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Young adult drivers' sensitivity to changes in speed and driving mode in a simple vehicle simulator.

The study was done to check replication of changes in sensitivity with a simple simulator as had been obtained in an experiment using the real road situation. Another purpose was to control simulator sickness which could have confounded data from testing with a simulator or in actual driving. Sensitivity of the drivers (72 healthy young adults, M age = 24 yr., SD = 5) while performing the driving task was measured in terms of subjective ratings of simulator sickness and affect, and physiological measures (i.e., galvanic skin responses and skin temperature) at different driving speeds and in driving mode conditions, using a simple vehicle simulator. Analysis showed measures of drivers' state, including simulator sickness, physiological indices, and subjective reports, increased with driving speed (30 --> 90 -->120 km/hr.) and driving mode change from the regular speed to sudden increasing to sudden decreasing speeds. Particularly, the results suggest that the increased autonomic nervous activation induces increase of rated simulator sickness. Based upon the same tendency in change of the simulator sickness and physiological state with driving speed and driving mode conditions, it was concluded that, if the results obtained from the simulator experiment can be generalized to the real situation, the simulator sickness must be considered a confounding factor. The results also suggest that the changes in human sensitivity are dependent upon aspects related to speed of a vehicle and driving mode.

Acceleration↗

Global and specific migration of antioxidants from polypropylene films into food simulants.

Global migration and specific migration of antioxidants (AOs--Irgafos 168 [tris(2,4-di-tert-butylphenyl) phosphite], Irganox 1076 [octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl-propionate], and Hostanox SE2 (distery thiodipropionate)--from polypropylene (PP) films into food simulants (water, 3% acetic acid, 95% ethanol, olive oil, and heptane) were studied. Films (50, 100, and 200 microns thick) were exposed to simulants at temperature-time conditions simulating migration under retorting and long-term storage. Global migration into aqueous simulants was independent of film thickness and conditions of exposure, so it seems as if the migration process was limited to the dissolution of migrants on the contacting surface. Global migration to fatty food simulants was dependent on simulant, conditions of exposure, and in some cases film thickness. Specific AO migration was analyzed from dry residues obtained from global migration analysis. Migration of AOs into aqueous simulants was below the detection limit (0.01 mg/dm2). Migration into fatty food simulants was dependent on the simulant. The extractive power of simulants was similar to that observed in global migration studies. Specific migration into heptane was independent of the polymer mass, though dependent on the thickness. Migration into ethanol was dependent on both mass and thickness. A theoretical discussion about the controversial effect of thickness on migration results, based on the kinetics of the process, is presented.

Antioxidants↗

[Clinical and communication simulation workshop for fellows in gastroenterology: the trainees' perspective].

BACKGROUND: The continuing development in computer-based medical simulators provides an ideal platform for simulator-assisted training programs for medical trainees. Computer-based endoscopic simulators provide a virtual reality environment for training endoscopic procedures. This study illustrates the use of a comprehensive training model combining the use of endoscopic simulators with simulated (actor) patients (SP). AIM: To evaluate the effectiveness of a comprehensive simulation workshop from the trainee perspective. METHODS: Four case studies were developed with emphasis on communication skills. Three workshops with 10 fellows in each were conducted. During each workshop the trainees spent half of the time in SP case studies and the remaining half working with computerized endoscopic simulators with continuous guidance by an expert endoscopist. Questionnaires were completed by the fellows at the end of the workshop. RESULTS: Seventy percent of the fellows felt that the endoscopic simulator was close or very close to reality for gastroscopy and 63% for colonoscopy. Eighty eight percent thought the close guidance was important for the learning process with the simulator. Eighty percent felt that the case studies were an important learning experience for risk management. CONCLUSION: Further evaluation of multi-modality simulation workshops in gastroenterologist training is needed to identify how best to incorporate this form of instruction into training for gastroenterologists.

Computer-Assisted Instruction↗

A comprehensive anesthesia simulation environment: re-creating the operating room for research and training.

Simulation is used extensively in industries that involve routine, but risky activities. The authors describe an anesthesia simulation environment that provides a re-creation of the anesthesiologist's task environment in a real operating room. The system provides appropriate inputs to standard monitoring equipment in common use during anesthesia, including ECG (with arrhythmias); invasive systemic arterial, pulmonary arterial, and central venous pressures (all coupled to ECG arrhythmias); automated cuff blood pressure; pulse oximetry; mass spectrometry; breathing circuit spirometry; and oxygen analysis. An intubation/thorax mannequin allows tracheal intubation and tube manipulation, and provides for simulation of occlusion, malposition, or disconnection of the tracheal tube, as well as regurgitation of gastric contents. The simulation is comprehensive in that it is "hands-on" and requires actual performance of most interventions using actual equipment. The simulation is conducted by a systems operator and a simulation director; the latter also acts in the roles of surgeon and circulating nurse. The simulator outputs are determined by a "script" that defines the consequences of routine anesthetic actions and pre-established critical incidents. Decisions about timing and override of the script are made by the simulation director. This control system offers maximum flexibility while maintaining clinical realism. The simulator experiences were judged as highly realistic by 21 subjects. Limitations in this version have centered on the mannequin (e.g., no patient movement, minimal or confusing physical signs) and will be addressed in future versions of the system. The authors suggest that anesthesia simulation can be accomplished at nominal expense and has major potential for training, continuing education, certification, and research.

Anesthesia↗

Postural and performance changes following exposures to flight simulators.

Flight simulators are cost-effective, safe, and flexible training tools for aviators. However, their advantages may be offset by the occurrence of motion sickness-like symptoms which have been reported during and following simulator training. Although symptoms have been well documented in simulators, their time course, causes, and implications for training are not yet fully understood. Tests of standing and walking steadiness were administered along with cognitive and motor performance tests to Navy and Marine Corps aviators before and after their regular simulator training, resulting in records of 726 pilot exposure observations. When exposed pilots were compared to a control group who did not fly in a simulator, statistically significant decrements in postural equilibrium test scores were found for all of the moving base simulators, but for only one of the three fixed-base simulators. The size of these losses was approximately 15% of baseline. Cognitive and motor changes, while statistically significant, were complicated by learning effects in all groups for all tests. When compared to the control group, improvement in cognitive scores was always less in the simulator groups, but greater improvement occurred in the simulator groups for motor speed scores, although this latter difference was small (< 1% of baseline). Further study of performance changes is recommended. In those simulators where significant effects occurred, the ataxia and the time-course of the disequilibrium should be followed.

Aerospace Medicine↗

Correlates of military tank simulator sickness.

A military tank driving simulator is currently widely used as a training aid for tank drivers. The purpose of this study was to investigate the relationship between possible correlates of simulator sickness and the occurrence of sickness and performance test results among simulator drivers. The average number of motion sickness-like symptoms reported after driving the simulator among subjects with a history of susceptibility to motion sickness was 3.4, significantly higher than the average of 1.6 reported among subjects who did not report previous susceptibility to motion sickness (p < 0.05). Subjects driving the simulator while screen image quality was disturbed had a longer reaction time (42.0 s) than when driving the simulator without screen interferences (18.4 s, p = 0.001). Subjects driving the simulator for a short period had the same number of symptoms as did those driving for a longer period, but had better digit symbol test results. There was no statistically significant association between the development of sickness and tank driving experience. Suggested countermeasures are expected to prevent simulator sickness among some of the simulator trainees and to make simulator training more effective.

Adolescent↗

Faking it? Simulation in the training of obstetricians and gynaecologists.

PURPOSE OF REVIEW: This paper discusses the use of simulation as a training tool in obstetrics and gynaecology. RECENT FINDINGS: Modern medical training and patient pressure for treatment by more experienced clinicians have contributed to a reduction in the training opportunities available to junior doctors. Advances in information technology have led to the successful introduction of simulator-based training in many safety-critical industries such as aviation and nuclear power. In this editorial we describe simulation devices that are available to obstetrics and gynaecology and explain how simulation can benefit the patient, trainee and educator. We also explore how simulation could be integrated into obstetrics and gynaecology training programmes. SUMMARY: At present simulation is very much underused as a training tool in medicine, and features little in the postgraduate training curriculum. In obstetrics and gynaecology simulation could be used as an educational tool to assist in (1) transfer of knowledge, (2) practising diagnostic and simple practical skills, (3) surgical skills training, (4) emergency drill training and (5) human factors and team training. Whereas simulation should not be perceived as a replacement for training with real patients, educators should embrace the opportunities that simulation provides and integrate it into current training programmes to maximize training opportunities and patient safety.

Clinical Competence↗

Molecular dynamics studies of a DNA-binding protein: 2. An evaluation of implicit and explicit solvent models for the molecular dynamics simulation of the Escherichia coli trp repressor.

Although aqueous simulations with periodic boundary conditions more accurately describe protein dynamics than in vacuo simulations, these are computationally intensive for most proteins. Trp repressor dynamic simulations with a small water shell surrounding the starting model yield protein trajectories that are markedly improved over gas phase, yet computationally efficient. Explicit water in molecular dynamics simulations maintains surface exposure of protein hydrophilic atoms and burial of hydrophobic atoms by opposing the otherwise asymmetric protein-protein forces. This properly orients protein surface side chains, reduces protein fluctuations, and lowers the overall root mean square deviation from the crystal structure. For simulations with crystallographic waters only, a linear or sigmoidal distance-dependent dielectric yields a much better trajectory than does a constant dielectric model. As more water is added to the starting model, the differences between using distance-dependent and constant dielectric models becomes smaller, although the linear distance-dependent dielectric yields an average structure closer to the crystal structure than does a constant dielectric model. Multiplicative constants greater than one, for the linear distance-dependent dielectric simulations, produced trajectories that are progressively worse in describing trp repressor dynamics. Simulations of bovine pancreatic trypsin were used to ensure that the trp repressor results were not protein dependent and to explore the effect of the nonbonded cutoff on the distance-dependent and constant dielectric simulation models. The nonbonded cutoff markedly affected the constant but not distance-dependent dielectric bovine pancreatic trypsin inhibitor simulations. As with trp repressor, the distance-dependent dielectric model with a shell of water surrounding the protein produced a trajectory in better agreement with the crystal structure than a constant dielectric model, and the physical properties of the trajectory average structure, both with and without a nonbonded cutoff, were comparable.

Amino Acid Sequence↗

Simulations of ion current in realistic models of ion channels: the KcsA potassium channel.

Realistic studies of ion current in biologic channels present a major challenge for computer simulation approaches. All-atom molecular dynamics simulations involve serious time limitations that prevent their use in direct evaluation of ion current in channels with significant barriers. The alternative use of Brownian dynamics (BD) simulations can provide the current for simplified macroscopic models. However, the time needed for accurate calculations of electrostatic energies can make BD simulations of ion current expensive. The present work develops an approach that overcomes some of the above challenges and allows one to simulate ion currents in models of biologic channels. Our method provides a fast and reliable estimate of the energetics of the system by combining semimacroscopic calculations of the self-energy of each ion and an implicit treatment of the interactions between the ions, as well as the interactions between the ions and the protein-ionizable groups. This treatment involves the use of the semimacroscopic version of the protein dipole Langevin dipole (PDLD/S) model in its linear response approximation (LRA) implementation, which reduces the uncertainties about the value of the protein "dielectric constant." The resulting free energy surface is used to generate the forces for on-the-fly BD simulations of the corresponding ion currents. Our model is examined in a preliminary simulation of the ion current in the KcsA potassium channel. The complete free energy profile for a single ion transport reflects reasonable energetics and captures the effect of the protein-ionized groups. This calculated profile indicates that we are dealing with the channel in its closed state. Reducing the barrier at the gate region allows us to simulate the ion current in a reasonable computational time. Several limiting cases are examined, including those that reproduce the observed current, and the nature of the productive trajectories is considered. The ability to simulate the current in realistic models of ion channels should provide a powerful tool for studies of the biologic function of such systems, including the analysis of the effect of mutations, pH, and electric potentials.

Bacterial Proteins↗

The design of simulation studies in medical statistics.

Simulation studies use computer intensive procedures to assess the performance of a variety of statistical methods in relation to a known truth. Such evaluation cannot be achieved with studies of real data alone. Designing high-quality simulations that reflect the complex situations seen in practice, such as in prognostic factors studies, is not a simple process. Unfortunately, very few published simulation studies provide sufficient details to allow readers to understand fully all the processes required to design a simulation study. When planning a simulation study, it is recommended that a detailed protocol be produced, giving full details of how the study will be performed, analysed and reported. This paper details the important considerations necessary when designing any simulation study, including defining specific objectives of the study, determining the procedures for generating the data sets and the number of simulations to perform. A checklist highlighting the important considerations when designing a simulation study is provided. A small review of the literature identifies the current practices within published simulation studies.

Biomedical Research↗

Effects of Na+ and Mg2+ on the structures of supercoiled DNAs: comparison of simulations with experiments.

Recent cryo-electron microscopy (cryo-EM) results suggest that sufficient NaCl concentration (> or approximately 0.1 M) and superhelix density (> or approximately-0.05) cause circular DNAs to adopt highly extended, tightly interwound configurations, in which the strands are laterally contiguous along almost their entire length. Millimolar levels of MgCl2 reportedly act synergistically with NaCl to produce similar conformations. However, Monte Carlo simulations with purely repulsive interduplex forces failed to reproduce such structures. In the present work, solution measurements of particular physical properties were performed both to characterize the effects of Na+ and Mg2+ on DNA structure and to provide quantitative tests of Monte Carlo simulations of circular DNAs. Supercoiled p30 delta DNAs in 10 mM Tris plus 0, 0.122, and 0.1 M NaCl, and 0.1 M NaCl plus 4 mM Mg2+ were examined by static and dynamic light scattering (LS and DLS), time-resolved fluorescence polarization anisotropy (FPA) of intercalated ethidium, and circular dichroism (CD) spectroscopy. Upon addition of 0.122 M NaCl, the radius of gyration (Rg) decreased substantially, which indicates that p30 delta adopts a more compact structure. This contradicts the cryo-EM studies, where molecular extension and Rg both increase upon adding 0.1 M NaCl. In 0.1 M NaCl, the torsion constant measured by FPA is practically invariant to superhelix density, and the plateau diffusion coefficient at large scattering vector (Dplat) is likewise nearly the same at both relaxed and native superhelix densities. Such invariance is difficult to reconcile with any transition from relaxed circles to tightly interwound structures with laterally contiguous strands. Metropolis Monte Carlo simulations were performed to generate canonically distributed sets of structures, from which average Do values and scattered intensity ratios, [symbol: see text]I (zero) [symbol: see text]/[symbol: see text] l(k) [symbol: see text], were calculated. Agreement between simulations and experiments in regard to [symbol: see text] I(O) [symbol: see text] /[symbol: see text] I(k) [symbol: see text], D(zero) and the supercoiling free energy, delta Gsc (delta l), is remarkably good for the most extensively studied p30 delta samples. The simulated structures exhibit no sign of very tight interwinding with extensive lateral contacts, but instead exhibit most probable superhelix diameters of 85 to 90 A. When 4 mM Mg2+ was added to native supercoiled p30 delta in 0.1 M NaCl, Rg decreased, D(zero) increased, and the longest internal relaxation rate (1/tau 2(zero)) increased, all of which indicate a further overall contraction of the molecular envelope. The torsion constant exhibited a slight increase that is hardly statistically significant. In this case, agreement between the simulations and experiments was only semi-quantitative for most samples investigated, although the predicted contraction was exhibited by all five samples of p30 delta and one of pBR322 DNA. The simulated structures in 0.1 M NaCl plus 4 mM Mg2+ again showed no sign of extensive lateral contacts. A plausible explanation is proposed for the highly extended, tightly interwound structures seen in cryo-EM, and explicitly tested by Monte Carlo simulations of a 1000 bp circular DNA at +25 and -50 degrees C. Structures identical to those seen in cryo-EM are in fact the equilibrium structures in the simulations at -50 degrees C, and the estimated time for equilibration (2.3 x 10(-6) second) is much smaller than the estimated time for vitrification (1 x 10(-4) second).

Computer Simulation↗

Validity and reliability of undergraduate performance assessments in an anesthesia simulator.

PURPOSE: To examine the validity and reliability of performance assessment of undergraduate students using the anesthesia simulator as an evaluation tool. METHODS: After ethics approval and informed consent, 135 final year medical students and 5 elective students participated in a videotaped simulator scenario with a Link-Med Patient Simulator (CAE-Link Corporation). Scenarios were based on published educational objectives of the undergraduate curriculum in anesthesia at the University of Toronto. During the simulator sessions, faculty followed a script guiding student interaction with the mannequin. Two faculty independently viewed and evaluated each videotaped performance with a 25-point criterion-based checklist. Means and standard deviations of simulator-based marks were determined and compared with clinical and written evaluations received during the rotation. Internal consistency of the evaluation protocol was determined using inter-item and item-total correlations and correlations of specific simulator items to existing methods of evaluation. RESULTS: Mean reliability estimates for single and average paired assessments were 0.77 and 0.86 respectively. Means of simulator scores were low and there was minimal correlation between the checklist and clinical marks (r = 0.13), checklist and written marks (r = 0.19) and clinical and written marks (r = 0.23). Inter-item and item-total correlations varied widely and correlation between simulator items and existing evaluation tools was low. CONCLUSIONS: Simulator checklist scoring demonstrated acceptable reliability. Low correlation between different methods of evaluation may reflect reliability problems with the written and clinical marks, or that different aspects are being tested. The performance assessment demonstrated low internal consistency and further work is required.

Anesthesiology↗

Molecular dynamics simulations of photoactive yellow protein (PYP) in three states of its photocycle: a comparison with X-ray and NMR data and analysis of the effects of Glu46 deprotonation and mutation.

Photoactive yellow protein (PYP) is a prototype of the PAS domain superfamily of signaling proteins. The signaling process is coupled to a three-state photocycle. After the photoinduced trans-cis isomerization of the chromophore, 4-hydroxycinnamic acid (pCA), an early intermediate (pR) is formed, which proceeds to a second intermediate state (pB) on a sub-millisecond time scale. The signaling process is thought to be connected to the conformational changes upon the formation of pB and its recovery to the ground state (pG), but the exact signaling mechanism is not known. Experimental studies of PYP by solution NMR and X-ray crystallography suggest a very flexible protein backbone in the ground as well as in the signaling state. The relaxation from the pR to the pB state is accompanied by the protonation of the chromophore's phenoxyl group. This was found to be of crucial importance for the relaxation process. With the goal of gaining a better understanding of these experimental observations on an atomistic level, we performed five MD simulations on the three different states of PYP: a 1 ns simulation of PYP in its ground state [pG(MD)], a 1 ns simulation of the pR state [pR(MD)], a 2 ns simulation of the pR state with the chromophore protonated (pRprot), a 2 ns simulation of the pR state with Glu46 exchanged by Gln (pRGln) and a 2 ns simulation of PYP in its signaling state [pB(MD)]. Comparison of the pG simulation results with X-ray and NMR data, and with the results obtained for the pB simulation, confirmed the experimental observations of a rather flexible protein backbone and conformational changes during the recovery of the pG from the pB state. The conformational changes in the region around the chromophore pocket in the pR state were found to be crucially dependent on the strength of the Glu46-pCA hydrogen bond, which restricts the mobility of the chromophore in its unprotonated form considerably. Both the mutation of Glu46 with Gln and the protonation of the chromophore weaken this hydrogen bond, leading to an increased mobility of pCA and large structural changes in its surroundings. These changes, however, differ considerably during the pRGln and pRprot simulations, providing an atomistic explanation for the enhancement of the rate constant in the Gln46 mutant.

Bacterial Proteins↗

Determining the need for simulated training of invasive procedures.

Unlike the airline industry, where pilots first learn to fly on simulators before navigating planes, physicians practice invasive procedures on real patients. To determine the need for the simulated training of invasive procedures prior to working on patients, we studied the views of physicians-in-training. Five hundred medical students, residents, and fellows at Harvard Medical School were asked if there was a problem with the way medical procedures presently are learned in health care. Next, they were surveyed to inquire whether using a simulator would be beneficial. Finally, they were asked what specific procedures would be most suitable for virtual training. The effects of respondent gender, level of training, specialty, and previous experience using simulation on survey results was tested using Student t-tests. One hundred and fifty-eight trainees responded that they were uncomfortable learning to perform invasive procedures on patients. Students and physicians were very interested in obtaining simulated training prior to practicing on patients. The more complicated the procedure, the greater the feeling that it should be simulated prior to attempting it on patients. Respondents most preferred that simulation be used to teach chest tube placement. Respondent gender, specialty, level of training, and prior simulation experience did not affect survey results (p > 0.05). Simulation should be incorporated into the education of medical students and residents as a tool to practice invasive procedures prior to working on patients.

Adult↗

Clinical results of computerized tomography-based simulation with laser patient marking.

PURPOSE: Accuracy of a patient treatment portal marking device and computerized tomography (CT) simulation have been clinically tested. METHODS AND MATERIALS: A CT-based simulator has been assembled based on a commercial CT scanner. This includes visualization software and a computer-controlled laser drawing device. This laser drawing device is used to transfer the setup, central axis, and/or radiation portals from the CT simulator to the patient for appropriate patient skin marking. A protocol for clinical testing is reported. Twenty-five prospectively, sequentially accessioned patients have been analyzed. RESULTS: The simulation process can be completed in an average time of 62 min. Under many cases, the treatment portals can be designed and the patient marked in one session. Mechanical accuracy of the system was found to be within +/- 1mm. The portal projection accuracy in clinical cases is observed to be better than +/- 1.2 mm. Operating costs are equivalent to the conventional simulation process it replaces. CONCLUSION: Computed tomography simulation is a clinical accurate substitute for conventional simulation when used with an appropriate patient marking system and digitally reconstructed radiographs. Personnel time spent in CT simulation is equivalent to time in conventional simulation.

Computer Simulation↗

Initial experience using an endoscopic simulator to train surgical residents in flexible endoscopy in a community medical center residency program.

INTRODUCTION: The importance of training surgical residents in GI endoscopy has been recognized for years. Despite advice from SAGES and the RRC, few programs have managed to incorporate effective flexible endoscopy training into their curriculum, making it difficult for their graduates to be credentialed in GI endoscopy. Prior to October 2001, our residents obtained their entire clinical experience in the endoscopy unit with staff surgical endoscopists. Attendance was inconsistent because of their many other responsibilities, and residents often used much of their clinical endoscopic exposure gaining basic familiarity with the equipment, precluding the development of therapeutic facility. Since October 2001, we have used the Simbionix endoscopic simulator to supplement resident training in GI endoscopy. With the advent of virtual-reality simulators, and studies validating their effectiveness in teaching fundamental technical skills, we report our initial success in implementing a formal GI endoscopy curriculum using a virtual reality endoscopic simulator to provide basic experience before the clinical endoscopic experience begins. METHODS: Residents are given monthly assignments of simulated cases on the GI Mentor simulator. Junior residents complete the diagnostic case modules; senior residents complete the therapeutic modules. Data were accumulated over the course of two years with a total of five PGY-I and eight senior surgical residents completing assigned cases on the simulator. Objective criteria were measured from their performance on the simulator to determine the efficiency of the examination for each case completed. RESULTS: Preliminary data collected over the course of two years indicates that residents improve the efficiency of their endoscopic examinations over time as measured by objective criteria. Junior surgery residents attained an aggregate average of 59% efficiency in their examinations whereas senior surgical residents who had previous experience with the simulator, attained an aggregate efficiency of 80%. CONCLUSIONS: A formal flexible endoscopy curriculum enhances surgical resident training and positively impacts careers in general and gastrointestinal surgery. Endoscopic simulators allow surgical residents to master the technical aspects of GI endoscopy quickly, thereby permitting them more benefit from their clinical exposure in the endoscopy unit. We anticipate that our formal curriculum in GI endoscopy training will prepare our graduates well for careers that include flexible endoscopy as a component of their clinical practices, and position them to be credentialled in GI endoscopy upon graduation.

Colonoscopy↗

Scenario-based simulation of runoff-related pesticide entries into small streams on a landscape level.

The prediction of runoff-related pesticide entry into surface waters on a landscape level usually requires considerable efforts with regard to input data, time, and personnel. Therefore, the need for an easy to use simulation tool with easily accessible input data, for example from already existing public sources, is obvious. In this paper, we present a simulation tool for the simulation of pesticide entry from arable land into adjacent streams. Our aim was to develop a tool applicable on the landscape level using "real world data" from numerous sites and for the simulation of parameter case studies concerning particular parameters at single sites. We used the ratio of exposure to toxicity (REXTOX) model proposed by the OECD, which had been successfully validated in the study area as part of a previous study and which was extended to calculate pesticide concentrations in adjacent streams. We simulated the pesticide entry on the landscape level at 737 sites in small streams situated in the central lowland of Germany with winter wheat, barley, and sugar beat as the main agricultural crops. A sensitivity analysis indicated that the most significant model parameters were the width of the no-application zone and the degree of plant interception. The simulation was carried out for the 15 most frequently detected substances found in the study area using eight different environmental scenarios, covering variation of the width of the no-application zone, climate, and seasonal scenarios. The highest in-stream concentrations were predicted for a scenario using no (0m) buffer zone in conjunction with increased precipitation. According to the predicted concentrations, the risk for the aquatic communities was estimated based on standard toxicity tests and the application of a safety factor. The simulation results are presented both by means of risk maps for the study area showing the simulated pesticide concentration and the resulting ecological risk for numerous sites under varying scenarios and by case study diagrams with focus on the model behavior under the influence of single parameters. Risk maps confirmed the importance of no-application (buffer) zones for the levels of pesticide input. They also indicated the importance of the existing no-application zones for certain compounds and in some cases the need for a further evaluation of these regulations. The simulation tool was implemented as a standard PC software combining the REXTOX model with a geographical information system and can be used on any current personal computer. All input data was taken from public sources of German authorities. With little effort the tool should be applicable for other areas with similar data quality.

Computer Simulation↗

Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency.

Simulation technology in laparoscopic surgery has developed in response to a need to teach fundamental surgical skills in a safe environment. The skill set needed was defined carefully according to the classic educational model of needs assessment. Once defined, the skills were modeled in a simulator. The recognition that a simulator need not have high fidelity to achieve significant educational value was important in keeping costs reasonably low. Intrinsic to an effective simulation program is a set of metrics or measurements of performance. These metrics provide motivation for the student and allow comparison among students. Once shown to be reliable and valid, the simulator metrics can be used to set reasonable goals and standards for certification. Although simulators permit verification of learning, point simulation testing cannot by itself be used at present to ensure competence. Until the predictive value of these tests has been validated further, competence still needs to be determined by expert assessment of observed performance in real cases and by measurable outcome variables from real procedures. Simulation training is most beneficial when incorporated into a curriculum that teaches the accompanying knowledge and judgment essential for safe practice of the skills taught in the simulator. The FLS program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons is an example of a carefully planned and validated program that incorporates these principles in laparoscopic surgery education. The lessons learned from development of the FLS program can be useful in designing a similar program for flexible gastrointestinal endoscopy.

Clinical Competence↗