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The aim of this systematic review is to evaluate effect of simulation -based training on nurses' skills and knowledge. Searches were completed in December Two reviewers independently screened abstracts and full-text, extracted data, and assessed risk of bias. We compared simulation -based training to other learning strategies, high-fidelity simulation to other simulation strategies, and different organisation of simulation training.

Data were analysed through meta-analysis and narrative syntheses. GRADE was used to assess the quality of evidence. Fifteen RCTs met the inclusion criteria. For the comparison of simulation -based training to other learning strategies on nurses' skills, six studies in the meta-analysis showed a significant, but small effect in favour of simulation SMD For the other comparisons, there was large between- study variation in results. The quality of evidence for all comparisons was graded as low.

The effect of simulation -based training varies substantially between studies. Our meta-analysis showed a significant effect of simulation training compared to other learning strategies, but the quality of evidence was low indicating uncertainty.

Other comparisons showed inconsistency in results. Based on our findings simulation training appears to be an effective strategy to improve nurses' skills, but further good-quality RCTs with adequate sample sizes are needed. Systematic land climate and evapotranspiration biases in CMIP5 simulations. Here we evaluate the realism of simulated evapotranspiration ET , precipitation, and temperature in the CMIP5 multimodel ensemble on continental areas.

The global average overestimation amounts to 0. This bias is more pronounced than in the previous CMIP3 ensemble overestimation of 0. Consistent with the ET overestimation, precipitation is also overestimated relative to existing reference data sets.

We suggest that the identified biases in ET can explain respective systematic biases in temperature in many of the considered regions. The biases additionally display a seasonal dependence and are generally of opposite sign ET underestimation and temperature overestimation in boreal summer June-August. This research aims to design the factory layout of PT. Gunaprima Budiwijaya in order to increase production capacity.

The problem faced by this company is inappropriate layout causes cross traffic on the production floor. The re-layout procedure consist of these three steps: analysing the existing layout, designing plant layout based on SLP and evaluation and selection of alternative layout using Simulation Pro model version 6. Systematic layout planning is used to re-layout not based on the initial layout. This SLP produces four layout alternatives, and each alternative will be evaluated based on two criteria, namely cost of material handling using Material Handling Evaluation Sheet MHES and processing time by simulation.

The results showed that production capacity is increasing as much as Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. Objective: To explore how simulation models were used in the field of socioeconomic inequalities in health.

Methods: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified. As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed.

Results: We found 61 studies published between and Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly.

Discussion and Conclusions: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks.

Previous GCM studies have found that the systematic errors in the GCM simulation of the seasonal mean ITCZ intensity and location could be substantially corrected by adding suitable amount of rain re-evaporation or cumulus momentum transport. However, the reason s for these systematic errors and solutions has remained a puzzle. In this work the knowledge gained from previous studies of the ITCZ in an aqua-planet model with zonally uniform SST is applied to solve this puzzle.

The solution is supported by further aqua-planet and full model experiments using the latest version of the Goddard Earth Observing System GCM. ABSTRACT Purpose: To review the literature on simulation -based learning experiences and to examine their potential to have a positive impact on physiotherapy PT learners' knowledge, skills, and attitudes in entry-to-practice curricula.

Results: A total of abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula.

Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety. There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning.

Conclusions: Simulation -based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost—benefit analysis are necessary to help curriculum developers make informed choices in curriculum design.

The role of simulation in continuing medical education for acute care physicians: a systematic review. We systematically reviewed the effectiveness of simulation -based education, targeting independently practicing qualified physicians in acute care specialties. We also describe how simulation is used for performance assessment in this population.

The last date of search was January 31, All original research describing simulation -based education for independently practicing physicians in anesthesiology, critical care, and emergency medicine was reviewed.

Data analysis was performed in duplicate with further review by a third author in cases of disagreement until consensus was reached. Data extraction was focused on effectiveness according to Kirkpatrick's model. For simulation -based performance assessment, tool characteristics and sources of validity evidence were also collated.

Of 39 studies identified, 30 studies focused on the effectiveness of simulation -based education and nine studies evaluated the validity of simulation -based assessment. Simulation was unanimously described as a positive learning experience with perceived impact on clinical practice. Of the 17 remaining studies , 10 used a single group or "no intervention comparison group" design. Nine studies reported the psychometric properties of simulation -based performance assessment as their sole objective.

These predominantly recruited independent practitioners as a convenience sample to establish whether the tool could discriminate between experienced and inexperienced operators and concentrated on a single aspect of validity evidence. Simulation is perceived as a positive learning.

Simulation models in population breast cancer screening: A systematic review. The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling. A systematic literature search was performed to identify simulation models with more than one application. Predicted mortality reduction MR and cost-effectiveness CE were compared to estimates from meta-analyses of randomized control trials RCTs and acceptability thresholds.

Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression except one model with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled.

Only recently, potential harms due to regular breast cancer screening were reported. Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes.

Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening. A systematic Monte Carlo simulation study of the primitive model planar electrical double layer over an extended range of concentrations, electrode charges, cation diameters and valences.

We use canonical and grand canonical Monte Carlo simulations to compute the concentration profiles, from which the electric field and electrostatic potential profiles are obtained by solving Poisson's equation. The use of psychiatry-focused simulation in undergraduate nursing education: A systematic search and review. Evidence on the use of simulation to teach psychiatry and mental health including addiction content is emerging, yet no summary of the implementation processes or associated outcomes exists.

The aim of this study was to systematically search and review empirical literature on the use of psychiatry-focused simulation in undergraduate nursing education. Thirty-two simulation studies were identified describing and evaluating six types of simulations standardized patients, audio simulations , high-fidelity simulators , virtual world, multimodal, and tabletop.

Overall, participants were included in the studies. Studies reflected a limited number of intervention designs, and outcomes were evaluated with qualitative and quantitative methods incorporating a variety of tools. Results indicated that simulation was effective in reducing student anxiety and improving their knowledge, empathy, communication, and confidence.

The summarized qualitative findings all supported the benefit of simulation ; however, more research is needed to assess the comparative effectiveness of the types of simulations. Recommendations from the findings include the development of guidelines for educators to deliver each simulation component briefing, active simulation , debriefing. Finally, consensus around appropriate training of facilitators is needed, as is consistent and agreed upon simulation terminology.

Virtual reality-based simulators for spine surgery: a systematic review. Virtual reality VR -based simulators offer numerous benefits and are very useful in assessing and training surgical skills. Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery.

Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures. We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field.

This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery. Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery.

A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes. The initial review identified abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement.

This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored. Higher-quality studies with. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review.

Simulation -based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management CRM. This systematic review was conducted to gain a better understanding of the impact of simulation -based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes.

All studies that used simulation -based CRM teaching with outcomes measured at Kirkpatrick Level 3 transfer of learning to the workplace or 4 patient outcome were included. Studies measuring only learners' reactions or simple learning Kirkpatrick Level 1 or 2, respectively were excluded.

Two authors independently reviewed all identified titles and abstracts for eligibility. Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation -based CRM learning into the clinical setting Kirkpatrick Level 3. In three of these studies , simulation -enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes Kirkpatrick Level 4.

Only one of these studies found that simulation -based CRM training made a clearly significant impact on patient mortality. Based on a small number of studies , this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality.

To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence LoE and level of recommendation. Medline and EMBASE library databases were searched for English language articles published between and , describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education.

A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. Construct validation was the most frequent validation study attempted by authors. Orthopedic simulators are increasingly being subjected to validation studies , although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.

Published by Elsevier Inc. Snowplow Simulator Training Study. Specifically, it assesses a drivers evaluation of snowplow simulation training immediately after : training in fall and ag Current status of validation for robotic surgery simulators - a systematic review.

To analyse studies validating the effectiveness of robotic surgery simulators. References from retrieved articles were reviewed to broaden the search. The simulator name, training tasks, participant level, training duration and evaluation scoring were extracted from each study. We also extracted data on feasibility, validity, cost-effectiveness, reliability and educational impact. We identified 19 studies investigating simulation options in robotic surgery. There are five different robotic surgery simulation platforms available on the market.

In all, 11 studies sought opinion and compared performance between two different groups; 'expert' and 'novice'. Experts ranged in experience from robotic cases. The novice groups consisted of participants with no prior experience on a robotic platform and were often medical students or junior doctors. All of the simulators except SEP have shown educational impact. Feasibility and cost-effectiveness of simulation systems was not evaluated in any trial. Virtual reality simulators were shown to be effective training tools for junior trainees.

Simulation training holds the greatest potential to be used as an adjunct to traditional training methods to equip the next generation of robotic surgeons with the skills required to operate safely. However, current simulation models have only been validated in small studies.

There is no evidence to suggest one type of simulator provides more effective training than any other. More research is needed to validate simulated environments further and investigate the effectiveness of animal and cadaveric training in robotic surgery. Observer roles that optimise learning in healthcare simulation education: a systematic review. Simulation is widely used in health professional education. The convention that learners are actively involved may limit access to this educational method.

The aim of this paper is to review the evidence for learning methods that employ directed observation as an alternative to hands-on participation in scenario-based simulation training. We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation.

We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations.

A quality framework was used to rate the studies. Nine studies met the inclusion criteria. Five studies suggest learning outcomes in observer roles are as good or better than hands-on roles in simulation. Four studies document learner satisfaction in observer roles.

Five studies used a tool to guide observers. Eight studies involved observers in the debrief. Learning and satisfaction in observer roles is closely associated with observer tools, learner engagement, role clarity and contribution to the debrief. Learners that valued observer roles described them as affording an overarching view, examination of details from a distance, and meaningful feedback during the debrief. Learners who did not value observer roles. Objective: To systematically review the current literature of simulation in healthcare including the structured steps in the emergency healthcare sector by proposing a framework for simulation in the emergency department.

The inclusion criteria were to select English-written articles available in full text with the closest objectives from among a total of 54 articles retrieved from the databases. Subsequently, 11 articles were selected for further analysis. Results: The studies focused on the reduction of waiting time and patient stay, optimization of resources allocation, creation of crisis and maximum demand scenarios, identification of overcrowding bottlenecks, investigation of the impact of other systems on the existing system, and improvement of the system operations and functions.

Conclusion: The steps approach proposed on the basis of the selected studies provides simulation and planning specialists with a structured method for both analyzing problems and choosing best-case scenarios. Moreover, following this framework systematically enables the development of design processes as well as software implementation of simulation problems. To systematically review the current literature of simulation in healthcare including the structured steps in the emergency healthcare sector by proposing a framework for simulation in the emergency department.

For the purpose of collecting the data, PubMed and ACM databases were used between the years and The studies focused on the reduction of waiting time and patient stay, optimization of resources allocation, creation of crisis and maximum demand scenarios, identification of overcrowding bottlenecks, investigation of the impact of other systems on the existing system, and improvement of the system operations and functions.

Subsequently, 10 simulation steps were derived from the relevant studies after an expert's evaluation. The steps approach proposed on the basis of the selected studies provides simulation and planning specialists with a structured method for both analyzing problems and choosing best-case scenarios. Simulation training for breast and pelvic physical examination: a systematic review and meta-analysis.

Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges. To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination. Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities.

The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes. In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0.

Among breast examination simulation studies , dynamic models providing feedback were associated with improved outcomes. In pelvic examination simulation studies , the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes.

In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes. Enhanced feedback appears to improve learning. Human- simulation -based learning to prevent medication error: A systematic review.

In the past 2 decades, there has been an increasing interest in simulation -based learning programs to prevent medication error ME. To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients. However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME.

A systematic review was conducted on Medline from to June , associating the terms "Patient Simulation ," "Medication Errors," and " Simulation Healthcare. Twenty-one studies assessing simulation -based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals.

The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples.

These various experiences, however, help in identifying the key elements required for an effective human simulation -based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment. The performance of these programs depends on their ability to reflect reality and on professional guidance. Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities.

By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is. Mapping and simulating systematics due to spatially-varying observing conditions in DES science verification data. Spatially-varying depth and characteristics of observing conditions, such as seeing, airmass, or sky background, are major sources of systematic uncertainties in modern galaxy survey analyses, in particular in deep multi-epoch surveys.

We present a framework to extract and project these sources of systematics onto the sky, and apply it to the Dark Energy Survey DES to map the observing conditions of the Science Verification SV data. The resulting distributions and maps of sources of systematics are used in several analyses of DES SV to perform detailed null tests with the data, and also to incorporate systematics in survey simulations.

We show that the spatially-varying survey depth imprinted in the observed galaxy densities and the redshift distributions of the SV data are successfully reproduced by the simulation and well-captured by the maps of observing conditions. The combined use of the maps, the SV data and the BCC-UFig simulation allows us to quantify the impact of spatial systematics on N z , the redshift distributions inferred using photometric redshifts. We conclude that spatial systematics in the SV data are mainly due to seeing fluctuations and are under control in current clustering and weak lensing analyses.

However, they will need to be carefully characterised in upcoming phases of DES in order to avoid biasing the inferred cosmological results. The framework presented is relevant to all multi-epoch surveys, and will be essential for exploiting future surveys such as the Large Synoptic Survey Telescope, which will require detailed null-tests and realistic end-to-end image simulations to correctly interpret the deep, high.

Spatially varying depth and the characteristics of observing conditions, such as seeing, airmass, or sky background, are major sources of systematic uncertainties in modern galaxy survey analyses, particularly in deep multi-epoch surveys. The resulting distributions and maps of sources of systematics are used in several analyses of DES-SV to perform detailed null tests with the data, and also to incorporate systematics in survey simulations. We show that the spatially varying survey depth imprinted in the observed galaxy densities and the redshift distributions of the SV data are successfully reproduced by the simulation and are well-captured by the maps of observing conditions.

The combined use of the maps, the SV data, and the BCC-UFig simulation allows us to quantify the impact of spatial systematics on N z , the redshift distributions inferred using photometric redshifts. We conclude that spatial systematics in the SV data are mainly due to seeing fluctuations and are under control in current clustering and weak-lensing analyses.

However, they will need to be carefully characterized in upcoming phases of DES in order to avoid biasing the inferred cosmological results. The framework presented here is relevant to all multi-epoch surveys and will be essential for exploiting future surveys such as the Large Synoptic Survey Telescope, which will require detailed null tests and realistic end-to-end image simulations to correctly interpret the deep, high. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis.

Technology-enhanced simulation is used frequently in emergency medicine EM training programs. Evidence for its effectiveness, however, remains unclear. The objective of this study was to evaluate the effectiveness of technology-enhanced simulation for training in EM and identify instructional design features associated with improved outcomes by conducting a systematic review. Original research articles in any language were selected if they compared simulation to no intervention or another educational activity for the purposes of training EM health professionals including student and practicing physicians, midlevel providers, nurses, and prehospital providers.

Reviewers evaluated study quality and abstracted information on learners, instructional design curricular integration, feedback, repetitive practice, mastery learning , and outcomes. From a collection of 10, articles, 85 eligible studies enrolling 6, EM learners were identified. Of these, 56 studies compared simulation to no intervention, 12 compared simulation with another form of instruction, and 19 compared two forms of simulation.

Effect sizes were pooled using a random-effects model. Qualitative comparisons of different simulation curricula are limited, although feedback, mastery learning, and higher fidelity were associated with improved learning. Simulation -based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties.

However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training.

We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation , patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies , and case-control studies published between and Two independent reviewers W.

D conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional 3D synthetic models. A number of surgical specialties evaluated patient-specific simulation , including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology.

However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation -based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills.

State of the evidence on simulation -based training for laparoscopic surgery: a systematic review. Summarize the outcomes and best practices of simulation training for laparoscopic surgery. Simulation -based training for laparoscopic surgery has become a mainstay of surgical training.

Much new evidence has accrued since previous reviews were published. We systematically searched the literature through May for studies evaluating simulation , in comparison with no intervention or an alternate training activity, for training health professionals in laparoscopic surgery. Outcomes were classified as satisfaction, skills in a test setting of time to perform the task , process eg, performance rating , product eg, knot strength , and behaviors when caring for patients. We used random effects to pool effect sizes.

For example, in comparison with virtual reality, box trainers have similar effects for process skills outcomes and seem to be superior for outcomes of satisfaction and skills time. Simulation -based laparoscopic surgery training of health professionals has large benefits when compared with no intervention and is moderately more effective than nonsimulation instruction.

Investigating the impact of moulage on simulation engagement - A systematic review. Simulation Based Education SBE is used as a primer for clinical education in nursing and other health professions. Participant engagement strategies and good debriefing have been identified as key for effective simulations. The environment in which the simulation is situated also plays a large role in the degree of participant engagement.

Various cues are staged within simulations to enhance this engagement process. Moulage techniques are used in current-day simulation to mimic illnesses and wounds, acting as visual and tactile cues for the learner. To effectively utilise moulage in simulation , significant expense is required to train simulation staff and to purchase relevant equipment. Explore the use of moulage in simulation practice today and its influence on participant engagement.

Using a systematic process to extract papers, we reviewed the literature with a critical-realist lens. The majority of papers were situated in dermatology teaching, with only one nursing paper. Study participants were both undergraduate and postgraduate. Most of the studies were undertaken at a university setting. No papers comprehensively addressed whether the authenticity of moulage influences learner engagement. Results were limited, yet clearly outline a widely held assumption that moulage is essential in simulation -based education for improved realism and subsequent learner engagement.

Despite this. Use of simulation -based learning in undergraduate nurse education: An umbrella systematic review. An umbrella review review of reviews. Reviews of literature conducted between and regarding simulation -based education for pre-licensure nursing students.

The Joanna Briggs Institute methodology for conduct of an umbrella review was used to inform the review process. Twenty-five systematic reviews of literature were included, of which 14 were recent Most described the level of evidence of component studies as a mix of experimental and quasi-experimental designs.

The reviews measured around 14 different main outcome variables, thus limiting the number of primary studies that each individual review could pool to appraise. Many reviews agreed on the key learning outcome of knowledge acquisition, although no overall quantitative effect was derived. Three of four high-quality reviews found that simulation supported psychomotor development; a fourth found too few high quality studies to make a statistical comparison.

Simulation statistically improved self-efficacy in pretest-posttest studies , and in experimental designs self-efficacy was superior to that of other teaching methods; lower level research designs limiting further comparison. This umbrella review took a global view of 25 reviews of simulation research in nursing education, comprising over primary studies. To discern overall outcomes across reviews, statistical comparison of quantitative results effect size must be the key comparator.

Simulation -based education contributes to students' learning in a number of ways when integrated into pre. The lattice and off-lattice systems exhibit quite different self-assembly behavior at equivalent thermodynamic conditions. We found that in the weakly aggregating regime no preferred-size micelles , all models yield similar micelle size distributions at the same average aggregation number, albeit at different thermodynamic conditions temperatures. In the strongly aggregating regime, this mapping between models through temperature adjustment fails, and the models exhibit qualitatively different micellization behavior.

Incipient micellization in a model self-associating telechelic polymer solution results in a network with a transient elastic response that decays by a two-step relaxation: the first is due to a heterogeneous jump-diffusion process involving entrapment of end-groups within well-defined clusters and this is followed by rapid diffusion to neighboring clusters and a decay terminal relaxation due to cluster disintegration. The viscoelastic response of the solution manifests characteristics of a glass transition and entangled polymer network.

Conducting Simulation Studies in Psychometrics. Simulation studies are fundamental to psychometric discourse and play a crucial role in operational and academic research. Yet, resources for psychometricians interested in conducting simulations are scarce. Intra-protein information is transmitted over distances via allosteric processes. This ubiquitous protein process allows for protein function changes due to ligand binding events. Understanding protein allostery is essential to understanding protein functions.

In this study , allostery in the second PDZ domain PDZ2 in the human PTP1E protein is examined as model system to advance a recently developed rigid residue scan method combining with configurational entropy calculation and principal component analysis.

The contributions from individual residues to whole-protein dynamics and allostery were systematically assessed via rigid body simulations of both unbound and ligand-bound states of the protein. The entropic contributions of individual residues to whole-protein dynamics were evaluated based on covariance-based correlation analysis of all simulations.

Key residues of PDZ2 allostery were identified with good agreement with NMR studies of the same protein bound to the same peptide. On the other hand, the change of entropic contribution from each residue upon perturbation revealed intrinsic differences among all the residues. The quasi-harmonic and principal component analyses of simulations without rigid residue perturbation showed a coherent allosteric mode from unbound and bound states, respectively. The projection of simulations with rigid residue perturbation onto coherent allosteric modes demonstrated the intrinsic shifting of ensemble distributions supporting the population-shift theory of protein allostery.

Overall, the study presented here provides a robust and systematic approach to estimate the contribution of individual residue internal motion to overall protein dynamics and allostery. Update on simulation -based surgical training and assessment in ophthalmology: a systematic review.

This study reviews the evidence behind simulation -based surgical training of ophthalmologists to determine 1 the validity of the reported models and 2 the ability to transfer skills to the operating room. Simulation -based training is established widely within ophthalmology, although it often lacks a scientific basis for implementation. We conducted a systematic review of trials involving simulation -based training or assessment of ophthalmic surgical skills among health professionals.

Overall, the included trials were divided into animal, cadaver, inanimate, and virtual-reality models. Risk of bias was assessed using the Cochrane Collaboration's tool. Validity evidence was evaluated using a modern validity framework Messick's. We screened reports for eligibility and included trials. The most common surgery simulated was cataract surgery.

Only 2 trials 48 participants investigated transfer of skills to the operating room; 4 trials 65 participants evaluated the effect of simulation -based training on patient-related outcomes. Because of heterogeneity of the studies , it was not possible to conduct a quantitative analysis.

The methodologic rigor of trials investigating simulation -based surgical training in ophthalmology is inadequate. To ensure effective implementation of training models, evidence-based knowledge of validity and efficacy is needed. We provide a useful tool for implementation and evaluation of research in simulation -based training.

Simulation in International Studies. Social scientists have long worked to replicate real-world phenomena in their research and teaching environments. Unlike our biophysical science colleagues, we are faced with an area of study that is not governed by the laws of physics and other more predictable relationships. As a result, social scientists, and international studies scholars more…. A Simulated Stream Ecology Study. Describes a simulated field experience to study stream ecology in the classroom.

Secondary students determine the composition of the stream community, describe the distribution of the benthic invertebrates, and design a food web. Cost: the missing outcome in simulation -based medical education research: a systematic review.

The costs involved with technology-enhanced simulation remain unknown. Appraising the value of simulation -based medical education SBME requires complete accounting and reporting of cost. We sought to summarize the quantity and quality of studies that contain an economic analysis of SBME for the training of health professions learners. Articles reporting original research in any language evaluating the cost of simulation , in comparison with nonstimulation instruction or another simulation intervention, for training practicing and student physicians, nurses, and other health professionals were selected.

Reviewers working in duplicate evaluated study quality and abstracted information on learners, instructional design, cost elements, and outcomes. From a pool of 10, articles we identified comparative studies. Of these, 59 studies 6. Ten potential cost components were never reported. The median number of cost components reported per study was 2 range, Cost reporting in SBME research is infrequent and incomplete. We propose a comprehensive model for accounting and reporting costs in SBME.

Systematic versus random sampling in stereological studies. The sampling that takes place at all levels of an experimental design must be random if the estimate is to be unbiased in a statistical sense. There are two fundamental ways by which one can make a random sample of the sections and positions to be probed on the sections.

Using a card-sampling analogy, one can pick any card at all out of a deck of cards. This is referred to as independent random sampling because the sampling of any one card is made without reference to the position of the other cards.

The other approach to obtaining a random sample would be to pick a card within a set number of cards and others at equal intervals within the deck. Systematic sampling along one axis of many biological structures is more efficient than random sampling, because most biological structures are not randomly organized.

This article discusses the merits of systematic versus random sampling in stereological studies. Many astrophysical systems encompass very large dynamical ranges in space and time, which are not accessible by direct numerical simulations. Thus, idealized subvolumes are often used to study small-scale effects including the dynamics of turbulence. These turbulent boxes require an artificial driving in order to mimic energy injection from large-scale processes.

In this Letter, we show and quantify how the autocorrelation time of the driving and its normalization systematically change the properties of an isothermal compressible magnetohydrodynamic flow in the sub- and supersonic regime and affect astrophysical observations such as Faraday rotation. In general, we show that shorter autocorrelation times require more power in the acceleration field, which results in more power in compressive modes that weaken the anticorrelation between density and magnetic field strength.

Thus, derived observables, such as the line-of-sight LOS magnetic field from rotation measures, are systematically biased by the driving mechanism. Surgeons' and surgical trainees' acute stress in real operations or simulation : A systematic review. Acute stress in surgery is ubiquitous and has an immediate impact on surgical performance and patient safety.

Surgeons react with several coping strategies; however, they recognise the necessity of formal stress management training. Thus, stress assessment is a direct need. Surgical simulation is a validated standardised training milieu designed to replicate real-life situations.

It replicates stress, prevents biases, and provides objective metrics. The complexity of stress mechanisms makes stress measurement difficult to quantify and interpret. This systematic review aims to identify studies that have used acute stress estimation measurements in surgeons or surgical trainees during real operations or surgical simulation , and to collectively present the rationale of these tools, with special emphasis in salivary markers. Thirty-three studies were included in this systematic review.

The methods for acute stress assessment varied greatly among studies with the non-invasive techniques being the most commonly used. Subjective and objective tests for surgeons' acute stress assessment are being presented. There is a broad spectrum of acute mental stress assessment tools in the surgical field and simulation and salivary biomarkers have recently gained popularity. There is a need to maintain a consistent methodology in future research, towards a deeper understanding of acute stress in the surgical field.

Effect of simulation training on the development of nurses and nursing students' critical thinking: A systematic literature review. To gain insight into the existing scientific evidence on the effect of simulation on critical thinking in nursing education.

A systematic literature review of original research publications. Original research publications were eligible for review when they described simulation program directed on nursing student and nurses; used a control group or a pretest post-test design; and gave information about the effects of simulation on critical thinking.

Two reviewers independently assessed the studies for inclusion. Methodological quality of the included studies was also independently assessed by the reviewers, using a checklist developed by Greenhalgh et al. Data related to the original publications were extracted by one reviewer and checked by a second reviewer. No statistical pooling of outcomes was performed, due to the large heterogeneity of outcomes. After screening the titles and abstracts of papers, 16 ones were included in the review according to the inclusion criteria.

These used experimental or quasi-experimental designs. The studies used a variety of instruments and a wide range of simulation methods with differences in duration and numbers of exposures to simulation. Eight of the studies reported that simulation training positively affected the critical thinking skills. However, eight studies reported ineffectiveness of simulation on critical thinking. Studies are conflicting about the effect of simulation on nurses and nursing students' critical thinking.

Also, a large heterogeneity exists between the studies in terms of the instruments and the methods used. Thus, more studies with careful designs are needed to produce more credible evidence on the effectiveness of simulation on critical. Virtual reality VR simulators have become useful tools in various fields of medicine. Prominent uses of VR technologies include assessment of physician skills and presurgical planning.

VR has shown effectiveness in multiple surgical specialties, yet its use in neurosurgery remains limited. To examine all current literature on VR-based simulation for presurgical planning and training in cranial tumor surgeries and to assess the quality of these studies. The initial search identified articles. Thirty-seven full-text articles were assessed for inclusion.

Nine studies were included. These studies were subdivided into presurgical planning and training using VR. Prospects for VR are bright when surgical planning and skills training are considered. In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries. Further, VR has been central to establishing reproducible benchmarks of performance in relation to cranial tumor resection, which are helpful not only in showing face and construct validity but also in enhancing neurosurgical training in a way not previously examined.

We examine the relationship between three parameters of Type Ia supernovae SNe Ia : peak magnitude, rise time, and photospheric velocity at the time of peak brightness. The peak magnitude is corrected for extinction using an estimate determined from MLCS2k2 fitting. We model the relationship among these three parameters using an expanding fireball with two assumptions: a the optical emission is approximately that of a blackbody, and b the photospheric temperatures of all SNe Ia are the same at the time of peak brightness.

We compare the precision of the distance residuals inferred using this physically motivated model against those from the empirical Phillips relation and the MLCS2k2 method for 47 low-redshift SNe Ia 0. The role of integer-mode rational surface on peaked profile formation in toroidal rotation velocity and ion temperature.

A particular role of integer-mode rational surfaces on the formation of peaked T i r and V t r is observed. Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression.

Heart failure and increased arterial stiffness are associated with declining renal function. Few studies have evaluated the association between left ventricular ejection fraction LVEF and brachial-ankle pulse-wave velocity baPWV and renal function progression. Clinical and echocardiographic parameters were compared and analyzed. Resting multilayer 2D speckle-tracking TTE for detection of ischemic segments confirmed by invasive FFR part-2, using post- systolic -strain-index and time from aortic-valve-closure to regional peak longitudinal-strain.

This study evaluated the post- systolic strain index PSI , and the time interval between aortic valve closure AVC and regional peak longitudinal strain PLS , measured by transthoracic echocardiography TTE , for detection of left ventricular LV myocardial ischemic segments confirmed by invasive fractional flow reserve FFR.

However, the AUC values were not statistically significant. Impact of a systolic parameter, defined as the ratio of right brachial pre-ejection period to ejection time, on the relationship between brachial-ankle pulse wave velocity and left ventricular diastolic function.

Arterial stiffness is correlated with left ventricular LV diastolic function as well as susceptibility to LV systolic function. Therefore, if LV systolic function is not known, the relationship between arterial stiffness and LV diastolic function is difficult to determine. A total of patients were included in the study. Patients were classified into four groups. The LV ejection fractions in groups 1 and 3 were higher than those in groups 2 and 4 Pwave velocity to Ea that were comparable to those in groups 3 and 4.

Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at weeks of gestation. The aim of this study was to define from umbilical artery flow velocity waveforms absolute peak systolic and time-averaged velocity , fetal heart rate, fetal heart rate variability and flow velocity variability, and the relation between fetal heart rate and velocity variables in early pregnancy.

A total of women presenting with a normal pregnancy from 10 to 20 weeks of gestation consented to participate in a cross-sectional study design. Doppler ultrasound recordings were made from the free-floating loop of the umbilical cord. Umbilical artery peak systolic and time-averaged velocity increased at weeks, whereas fetal heart rate decreased at weeks of gestation and plateaued thereafter.

Umbilical artery peak systolic velocity variability and fetal heart rate variability increased at and weeks respectively. The inverse relationship between umbilical artery flow velocity and fetal heart rate at weeks of gestation suggests that the Frank-Starling mechanism regulates cardiovascular control as early as the late first and early second trimesters of pregnancy.

A different underlying mechanism is suggested for the observed variability profiles in heart rate and umbilical artery peak systolic velocity. It is speculated that heart rate variability is mediated by maturation of the parasympathetic nervous system, whereas peak systolic velocity variability reflects the activation of a haemodynamic feedback mechanism.

Comparison of peak flow velocity through the left ventricular outflow tract and effective orifice area indexed to body surface area in Golden Retriever puppies to predict development of subaortic stenosis in adult dogs. To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract LVOT Vmax and effective orifice area indexed to body surface area EOAi in puppies to predict development of subaortic stenosis SAS in the same dogs as adults.

Prospective, longitudinal, observational study. Cardiac auscultation and echocardiography were performed on 2- to 6-month-old puppies, then repeated at 12 to 18 months. All puppies with EOAi 2. Background: There is a limited knowledge about left atrial LA systolic force LASF and its key determinants in patients with asymptomatic mild-moderate aortic stenosis AS.

Methods: We used baseline clinic and echocardiographic data from 1, patients recruited in the simvastatin ezetimibe Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean Mitral E wave deceleration time to peak E velocity ratio and cardiovascular outcome in hypertensive patients during antihypertensive treatment from the LIFE echo-substudy.

We evaluated hypertensive patients Unadjusted Cox regression analysis showed a positive association between the baseline MDI and CV events hazard ratio 1. In the time-varied Cox models, a greater in-treatment MDI was associated with a greater rate of CV events hazard ratio 1. Normalization of DTE for E velocity might be preferred to other traditional diastolic function indexes in evaluating diastolic function during antihypertensive treatment The purpose of this study was to compare the effectiveness of 6-week training interventions using different modes of resistance traditional strength, plyometric, and combined training on sprinting and jumping performances in boys before and after peak height velocity PHV.

Eighty school-aged boys were categorized into 2 maturity groups pre- or post-PHV and then randomly assigned to a plyometric training, b traditional strength training, c combined training, or d a control group. Experimental groups participated in twice-weekly training programs for 6 weeks. Acceleration, maximal running velocity , squat jump height, and reactive strength index data were collected pre- and postintervention. All training groups made significant gains in measures of sprinting and jumping irrespective of the mode of resistance training and maturity.

Plyometric training elicited the greatest gains across all performance variables in pre-PHV children, whereas combined training was the most effective in eliciting change in all performance variables for the post-PHV cohort. Statistical analysis indicated that plyometric training produced greater changes in squat jump and acceleration performances in the pre-PHV group compared with the post-PHV cohort. All other training responses between pre- and post-PHV cohorts were not significant and not clinically meaningful.

The study indicates that plyometric training might be more effective in eliciting short-term gains in jumping and sprinting in boys who are pre-PHV, whereas those who are post-PHV may benefit from the additive stimulus of combined training. Assessment of regional systolic and diastolic myocardial function using tissue Doppler and strain imaging in dogs with dilated cardiomyopathy. Analysis of TDI and St features in dogs with overt DCM is a prerequisite before using these new criteria in prospective screenings of predisposed families or in clinical trials.

Case records for 26 dogs; 14 with DCM and 12 healthy controls of comparable age and weight were reviewed. A retrospective analysis was conducted of conventional echocardiography, 2-dimensional color TDI, and St imaging data. We find that the peak velocit Systolic hypertension in adult nigerians with hypertension.

To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. The total number of hypertensive patients treated over this period was also taken into consideration. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy LVH , heart failure, renal impairment etc. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients.

Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 7. There were 94 males and females. Seventy-seven One hundred and seventy-eight Twenty-nine Twenty-five Eleven 5. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined.

Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ. The experiments developed over the course of this project made it possible not only to study the fragmentation of uracil, thymine, adenine, and cytosine, but also to measure absolute cross sections for different ionization processes initiated by proton interactions with these important biological molecules.

Firstly, the experimental system enabled the contributions of two key ionization processes to be separated: direct ionization and electron capture. The corresponding mass spectra were measured and analyzed on an event-by-event basis. For uracil, the branching ratios for these two processes were measured as function of the projectile velocity.

Secondly, we have developed a system to measure absolute cross sections for the electron capture process. The production rate of neutral atoms compared to protons was measured for the four biological molecules: uracil, cytosine, thymine, and adenine at different vaporization temperatures. This production rate varies as a function of the thickness of the target jet traversed by the protons.

Accordingly, a deposit experiment was developed in order to characterize the density of molecules in the targeted gas jets. Theoretical and experimental study of the total effusion and density-profile of the gaseous molecular beams enabled us to deduce the thickness of the target jets traversed by the protons. Thus it was possible to determine absolute cross sections for the ionization of each of the four isolated biological molecules by 80 keV protons impact.

To our knowledge, this work provides the first experimental absolute cross sections for DNA and RNA base ionization processes initiated by proton impact in the velocity range corresponding to the Bragg peak. Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure. Previous studies comparing levosimendan vs. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered.

The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. The NYHA class improved in both groups, but improvements were prominent in the levosimendan group.

NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.

A 3-D version of the Transverse Oscillation TO method has previously been used to obtain this information in a carotid flow The full 3-D velocity profile can be created and examined at peak-systole and end-diastole without ECG gating in two planes. Maximum out-of-plane velocities for the three peak-systoles and end-diastoles were In the longitudinal plane, average maximum peak velocity in flow direction was This demonstrates that real-time 3-D Preliminary comparison between real-time in-vivo spectral and transverse oscillation velocity estimates.

Spectral velocity estimation is considered the gold standard in medical ultrasound. Angle correction is performed using a flow angle set manually. With Transverse Oscillation TO velocity estimates the flow angle This study investigates if these clinical parameters are estimated equally good using spectral and TO data.

The right common carotid arteries of three healthy volunteers were scanned longitudinally. Average TO flow Systolic pressure errors were defined and correlations with other specific values, like pressure rise time, pulse wave velocity , systolic pressure, augmentation, arm circumference and body mass index were calculated This paper reports a serendipitous observation of a significant ion yield in a post-ionization experiment conducted after the sample had been removed from a standard atmospheric pressure AP -MALDI source.

These observations contribute some new perspective to ion formation in both laser and laser-less matrix-assisted ionization. After the laser had been turned off and the MALDI sample removed, ions were detected during a gradual reduction of the background pressure in the first funnel.

The constant-rate pressure reduction led to the reproducible appearance of different singly and doubly charged peptide peaks in mass spectra taken a few seconds after the end of the MALDI analysis of a dried-droplet spot. The ion yield as well as the mass range of ions observed with a significant delay after a completion of the primary MALDI analysis depended primarily on the background pressure inside the first funnel.

The observations were partially consistent. Hyperbolic isometries of systolic complexes. The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles. Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal displace Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal In addition, we provide newexamples of systolic groups.

In the first article we show that the minimal displacement set of a hyperbolicisometry of a systolic complex is quasi-isometric to the product of a tree andthe real line. We use this theorem We find that the peak Similar, the Kp index per coronal hole area is highest for the coronal holes located near the solar equator and strongly decreases with increasing latitudes of the coronal holes.

We interpret Isolated systolic hypertension: A health concern? Is having a high top number systolic blood pressure, but a normal bottom number diastolic Isolated systolic hypertension can Systolic ventricular filling. The evidence of the ventricular myocardial band VMB has revealed unavoidable coherence and mutual coupling of form and function in the ventricular myocardium, making it possible to understand the principles governing electrical, mechanical and energetical events within the human heart.

From the earliest Erasistratus' observations, principal mechanisms responsible for the ventricular filling have still remained obscured. Contemporary experimental and clinical investigations unequivocally support the attitude that only powerful suction force, developed by the normal ventricles, would be able to produce an efficient filling of the ventricular cavities.

The true origin and the precise time frame for generating such force are still controversial. Elastic recoil and muscular contraction were the most commonly mentioned, but yet, still not clearly explained mechanisms involved in the ventricular suction. Classical concepts about timing of successive mechanical events during the cardiac cycle, also do not offer understandable insight into the mechanism of the ventricular filling.

The net result is the current state of insufficient knowledge of systolic and particularly diastolic function of normal and diseased heart. Here we summarize experimental evidence and theoretical backgrounds, which could be useful in understanding the phenomenon of the ventricular filling. Anatomy of the VMB, and recent proofs for its segmental electrical and mechanical activation, undoubtedly indicates that ventricular filling is the consequence of an active muscular contraction.

Contraction of the ascendent segment of the VMB, with simultaneous shortening and rectifying of its fibers, produces the paradoxical increase of the ventricular volume and lengthening of its long axis. Specific spatial arrangement of the ascendent segment fibers, their interaction with adjacent descendent segment fibers, elastic elements and intra-cavitary blood volume hemoskeleton , explain the physical principles.

Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: new insights in chronic heart failure. Tissue Doppler imaging TDI is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis.

We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure CHF with normal and reduced ejection fraction. One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction EF was obtained and longitudinal systolic S and diastolic E' and A' wall velocities were recorded from basal septum. The cut-off of ms for IVRT and 5.

These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition. Right ventricular systolic function in hypertensive heart failure.

Right ventricular RV dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters. Methodology: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls.

All study participants gave written informed consent, and had a full physical examination, blood investigations, lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults.

Keywords: right ventricle. We find that the peak velocities of high-speed streams depend strongly on both the areas and the co-latitudes of their solar source coronal holes with regard to the heliospheric latitude of the satellites. Therefore, the co-latitude of their source coronal hole is an important parameter for the prediction of the high-speed stream properties near the Earth.

We derive the largest solar wind peak velocities normalized to the coronal hole areas for coronal holes located near the solar equator and that they linearly decrease with increasing latitudes of the coronal holes. Similarly, the Kp index per coronal hole area is highest for the coronal holes located near the solar equator and strongly decreases with increasing latitudes of the coronal holes. We interpret these results as an effect of the three-dimensional propagation of high-speed streams in the heliosphere; that is, high-speed streams arising from coronal holes near the solar equator propagate in direction toward and directly hit the Earth, whereas solar wind streams arising from coronal holes at higher solar latitudes only graze or even miss the Earth.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study. To determine the role of peak systolic velocity , end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

The right and left inferior thyroid artery- peak systolic velocity , end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis 41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography.

The right and left inferior thyroid artery- peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease.

The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Systolic trees and systolic language recognition by tree automata. Culik II, J. Gruska, A. Salomaa and D. Wood have studied the language recognition capabilities of certain types of systolically operating networks of processors see research reports Cs, Cs and Cs, Univ.

In this paper, their model for systolic VLSI trees is formalised in terms of standard tree automaton theory, and the way in which some known facts about recognisable forests and tree transductions can be applied in VLSI tree theory is demonstrated. Age-related changes in aortic 3D blood flow velocities and wall shear stress: Implications for the identification of altered hemodynamics in patients with aortic valve disease.

Chris; Collins, Jeremy D. To investigate age-related changes in peak systolic aortic 3D velocity and wall shear stress WSS in healthy controls and to investigate the importance of age-matching for 3D mapping of abnormal aortic hemodynamics in bicuspid aortic valve disease BAV. Hyper- systolic matrix multiplication. A novel parallel algorithm for matrix multiplication is presented. It is based on a 1-D hyper- systolic processor abstraction.

The procedure can be implemented on all types of parallel systems. C Elsevier Science B,V. Accurate skeletal maturity assessment is important to guide clinical evaluation of idiopathic scoliosis, but commonly used methods are inadequate or too complex for rapid clinical use. The objective of the study was to propose a new simplified staging method, called the thumb ossification composite index TOCI , based on the ossification pattern of the 2 thumb epiphyses and the adductor sesamoid bone; to determine its accuracy in predicting skeletal maturation when compared with the Sanders simplified skeletal maturity system SSMS ; and to validate its interrater and intrarater reliability.

Hand radiographs of girls, acquired when they were newly diagnosed with idiopathic scoliosis prior to menarche and during longitudinal follow-up until skeletal maturity a minimum of 4 years , were scored with the TOCI and SSMS. These scores were compared with digital skeletal age DSA and radius, ulna, and small hand bones RUS scores; anthropometric data; peak height velocity ; and growth-remaining profiles.

Correlations were analyzed with the chi-square test, Spearman and Cramer V correlation methods, and receiver operating characteristic curve analysis. Reliability analysis using the intraclass correlation ICC was conducted. Six hundred and forty-five hand radiographs average, 5 of each girl were scored.

The new proposed TOCI could provide a simplified staging system for the assessment of skeletal maturity of subjects with idiopathic scoliosis. The index needs to be subjected to further multicenter validation in different ethnic groups. Left ventricular systolic and diastolic function in hyperthyroidism. In order to assess the effect of hyperthyroidism on systolic and diastolic function of the left ventricle, M-mode echocardiograms and systolic time intervals were obtained in 13 patients while they were clinically hyperthyroid and again when they were euthyroid following radioactive iodine therapy.

Echocardiographic tracings of the septum and left ventricular posterior wall were digitized and analyzed to provide the maximum velocity of shortening and maximum velocity of lengthening. These velocities were normalized for left ventricular diastolic dimension.

The left ventricular minor axis fractional shortening and the normalized maximum velocity of shortening were both increased during the hyperthyroid state. The normalized maximum velocity of lengthening, a measure of diastolic left ventricular function, was also increased during the hyperthyroid state when compared to the euthyroid state.

These data confirm the increased inotropic state and demonstrated increased diastolic relaxation velocities of the hyperthyroid left ventricle. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram.

Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. The mean time in which systolic peak velocity was recorded was This article reports a workshop which addressed several energy issues like the objectives and constraints of energy mix scenarios, the differences between the approaches in different countries, the cost of new technologies implemented for this purposes, how these technologies will be developed and marketed, which will be the environmental and societal acceptability of these technical choices.

Different aspects and issues have been more precisely presented and discussed: the peak oil, development of shale gases and their cost will non conventional hydrocarbons modify the peak oil and be socially accepted? Velocity and shear stress distribution downstream of mechanical heart valves in pulsatile flow. The velocity and turbulent shear stress profiles of the valves were determined by Laser Doppler anemometry in two different downstream axes within a model aortic root.

Depending on the individual valve design, velocity peaks up to 1. These shear stress peaks mainly occurred in areas of flow separation and intense momentum exchange. Directly downstream of the valves measuring axis 0. Shear stress levels were high at the borders of the fluid jets. The results are discussed from a fluid-dynamic point of view.

Impaired left ventricular systolic function reserve limits cardiac output and exercise capacity in HFpEF patients due to systemic hypertension. Despite having normal EF at rest, we hypothesize that these patients have abnormal systolic function reserve limiting their exercise capacity. Exercise capacity was determined as the workload divided by body surface area. HFpEF patients with hypertensive LV disease have significantly limited exercise capacity which is related to left atrial enlargement as well as compromised LV systolic function at the time of the symptoms.

The limited myocardial systolic function reserve seems to be underlying important explanation for their limited exercise capacity. Reducing maternal mortality: Systolic blood pressure. Mar 21, While deaths due to fluid overload have Promoting Healthy Life. Systolic automata for VLSI on balanced trees.

Systolic tree automata with a binary or, more generally, balanced underlying tree are investigated. The main emphasis is on input conditions, decidability, and characterization of acceptable languages. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease. One hundred ninety-eight outpatients with rheumatoid arthritis without overt cardiac disease were prospectively analyzed from January through June and compared with matched control subjects.

Of note, the idea to combine in the analysis longitudinal function came therefore well after the starting process of revision of the paper E and was, in some way inspired by a reviewer's comment. That is why we did not put both findings in the same paper. We think that our explanations provide the broad audience of your journal a perspective of transparency and our respect for the readers' right to understand how the work described in the paper J relates to other work by our research group.

Full Text Available Background: Atherosclerosis is a multifactor process in which several risk factors are involved. It is the leading cause of death and morbidity in hospital admitted patients, and it may cause a marked decrease in blood flow to all organs of the body. Objective: To determine the impact of systolic hypertension on cerebrovascular disease. Methods: A cross-sectional, observational and analytical study was conducted in 59 death patients who suffered from hypertension.

Cerebral arteries were analyzed and atherosclerotic lesion and its variety were quantified by using the atherometric system. The different types of hypertension were considered. Results: Recent strokes were more frequent in systodiastolic hypertensive patients. There was no significant difference in the injury onset age for both sexes, but women with systolic hypertension were significantly more damaged from a morphometric point of view. Significant correlation for both groups of hypertensive patients was observed between type of stroke and atherometric system variables.

Conclusions: Systolic hypertension is an important factor in the genesis of cerebrovascular disease and is associated with the progression of atherosclerotic plaque. Out of stroke-free patients, carotid stenosis Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth.

Elderly with asymptomatic carotid stenosis peak systolic velocities in ICA 0. Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure? Hydrotherapy exercise in warm water is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure.

We present a case of an elderly man who was recruited to participate in a hydrotherapy study. By contrast, right ventricular systolic velocity decreased from The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure.

Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction HFNEF remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes.

Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls.

However, systolic strain did not differ significantly between the two groups Effect of atrial systole on canine and porcine coronary blood flow. A feature of phasic coronary flow patterns recorded in conscious chronically instrumented dogs is the atrial cove--a transient depression of arterial flow that occurs during atrial systole.

The association between the hemodynamic effects of atrial systole and the atrial cove was studied in anesthetized dogs and pigs with complete heart block. Many atrial coves are available for study in these preparations because atrial activity continues unabated during the diastolic ventricular arrest that follows cessation of electrical pacing.

The effect of atrial systole is to translate the pressure-flow relation found during diastole to a higher intercept pressure without change in slope. The increase in the intercept pressure equals the increase in intramyocardial pressure measured with microtransducers embedded in the left ventricular wall. The decrement in flow during the atrial cove is a direct function of the change in intramyocardial pressure and an inverse function of coronary vascular resistance.

Each atrial systole is associated with a forward flow transient in the coronary veins, the peak of which occurs at the same instant as does the nadir of atrial flow. These data suggest that the coronary vessels are acting as collapsible tubes and that the waterfall model of the coronary circulation is applicable.

The following sequence is proposed to account for the atrial cove. Atrial systole ejects a bolus of blood into the left ventricle increasing both ventricular cavity and intramyocardial pressures. The increase in intramyocardial pressure raises the back pressure opposing coronary flow, reducing the arterial perfusion pressure gradient and causing flow to fall. Treatment of anemia with darbepoetin alfa in systolic heart failure.

Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome. Metabolic syndrome MetS is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular LV systolic dysfunction.

However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects.

A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.

The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure. However, it is often difficult to obtain adequate tricuspid regurgitation signals for measurement of PAPs, what could lead to its underestimation. Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts.

It is now recommended in the evaluation of patients with pulmonary hypertension. Physical activity is severely restricted in patients with PAH, being exertional dypnea the most typical symptom. Exercise stress echo-Doppler imaging allows assessment of the response to exercise.

It is an excellent screening test for patients with suspected PAH. Our purpose was to evaluate the value and accuracy of agitated saline with blood contrast echocardiography, in the improvement of the Doppler signal, to quantify PAPs during treadmill exercise-echocardiography.

Purpose To evaluate the value of contrast echocardiography, using agitated saline with blood, in the improvement of the Doppler signal used to quantify the pulmonary artery systolic pressure during exercise. Exercise echocardiography EE was begun, with evaluation of RV. Systolic hypertension: an increasing clinical challenge in Asia. Systolic hypertension, the predominant form of hypertension in patients aged over 50—60 years, is a growing health issue as the Asian population ages.

Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects.

Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs.

Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.

The aim of this study was to evaluate the systolic function of the left atrial appendage LAA in a group with and without patent foramen ovale PFO who suffered ischemic cerebrovascular events. Between September and October , 17 patients were referred for transesophageal echocardiography TEE after suffering a stroke.

PFO was defined as the passage of at least one bubble through atrial septum with bubble test. We compared systolic velocity in the appendage between patients with and without PFO and a control group. Were 8 women and 9 men, mean age All patients had suffered a ischemic cerebrovascular events, In the assessment of TEE, Mean LAA systolic velocity was The control group of 8 patients, 5 women and 3 men, mean age There were no differences in systolic function of the LAA between patients with and without PFO with ischemic cerebrovascular event.

Velocity Dispersions Across Bulge Types. We present first results from a long-slit spectroscopic survey of bulge kinematics in local spiral galaxies. We find that the velocity dispersion profiles in morphological classical bulge galaxies are always centrally peaked while the velocity dispersion of morphologically disk-like bulges stays relatively flat towards the center--once strongly barred galaxies are discarded.

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy. We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular LV myocardial contraction pattern in patients with hypertrophic cardiomyopathy HCM , and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension HT.

Similar but less distinct results were obtained in the circumferential direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity , and severe systolic anterior motion of the mitral valve.

The patients' symptoms were Diastolic effects of chronic digitalization in systolic heart failure. The efficacy of short-term digitalization on exercise tolerance may, in part, reflect enhanced diastolic performance. To detect any time-dependent adverse effect, we assessed the diastolic function after long-term use of digitalis in patients with mild to moderate systolic left ventricular failure.

From a cohort of 80 patients who received long-term, randomized, double-blind treatment with digitalis versus placebo at the WJB Dorn Veterans Affairs Medical Center, 38 survivors were evaluated at the end of follow-up mean Each survivor underwent equilibrium scintigraphic and echocardiographic assessment of diastolic function. Peak and mean filling rates normalized with filling volume FV , diastolic phase durations normalized with duration of diastole, and filling fractions were measured from the time-activity curve.

The isovolumic relaxation period and ventricular dimensions were computed echocardiographically. By actual-treatment-received analysis, treated versus untreated patients manifested a trend toward longer isovolumic relaxation In addition, treated patients exhibited a lower mean rate of rapid filling 2. However, the end-diastolic ventricular dimension did not differ between the 2 groups.

Similar results were obtained by intention-to-treat analysis. After long-term digitalization for systolic left ventricular failure, cross-sectional comparison with a control group. MR measurement of coronary arterial blood flow velocity. Evaluation of age, stenosis and drugs as factors affecting coronary blood flow. Coronary arterial blood flow velocity was measured using MRI. Two types of phase contrast methods were used for the measurements, one of which exhibited good resolving power whereas the other provided more distinct images acquired while the subject patients held their breath.

Before measuring coronary arterial blood flow velocity , accuracy of the two phase contrast methods was evaluated using a phantom. The results obtained with both methods largely agreed with the values obtained using the phantom. Using both methods, the patterns of coronary arterial blood flow over one cardiac cycle were essentially identical. A peak was noted in late systole or in early diastole in the right coronary artery, whereas in the left coronary artery, a peak was noted somewhat later in diastole.

In healthy volunteers, no significant difference in the maximal flow velocity in the coronary arteries was found from one age group to another. Among patients with coronary arterial stenosis, coronary arterial blood flow velocity central to the area of stenosis was lower than that observed in the healthy volunteers. Coronary arterial blood flow velocity was observed to decrease after administration of isosorbide dinitrate and increased following administration of nifedipine.

Pulmonary branch arterial flow can be measured with cine MR velocity mapping. This paper assesses the capability of cine MR phase velocity mapping CVM to measure main, right-sided, and left-sided pulmonary arterial PA blood flow. The authors examined a constant-flow phantom and nine healthy volunteers with use of 1. Noninvasive calculation of the aortic blood pressure waveform from the flow velocity waveform: a proof of concept.

Estimation of aortic and left ventricular LV pressure usually requires measurements that are difficult to acquire during the imaging required to obtain concurrent LV dimensions essential for determination of LV mechanical properties. We describe a novel method for deriving aortic pressure from the aortic flow velocity. The target pressure waveform is divided into an early systolic upstroke, determined by the water hammer equation, and a diastolic decay equal to that in the peripheral arterial tree, interposed by a late systolic portion described by a second-order polynomial constrained by conditions of continuity and conservation of mean arterial pressure.

Pulse wave velocity PWV, which can be obtained through imaging , mean arterial pressure, diastolic pressure, and diastolic decay are required inputs for the algorithm. Similarly, for experimental data, pressure reconstructed from measured flow agreed well with measured pressure mean RMS error 2. This is the first noninvasive derivation of aortic pressure based on fluid dynamics flow and wave speed in the. Peak Experience Project.

This paper emerges from the continued analysis of data collected in a series of international studies concerning Childhood Peak Experiences CPEs based on developments in understanding peak experiences in Maslow's hierarchy of needs initiated by Dr Edward Hoffman. Bridging from the series of studies, Canadian researchers explore collected…. Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction.

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction Celular em Cardiopatias - Chagas heart disease arm.

In the mean The mean ejection fraction was Validation of subclavian duplex velocity criteria to grade severity of subclavian artery stenosis. Validation of subclavian duplex ultrasound velocity criteria SDUS VC to grade the severity of subclavian artery stenosis has not been established or systematically studied.

Currently, there is a paucity of published literature and lack of practitioner consensus for how subclavian duplex velocity findings should be interpreted in patients with subclavian artery stenosis. The objective of the present study was to validate SDUS measurements using subclavian conventional or computed tomography angiogram subclavian angiogram [SA] -derived measurements.

This is a retrospective review of all patients with suspected subclavian artery stenosis and a convenience sample of carotid artery patients who underwent SDUS and SA from May to July Percent stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial method for detecting stenosis in a sufficiently large cohort.

Velocity cutoff points were determined with equal weighting of sensitivity and specificity. We examined arteries for patients. The majority of the arteries were for female patients Twenty-three arteries had retrograde vertebral artery flow and excluded from further analysis. For the remaining arteries, the average peak systolic velocity was Average stenosis was Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction.

The presence of LV diastolic dysfunction with preserved The contribution of diastolic dysfunction in patients with preserved left ventricular LV systolic function to impaired functional status and cardiac mortality in myocardial infarction MI is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis Peak -interviewet. Fokuspersonen den interviewede interviewes om en selvvalgt, personlig succesoplevelse.

The geomorphic structure of the runoff peak. Full Text Available This paper develops a theoretical framework to investigate the core dependence of peak flows on the geomorphic properties of river basins. Based on the theory of transport by travel times, and simple hydrodynamic characterization of floods, this new framework invokes the linearity and invariance of the hydrologic response to provide analytical and semi-analytical expressions for peak flow, time to peak , and area contributing to the peak runoff.

These results are obtained for the case of constant-intensity hyetograph using the Intensity-Duration-Frequency IDF curves to estimate extreme flow values as a function of the rainfall return period. Results show that, with constant-intensity hyetographs, the time-to- peak is greater than rainfall duration and usually shorter than the basin concentration time.

Moreover, the critical storm duration is shown to be independent of rainfall return period as well as the area contributing to the flow peak. The same results are found when the effects of hydrodynamic dispersion are accounted for. Further, it is shown that, when the effects of hydrodynamic dispersion are negligible, the basin area contributing to the peak discharge does not depend on the channel velocity , but is a geomorphic propriety of the basin.

As an example this framework is applied to three watersheds. In particular, the runoff peak , the critical rainfall durations and the time to peak are calculated for all links within a network to assess how they increase with basin area. Right ventricular systolic and diastolic function at rest in patients with coronary artery disease.

Right ventricular systolic and diastolic function was studied in patients with ischemic heart disease using equilibrium radionuclide ventriculography. In patients with inferior myocardial infarction and proximal right coronary lesions, the right ventricular ejection fraction 0.

CRYPTOCURRENCY COMPANIES THAT BUY

Our analysis demonstrated that increasing. To identify current trends in the use of validity frameworks in surgical simulation , to provide an overview of the evidence behind the assessment of technical skills in all surgical specialties, and to present recommendations and guidelines for future validity studies. Validity evidence for assessment tools used in the evaluation of surgical performance is of paramount importance to ensure valid and reliable assessment of skills.

We included original studies evaluating simulation -based assessments of health professionals in surgical specialties and extracted data on surgical specialty, simulator modality, participant characteristics, and the validity framework used. Data were synthesized qualitatively. We identified studies with a total of 18, participants. Only 6. The majority of studies used outdated frameworks such as face validity.

Significant differences were identified across surgical specialties. The evaluated assessment tools were mostly inanimate or virtual reality simulation models. An increasing number of studies have gathered validity evidence for simulation -based assessments in surgical specialties, but the use of outdated frameworks remains common.

To address the current practice, this paper presents guidelines on how to use the contemporary validity framework when designing validity studies. Song and U. Heinz, Phys. Song, Ph. Changing other model parameters does not appear to permit dissolution of this tension. B , ; H. C 77, ; H. This research report describes: 1 the FAA's ATP airman certification system; 2 needs of the system regarding simulator use; 3 a systematic methodology for meeting these needs; 4 application of the methodology; 5 results of the study ; and The aim is to provide a complete overview of the different simulation -based training options for abdominal ultrasound and to explore the evidence of their effect.

Articles were divided into three categories based on study design randomized controlled trials, before-and-after studies and descriptive studies and assessed for level of evidence using the Oxford Centre for Evidence Based Medicine OCEBM system and for bias using the Cochrane Collaboration risk of bias assessment tool. Seventeen studies were included in the analysis: four randomized controlled trials, eight before-and-after studies with pre- and post-test evaluations, and five descriptive studies.

No studies scored the highest level of evidence, and 14 had the lowest level. Bias was high for 11 studies , low for four, and unclear for two. No studies used a test with established evidence of validity or examined the correlation between obtained skills on the simulators and real-life clinical skills. Only one study used blinded assessors.

The included studies were heterogeneous in the choice of simulator , study design, participants, and outcome measures, and the level of evidence for effect was inadequate. In all studies simulation training was equally or more beneficial than other instructions or no instructions. Study designs had significant built-in bias and confounding issues; therefore, further research should be based on randomized controlled trials using tests with validity evidence and blinded assessors. Structure of spherical electric double layers with fully asymmetric electrolytes: a systematic study by Monte Carlo simulations and density functional theory.

A systematic investigation of the spherical electric double layers with the electrolytes having size as well as charge asymmetry is carried out using density functional theory and Monte Carlo simulations. The system is considered within the primitive model, where the macroion is a structureless hard spherical colloid, the small ions as charged hard spheres of different size, and the solvent is represented as a dielectric continuum.

The present theory approximates the hard sphere part of the one particle correlation function using a weighted density approach whereas a perturbation expansion around the uniform fluid is applied to evaluate the ionic contribution. The theory is in quantitative agreement with Monte Carlo simulation for the density and the mean electrostatic potential profiles over a wide range of electrolyte concentrations, surface charge densities, valence of small ions, and macroion sizes.

The theory provides distinctive evidence of charge and size correlations within the electrode-electrolyte interface in spherical geometry. Simulated learning environment SLE in audiology education: A systematic review. To systematically review the relevant peer-review literature investigating the outcome of simulated learning environment SLE training in audiology education.

A systematic review research design. Fifteen databases were searched with four studies meeting the inclusion criteria. Three of the four studies revealed positive findings for the use of an SLE that is, the SLE group showed a higher post-training score compared to the traditional training group or a significantly higher post-training score than the non-training groups.

One study revealed negative findings where the traditional training group showed a significantly higher post-training score than the SLE group. In addition, both the studies comparing post- and pre-training scores reported significantly higher post-training scores than the pre-training scores of the participants that underwent SLE training.

Overall, this review supports the notions that SLE training is an effective learning tool and can be used for basic clinical training. This conclusion should be treated with caution, considering the limited numbers of studies published in this area and future research should be conducted to cope with the gaps highlighted in this review. A systematic review of validated sinus surgery simulators. Simulation provides a safe and effective opportunity to develop surgical skills. A variety of endoscopic sinus surgery ESS simulators has been described in the literature.

Validation of these simulators allows for effective utilisation in training. To conduct a systematic review of the published literature to analyse the evidence for validated ESS simulation. Pubmed, Embase, Cochrane and Cinahl were searched from inception of the databases to 11 January Twelve thousand five hundred and sixteen articles were retrieved of which 10 were screened following the removal of duplicates.

Thirty-eight full-text articles were reviewed after meeting search criteria. Evidence of face, content, construct, discriminant and predictive validity was extracted. Twenty articles were included in the analysis describing 12 ESS simulators. Eleven of these simulators had undergone validation: 3 virtual reality, 7 physical bench models and 1 cadaveric simulator.

Seven of the simulators were shown to have face validity, 7 had construct validity and 1 had predictive validity. None of the simulators demonstrated discriminate validity. This systematic review demonstrates that a number of ESS simulators have been comprehensively validated. Many of the validation processes, however, lack standardisation in outcome reporting, thus limiting a meta-analysis comparison between simulators. Systematic review on mentoring and simulation in laparoscopic colorectal surgery.

To identify and evaluate the influence of mentoring and simulated training in laparoscopic colorectal surgery LCS and define the key components for learning advanced technical skills. Laparoscopic colorectal surgery is a complex procedure, often being self-taught by senior surgeons.

Educational issues such as inadequate training facilities or a shortfall of training fellowships may result in a slow uptake of LCS. The effectiveness of mentored and simulated training, however, remains unclear. We conducted a systematic search, using Ovid databases. Four study categories were identified: mentored versus nonmentored cases, training case selection, simulation , and assessment.

We performed a meta-analysis and a mixed model regression on the difference of the main outcome measures conversion rates, morbidity, and mortality for mentored trainees and expert surgeons. We also compared conversion rates of mentored and nonmentored.

Meta-analysis of risk factors for conversion was performed using published and unpublished data sets requested from various investigators. For studies on simulation , we compared scores of surveys on the perception of different training courses. Thirty-seven studies were included.

Results are summarized of the simulation verification techniques study which consisted of two tasks: to develop techniques for simulator hardware checkout and to develop techniques for simulation performance verification validation.

The hardware verification task involved definition of simulation hardware hardware units and integrated simulator configurations , survey of current hardware self-test techniques, and definition of hardware and software techniques for checkout of simulator subsystems. The performance verification task included definition of simulation performance parameters and critical performance parameters , definition of methods for establishing standards of performance sources of reference data or validation , and definition of methods for validating performance.

Both major tasks included definition of verification software and assessment of verification data base impact. An annotated bibliography of all documents generated during this study is provided. Numerous studies examine simulation modelling in healthcare. These studies present a bewildering array of simulation techniques and applications, making it challenging to characterise the literature. The aim of this paper is to provide an overview of the level of activity of simulation modelling in healthcare and the key themes.

We performed an umbrella review of systematic literature reviews of simulation modelling in healthcare. The articles were included if they performed a systematic review of simulation modelling techniques in healthcare. After quality assessment of all included articles, data were extracted on numbers of studies included in each review, types of applications, techniques used for simulation modelling, data sources and simulation software.

The search strategy yielded a total of potential articles. Following sifting, 37 heterogeneous reviews were included. All the review articles described the types of applications used for simulation modelling; 15 reviews described techniques used for simulation modelling; three reviews described data sources used for simulation modelling; and six reviews described software used for simulation modelling. The remaining reviews either did not report or did not provide enough detail for the data to be extracted.

Simulation modelling techniques have been used for a wide range of applications in healthcare, with a variety of software tools and data sources. The number of reviews published in recent years suggest an increased interest in simulation modelling in healthcare. Airblast Simulator Studies. During the course of this study. Direct numerical simulation of flow over dissimilar, randomly distributed roughness elements: A systematic study on the effect of surface morphology on turbulence.

Direct numerical simulations are used to investigate turbulent flow in rough channels, in which topographical parameters of the rough wall are systematically varied at a fixed friction Reynolds number of , based on a mean channel half-height h and friction velocity.

The utilized roughness generation approach allows independent variation of moments of the surface height probability distribution function [thus root-mean-square rms surface height, skewness, and kurtosis], surface mean slope, and standard deviation of the roughness peak sizes. All calculations are done in the fully rough regime and for surfaces with high slope effective slope equal to 0.

The rms roughness height is fixed for all cases at 0. The goal of the paper is twofold: first, to investigate the possible effect of topographical parameters on the mean turbulent flow, Reynolds, and dispersive stresses particularly in the vicinity of the roughness crest, and second, to investigate the possibility of using the wall-normal turbulence intensity as a physical parameter for parametrization of the flow.

Such a possibility, already suggested for regular roughness in the literature, is here extended to irregular roughness. Systematic study of magnetar outbursts. We present the results of the systematic study of all magnetar outbursts observed to date through a reanalysis of data acquired in about X-ray observations. We track the temporal evolution of the luminosity for all these events, model empirically their decays, and estimate the characteristic decay time-scales and the energy involved.

We study the link between different parameters maximum luminosity increase, outburst peak luminosities, quiescent X-ray and bolometric luminosities, energetics, decay time-scales, magnetic field, spin-down luminosity and age , and reveal several correlations between different quantities.

We discuss our results in the framework of the models proposed to explain the triggering mechanism and evolution of magnetar outbursts. Simulation training: a systematic review of simulation in arthroscopy and proposal of a new competency-based training framework. Traditional orthopaedic training has followed an apprenticeship model whereby trainees enhance their skills by operating under guidance.

However the introduction of limitations on training hours and shorter training programmes mean that alternative training strategies are required. To perform a literature review on simulation training in arthroscopy and devise a framework that structures different simulation techniques that could be used in arthroscopic training.

The majority of the studies demonstrated construct and transference validity but only one showed concurrent validity. More studies are required to assess its potential as a training and assessment tool, skills transference between simulators and to determine the extent of skills decay from prolonged delays in training. We also devised a "ladder of arthroscopic simulation " that provides a competency-based framework to implement different simulation strategies.

The incorporation of simulation into an orthopaedic curriculum will depend on a coordinated approach between many bodies. But the successful integration of simulators in other areas of surgery supports a possible role for simulation in advancing orthopaedic education.

Published by Elsevier Ltd. All rights reserved. Systematic review of skills transfer after surgical simulation -based training. Simulation -based training assumes that skills are directly transferable to the patient-based setting, but few studies have correlated simulated performance with surgical performance.

A systematic search strategy was undertaken to find studies published since the last systematic review, published in Inclusion of articles was determined using a predetermined protocol, independent assessment by two reviewers and a final consensus decision. Studies that reported on the use of surgical simulation -based training and assessed the transferability of the acquired skills to a patient-based setting were included.

Twenty-seven randomized clinical trials and seven non-randomized comparative studies were included. Fourteen studies investigated laparoscopic procedures, 13 endoscopic procedures and seven other procedures. These studies provided strong evidence that participants who reached proficiency in simulation -based training performed better in the patient-based setting than their counterparts who did not have simulation -based training. Simulation -based training was equally as effective as patient-based training for colonoscopy, laparoscopic camera navigation and endoscopic sinus surgery in the patient-based setting.

These studies strengthen the evidence that simulation -based training, as part of a structured programme and incorporating predetermined proficiency levels, results in skills transfer to the operative setting. The use of simulation in neurosurgical education and training. A systematic review. There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions.

Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty.

To their knowledge this is the first systematic review published on this topic to date. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations. Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures.

Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design.

Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes. A systematic review of surgical skills transfer after simulation -based training: laparoscopic cholecystectomy and endoscopy.

A systematic review to determine whether skills acquired through simulation -based training transfer to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy. Simulation -based training assumes that skills are directly transferable to the operation room, but only a few studies have investigated the effect of simulation -based training on surgical performance.

A systematic search strategy that was used in was updated to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Seventeen randomized controlled trials and 3 nonrandomized comparative studies were included in this review.

In most cases, simulation -based training was in addition to patient-based training programs. Only 2 studies directly compared simulation -based training in isolation with patient-based training. Not all parameters measured were improved. Two of the endoscopic studies compared simulation -based training in isolation with patient-based training with different results: for sigmoidoscopy, patient-based training was more effective, whereas for colonoscopy, simulation -based training was equally effective.

Skills acquired by simulation -based training seem to be transferable to the operative setting for laparoscopic cholecystectomy and endoscopy. Future research will strengthen these conclusions by evaluating predetermined competency levels on the same simulators and using objective validated global rating scales to measure operative performance.

We present the results of the systematic study of all magnetar outbursts observed to date, through a reanalysis of data acquired in about X-ray observations. We track the temporal evolution of the outbursts' soft X-ray spectral properties and the luminosities of the single spectral components as well as of the total emission.

We model empirically all outburst light curves, and estimate the characteristic decay time-scales as well as the energetics involved. We investigate the link between different parameters e. We discuss our results in the context of the internal crustal heating and twisted bundle models for magnetar outbursts. Simulated presence therapy for dementia: a systematic review protocol.

The majority of patients with dementia develop behavioural and psychological symptoms of dementia BPSD. Non-pharmacological interventions are an appealing alternative for the treatment of BPSD in patients with dementia. We propose a Cochrane protocol for the collection and assessment of evidence concerning the efficacy of SPT to treat relevant outcomes in people with dementia. We will include randomised and quasi-randomised controlled trials including cross-over studies that evaluated SPT in people with dementia.

Comparators such as usual care with no additional activity, or any activity that differs in content and approach from SPT, but is additional to usual care, will be considered. The primary outcomes of interest will comprise behavioural and psychological symptoms, as measured by relevant scales, and quality of life. Two review authors working independently and in tandem will be involved in title and abstract screening, full-text screening and data abstraction.

Assessment of risk of bias will be performed using the Cochrane risk-of-bias tool and the Grades of Recommendation, Assessment, Development and Evaluation approach. Ethics approval is not required. The final results of this systematic review will be presented to the Cochrane Library and will also be disseminated at relevant conference presentations.

For permission to use where not already granted under a. Simulation -based training for nurses: Systematic review and meta-analysis. Simulation -based training is a widespread strategy to improve health-care quality. However, its effect on registered nurses has previously not been established in systematic reviews.

The aim of this systematic review is to evaluate effect of simulation -based training on nurses' skills and knowledge. Searches were completed in December Two reviewers independently screened abstracts and full-text, extracted data, and assessed risk of bias. We compared simulation -based training to other learning strategies, high-fidelity simulation to other simulation strategies, and different organisation of simulation training. Data were analysed through meta-analysis and narrative syntheses.

GRADE was used to assess the quality of evidence. Fifteen RCTs met the inclusion criteria. For the comparison of simulation -based training to other learning strategies on nurses' skills, six studies in the meta-analysis showed a significant, but small effect in favour of simulation SMD For the other comparisons, there was large between- study variation in results.

The quality of evidence for all comparisons was graded as low. The effect of simulation -based training varies substantially between studies. Our meta-analysis showed a significant effect of simulation training compared to other learning strategies, but the quality of evidence was low indicating uncertainty. Other comparisons showed inconsistency in results. Based on our findings simulation training appears to be an effective strategy to improve nurses' skills, but further good-quality RCTs with adequate sample sizes are needed.

Systematic land climate and evapotranspiration biases in CMIP5 simulations. Here we evaluate the realism of simulated evapotranspiration ET , precipitation, and temperature in the CMIP5 multimodel ensemble on continental areas. The global average overestimation amounts to 0. This bias is more pronounced than in the previous CMIP3 ensemble overestimation of 0. Consistent with the ET overestimation, precipitation is also overestimated relative to existing reference data sets. We suggest that the identified biases in ET can explain respective systematic biases in temperature in many of the considered regions.

The biases additionally display a seasonal dependence and are generally of opposite sign ET underestimation and temperature overestimation in boreal summer June-August. This research aims to design the factory layout of PT. Gunaprima Budiwijaya in order to increase production capacity. The problem faced by this company is inappropriate layout causes cross traffic on the production floor. The re-layout procedure consist of these three steps: analysing the existing layout, designing plant layout based on SLP and evaluation and selection of alternative layout using Simulation Pro model version 6.

Systematic layout planning is used to re-layout not based on the initial layout. This SLP produces four layout alternatives, and each alternative will be evaluated based on two criteria, namely cost of material handling using Material Handling Evaluation Sheet MHES and processing time by simulation. The results showed that production capacity is increasing as much as Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels.

Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. Objective: To explore how simulation models were used in the field of socioeconomic inequalities in health. Methods: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified.

As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed. Results: We found 61 studies published between and Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly.

Discussion and Conclusions: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks.

Previous GCM studies have found that the systematic errors in the GCM simulation of the seasonal mean ITCZ intensity and location could be substantially corrected by adding suitable amount of rain re-evaporation or cumulus momentum transport. However, the reason s for these systematic errors and solutions has remained a puzzle.

In this work the knowledge gained from previous studies of the ITCZ in an aqua-planet model with zonally uniform SST is applied to solve this puzzle. The solution is supported by further aqua-planet and full model experiments using the latest version of the Goddard Earth Observing System GCM. ABSTRACT Purpose: To review the literature on simulation -based learning experiences and to examine their potential to have a positive impact on physiotherapy PT learners' knowledge, skills, and attitudes in entry-to-practice curricula.

Results: A total of abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula.

Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety.

There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning. Conclusions: Simulation -based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost—benefit analysis are necessary to help curriculum developers make informed choices in curriculum design. The role of simulation in continuing medical education for acute care physicians: a systematic review.

We systematically reviewed the effectiveness of simulation -based education, targeting independently practicing qualified physicians in acute care specialties. We also describe how simulation is used for performance assessment in this population. The last date of search was January 31, All original research describing simulation -based education for independently practicing physicians in anesthesiology, critical care, and emergency medicine was reviewed.

Data analysis was performed in duplicate with further review by a third author in cases of disagreement until consensus was reached. Data extraction was focused on effectiveness according to Kirkpatrick's model. For simulation -based performance assessment, tool characteristics and sources of validity evidence were also collated. Of 39 studies identified, 30 studies focused on the effectiveness of simulation -based education and nine studies evaluated the validity of simulation -based assessment.

Simulation was unanimously described as a positive learning experience with perceived impact on clinical practice. Of the 17 remaining studies , 10 used a single group or "no intervention comparison group" design. Nine studies reported the psychometric properties of simulation -based performance assessment as their sole objective.

These predominantly recruited independent practitioners as a convenience sample to establish whether the tool could discriminate between experienced and inexperienced operators and concentrated on a single aspect of validity evidence. Simulation is perceived as a positive learning. Simulation models in population breast cancer screening: A systematic review. The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling.

A systematic literature search was performed to identify simulation models with more than one application. Predicted mortality reduction MR and cost-effectiveness CE were compared to estimates from meta-analyses of randomized control trials RCTs and acceptability thresholds.

Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression except one model with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled. Only recently, potential harms due to regular breast cancer screening were reported.

Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes.

Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening. A systematic Monte Carlo simulation study of the primitive model planar electrical double layer over an extended range of concentrations, electrode charges, cation diameters and valences.

We use canonical and grand canonical Monte Carlo simulations to compute the concentration profiles, from which the electric field and electrostatic potential profiles are obtained by solving Poisson's equation. The use of psychiatry-focused simulation in undergraduate nursing education: A systematic search and review.

Evidence on the use of simulation to teach psychiatry and mental health including addiction content is emerging, yet no summary of the implementation processes or associated outcomes exists. The aim of this study was to systematically search and review empirical literature on the use of psychiatry-focused simulation in undergraduate nursing education. Thirty-two simulation studies were identified describing and evaluating six types of simulations standardized patients, audio simulations , high-fidelity simulators , virtual world, multimodal, and tabletop.

Overall, participants were included in the studies. Studies reflected a limited number of intervention designs, and outcomes were evaluated with qualitative and quantitative methods incorporating a variety of tools. Results indicated that simulation was effective in reducing student anxiety and improving their knowledge, empathy, communication, and confidence.

The summarized qualitative findings all supported the benefit of simulation ; however, more research is needed to assess the comparative effectiveness of the types of simulations. Recommendations from the findings include the development of guidelines for educators to deliver each simulation component briefing, active simulation , debriefing.

Finally, consensus around appropriate training of facilitators is needed, as is consistent and agreed upon simulation terminology. Virtual reality-based simulators for spine surgery: a systematic review. Virtual reality VR -based simulators offer numerous benefits and are very useful in assessing and training surgical skills.

Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery. Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures.

We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field. This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery.

Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery. A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes.

The initial review identified abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement.

This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored.

Higher-quality studies with. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Simulation -based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management CRM.

This systematic review was conducted to gain a better understanding of the impact of simulation -based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. All studies that used simulation -based CRM teaching with outcomes measured at Kirkpatrick Level 3 transfer of learning to the workplace or 4 patient outcome were included. Studies measuring only learners' reactions or simple learning Kirkpatrick Level 1 or 2, respectively were excluded.

Two authors independently reviewed all identified titles and abstracts for eligibility. Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation -based CRM learning into the clinical setting Kirkpatrick Level 3. In three of these studies , simulation -enhanced CRM training was found significantly more effective than no intervention or didactic teaching.

Five studies measured patient outcomes Kirkpatrick Level 4. Only one of these studies found that simulation -based CRM training made a clearly significant impact on patient mortality. Based on a small number of studies , this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality.

To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence LoE and level of recommendation. Medline and EMBASE library databases were searched for English language articles published between and , describing orthopedic simulators or validation studies of these models.

All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education. A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study.

Construct validation was the most frequent validation study attempted by authors. Orthopedic simulators are increasingly being subjected to validation studies , although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators. Published by Elsevier Inc.

Snowplow Simulator Training Study. Specifically, it assesses a drivers evaluation of snowplow simulation training immediately after : training in fall and ag Current status of validation for robotic surgery simulators - a systematic review. To analyse studies validating the effectiveness of robotic surgery simulators. References from retrieved articles were reviewed to broaden the search. The simulator name, training tasks, participant level, training duration and evaluation scoring were extracted from each study.

We also extracted data on feasibility, validity, cost-effectiveness, reliability and educational impact. We identified 19 studies investigating simulation options in robotic surgery. There are five different robotic surgery simulation platforms available on the market. In all, 11 studies sought opinion and compared performance between two different groups; 'expert' and 'novice'. Experts ranged in experience from robotic cases.

The novice groups consisted of participants with no prior experience on a robotic platform and were often medical students or junior doctors. All of the simulators except SEP have shown educational impact. Feasibility and cost-effectiveness of simulation systems was not evaluated in any trial. Virtual reality simulators were shown to be effective training tools for junior trainees. Simulation training holds the greatest potential to be used as an adjunct to traditional training methods to equip the next generation of robotic surgeons with the skills required to operate safely.

However, current simulation models have only been validated in small studies. There is no evidence to suggest one type of simulator provides more effective training than any other. More research is needed to validate simulated environments further and investigate the effectiveness of animal and cadaveric training in robotic surgery.

Observer roles that optimise learning in healthcare simulation education: a systematic review. Simulation is widely used in health professional education. The convention that learners are actively involved may limit access to this educational method. The aim of this paper is to review the evidence for learning methods that employ directed observation as an alternative to hands-on participation in scenario-based simulation training.

We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation. We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations.

A quality framework was used to rate the studies. Nine studies met the inclusion criteria. Five studies suggest learning outcomes in observer roles are as good or better than hands-on roles in simulation. Four studies document learner satisfaction in observer roles.

Five studies used a tool to guide observers. Eight studies involved observers in the debrief. Learning and satisfaction in observer roles is closely associated with observer tools, learner engagement, role clarity and contribution to the debrief. Learners that valued observer roles described them as affording an overarching view, examination of details from a distance, and meaningful feedback during the debrief. Learners who did not value observer roles.

Objective: To systematically review the current literature of simulation in healthcare including the structured steps in the emergency healthcare sector by proposing a framework for simulation in the emergency department. The inclusion criteria were to select English-written articles available in full text with the closest objectives from among a total of 54 articles retrieved from the databases. Subsequently, 11 articles were selected for further analysis. Results: The studies focused on the reduction of waiting time and patient stay, optimization of resources allocation, creation of crisis and maximum demand scenarios, identification of overcrowding bottlenecks, investigation of the impact of other systems on the existing system, and improvement of the system operations and functions.

Conclusion: The steps approach proposed on the basis of the selected studies provides simulation and planning specialists with a structured method for both analyzing problems and choosing best-case scenarios. Moreover, following this framework systematically enables the development of design processes as well as software implementation of simulation problems.

To systematically review the current literature of simulation in healthcare including the structured steps in the emergency healthcare sector by proposing a framework for simulation in the emergency department. For the purpose of collecting the data, PubMed and ACM databases were used between the years and The studies focused on the reduction of waiting time and patient stay, optimization of resources allocation, creation of crisis and maximum demand scenarios, identification of overcrowding bottlenecks, investigation of the impact of other systems on the existing system, and improvement of the system operations and functions.

Subsequently, 10 simulation steps were derived from the relevant studies after an expert's evaluation. The steps approach proposed on the basis of the selected studies provides simulation and planning specialists with a structured method for both analyzing problems and choosing best-case scenarios.

Simulation training for breast and pelvic physical examination: a systematic review and meta-analysis. Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges. To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination.

Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities. The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes.

In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0. Among breast examination simulation studies , dynamic models providing feedback were associated with improved outcomes.

In pelvic examination simulation studies , the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes. In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes.

Enhanced feedback appears to improve learning. Human- simulation -based learning to prevent medication error: A systematic review. In the past 2 decades, there has been an increasing interest in simulation -based learning programs to prevent medication error ME. To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients.

However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME. A systematic review was conducted on Medline from to June , associating the terms "Patient Simulation ," "Medication Errors," and " Simulation Healthcare.

Twenty-one studies assessing simulation -based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals.

The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples. These various experiences, however, help in identifying the key elements required for an effective human simulation -based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment.

The performance of these programs depends on their ability to reflect reality and on professional guidance. Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities. By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is.

Mapping and simulating systematics due to spatially-varying observing conditions in DES science verification data. Spatially-varying depth and characteristics of observing conditions, such as seeing, airmass, or sky background, are major sources of systematic uncertainties in modern galaxy survey analyses, in particular in deep multi-epoch surveys. We present a framework to extract and project these sources of systematics onto the sky, and apply it to the Dark Energy Survey DES to map the observing conditions of the Science Verification SV data.

The resulting distributions and maps of sources of systematics are used in several analyses of DES SV to perform detailed null tests with the data, and also to incorporate systematics in survey simulations. We show that the spatially-varying survey depth imprinted in the observed galaxy densities and the redshift distributions of the SV data are successfully reproduced by the simulation and well-captured by the maps of observing conditions.

The combined use of the maps, the SV data and the BCC-UFig simulation allows us to quantify the impact of spatial systematics on N z , the redshift distributions inferred using photometric redshifts. We conclude that spatial systematics in the SV data are mainly due to seeing fluctuations and are under control in current clustering and weak lensing analyses.

However, they will need to be carefully characterised in upcoming phases of DES in order to avoid biasing the inferred cosmological results. The framework presented is relevant to all multi-epoch surveys, and will be essential for exploiting future surveys such as the Large Synoptic Survey Telescope, which will require detailed null-tests and realistic end-to-end image simulations to correctly interpret the deep, high.

Spatially varying depth and the characteristics of observing conditions, such as seeing, airmass, or sky background, are major sources of systematic uncertainties in modern galaxy survey analyses, particularly in deep multi-epoch surveys. The resulting distributions and maps of sources of systematics are used in several analyses of DES-SV to perform detailed null tests with the data, and also to incorporate systematics in survey simulations.

We show that the spatially varying survey depth imprinted in the observed galaxy densities and the redshift distributions of the SV data are successfully reproduced by the simulation and are well-captured by the maps of observing conditions. The combined use of the maps, the SV data, and the BCC-UFig simulation allows us to quantify the impact of spatial systematics on N z , the redshift distributions inferred using photometric redshifts.

Isokinetic hamstrings-to-quadriceps peak torque ratio: the influence of sport modality, gender, and angular velocity. A total of athletes, including 58 judokas 26 females and 32 males , 39 handball players 22 females and 17 males , and 69 soccer players 17 females and 52 males , were evaluated using an isokinetic dynamometer.

In the analysis by sport, there were no differences among females at 1. Female handball players produced significantly lower peak torque ratios at 5. In the analysis by velocity , women's muscular ratios assessed at 1. The present results suggest that sport modality and angular velocity influence the isokinetic strength profiles of men and women.

We aimed to investigate whether a linear regression formula based on the relationship between joint torque and angular velocity measured using a high-speed video camera and image measurement software is effective for estimating 1 repetition maximum 1RM and isometric peak torque in knee extension. The concordance rate between the estimated value and actual measurement of 1RM and isometric peak torque was examined using intraclass correlation coefficients ICCs.

The concordance rate between the actual measurement and estimated value of 1RM resulted in an ICC 2,1 of 0. Our method for estimating 1RM was effective for decreasing the measurement time and reducing patients' burden. Additionally, isometric peak torque can be estimated using 3 levels of load, as we obtained the same results as those reported previously. We plan to expand the range of subjects and examine the generalizability of our results. Peak particle velocity for rockbursts in underground coal mines and for shot-hole explosions in open-pit mines.

Importance of peak height velocity timing in terms of injuries in talented soccer players. The purpose of this study was to identify differences in traumatic and overuse injury incidence between talented soccer players who differ in the timing of their adolescent growth spurt. Relationship between selected strength and power assessments to peak and average velocity of the drive block in offensive line play. However, little research exists regarding the association between the strength exercises and velocity of an actual on-the-field performance.

These data were correlated with PV and AV while performing the drive block. Peal velocity and AV were assessed using a Tendo Power and Speed Analyzer as the linemen fired, from a 3-point stance into a stationary blocking dummy. A significant inverse association was found for both PV and AV and body fat. These data help to confirm that the typical exercises recommended for American football linemen is positively associated with both PV and AV needed for the drive block effectiveness.

It is recommended that these exercises remain the focus of a weight room protocol and that ancillary exercises be built around these exercises. Additionally, efforts to reduce body fat are recommended. Current clinical ultrasound US systems are limited to show blood flow movement in either 1-D or 2-D.

Flow rates are estimated to be In mid the NIF implemented quartz based neutron time-of-flight nToF detectors which have a faster and narrower impulse response function IRF relative to traditional scintillator detectors. In this presentation we report on comparisons between fusion neutron first moments as measured by quartz and scintillator based detectors using DT layered implosions at the NIF.

We report on the change in precision presaged by the quartz converter and quantify the change in both in shot, line-of-site velocity variability. Work performed under the auspices of the U. Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia.

The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use.

Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values. Twenty-one children with normal cardiorespiratory status undergoing general anesthesia for neurosurgery were enrolled.

Pulse pressure variation PPV value was obtained from the bedside monitor. PPV failed to demonstrate utility in this patient population. Respiratory variation in peak aortic velocity is a promising marker for optimization of perioperative fluid therapy in the pediatric population and can be accurately measured using bedside ultrasonography.

More research is needed to evaluate the lack of effectiveness of pulse pressure variation for this purpose. Global longitudinal strain GLS is well validated and has important applications in contemporary clinical practice. The aim of this analysis was to evaluate the accuracy of resting peak GLS in the diagnosis of obstructive coronary artery disease CAD. A systematic literature search was performed through July using four databases.

Data were extracted independently by two authors and correlated before analyses. Screening of 1, articles yielded 10 studies with 1, patients appropriate for inclusion in the analysis. The mean age and left ventricular ejection fraction were On the whole, The area under the curve and diagnostic odds ratio were 0.

Subgroup analyses for patients with severe CAD and normal left ventricular ejection fractions yielded similar results. Current evidence supports the use of GLS in the detection of moderate to severe obstructive CAD in symptomatic patients. GLS may complement existing diagnostic algorithms and act as an early adjunctive marker of cardiac ischemia. Full Text Available Background: We assessed different systolic cardiac indices to describe left and right ventricular dysfunction in cirrhotic patients before liver transplantation.

Methods: In this case-control study, eighty-one consecutive individuals with the confirmed hepatic cirrhosis and candidate for liver transplantation in the Imam Khomeini Hospital between March and March were selected. Thirty-two age and gender cross-matched healthy volunteers were also selected as the control group.

A detailed two-dimensional and Doppler echocardiography was obtained in all patients and controls performed by the same operator on the day of admission. Results: Dimensions of both left and right atriums as well as left ventricular end-diastolic volume and basal right ventricular dimension in the cirrhotic group were significantly higher than control group.

Left ventricular end- systolic dimensions as well as aortic annulus diameter were not different between the two study groups. In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation n Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity.

Left atrial systolic force was high in Ghost peaks observed after AP-MALDI experiment may disclose new ionization mechanism of matrix assisted hypersonic velocity impact ionization. This paper reports a serendipitous observation of a significant ion yield in a post-ionization experiment conducted after the sample has been removed from a standard atmospheric pressure AP -MALDI source. This post-ionization is interpreted in terms of collisions of microparticles moving with a hypersonic velocity into a solid surface.

Calculations show that the thermal energy released during such collisions is close to that absorbed by the top matrix layer in traditional MALDI. The microparticles, containing both the matrix and analytes, could be detached from a film produced inside the inlet capillary during the sample ablation and accelerated by the flow rushing through the capillary.

These observations contribute some new perspective to ion formation in both laser and laserless matrix-assisted ionization. After the laser was turned off and MALDI sample was removed, ions were detected during a gradual reduction of the background pressure in the first funnel. The constant-rate pressure reduction led to the reproducible appearance of different singly- and doubly-charged peptide peaks in mass spectra taken a few seconds after the end of the MALDI analysis of a dried-droplet spot.

The production of ions in this post-ionization step was exclusively observed during the pressure drop. A lower matrix background and significant increase in relative yield of double-protonated ions are reported. Arterial wave reflection and subclinical left ventricular systolic dysfunction. Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure.

Whether increased wave reflection is inversely associated with left-ventricular LV systolic function in individuals without heart failure is not clear. Arterial wave reflection and LV systolic function were assessed in participants from the Cardiovascular Abnormalities and Brain Lesions CABL study using two-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function.

Aortic augmentation index AIx and wasted energy index WEi were used as indices of wave reflection. Mitral annulus peak systolic velocity Sm , peak longitudinal strain and strain rate were measured. Mean age of the study population was In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques.

Further studies are needed to investigate the prognostic implications of this relationship. Liu, Jia; Halpern, Jules P. One of the proposed explanations for the broad, double- peaked Balmer emission lines observed in the spectra of some active galactic nuclei AGNs is that they are associated with sub-parsec supermassive black hole SMBH binaries.

This is a much larger set of objects compared to an earlier test by Eracleous et al. Although systematic changes in radial velocity can be traced in many of their lines, they are demonstrably not like those of a spectroscopic binary in a circular orbit.

Any spectroscopic binary period must therefore be much longer than the span of the monitoring assuming a circular orbit , which in turn would require black hole masses that exceed by 1—2 orders of magnitude the values obtained for these objects using techniques such as reverberation mapping and stellar velocity dispersion. The binary broad-line region hypothesis is therefore disfavored.

Other processes evidently shape these line profiles and cause the long-term velocity variations of the double peaks. The growth of different body length dimensions is not predictive for the peak growth velocity of sitting height in the individual child. The aim of this study was to determine whether the differences in timing of the peak growth velocity PGV between sitting height, total body height, subischial leg length, and foot length can be used to predict whether the individual patient with adolescent idiopathic scoliosis is before or past.

Busscher, Iris; Gerver, W. Axial flow velocity patterns in a normal human pulmonary artery model: pulsatile in vitro studies. It has been clinically observed that the flow velocity patterns in the pulmonary artery are directly modified by disease. The present study addresses the hypothesis that altered velocity patterns relate to the severity of various diseases in the pulmonary artery. This paper lays a foundation for that analysis by providing a detailed description of flow velocity patterns in the normal pulmonary artery, using flow visualization and laser Doppler anemometry techniques.

The studies were conducted in an in vitro rigid model in a right heart pulse duplicator system. In the main pulmonary artery, a broad central flow field was observed throughout systole. The maximum axial velocity cm s-1 was measured at peak systole.

In the left pulmonary artery, the axial velocities were approximately evenly distributed in the perpendicular plane. However, in the bifurcation plane, they were slightly skewed toward the inner wall at peak systole and during the deceleration phase. In the right pulmonary artery, the axial velocity in the perpendicular plane had a very marked M-shaped profile at peak systole and during the deceleration phase, due to a pair of strong secondary flows.

In the bifurcation plane, higher axial velocities were observed along the inner wall, while lower axial velocities were observed along the outer wall and in the center. Overall, relatively low levels of turbulence were observed in all the branches during systole.

The maximum turbulence intensity measured was at the boundary of the broad central flow field in the main pulmonary artery at peak systole. Ten professional futsal players age, The players performed three tests, with an interval of at least 48 hours, as follows: the T-CAR to determine the peak velocity and the maximal heart rate; an incremental treadmill protocol to determine the maximal physiological responses; and a time limit running test at the peak velocity reached in the T-CAR.

During the last two tests, a portable gas analyzer was used for direct measurement of cardiorespiratory variables. All athletes reached their maximum oxygen uptake during the time limit test. The maximum oxygen uptake achieved during the time limit test was not different from that observed in the laboratory condition In addition, Bland and Altman plots evidenced acceptable agreement between them.

Therefore, the peak velocity intensity can be used as an indicator of maximal aerobic power of futsal athletes and the time limit can be used as a reference for training prescription. We examine the relationship between three parameters of Type Ia supernovae SNe Ia : peak magnitude, rise time, and photospheric velocity at the time of peak brightness. The peak magnitude is corrected for extinction using an estimate determined from MLCS2k2 fitting. We model the relationship among these three parameters using an expanding fireball with two assumptions: a the optical emission is approximately that of a blackbody, and b the photospheric temperatures of all SNe Ia are the same at the time of peak brightness.

We compare the precision of the distance residuals inferred using this physically motivated model against those from the empirical Phillips relation and the MLCS2k2 method for 47 low-redshift SNe Ia 0. The role of integer-mode rational surface on peaked profile formation in toroidal rotation velocity and ion temperature.

A particular role of integer-mode rational surfaces on the formation of peaked T i r and V t r is observed. Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression. Heart failure and increased arterial stiffness are associated with declining renal function.

Few studies have evaluated the association between left ventricular ejection fraction LVEF and brachial-ankle pulse-wave velocity baPWV and renal function progression. Clinical and echocardiographic parameters were compared and analyzed. Resting multilayer 2D speckle-tracking TTE for detection of ischemic segments confirmed by invasive FFR part-2, using post- systolic -strain-index and time from aortic-valve-closure to regional peak longitudinal-strain.

This study evaluated the post- systolic strain index PSI , and the time interval between aortic valve closure AVC and regional peak longitudinal strain PLS , measured by transthoracic echocardiography TTE , for detection of left ventricular LV myocardial ischemic segments confirmed by invasive fractional flow reserve FFR. However, the AUC values were not statistically significant.

Impact of a systolic parameter, defined as the ratio of right brachial pre-ejection period to ejection time, on the relationship between brachial-ankle pulse wave velocity and left ventricular diastolic function. Arterial stiffness is correlated with left ventricular LV diastolic function as well as susceptibility to LV systolic function.

Therefore, if LV systolic function is not known, the relationship between arterial stiffness and LV diastolic function is difficult to determine. A total of patients were included in the study. Patients were classified into four groups.

The LV ejection fractions in groups 1 and 3 were higher than those in groups 2 and 4 Pwave velocity to Ea that were comparable to those in groups 3 and 4. Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at weeks of gestation. The aim of this study was to define from umbilical artery flow velocity waveforms absolute peak systolic and time-averaged velocity , fetal heart rate, fetal heart rate variability and flow velocity variability, and the relation between fetal heart rate and velocity variables in early pregnancy.

A total of women presenting with a normal pregnancy from 10 to 20 weeks of gestation consented to participate in a cross-sectional study design. Doppler ultrasound recordings were made from the free-floating loop of the umbilical cord.

Umbilical artery peak systolic and time-averaged velocity increased at weeks, whereas fetal heart rate decreased at weeks of gestation and plateaued thereafter. Umbilical artery peak systolic velocity variability and fetal heart rate variability increased at and weeks respectively. The inverse relationship between umbilical artery flow velocity and fetal heart rate at weeks of gestation suggests that the Frank-Starling mechanism regulates cardiovascular control as early as the late first and early second trimesters of pregnancy.

A different underlying mechanism is suggested for the observed variability profiles in heart rate and umbilical artery peak systolic velocity. It is speculated that heart rate variability is mediated by maturation of the parasympathetic nervous system, whereas peak systolic velocity variability reflects the activation of a haemodynamic feedback mechanism.

Comparison of peak flow velocity through the left ventricular outflow tract and effective orifice area indexed to body surface area in Golden Retriever puppies to predict development of subaortic stenosis in adult dogs. To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract LVOT Vmax and effective orifice area indexed to body surface area EOAi in puppies to predict development of subaortic stenosis SAS in the same dogs as adults. Prospective, longitudinal, observational study.

Cardiac auscultation and echocardiography were performed on 2- to 6-month-old puppies, then repeated at 12 to 18 months. All puppies with EOAi 2. Background: There is a limited knowledge about left atrial LA systolic force LASF and its key determinants in patients with asymptomatic mild-moderate aortic stenosis AS. Methods: We used baseline clinic and echocardiographic data from 1, patients recruited in the simvastatin ezetimibe Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively.

Results: Mean Mitral E wave deceleration time to peak E velocity ratio and cardiovascular outcome in hypertensive patients during antihypertensive treatment from the LIFE echo-substudy. We evaluated hypertensive patients Unadjusted Cox regression analysis showed a positive association between the baseline MDI and CV events hazard ratio 1.

In the time-varied Cox models, a greater in-treatment MDI was associated with a greater rate of CV events hazard ratio 1. Normalization of DTE for E velocity might be preferred to other traditional diastolic function indexes in evaluating diastolic function during antihypertensive treatment The purpose of this study was to compare the effectiveness of 6-week training interventions using different modes of resistance traditional strength, plyometric, and combined training on sprinting and jumping performances in boys before and after peak height velocity PHV.

Eighty school-aged boys were categorized into 2 maturity groups pre- or post-PHV and then randomly assigned to a plyometric training, b traditional strength training, c combined training, or d a control group. Experimental groups participated in twice-weekly training programs for 6 weeks. Acceleration, maximal running velocity , squat jump height, and reactive strength index data were collected pre- and postintervention.

All training groups made significant gains in measures of sprinting and jumping irrespective of the mode of resistance training and maturity. Plyometric training elicited the greatest gains across all performance variables in pre-PHV children, whereas combined training was the most effective in eliciting change in all performance variables for the post-PHV cohort.

Statistical analysis indicated that plyometric training produced greater changes in squat jump and acceleration performances in the pre-PHV group compared with the post-PHV cohort. All other training responses between pre- and post-PHV cohorts were not significant and not clinically meaningful. The study indicates that plyometric training might be more effective in eliciting short-term gains in jumping and sprinting in boys who are pre-PHV, whereas those who are post-PHV may benefit from the additive stimulus of combined training.

Assessment of regional systolic and diastolic myocardial function using tissue Doppler and strain imaging in dogs with dilated cardiomyopathy. Analysis of TDI and St features in dogs with overt DCM is a prerequisite before using these new criteria in prospective screenings of predisposed families or in clinical trials. Case records for 26 dogs; 14 with DCM and 12 healthy controls of comparable age and weight were reviewed.

A retrospective analysis was conducted of conventional echocardiography, 2-dimensional color TDI, and St imaging data. We find that the peak velocit Systolic hypertension in adult nigerians with hypertension. To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension.

The total number of hypertensive patients treated over this period was also taken into consideration. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy LVH , heart failure, renal impairment etc. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role.

Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 7. There were 94 males and females. Seventy-seven One hundred and seventy-eight Twenty-nine Twenty-five Eleven 5. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined.

Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ. The experiments developed over the course of this project made it possible not only to study the fragmentation of uracil, thymine, adenine, and cytosine, but also to measure absolute cross sections for different ionization processes initiated by proton interactions with these important biological molecules.

Firstly, the experimental system enabled the contributions of two key ionization processes to be separated: direct ionization and electron capture. The corresponding mass spectra were measured and analyzed on an event-by-event basis. For uracil, the branching ratios for these two processes were measured as function of the projectile velocity.

Secondly, we have developed a system to measure absolute cross sections for the electron capture process. The production rate of neutral atoms compared to protons was measured for the four biological molecules: uracil, cytosine, thymine, and adenine at different vaporization temperatures. This production rate varies as a function of the thickness of the target jet traversed by the protons. Accordingly, a deposit experiment was developed in order to characterize the density of molecules in the targeted gas jets.

Theoretical and experimental study of the total effusion and density-profile of the gaseous molecular beams enabled us to deduce the thickness of the target jets traversed by the protons. Thus it was possible to determine absolute cross sections for the ionization of each of the four isolated biological molecules by 80 keV protons impact. To our knowledge, this work provides the first experimental absolute cross sections for DNA and RNA base ionization processes initiated by proton impact in the velocity range corresponding to the Bragg peak.

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure. Previous studies comparing levosimendan vs. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered.

The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group.

Improvements in LVEF and diastolic indices were significant in the levosimendan group. Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion. A 3-D version of the Transverse Oscillation TO method has previously been used to obtain this information in a carotid flow The full 3-D velocity profile can be created and examined at peak-systole and end-diastole without ECG gating in two planes.

Maximum out-of-plane velocities for the three peak-systoles and end-diastoles were In the longitudinal plane, average maximum peak velocity in flow direction was This demonstrates that real-time 3-D Preliminary comparison between real-time in-vivo spectral and transverse oscillation velocity estimates.

Spectral velocity estimation is considered the gold standard in medical ultrasound. Angle correction is performed using a flow angle set manually. With Transverse Oscillation TO velocity estimates the flow angle This study investigates if these clinical parameters are estimated equally good using spectral and TO data. The right common carotid arteries of three healthy volunteers were scanned longitudinally.

Average TO flow Systolic pressure errors were defined and correlations with other specific values, like pressure rise time, pulse wave velocity , systolic pressure, augmentation, arm circumference and body mass index were calculated This paper reports a serendipitous observation of a significant ion yield in a post-ionization experiment conducted after the sample had been removed from a standard atmospheric pressure AP -MALDI source.

These observations contribute some new perspective to ion formation in both laser and laser-less matrix-assisted ionization. After the laser had been turned off and the MALDI sample removed, ions were detected during a gradual reduction of the background pressure in the first funnel. The constant-rate pressure reduction led to the reproducible appearance of different singly and doubly charged peptide peaks in mass spectra taken a few seconds after the end of the MALDI analysis of a dried-droplet spot.

The ion yield as well as the mass range of ions observed with a significant delay after a completion of the primary MALDI analysis depended primarily on the background pressure inside the first funnel. The observations were partially consistent. Hyperbolic isometries of systolic complexes.

The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles. Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal displace Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal In addition, we provide newexamples of systolic groups.

In the first article we show that the minimal displacement set of a hyperbolicisometry of a systolic complex is quasi-isometric to the product of a tree andthe real line. We use this theorem We find that the peak Similar, the Kp index per coronal hole area is highest for the coronal holes located near the solar equator and strongly decreases with increasing latitudes of the coronal holes.

We interpret Isolated systolic hypertension: A health concern? Is having a high top number systolic blood pressure, but a normal bottom number diastolic Isolated systolic hypertension can Systolic ventricular filling. The evidence of the ventricular myocardial band VMB has revealed unavoidable coherence and mutual coupling of form and function in the ventricular myocardium, making it possible to understand the principles governing electrical, mechanical and energetical events within the human heart.

From the earliest Erasistratus' observations, principal mechanisms responsible for the ventricular filling have still remained obscured. Contemporary experimental and clinical investigations unequivocally support the attitude that only powerful suction force, developed by the normal ventricles, would be able to produce an efficient filling of the ventricular cavities.

The true origin and the precise time frame for generating such force are still controversial. Elastic recoil and muscular contraction were the most commonly mentioned, but yet, still not clearly explained mechanisms involved in the ventricular suction. Classical concepts about timing of successive mechanical events during the cardiac cycle, also do not offer understandable insight into the mechanism of the ventricular filling.

The net result is the current state of insufficient knowledge of systolic and particularly diastolic function of normal and diseased heart. Here we summarize experimental evidence and theoretical backgrounds, which could be useful in understanding the phenomenon of the ventricular filling. Anatomy of the VMB, and recent proofs for its segmental electrical and mechanical activation, undoubtedly indicates that ventricular filling is the consequence of an active muscular contraction.

Contraction of the ascendent segment of the VMB, with simultaneous shortening and rectifying of its fibers, produces the paradoxical increase of the ventricular volume and lengthening of its long axis. Specific spatial arrangement of the ascendent segment fibers, their interaction with adjacent descendent segment fibers, elastic elements and intra-cavitary blood volume hemoskeleton , explain the physical principles.

Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: new insights in chronic heart failure. Tissue Doppler imaging TDI is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure CHF with normal and reduced ejection fraction. One hundred ten outpatients with CHF and 68 controls were included.

Ejection fraction EF was obtained and longitudinal systolic S and diastolic E' and A' wall velocities were recorded from basal septum. The cut-off of ms for IVRT and 5. These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition. Right ventricular systolic function in hypertensive heart failure.

Right ventricular RV dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters.

Methodology: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults.

Keywords: right ventricle. We find that the peak velocities of high-speed streams depend strongly on both the areas and the co-latitudes of their solar source coronal holes with regard to the heliospheric latitude of the satellites.

Therefore, the co-latitude of their source coronal hole is an important parameter for the prediction of the high-speed stream properties near the Earth. We derive the largest solar wind peak velocities normalized to the coronal hole areas for coronal holes located near the solar equator and that they linearly decrease with increasing latitudes of the coronal holes.

Similarly, the Kp index per coronal hole area is highest for the coronal holes located near the solar equator and strongly decreases with increasing latitudes of the coronal holes. We interpret these results as an effect of the three-dimensional propagation of high-speed streams in the heliosphere; that is, high-speed streams arising from coronal holes near the solar equator propagate in direction toward and directly hit the Earth, whereas solar wind streams arising from coronal holes at higher solar latitudes only graze or even miss the Earth.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study. To determine the role of peak systolic velocity , end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

The right and left inferior thyroid artery- peak systolic velocity , end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis 41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography.

The right and left inferior thyroid artery- peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease.

The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease.

This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. Systolic trees and systolic language recognition by tree automata.

Culik II, J. Gruska, A. Salomaa and D. Wood have studied the language recognition capabilities of certain types of systolically operating networks of processors see research reports Cs, Cs and Cs, Univ. In this paper, their model for systolic VLSI trees is formalised in terms of standard tree automaton theory, and the way in which some known facts about recognisable forests and tree transductions can be applied in VLSI tree theory is demonstrated.

Age-related changes in aortic 3D blood flow velocities and wall shear stress: Implications for the identification of altered hemodynamics in patients with aortic valve disease. Chris; Collins, Jeremy D. To investigate age-related changes in peak systolic aortic 3D velocity and wall shear stress WSS in healthy controls and to investigate the importance of age-matching for 3D mapping of abnormal aortic hemodynamics in bicuspid aortic valve disease BAV.

Hyper- systolic matrix multiplication. A novel parallel algorithm for matrix multiplication is presented. It is based on a 1-D hyper- systolic processor abstraction. The procedure can be implemented on all types of parallel systems. C Elsevier Science B,V. Accurate skeletal maturity assessment is important to guide clinical evaluation of idiopathic scoliosis, but commonly used methods are inadequate or too complex for rapid clinical use.

The objective of the study was to propose a new simplified staging method, called the thumb ossification composite index TOCI , based on the ossification pattern of the 2 thumb epiphyses and the adductor sesamoid bone; to determine its accuracy in predicting skeletal maturation when compared with the Sanders simplified skeletal maturity system SSMS ; and to validate its interrater and intrarater reliability. Hand radiographs of girls, acquired when they were newly diagnosed with idiopathic scoliosis prior to menarche and during longitudinal follow-up until skeletal maturity a minimum of 4 years , were scored with the TOCI and SSMS.

These scores were compared with digital skeletal age DSA and radius, ulna, and small hand bones RUS scores; anthropometric data; peak height velocity ; and growth-remaining profiles. Correlations were analyzed with the chi-square test, Spearman and Cramer V correlation methods, and receiver operating characteristic curve analysis.

Reliability analysis using the intraclass correlation ICC was conducted. Six hundred and forty-five hand radiographs average, 5 of each girl were scored. The new proposed TOCI could provide a simplified staging system for the assessment of skeletal maturity of subjects with idiopathic scoliosis. The index needs to be subjected to further multicenter validation in different ethnic groups.

Left ventricular systolic and diastolic function in hyperthyroidism. In order to assess the effect of hyperthyroidism on systolic and diastolic function of the left ventricle, M-mode echocardiograms and systolic time intervals were obtained in 13 patients while they were clinically hyperthyroid and again when they were euthyroid following radioactive iodine therapy. Echocardiographic tracings of the septum and left ventricular posterior wall were digitized and analyzed to provide the maximum velocity of shortening and maximum velocity of lengthening.

These velocities were normalized for left ventricular diastolic dimension. The left ventricular minor axis fractional shortening and the normalized maximum velocity of shortening were both increased during the hyperthyroid state. The normalized maximum velocity of lengthening, a measure of diastolic left ventricular function, was also increased during the hyperthyroid state when compared to the euthyroid state.

These data confirm the increased inotropic state and demonstrated increased diastolic relaxation velocities of the hyperthyroid left ventricle. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle.

The mean time in which systolic peak velocity was recorded was This article reports a workshop which addressed several energy issues like the objectives and constraints of energy mix scenarios, the differences between the approaches in different countries, the cost of new technologies implemented for this purposes, how these technologies will be developed and marketed, which will be the environmental and societal acceptability of these technical choices.

Different aspects and issues have been more precisely presented and discussed: the peak oil, development of shale gases and their cost will non conventional hydrocarbons modify the peak oil and be socially accepted?

Velocity and shear stress distribution downstream of mechanical heart valves in pulsatile flow. The velocity and turbulent shear stress profiles of the valves were determined by Laser Doppler anemometry in two different downstream axes within a model aortic root.

Depending on the individual valve design, velocity peaks up to 1. These shear stress peaks mainly occurred in areas of flow separation and intense momentum exchange. Directly downstream of the valves measuring axis 0. Shear stress levels were high at the borders of the fluid jets. The results are discussed from a fluid-dynamic point of view. Impaired left ventricular systolic function reserve limits cardiac output and exercise capacity in HFpEF patients due to systemic hypertension.

Despite having normal EF at rest, we hypothesize that these patients have abnormal systolic function reserve limiting their exercise capacity. Exercise capacity was determined as the workload divided by body surface area. HFpEF patients with hypertensive LV disease have significantly limited exercise capacity which is related to left atrial enlargement as well as compromised LV systolic function at the time of the symptoms.

The limited myocardial systolic function reserve seems to be underlying important explanation for their limited exercise capacity. Reducing maternal mortality: Systolic blood pressure. Mar 21, While deaths due to fluid overload have Promoting Healthy Life. Systolic automata for VLSI on balanced trees.

Systolic tree automata with a binary or, more generally, balanced underlying tree are investigated. The main emphasis is on input conditions, decidability, and characterization of acceptable languages. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease. One hundred ninety-eight outpatients with rheumatoid arthritis without overt cardiac disease were prospectively analyzed from January through June and compared with matched control subjects. Of note, the idea to combine in the analysis longitudinal function came therefore well after the starting process of revision of the paper E and was, in some way inspired by a reviewer's comment.

That is why we did not put both findings in the same paper. We think that our explanations provide the broad audience of your journal a perspective of transparency and our respect for the readers' right to understand how the work described in the paper J relates to other work by our research group. Full Text Available Background: Atherosclerosis is a multifactor process in which several risk factors are involved.

It is the leading cause of death and morbidity in hospital admitted patients, and it may cause a marked decrease in blood flow to all organs of the body. Objective: To determine the impact of systolic hypertension on cerebrovascular disease. Methods: A cross-sectional, observational and analytical study was conducted in 59 death patients who suffered from hypertension. Cerebral arteries were analyzed and atherosclerotic lesion and its variety were quantified by using the atherometric system.

The different types of hypertension were considered. Results: Recent strokes were more frequent in systodiastolic hypertensive patients. There was no significant difference in the injury onset age for both sexes, but women with systolic hypertension were significantly more damaged from a morphometric point of view.

Significant correlation for both groups of hypertensive patients was observed between type of stroke and atherometric system variables. Conclusions: Systolic hypertension is an important factor in the genesis of cerebrovascular disease and is associated with the progression of atherosclerotic plaque. Out of stroke-free patients, carotid stenosis Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth.

Elderly with asymptomatic carotid stenosis peak systolic velocities in ICA 0. Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure? Hydrotherapy exercise in warm water is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure.

We present a case of an elderly man who was recruited to participate in a hydrotherapy study. By contrast, right ventricular systolic velocity decreased from The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure.

We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure. Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction HFNEF remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes.

Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls.

However, systolic strain did not differ significantly between the two groups Effect of atrial systole on canine and porcine coronary blood flow. A feature of phasic coronary flow patterns recorded in conscious chronically instrumented dogs is the atrial cove--a transient depression of arterial flow that occurs during atrial systole. The association between the hemodynamic effects of atrial systole and the atrial cove was studied in anesthetized dogs and pigs with complete heart block.

Many atrial coves are available for study in these preparations because atrial activity continues unabated during the diastolic ventricular arrest that follows cessation of electrical pacing. The effect of atrial systole is to translate the pressure-flow relation found during diastole to a higher intercept pressure without change in slope.

The increase in the intercept pressure equals the increase in intramyocardial pressure measured with microtransducers embedded in the left ventricular wall. The decrement in flow during the atrial cove is a direct function of the change in intramyocardial pressure and an inverse function of coronary vascular resistance. Each atrial systole is associated with a forward flow transient in the coronary veins, the peak of which occurs at the same instant as does the nadir of atrial flow.

These data suggest that the coronary vessels are acting as collapsible tubes and that the waterfall model of the coronary circulation is applicable. The following sequence is proposed to account for the atrial cove. Atrial systole ejects a bolus of blood into the left ventricle increasing both ventricular cavity and intramyocardial pressures.

The increase in intramyocardial pressure raises the back pressure opposing coronary flow, reducing the arterial perfusion pressure gradient and causing flow to fall. Treatment of anemia with darbepoetin alfa in systolic heart failure.

Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome.

Metabolic syndrome MetS is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular LV systolic dysfunction.

However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects.

During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects.

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Perhaps he will have outfield eligibility in your league; he played there six times last season. Even if he's not DH-only, this would be quite an unexpected market for a guy who just hit. That's a literal third of a normal season and was reminiscent of his Houston days before anyone knew he was a real player. He had an The list goes on. Across the board, his batted-ball numbers were as bad as they've been in years.

Martinez isn't the only player whose season is being somewhat dismissed because it's a small sample. These guys at least hit the ball hard last year It isn't guaranteed to be the wrong move to make these guys one of your top hitters, but it sure feels riskier than necessary. FantasyPros seemed to overrate this group. Another publication could do the opposite by marking them down too much, or overrate those who excelled in the short year.

Maybe that is a question with Sale, but we'll give them the benefit of the doubt. It doesn't matter. You can't spend top-starter money on a guy who will play anywhere from half a season to not at all. Verlander and Sale respectively rank as the sixth and 13th tied most expensive pitchers for There is no scenario where they see enough game action to warrant such rankings, even if they perform as the two best pitchers in baseball when on the mound.

Verlander hopes to pitch in '21, but his general manager called that an "aggressive timeline. Sale's injury happened well before Verlander's, putting his rehab months ahead. Even still, his current timetable has him returning possibly in the middle of the summer if there are no setbacks. That would leave him with maybe 12 starts, and this is the best-case scenario. Edwin Diaz is occasionally really good. In standard leagues where relievers only push the standings in one category, no manager should spend that much on any closer.

Hader is pretty much the perfect reason why. He is as good as a closer can get in terms of strikeouts and rate stats. Yet at his best, he will only strike out something like 60 percent as many hitters as the top starters. That's for the best case of the best closer. Everything trickles down from there. We can't even be sure any man finishes as his team's leader in saves, which would submarine his entire value.

This is the key point that separates RP from other one-category contributors. The position is so volatile that the top preseason guys may not collect the most saves, and tons of guys each year find themselves in possession of saves when it's all said and done. Just imagine if Kevin Merrell would get called up and siphon off all the steals that Whit Merrifield or Adalberto Mondesi would have collected in Kansas City.

It doesn't happen like that at other positions. There is no realistic comp. It is a losing proposition to pay up for relievers in standard leagues. Win Big With RotoBaller Be sure to also check out all of our other daily fantasy baseball articles and analysis to help you set those winning lineups, including this new RotoBaller YouTube video:. We continue with our evaluation of the dynasty league value of high-profile players in our Dynasty Price Check series.

Should you trade them or trade for them? Are they being overvalued or undervalued by dynasty players? Read More. It's the offseason! Except when it comes to dynasty leagues, there is no offseason. We'll be spending some time this year thinking about how to value individual players in dynasty in our Dynasty Price Check series. What's a player's current value? Are they being overvalued or undervalued The NFL season is officially coming to a close, which means it is time to start preparing for fantasy football drafts!

Free agency will have a chance to change the landscape of the league for several teams and players and could have a massive fantasy impact for next season. Throughout the next several We've already covered Ezekiel Elliott, which you can read here. Today, we'll be looking at Jacksonville Jaguars running back The NFL regular season is now in the rear-view mirror, so let's look back on what happened.

Today, that means looking back on some busts. While plenty of good things happened this season, some players didn't live up to expectations. We're going to take a look at some of those players and try to With the wild and crazy NFL season now behind us, looking ahead to the offseason coms fast for dynasty managers. Whether it's the first year of a start-up or you're years into a build, contemplating moves you want to make are always in your head.

But before you get there, you have to have The NFL season is not quite over yet, but it's never too early to start evaluating draft prospects. I have experience working in college football and have been studying the NFL Draft for over So too did two retail sportsbooks, leaving just three places to bet on sports in the state.

West Virginia reports results on a weekly basis, so results for some months may include days from other months. WV revenue here. Arkansas sports betting began in July at Oaklawn Casino. Saracen Casino added sports betting in October and Southland Casino took its first bet in January New York sports betting began in July at the upstate casinos. As such, expectations for NY sports betting revenue should be mitigated.

NY revenue here. Iowa revenue here. Indiana revenue here. Oregon sports betting began with the tribes in August The reported data does not include tribal sports betting. New Hampshire sports betting launched in late December through its DraftKings Sportsbook mobile app. DraftKings Sportsbook can also open retail locations throughout the state. Intralot will eventually launch sports betting through the New Hampshire Lottery. Michigan sports betting launched retail betting in March , right before sports leagues began to shut down because of the coronavirus pandemic.

Casinos did not reopen until Aug. They closed again Nov. Michigan launched online sports betting Jan. Michigan revenue here. Colorado sports betting launched May 1, in the middle of the coronavirus pandemic. Colorado revenue here. Washington DC revenue here.

Illinois sports betting launched March 9 but was suspended March Illinois revenue here. Tennessee sports betting launched November 1 as a mobile-only market. Some tribal casinos currently feature sportsbooks. However, revenue figures from these casinos are not currently available. US sports betting revenue: All states Legal betting in the US started expanding after the Supreme Court decision striking down the federal ban outside Nevada.

Revenue: Amount of money kept by sportsbooks out of the amount wagered. The numbers reflect all reported numbers starting in June to date. Pennsylvania sports betting PA sports betting is poised to become one of the biggest markets in the near future. Delaware sports betting Delaware sports betting was the first to go live outside Nevada in June Mississippi sports betting Mississippi sports betting went live in at casinos around the state.

Nevada sports betting Nevada has had legal wagering for decades. Nevada has one of the lowest tax rates in the country at 6. Rhode Island sports betting RI sports betting started in late , after the state legalized it earlier in the year. Rhode Island did not launch with online betting, but a law authorized it.

West Virginia sports betting WV sports betting went live in , thanks to a law passed even before the federal ban was struck down. Sportsbook apps returned in August Arkansas sports betting Arkansas sports betting began in July at Oaklawn Casino.