Can Virtual Reality assist the recoupling of theory and practice in Civil Engineering education?

Civil Engineering education is intended to prepare students for a career working in often large, dynamic and complex environments. Despite this,most education typically takes place in a classroom, with students engaging in learning conceptualised design processes while removed fromengaging with authentic and contextualised tasks. Problem-based learning (PBL), where students are encouraged to take an inquiry-led ratherthan instructed approach to learning is often recommended as a solution to re-connecting theory and practice. Deriving the problem to be solvedin PBL from real case studies from industry can add to authenticity. However, the scale and complexity of, for example, a working site, is difficultto replicate.Virtual Reality (VR) can offer a realistic immersive experience and appears to have potential to effectively augment PBL in Civil Engineering education. This paper explores how familiar current students are with VR technology and how useful they perceive it to be for education. The paper alsoseeks to understand whether a relatively cheap and accessible VR solution (navigable site tour captured using 360° photospheres, viewed usinga Google Cardboard-type device and smartphone) can improve a PBL learning experience. Students were asked to complete a design exerciseinvolving a large excavation. They were then invited to view a VR experience of an excavation of the same size in order for them to compare theirconceptualised design with the experience of the actual investigation. Thematic analysis of student responses after the VR experience showedstudent responses were positive, with themes of fun, realism, improved sense of presence and scale emerging as perceived benefits. It is concludedthat VR has good potential to improve PBL tasks in Civil Engineering education, however, it is identified that more research is required to understand whether VR in PBL can help to develop the spatial intelligence of classroom-taught students

Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation

Superior vena cava (SVC) perforation is a rare but potentially fatal complication of transvenous lead removal. The aim of this study was to evaluate the feasibility of hemodynamic stabilization using an occlusion balloon during SVC tear in a porcine model. A surgically induced SVC perforation was created in Yorkshire cross swine (n = 7). Three animals were used to develop and test surgical repair methods. Four animals were used to evaluate hemodynamic, behavioral, and neurological effects up to 5 days after SVC tear and repair. An occlusion balloon (Bridge Occlusion Balloon, Spectranetics Corporation, Colorado Springs, CO) was percutaneously delivered through the femoral vein to the location of the injury and inflated. Once hemodynamic control was achieved, the perforation was surgically repaired. After SVC perforation and clamp release, the rate of blood loss was 7.0 ± 0.8 mL/s. Mean time from SVC tear to occlusion balloon deployment was 55 ± 12 seconds, during which mean arterial pressure decreased from 56 ± 2 to 25 ± 3 mm Hg and heart rate decreased from 76 ± 7 to 62 ± 7 beats/min. After the deployment of the occlusion balloon, the rate of blood loss decreased by 90%, to 0.7 ± 0.2 mL/s. The mean time of balloon occlusion of the SVC was 16 ± 4 minutes and hemodynamic measures returned to baseline levels during this time. Study animals experienced no major complications, demonstrated stable recovery, and exhibited normal neurological function at each postoperative assessment. Endovascular temporary balloon occlusion may be a feasible option to reduce blood loss, maintain hemodynamic control, and provide a bridge to surgery after SVC injury

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

International audienc

Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures

International audienceBackgroundRight ventricle (RV) size and function assessment by echocardiography (echo) is a standard tool in the ICU. Frequently subjective assessment is performed, and guidelines suggest its utility in adequately trained clinicians. We aimed to compare subjective (visual) assessment of RV size and function by ICU physicians, with advanced qualifications in echocardiography, vs objective measurements.MethodsICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO(2) <300. Subjective assessments of RV size and function were made independently using a three-class categorical scale. Agreement (B-score) and bias (p value) were analysed using objective echo measurements. RV size assessment included RV end-diastolic area (EDA) and diameters. RV function assessment included fractional area change, S, TAPSE and RV free wall strain. Binary and ordinal analysis was performed.ResultsFifty-two clinicians reviewed 2D images from 80 patients. Fair agreement was seen with objective measures vs binary assessment of RV size (RV EDA 0.26 [p<0.001], RV dimensions 0.29 [p=0.06]) and function (RV free wall strain 0.27 [p<0.001], TAPSE 0.27 [p<0.001], S 0.29 [p<0.001], FAC 0.31 [p=0.16]). However, ordinal data analysis showed poor agreement with RV dimensions (0.11 [p=0.06]) and RV free wall strain (0.14 [p=0.16]). If one-step disagreement was allowed, agreement was good (RV dimensions 0.6 [p=0.06], RV free wall strain 0.6 [p=0.16]). Significant overestimation of severity of abnormalities was seen with subjective assessment vs RV EDA, TAPSE, S and fractional area change.ConclusionSubjective (visual) assessment of RV size and function, by ICU specialists trained in advanced echo, can be fairly reliable for the initial exclusion of significant RV pathology. It seems prudent to avoid subjective RV assessment in isolation