Simulated Room Research Articles

345 Comparing Scenario-Based Simulation Education to Escape Room Simulation Education With Emergency Medicine Residents

345 Comparing Scenario-Based Simulation Education to Escape Room Simulation Education With Emergency Medicine Residents

Prevalence of Trauma History and Symptoms in Patients Who Have Received Vaginal Brachytherapy as Part of their Endometrial Cancer Treatment

Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and is important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to retrospectively identify patients treated with VBT for early-stage endometrial cancer and collect survey data to assess the prevalence of trauma history, whether VBT re-induced trauma symptoms, and whether VBT was considered an independent traumatic event by patients. We retrospectively identified patients with endometrial cancer treated with VBT at our institution from January 2017 to August 2022. Patients were mailed a cover letter and unique-identifier coded survey that included the Brief Trauma Questionnaire (BTQ) and Primary Care Post Traumatic Stress Disorder Screen for DSM-V (PC-PTSD-5), both validated instruments. Patients were instructed to fill out the surveys as it relates to their trauma history prior to VBT and again considering any trauma symptomatology related to VBT. BTQ was interpreted as positive if the patient responded yes to any question. PC-PTSD-5 was interpreted positive if the patient responded yes to at least 3 questions. Electronic medical record review was performed to identify clinical and pathologic features. Descriptive statistics and qualitative analysis were used to assess survey responses. A total of 51 of 206 patients returned the survey at the time of interim analysis. 43 patients (84%) screened positive on the BTQ for having trauma history. Of those patients, 7 (16%) screened positive on the PC-PTSD-5 for a probable PTSD diagnosis. Additionally, 22 (51%)/18 (42%) patients answered yes to at least one/two symptoms on the PC-PTSD-5 respectively. Of the patients who answered yes to at least one question on the PC-PTSD-5, 18% (4 patients) responded that VBT triggered flashbacks of their past trauma. Regarding PC-PTSD-5 considering trauma symptomatology related to VBT, 20 patients (39%) answered yes to any question, though only 2 patients (4%) met the threshold to screen positive for probable PTSD. 20 patients (39%) indicated they would have accepted a referral to psychology before or during VBT. Suggested improvements made via free text responses included minimizing the time the cylinder was inserted and eliminating the need to transfer via hallway from the simulation room to the treatment room. This study provides a baseline for understanding the prevalence of trauma history and trauma related to VBT in patients with endometrial cancer. This data can be used to guide patient centered discussions of endometrial cancer care, importantly including to counsel patients that a possible toxicity of VBT is trauma symptomatology, particularly for those with a history of trauma.

Simulator Feature Framework: Requirements to Support Training, Research, and Education

There is an expansion of nuclear power plant control room simulator use beyond traditional operator training. Modern simulator designs require more robust capabilities to serve the diverse needs of multiple user groups including researchers and educators. A common framework for evaluating simulator features to support training, research, and education is critical to ensure future simulators enable research for immediate and future plant modernization and advanced reactor deployment needs. An initial framework comprised of 8 feature categories was developed by reviewing published simulator-based research and analyzing simulator features against research objectives and results. Future research will focus on evaluating the suitability of this framework in characterizing and differentiating simulators across training, research, and education use cases.

Sharing imagery and analysis tools in a simulated submarine control room

We examined the impact of sharing periscope imagery and analysis tools in eighteen five-member teams (Sonar, Periscope, 2xTrack Motion Analysts, Track Manager) who undertook simulated submarine patrol tasks. Compared to a baseline condition, sharing imagery to team members increased perceived individual workload, with no improvement to team performance (tactical picture accuracy). When both imagery and analysis tools were shared, perceived workload increased and tactical picture compilation was more accurate. Despite this improved tactical picture for the imagery and analysis tools condition, there was no advantage to mission completion (rendezvous/close contact detection) or situation awareness. In contrast to the increased subjective workload, individuals in teams provided with shared imagery (with or without tools) had a lower physiological response (heart rate, electrodermal) to task demands compared to the baseline condition. Sharing imagery and analysis tools likely benefited tactical picture compilation by enabling dynamic task redistribution and multiple streams of concurrent data analysis.

Online and Remote Training Experience in the Engine Room Simulator Training Courses using the IMO Model Course 2.07 Exercises

In the age of technology, changes are experienced in many areas such as globalization, information society, new basic technology, the spread of the Internet, and the realization of competition on a global scale. New methods used in education and training have been developed and kept up with technological developments. With the widespread use of the Internet, online and remote training has become more possible than ever. Technology was ready for online education and training for the past decades, yet the COVID-19 pandemic caused the traditional training to be disrupted and training institutions had to carry out studies for traditional training to be conducted online and remotely. This caused a paradigm change in the training methods. Online or remote education, even in training using the engine room simulator (ERS), has become more popular as an alternative to traditional classroom teachings, even though the pandemic is disappearing. Additionally, the progress in autonomous ships and recent regulatory studies indicates the importance of a better understanding of the engineering data in remote or autonomous ship operations. The authors have been offering Engine Room Simulator (ERS) training courses using online methods since the first semester of 2020, totaling six semesters of online training so far. This paper presents the online training process used in courses including the technological setup and method of teaching and assessment. Experiences and lessons learned by the lecturers in providing operational and management level ERS courses and feedback from students are examined and presented. The use of IMO Model Course 2017 Edition became helpful as it describes exercises for each training objective in accordance with IMO STCW 2010. An Engine Room Simulator (ERS) called Ship ERS or SERS™ was utilized as the remote training tool in the pilot implementation of these courses that were spread over two semesters. The advantages and disadvantages of online ERS training was presented and discussed. A particular and interesting observation has been that the students could have longer duration of exercise opportunities when using SERS™ in the remote training than in traditional ones.

Removal of indoor aerosol particles generated in a medically relevant space using a portable airborne particle filtration device

Aerosol generating procedures expose operating room personnel to pathogens. Applying localized negative pressure within the proximity of a patient’s airway is expected to reduce the amount of bioaerosols dispersed within the vicinity of a healthcare worker applying an aerosol generating procedure. Nebulized saline was used as a proxy for bioaerosols and was produced with an aerosol generator placed near the centre of a simulated operating room. A particle counter was placed nearby to detect aerosols and determine their size distribution. A portable filtration unit was placed at fixed distances from the site of aerosol emittance to reduce the concentration of aerosols. In the presence of vacuum at distances of 10, 20, 30 and 40 cm from the site of aerosol emittance, the reduction in the average concentrations of 0.5, 0.7, 1.0 and 3.0 μm particles relative to the control ranged from 87 to 99% depending on the distance and particle size. The efficiency of particle capture was dependent on the distance of the vacuum inlet to the aerosol outlet. At all distances tested, significant aerosol reduction was observed ( p < 0.05), indicating that the portable filtration unit has the potential to increase safety without contacting the patient.

Impact of Just-in-Time TeamSTEPPS® Training on Team Performance in a Pediatric Escape Room Simulation

Impact of Just-in-Time TeamSTEPPS® Training on Team Performance in a Pediatric Escape Room Simulation

Paediatric cardiopulmonary resuscitation quality during simulation of in-hospital transport

In-hospital cardiac arrests that occur outside of the intensive care unit may require transportation during active cardiopulmonary resuscitation. Studies have shown that high-quality cardiopulmonary resuscitation is imperative for survival with preserved neurologic function. We sought to determine if high-quality cardiopulmonary resuscitation is maintained during simulated transportation of paediatric in-hospital cardiac arrest. Randomized crossover simulated study of paediatric in-hospital cardiac arrest with 10 teams composed of five providers (physicians, advanced practice providers, nurses and respiratory therapists). Teams remained in a simulation room or transported the mannequin between two rooms. The primary analysis compared chest compression fraction in stationary versus transport simulations. Secondary analyses included additional cardiopulmonary resuscitation quality metrics with comparison to the 2015 American Heart Association standards. There was no significant difference in chest compression fraction or rate between the transport and stationary groups. 92%, 72% and 26% of epochs met American Heart Association criteria for compression fraction, rate and depth, respectively. Stationary simulations were more likely to meet recommendations for combined quality metrics, including compression fraction and rate (77 vs. 53; Chest compression fraction was preserved during simulated in-hospital cardiac arrest with transport. However, the transport simulation was less likely to meet American Heart Association recommendations for combined metrics. Similar to previous cardiopulmonary resuscitation quality studies, both teams failed to meet depth requirements in the majority of simulations.

Condition Monitoring and Fault Diagnosis of a Marine Diesel Engine with Machine Learning Techniques

A marine engine room is a complex system in which many different subsystems are interacting with each other. At the center of this system is the main diesel engine which produces the propulsion force. Many other components such as compressed air, cooling, heating, lubricating oil, fuel, and pumping systems act as auxiliary machines to the main engine. Automation of many functions in the engine room is starting to play an important role in new generation ships to provide better control using sensors monitoring the engine and its environment. Sensors exist in the current generation ships, but engineers evaluate the sensor data for the presence of any problems. Maintenance actions are taken based on these manual analyses or regular maintenance is carried out at times determined by manufacturers, whether such actions are needed or not. With machine learning, it is possible to develop an algorithm using past evaluations made by engineers. Recent studies show that highly accurate results can be obtained using machine learning methods when there is sufficient data. In this study, we develop new learning-based algorithms and evaluate them on data obtained from a realistic ship engine room simulator. Data for a predetermined set of parameters of a high-power diesel engine were collected and analyzed for their role in a set of fault situations. These fault conditions and the associated sensor data are used to train a set of classifiers achieving fault detection up to 99% accuracy. These are promising results in preventing future damage to the engine or its supporting components by predicting failures before they occur.

A comprehensive experimental framework based on analysis of the pilot's EEG and NASA-TLX questionnaire in a VR environment.

The relationship framework between electroencephalogram (EEG) signals and subjective perception during pilots' missions was established to improve pilots' training efficiency and flight safety. Primarily, this study constructs a real flight scene through virtual reality (VR) and then obtains EEG data in simulated scenes. Researchers use VR technology to build a mission simulation room and then acquire EEG data from participants wearing EEG acquisition devices in the simulated room. The experimental process is divided into flight simulation and a questionnaire survey. Based on the participants' EEG analysis, the researchers verified the changes of β rhythm under a high-difficulty operation mission. In addition, this study infers the mechanism of affecting pilots' mental workload under high-difficulty operation by analyzing the correlation between subjective questionnaire results and β rhythms. The results showed that in the context of pilots performing flight missions in the aircraft space environment, the pilots' mental load had the most excellent rhythmic relationship with the regions representing β rhythm. Therefore, a comprehensive experimental framework constructed in this study based on virtual simulation space to analyze the relationship between EEG and NASA-TLX subjective questionnaire provides a set of more accurate reference information for the design of a pilot training system based on pilot training efficiency and flight safety.

Role of video self-assessment in laparoscopic simulation training: a randomized pilot trial

Residency programs have implemented simulation training to compensate for reduced operating room exposure. Video recording is an educational tool that can be utilized for coaching, telepresence, and self-assessment during simulation training. Data is limited on the utility of video recording and self-assessment for laparoscopic training in Ob/Gyn residency programs.. This study aimed to determine the role of video self-assessment as an educational tool in laparoscopic simulation training and to establish the feasibility of our study design for a larger randomized controlled trial. This was a prospective pilot study with a parallel, randomized, trial design that occurred in the Department of Obstetrics and Gynecology at the Mount Sinai Hospital. Subject participation took place in a surgical simulation training room. A total of 23 subjects were recruited (7 medical students, 15 residents, 1 fellow) voluntarily. All participants completed the study. All the subjects completed a pretest survey. The surgical simulation room contained a single Fundamentals of Laparoscopic Surgery box trainer and video-recording station. For session #1, each participant performed 2 Fundamentals of Laparoscopic Surgery tasks (A, peg transfer; B, intracorporeal knot tie). Participants were video recorded during session #1 and were randomized to either receive or not receive their video recording. The video group (n=13) and control group (n=10) repeated the Fundamentals of Laparoscopic Surgery tasks 7 to 10 days later (session #2). The primary outcome was percentage change in completion time between sessions. Secondary outcomes were percentage change in peg and needle drops between sessions. The participant characteristics (video vs control) were as follows: average training level (6.15 vs 4.90 years), self-assessment (1=poor, 10=excellent) of surgical skill (4.8 vs 3.7), and laparoscopic skill (4.4 vs 3.5). Training level was inversely correlated with completion time for tasks A and B (r, -0.79 and -0.87; P<.0001). Less experienced trainees required the maximum time allotted for each task in session #1 (A, 3; B, 13). Regarding the primary outcome, the video group improved less than the control group (A, 16.7% vs 28.3%; B, 14.4% vs 17.3%). After controlling for training level (residents only), the video group improved more in the primary outcome (A, 17% vs 7.4%; B, 20.9% vs 16.5%) and secondary outcomes (A, 0.0% vs -194.1%; B, 41.3% vs 37.6%). Video self-assessment has a potential role in simulation training for obstetrics-gynecology residents. With key improvements, the feasibility of our study design was demonstrated in preparation for a future definitive trial.

Development of a Novel Low-Energy Building: Effects of Room Orientation and Wall Materials

The development of low energy buildings in hot subtropical and desert like climates such as Australia and Kuwait, requires strategies that are rather challenging. Five (5) experimental rooms are going to be built to assess these energy saving techniques for a research program jointly between Kuwait and Australia. Before the construction phase, these rooms are simulated in TRNSYS18 for the two sites based on available weather data collected from Kuwait International Airport and Rockhampton Airport. The objectives are to investigate room orientation and walling materials on energy performance of the rooms. It was found that all rooms return identical temperature profiles in each of the eight (8) dominant directions, i.e., N, NE, E, SE, S, SE, E, and NW. Five (5) different commercially available wall materials were employed for the five (5) simulated rooms in Kuwait and Australia. It was found that autoclaved aerated concrete (AAC) wall materials and north (N) building face orientation are the preferred construction material and orientation in both sites. The energy performance index (EPI) showed that AAC wall materials for the room faced towards north (N) provides the lowest cooling EPI of 646 and 448.4 kW/m2/year in Kuwait and Rockhampton, Australia, respectively.

Minimizing Surgeon Radiation Exposure During Operative Treatment of Pediatric Supracondylar Humerus Fractures.

Orthopaedic surgeons are exposed to high levels of radiation, which may lead to higher rates of cancer among orthopaedic surgeons. There are a series of techniques currently practiced to pin supracondylar humerus fractures including pinning the arm on the C-arm itself, using a plexiglass rectangle or a graphite floating arm board; however, the variation in radiation exposure to the surgeon is unknown. We aimed to determine how the position of the C-arm affects radiation exposure to the surgeon during the treatment of a pediatric supracondylar humerus fracture. A simulated operating room was created to simulate a closed reduction and percutaneous pinning of a supracondylar humerus fracture. A phantom model was used to simulate the patient's arm. We assessed performing the procedure with the arm on plexiglass, graphite, or on top of the C-arm image receptor. The C-arm was positioned either with the source down and image receptor up (standard position) or with the source up and image receptor down (inverted position). Radiation exposure was recorded from levels corresponding to the surgeon's head, midline, and groin. The estimated effective dose equivalent was calculated to account for the varying radiation sensitivity of different organs. We found the effective dose equivalent, or the overall body damage from radiation, was 5.4 to 7.8% higher than the surgeon when the C-arm was in the inverted position (source up, image receptor down). We did not find any differences in radiation exposure to the surgeon when the arm was supported on plexiglass versus graphite. The C-arm positioned in the standard fashion exposes the surgeon to less damaging radiation. Therefore, when the surgeon is standing, we recommend using the C-arm in the standard position. Orthopaedic surgeons who stand should use the C-arm in the standard position to pin supracondylar humerus fractures to lower the risk of ionizing radiation exposure.

Wax actuator’s empirical model development and application to underfloor heating control with varying complexity of controller modelling detail

This paper investigates how a simulated room’s energy and temperature performance are affected if its underfloor heating control is modelled with increasing detail. Experiments were performed to develop and calibrate an empirical model of wax motor and to calibrate the valve curve. These models were used to implement and test the On/Off and proportional-integral (PI) control processes at various levels of modelling detail. Controllers were implemented by gradually adding optimized control parameters, signal delay, calibrated valve curve, signal modulation, and actuator modelling. The On/Off control dead band and PI parameters exhibited the largest impact, reducing energy use (1%–5%) and temperature fluctuations (ca 1 K). Modulating the PI output signal increased temperature fluctuations to the same amplitude as On/Off with 0.5 K dead band, increasing space heating demand by 1.3%. The wax actuator counted for less than 1%; however, it increased time delays to maximally 7 min and remarkably changed the mass flows.

Biofouling occlusion of ships’ internal seawater systems: operational, economic, and biosecurity consequences

Biofouling of ships’ internal seawater systems (ISS) can cause significant operational issues and is a potential transfer mechanism for marine nonindigenous species. This study used an engine room simulator and economic evaluation to quantify impacts on commercial ship performance of biofouling occlusion within various ISS nodes (sea chest, strainer, and heat exchangers). A characteristic hockey-stick relationship between occlusion and impact emerged, whereby engine room systems could tolerate up to 55% occlusion of a single node without operational impact, followed by rapid performance deterioration. The relative magnitude of impacts varied by ISS node and in response to changes in ambient seawater temperatures. System tolerance was much lower when simultaneous occlusion of multiple nodes was assessed. In economic terms, consequences included required freight rate increases of 1–26% prior to forced (automatic) slowdown of the ship and up to 82% increases if slowdown conditions were required.

Rudeness and civility in health care

Rudeness and civility in health care

Senses and Emotion Experience at Aceh Tsunami Museum

The purpose of this research is to find out how exhibitions in museums that use various senses can evoke the emotions of visitors and provide visitors with a more memorable spatial experience. In 2004 there was a very powerful Tsunami in Aceh. This incident is remembered in one of the museums designed by Ridwan Kamil, located in Aceh. This museum captures the moment Aceh Tsunami and also tries to present these past events as an exhibition area in a simulation room. This simulation room uses a multisensory delivery method involving several senses. This simulation room is known as the Tsunami Alley. The article discusses what feelings are involved in conveying messages from this space, and the spatial and emotional experience visitors feel. The method used is descriptive qualitative, and the object of this research is the Tsunami Alley of Aceh Tsunami Museum. According to the analysis results, sensory and emotional processes are inseparable and support one another. The application of integrated senses in the museum space will further evoke visitors' emotions and strengthen the message's memory. The results of this study are expected to be the development of design references regarding the delivery of news and information using multisensory methods to provide an impressive space experience in exhibition halls.

One-step hydrothermal synthesis of Bi2WxMo1-xO6 solid solution with adjustable energy band coupling with g-C3N4: 2D/2D Z-scheme heterojunction for enhanced photocatalytic HCHO degradation under indoor conditions

In this work, 2D/2D Bi2WxMo1-xO6/g-C3N4 was synthesized via surfactant-assisted one-step hydrothermal method for the degradation of formaldehyde in simulated room environment. We utilized CTAC as surfactant to control the morphologies of Bi2WxMo1-xO6 coupling with g-C3N4 nanosheets. In the hydrothermal method, Mo replaced W to form solid solution which could reduce energy band gap of Bi2WO6. In contrast to Bi2W0.6Mo0.4O6 (43.1%) and g-C3N4 (23.2%), Bi2W0.6Mo0.4O6/g-C3N4 exhibited superior activity (92.4%) of photocatalytic degradation for formaldehyde at the initial concentration of 1 ppm under the relative humidity (RH) of 20%. Meanwhile, we simulated diverse typical indoor conditions to evaluate the applicability of catalysts. More importantly, Bi2W0.6Mo0.4O6/g-C3N4 performed satisfactory stability with 5.5% decrease in degradation efficiency after five cycles. The mechanism of enhanced HCHO conversion was ascribed to the formation of 2D/2D Z-scheme heterojunction between Bi2W0.6Mo0.4O6 and g-C3N4 which increased the accessible interface and promoted the separation of photo-generated carriers for oxidation of formaldehyde.

Intraoperative Fluoroscopy Radiation Using OEC 9900 Elite C-arm: Risk and Method for Decreasing Exposure.

The use of intraoperative fluoroscopy in surgery produces scattered radiation that can expose all operating room personnel to measurable and, in some cases, substantial radiation doses. The goal of this work is to assess and document potential radiation doses to various staff positions in a simulated standard operating room environment. Adult-sized mannequins wearing standard lead protective aprons were placed at seven positions around large and small BMI cadavers. Doses were recorded in real time at thyroid level with Bluetooth-enabled dosimeters for a variety of fluoroscope settings and imaging views. A total of 320 images were acquired, resulting in 2,240 dosimeter readings from the seven mannequins. Doses were compared to cumulative air kerma (CAK) calculations provided by the fluoroscope. There was a strong correlation between the CAK and the recorded scattered radiation doses ( P < 0.001). Radiation doses could be reduced by manipulating C-arm manual technique settings [e.g., turning off the automatic exposure control (AEC) and using pulse (PULSE) or low dose (LD) settings]. Staff position and patient size also affected the recorded doses. The highest radiation doses were recorded across all settings for the mannequin positioned immediately adjacent to the C-arm x-ray tube. The larger BMI cadaver generated greater scattered radiation than the smaller BMI cadaver for all views and settings. This work provides suggestions for reducing exposure to operating room personnel beyond standard techniques of reducing beam-on time, increasing the distance from the radiation source, and use of shielding. Simple changes in C-arm settings (turning AEC off, avoiding DS setting, use of PULSE or LD settings) can markedly reduce dose to staff.

Loudness in rooms and the sound strength parameter: Linking perception and physical acoustics

Loudness as a perceptual phenomenon has been extensively studied within psychoacoustics. In room acoustics, however, the psychoacoustical factors influencing loudness have yet to be incorporated into standard parameters such as sound strength (G). G is the decibel ratio of the integrated energy of a room impulse response (RIR) compared to the same source located 10m away in a free field. The purpose of this study was to determine how the physical RIR properties measured by G relate to perceived loudness in the same room. Listeners were asked to match pink noise presented anechoically to the perceived loudness of the same noise in a simulated room. Listeners could continuously adjust the level of the anechoic reference. Room simulations were rendered over a 36-channel loudspeaker array in an anechoic chamber. Loudness matches were performed for different room types, source-receiver distances, and source powers, which produced received sound levels between 35 and 85 dBA. Results show a relatively linear relationship between loudness and G. However, it is clear that G underpredicts loudness ratings at higher sound levels. This demonstrates a more complex relationship between G and loudness. Effects of room type and source-receiver distance appear to introduce additional complexity not represented by G.