produced CO2 and NOX emissions onboard a ship. Moreover, the combined system is investigated through a voyage‐based case study using an engine room simulator, assuming that CCS and SCR are implemented on the reference ship. During the case study, the referenced container ship sailed from Rotterdam to New York, and the estimations were made by using Netpas Distance 4.0 software program. Results indicate that a total of 3,606.04 ton‐CO2 and 92.40 ton‐NOX are produced, while 3,345.43 ton‐CO2 and 40.67 ton‐NOX are captured during the voyage. Furthermore, an economic analysis is carried out after the case study. Findings of the economic analysis are: CAPEX of CCS is $32.07 MM and SCR is $2.19 MM, while OPEX of CCS and SCR are $188,873 and $103,681, respectively. In addition, it was calculated that implementing CCS could avoid the CO2 tax cost of $19,472, while the economic value of the CO2 captured was $113,590. © 2024 Society of Chemical Industry and John Wiley &amp; Sons, Ltd.

Implementing a Pediatric Escape Room Simulation to Improve Student Learning.

Escape room simulations are an innovative teaching methodology that may be useful in addressing pediatric-specific content and clinical placement limitations of generalist nursing programs. This project studied if a pediatric escape room simulation improved students' knowledge and confidence in pediatric nursing to support the development of the pediatric nursing workforce. A pediatric escape room simulation was developed for a large Midwestern university's prelicensure nursing program. Students completed surveys to assess knowledge and confidence in pediatric nursing. Simulation quality was assessed using the Simulation Learning Effectiveness Inventory. Students' (N=37) knowledge and confidence in pediatric nursing concepts significantly increased after the simulation. Students responded positively to the simulation and recommended it be included in the undergraduate curriculum. The pediatric escape room simulation offers a promising alternative for students to gain pediatric-specific knowledge and confidence for prelicensure nursing programs in the context of limited pediatric clinical placements.