Effectiveness of high-fidelity simulation in training emergency medicine physicians in point of care ultrasonography in Pakistan: A quasi-experimental study

Background: Point-of-care ultrasound (PoCUS) is frequently utilized in emergency medicine (EM), with an extended-focused assessment with sonography in trauma (e-FAST) being the most widely used PoCUS modality. This modality is not only time- and cost-efficient, but it is highly accurate in the diagnosis and management of surgical patients in the emergency department, as well as being highly predictive of patient outcomes. Targeted training is essential to ensure a learner\u27s confidence in image acquisition, interpretation, and translation of knowledge to making clinical decisions. High-fidelity simulation offers a uniquely safe and mistake-forgiving environment to teach and train medical professionals. The present study evaluated the effectiveness of a high-fidelity simulator to train EM physicians in e-FAST at a tertiary care teaching hospital in a lower-middle-income country.Methods: This quasi-experimental study was performed at a state-of-the-art simulation center of a multidisciplinary university hospital in Karachi, Pakistan. Subjects were included if they were EM physicians who volunteered to participate and were available for the entire training and testing period. The educational intervention included lectures and hands-on practice on a high-fidelity simulator (SonoSim, Santa Monica, CA).Knowledge and image interpretation on e-FAST were evaluated using a questionnaire, administered before and after the training course. Each participant\u27s ability to acquire and interpret satisfactory images was assessed by experienced EM physicians and recorded. Participants were also administered a needs assessment survey and a course evaluation. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). All the tests were two-sided, and p-values ≤0.05 were considered significant. Baseline characteristics and outcome variables were recorded and compared by Wilcoxon signed-rank tests.Results: A total of 31 EM physicians, 12 (38.7%) men and 19 (61.3%) women, were enrolled in the study, with 24 (77.3%) having one to three years of EM experience. Mean and percentage group performance improved from 6 and 40% before the intervention to 14.5 and 96.6% after the intervention (Z=4.867, p≤0.05). Most improvement in image acquisition on high-fidelity simulation was observed in the upper right quadrant of the suprapubic window (29/31; 93.5%), followed by the upper left quadrant (27/31; 87%) and the subxiphoid window (21/31; 67%). All 31 participants reported improvements in comfort and confidence level with PoCUS after attending the workshop.Conclusions: EM physicians who attended a brief workshop incorporating simulation demonstrated improvements in knowledge and image acquisition skills in all domains tested. High-fidelity simulation training is an effective modality for training EM physicians in e-FAST

Effect of leading-edge erosion on the performance of offshore horizontal axis wind turbine using BEM method

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Mathematical models for estimating the degree of influence of major factors on performance and accuracy of coordinate measuring machines

Increased productivity of Coordinate Measuring Machines, while providing given level of accuracy, is complex and actual problem of robotics and metrology. Therefore, this article provides a set of mathematical models that allow for prediction of values for performance and accuracy of advanced Coordinate Measuring Machines based on system dynamics method. The analysis of scientific literature and statistical data of exploitation CMMs Global Performance (DEA, Italy), CMM-750 (Lapik, Russia), FARO Arm 9 (FARO Technologies, USA) has identified 25 major factors of the process control and their mutual impact. Of the 16 basic factors are internal system parameters, 6 input actions and 3 external factors. As a result of the system analysis of the research object identifies the main characteristics of coordinate measuring machines that affect performance and measurement accuracy. We have done a general graph of causal relationships between modeled characteristics, on the basis of which is made up and numerically solved a system of nonlinear differential equations. In developing this system of equations is used in statistical data describing the cause-effect relationship between the internal model parameters and environmental factors. These solutions make it possible to practically interpret developed models and methods of system dynamics used in solving the problem

Effects of Androgen Receptor and Androgen on Gene Expression in Prostate Stromal Fibroblasts and Paracrine Signaling to Prostate Cancer Cells

The androgen receptor (AR) is expressed in a subset of prostate stromal cells and functional stromal cell AR is required for normal prostate developmental and influences the growth of prostate tumors. Although we are broadly aware of the specifics of the genomic actions of AR in prostate cancer cells, relatively little is known regarding the gene targets of functional AR in prostate stromal cells. Here, we describe a novel human prostate stromal cell model that enabled us to study the effects of AR on gene expression in these cells. The model involves a genetically manipulated variant of immortalized human WPMY-1 prostate stromal cells that overexpresses wildtype AR (WPMY-AR) at a level comparable to LNCaP cells and is responsive to dihydrotestosterone (DHT) stimulation. Use of WPMY-AR cells for gene expression profiling showed that the presence of AR, even in the absence of DHT, significantly altered the gene expression pattern of the cells compared to control (WPMY-Vec) cells. Treatment of WPMY-AR cells, but not WPMY-Vec control cells, with DHT resulted in further changes that affected the expression of 141 genes by 2-fold or greater compared to vehicle treated WPMY-AR cells. Remarkably, DHT significantly downregulated more genes than were upregulated but many of these changes reversed the initial effects of AR overexpression alone on individual genes. The genes most highly effected by DHT treatment were categorized based upon their role in cancer pathways or in cell signaling pathways (transforming growth factor-β, Wnt, Hedgehog and MAP Kinase) thought to be involved in stromal-epithelial crosstalk during prostate or prostate cancer development. DHT treatment of WPMY-AR cells was also sufficient to alter their paracrine potential for prostate cancer cells as conditioned medium from DHT-treated WPMY-AR significantly increased growth of LNCaP cells compared to DHT-treated WPMY-Vec cell conditioned medium

Development Guidelines for Mobile Multiplayer Games

In the past decade the advances in mobile technology have produced new powerful genera-tions of mobile devices that come with ever-increasing computing powers and high-speed wireless connection technologies. It is more attractive than ever to develop mobile multiplayer games and many developers are straining to bring more and more multiplayer games into the market. However, there are not many concrete guidelines or helping-tools for developers programming and designing them. The purpose of this thesis is to investigate the relevant infrastructures of mobile multiplayer games and with the obtained results produce some development guidelines for the developers. Before the commencement of the investigation, the authors reviewed existing literatures using a structured review process. A search for relevant articles was conducted and the references used in the selected articles were searched in order to find additional relevant references for the investigation. There are many different factors and technical aspects to consider when developing mobile multiplayer games. For example different game genres have different prerequisites and it also governs the degree of complexity of the game design. It is important to also consider the dif-ferent mobile networks and the technical capabilities they encompass so that the developed game does not consume more bandwidth than is supported by the different mobile networks. The biggest hurdle to overcome when developing mobile multiplayer games is the issues re-garding network latency. There exist different approaches for handling this and they are brought up in the thesis. In the end of the thesis, guidelines are presented for facilitating the development of mobile multiplayer games.Under det senaste decenniet har stora tekniska framsteg skett inom mobil teknologi som har producerat nya kraftfulla generationer av mobiltelefoner. Det är mer attraktivt än någonsin att utveckla mobila multiplayer spel och många utvecklare kämpar med att få fler och fler mul-tiplayer spel på marknaden. Tyvärr så finns det inte många konkreta riktlinjer eller hjälpverk-tyg för utvecklare som programmerar och designar dem. Syftet med den här uppsatsen är att undersöka de relevanta infrastrukturerna för mobila mul-tiplayer spel och med de erhållna resultaten producera utvecklingsriktlinjer för utvecklare. Innan påbörjandet av undersökningen utförde författarna en sökning efter relevanta artiklar och de referenser som användes i de valda artiklarna söktes för att finna ytterligare relevanta referenser för undersökningen. Det finns många olika faktorer och tekniska aspekter att beakta när man utvecklar mobila multiplayer spel. Till exempel har olika spelgenrer olika förutsättningar och den valda genren har en inverkan på graden av komplexitet vid speldesignen. Det är viktigt att också beakta de olika mobilnät och de tekniska möjligheter som de besitter så att det utvecklade spelet inte förbrukar mer bandbredd än vad som stöds av de olika mobilnäten. Det största hindret att övervinna när man utvecklar mobila multiplayer spel är problem rörande nät latens. Det finns olika metoder för att hantera detta som tas upp i uppsatsen. I slutet av uppsatsen presenteras utvecklingsriktlinjer som är till för att förenkla utvecklingen av mobila multiplayer spel

Risk calculators and updated tools to select and plan a repeat biopsy for prostate cancer detection

Millions of men each year are faced with a clinical suspicion of prostate cancer (PCa) but the prostate biopsy fails to detect the disease. For the urologists, how to select the appropriate candidate for repeat biopsy is a significant clinical dilemma. Traditional risk-stratification tools in this setting such as prostate-specific antigen (PSA) related markers and histopathology findings have met with limited correlation with cancer diagnosis or with significant disease. Thus, an individualized approach using predictive models such as an online risk calculator (RC) or updated biomarkers is more suitable in counseling men about their risk of harboring clinically significant prostate cancer. This review will focus on the available risk-stratification tools in the population of men with prior negative biopsies and persistent suspicion of PCa. The underlying methodology and platforms of the available tools are reviewed to better understand the development and validation of these models. The index patient is then assessed with different RCs to determine the range of heterogeneity among various RCs. This should allow the urologists to better incorporate these various risk-stratification tools into their clinical practice and improve patient counseling