The document discusses the Telemedicine & Advanced Technology Research Center (TATRC) and its Medical Simulation and Training Technology Research Portfolio. TATRC is an agency of the US Army that serves all of DOD. It oversees projects related to medical simulation and training through its Armed Forces Simulation Institute for Medicine (AFSIM) and the Joint Program Committee 1a on Medical Simulation and Training Technology (JPC1a). JPC1a oversees several initiatives including the Combat Casualty Training Initiative to improve pre-hospital trauma training through advanced simulation technologies.
ICT for a global infrastructure for health research VPH Models, images and personalization. Frangi A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Embracing E-Learning: The Digital Footprints of University Students (Borneo E...Kee-Man Chuah
Presentation done for International Conference on Media and Society (IC-MAS 2015) Forum on Technology and Societal Development: The Borneo Experience. This presentation provided a glimpse on the data from the case study at two public universities in Borneo regarding student's online learning experience.
Slide della giornata formativa curata da Clara Serrao per alcuni nostri clienti dell'area di Vercelli.
Come unire la formazione aziendale sulla contribuzione e lo spirito di squadra con il Pi Quan Shu
ICT for a global infrastructure for health research VPH Models, images and personalization. Frangi A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Embracing E-Learning: The Digital Footprints of University Students (Borneo E...Kee-Man Chuah
Presentation done for International Conference on Media and Society (IC-MAS 2015) Forum on Technology and Societal Development: The Borneo Experience. This presentation provided a glimpse on the data from the case study at two public universities in Borneo regarding student's online learning experience.
Slide della giornata formativa curata da Clara Serrao per alcuni nostri clienti dell'area di Vercelli.
Come unire la formazione aziendale sulla contribuzione e lo spirito di squadra con il Pi Quan Shu
Dress for Success: From Head to Toe (Malaysian Ladies Edition)Kee-Man Chuah
This is a presentation for the “Go Professional Programme” 2014 By Academic and Career Exco, Sakura Residential College, Universiti Malaysia Sarawak. Most of the content is from thorough readings. Photos are for decorative purposes only and they belong to their respective owners.
Designing Interactions with iTeaching (Interactive Teaching) Tools Kee-Man Chuah
This presentation showcases some of the useful activities involving interactive teaching tools that could motivate your learners to be more engaged. All graphics used in the presentation belongs to their respective owners.
7 Useful Addons for Postgraduate StudentsKee-Man Chuah
Here are 7 useful Firefox add-ons that can help you turned your ordinary Firefox browser into a powerful and efficient research tool. Just search the add-on name via Firefox Extension page.
Medical Simulation Industry Overview (TechNet 2012)rheinl271
This presentation is intended to provide an introduction and overview of the medical simulation market domain for defense modeling, simulation, and training audiences interested in applying their capabilities, expertise and products to medical and healthcare training and education needs.
https://www.snmclub.com/presentation
PET/MRI Current & Future Status
DALE BAILEY PhD , Principal Physicist
Departement of Nuclear Medicine, Royal North Shore Hospital
Professor in Medical Radiation Sciences, University of Sydney
Sydney, Australia
icrm2018
Real-World Evidence: The Future of Data Generation and UsageApril Bright
As data is captured through electronic health records, registries and unique device identifiers, the generation of evidence based on this data is expected to play a crucial role in informing orthopedic manufacturers’ decisions before and after regulatory approval. While regulators, payors, hospitals and manufacturers support this shift, they acknowledge that gaps remain in its optimal execution. Priority considerations include how to generate evidence to expedite regulatory market decisions, device indication expansion, postmarket studies, postmarket surveillance and reimbursement decisions. The National Evaluation System for health Technology Coordinating Center (NESTcc), an initiative of the Medical Device Innovation Consortium (MDIC), is leading the conversation with various stakeholders, including FDA and orthopedic device companies to support the sustainable generation of Real-World Evidence (RWE) using Real-World Data (RWD).
Presentation given to health-care management class discussing how military research impacts medical innovations eventually benefiting the civilian population
Simultaneous PET-MRI – A one stop shop multi-modality imaging: Hype or a hope?Apollo Hospitals
Although the concept of hybrid imaging has been around for many years, in last few decades it has transformed from visual comparison of anatomical and functional images to software based image fusion, and currently integrated imaging systems have become the standard of care. The concept of PET-CT (Positron emission tomography-Computerized tomography) was introduced by David Townsend in 1998 and a decade after its prototype introduction; PET-CT has become the modality-of-choice for variety of clinical indications in oncology.
Spectral Computed Tomography (CT) Market Research Report: By Types (Spiral Ct, Electron Beam Tomography, Multi-Slice Computed Tomography, Positron Emission Tomography (Pet) And Single-Photon Emission Computed Tomography), By Application (Oncology, Neurology, Cardiology, Spine, Musculoskeletal Disorders, Body Imaging, Gastrointestinal Diseases), By End Users (Diagnostic Centers, Hospitals)- Global Forecast Till 2023
USE OF PET – HEALTH CARE POLICY PERSPECTIVESRuby Med Plus
POSITRON EMISSION TOMOGRAPHY (PET) USE BY TERTIARY HEALTH CARE CENT RES AND ITS ACCESSIBILITY TO POPULATION: A POLICY PERSPECTIVE. a BRIEF Cost-Benefit analysis.
Dress for Success: From Head to Toe (Malaysian Ladies Edition)Kee-Man Chuah
This is a presentation for the “Go Professional Programme” 2014 By Academic and Career Exco, Sakura Residential College, Universiti Malaysia Sarawak. Most of the content is from thorough readings. Photos are for decorative purposes only and they belong to their respective owners.
Designing Interactions with iTeaching (Interactive Teaching) Tools Kee-Man Chuah
This presentation showcases some of the useful activities involving interactive teaching tools that could motivate your learners to be more engaged. All graphics used in the presentation belongs to their respective owners.
7 Useful Addons for Postgraduate StudentsKee-Man Chuah
Here are 7 useful Firefox add-ons that can help you turned your ordinary Firefox browser into a powerful and efficient research tool. Just search the add-on name via Firefox Extension page.
Medical Simulation Industry Overview (TechNet 2012)rheinl271
This presentation is intended to provide an introduction and overview of the medical simulation market domain for defense modeling, simulation, and training audiences interested in applying their capabilities, expertise and products to medical and healthcare training and education needs.
https://www.snmclub.com/presentation
PET/MRI Current & Future Status
DALE BAILEY PhD , Principal Physicist
Departement of Nuclear Medicine, Royal North Shore Hospital
Professor in Medical Radiation Sciences, University of Sydney
Sydney, Australia
icrm2018
Real-World Evidence: The Future of Data Generation and UsageApril Bright
As data is captured through electronic health records, registries and unique device identifiers, the generation of evidence based on this data is expected to play a crucial role in informing orthopedic manufacturers’ decisions before and after regulatory approval. While regulators, payors, hospitals and manufacturers support this shift, they acknowledge that gaps remain in its optimal execution. Priority considerations include how to generate evidence to expedite regulatory market decisions, device indication expansion, postmarket studies, postmarket surveillance and reimbursement decisions. The National Evaluation System for health Technology Coordinating Center (NESTcc), an initiative of the Medical Device Innovation Consortium (MDIC), is leading the conversation with various stakeholders, including FDA and orthopedic device companies to support the sustainable generation of Real-World Evidence (RWE) using Real-World Data (RWD).
Presentation given to health-care management class discussing how military research impacts medical innovations eventually benefiting the civilian population
Simultaneous PET-MRI – A one stop shop multi-modality imaging: Hype or a hope?Apollo Hospitals
Although the concept of hybrid imaging has been around for many years, in last few decades it has transformed from visual comparison of anatomical and functional images to software based image fusion, and currently integrated imaging systems have become the standard of care. The concept of PET-CT (Positron emission tomography-Computerized tomography) was introduced by David Townsend in 1998 and a decade after its prototype introduction; PET-CT has become the modality-of-choice for variety of clinical indications in oncology.
Spectral Computed Tomography (CT) Market Research Report: By Types (Spiral Ct, Electron Beam Tomography, Multi-Slice Computed Tomography, Positron Emission Tomography (Pet) And Single-Photon Emission Computed Tomography), By Application (Oncology, Neurology, Cardiology, Spine, Musculoskeletal Disorders, Body Imaging, Gastrointestinal Diseases), By End Users (Diagnostic Centers, Hospitals)- Global Forecast Till 2023
USE OF PET – HEALTH CARE POLICY PERSPECTIVESRuby Med Plus
POSITRON EMISSION TOMOGRAPHY (PET) USE BY TERTIARY HEALTH CARE CENT RES AND ITS ACCESSIBILITY TO POPULATION: A POLICY PERSPECTIVE. a BRIEF Cost-Benefit analysis.
An overview of meta analysis in the field of cardiovascular imaging using art...Pubrica
• AI will completely change the era of medicine by doctors, mainly in cardiology and radiology.
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Report’s Key Features
• PDF with > 160 slides
• Excel file > 5,500 patents
• IP trends, including time-evolution of published patents, and countries of patent filings
• Patents’ legal status
• Ranking of main patent assignees
• Key players’ IP position and relative strength of their patent portfolios
• Summary of the IP related to the physical isolation: size, deformability, electrical charges or density.
• Summary of the IP related to the biological isolation: positive or negative enrichment.
• Summary of the IP related to the CTC detection: nucleic acid, protein or functional assay.
• Analysis of patent litigations and review of key patents.
• Excel database containing all patents analyzed in the report, including biological and physical isolation and detection segmentations
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
How to Give Better Lectures: Some Tips for Doctors
Gfh 17 may-tatrc, afsim-magee
1. Telemedicine & Advanced Technology
Research Center (TATRC)
1- Medical Simulation and
Training Technology
Research Portfolio
2- Armed Forces Simulation
Institute for Medicine (AFSIM)
Games for Health - 17 May 2011
COL Karl E. Friedl, Ph.D. COL Ron K. Poropatich, M.D.
Director, TATRC Deputy Director, TATRC
Fort Detrick, Maryland Fort Detrick, Maryland
UNCLASSIFIED
2. Presenter: J. Harvey Magee, Technical Director,
Medical Simulation & Training Technology
• Financial Disclosures: None
• Organizational Disclosures: Employed by University
of Maryland Med System, loaned to US Army under
the Intragovernmental Personnel Mobilization Act
(IPA)
• Disclaimer: I have no authority to negotiate for, or to
obligate, the US Government.
• This is an informational brief and not intended to
convey Department of Defense policy.
UNCLASSIFIED
3. TATRC MedSim Team
• Thomas B. Talbot, MAJ, USA, MC
• Chair, JPC-1a Steering Committee
• Director, Armed Forces Simulation Institute for Medicine
(AFSIM)
• Kevin Kunkler, MD, Interim Portfolio Manager
• Hugh Connacher, Engineer
• Harvey Magee, Hospital Administrator (Presenting in behalf
of team), Technical Director
• Harvey.magee@tatrc.org
• Greg Wimsatt, JPC1 Facilitator
• Adam Wyatt, Project Officer
• Elton Edinborough, Project Officer
UNCLASSIFIED
4. Who TATRC is
• A US Army agency reporting to HQ US Army
Medical Research Materiel Command
(USAMRMC)
• We serve all of DOD
UNCLASSIFIED
5. Purposes
• Inform the Games for Health community of interest about:
• “traditional” TATRC “MedSim” portfolio, 1999-2011-->>
• a new funding source for medical simulation, through the
Defense Health Program, managed by the Office of
Secretary of Defense / Health Affairs (OSD/HA)
• Armed Forces Institute for Medicine (AFSIM)
• Joint Program Committee1a-MedSim (JPC1a-MedSim)
• AFSIM strategic plan
• Identify and describe major initiatives / areas of interest
• Inform the public about Fiscal Year (FY) 10 investments
• Request information / ideas for future AFSIM strategies
UNCLASSIFIED
6. Fulfilling the Vision Thru R&D
Mission
Explore science and engineering
technologies ahead of programmed
research, leveraging other
programs to maximize benefits to
military medicine
Vision
Be the DoD model of
government enablement of
technology transfer to use
UNCLASSIFIED
7. Strategic Partnerships
US Military Partners
USAMRMC HQs and Labs
Naval Health Research Center
Army & Navy Medical Centers
Extramural Partners
Pacific Telehealth & Technology Hui
Center for Integration of Medical &
Innovative Technology (CIMIT)
Pain and Neuroscience Center
Research (Conemaugh) TATRC WEST TATRC office
LOS ANGELES, CA TATRC / BHSAI
UTHSC-Houston
FORT DETRICK, MD BRUSSELS, BELGIUM
Loma Linda University
Center for Advanced Surgical &
TRIPLER
Interventional Technology (CASIT) HONOLULU, HI TATRC South
Samueli Research Institute AUGUSTA, GA
Center for Excellence for Remote & Medically
Under-Served Areas (CERMUSA)
Windber Research Institute
Joslin Vision Network Projects Supported
Center for Military Biomaterials Research (CeMBR) Norway
Schepens Eye Research Institute Poland
University of Maryland Macedonia
Ryder Trauma Center Netherlands
Italy
International Medical Military Partners Austria
France, Germany, UK
UNCLASSIFIED
8. Sim-Game Based Research - TATRC
- Duke (Anesthesiology Team Training)
- Virtual Reality Med Cen
- Institute of Creative Technologies
- Higher Order Learning Skills to
Manage Blast / IED Events:
- MYMIC LLC
- SimQuest LLC
-Chem-Bio-Rad-Nuclear-Explosive
- Forterra (bought by SAIC)
TATRC WEST TATRC office
LOS ANGELES, CA TATRC / BHSAI
FORT DETRICK, MD BRUSSELS, BELGIUM
-Cog Motor Therapy / Console Game
-Blue Marble TRIPLER
-Kinetic Muscles HONOLULU, HI TATRC South
AUGUSTA, GA
-Pandemic Event Mgt
-SimQuest
-Total Immersion Solutions
- Interactive Game-based system for
Psych Health Ed
-Novonics
-SOAR
-Total Immersion Solutions
UNCLASSIFIED
9. Sim-Game Based Research – JPC1a
-Applied Research
Associate - Anesthesia and
Anaphylaxis for Physicians
-Blitz Games Studios
(Vitalize Game Based
Wellbeing [Kinect-based]
Physical Therapy Coach
TATRC WEST TATRC office
LOS ANGELES, CA TATRC / BHSAI
FORT DETRICK, MD BRUSSELS, BELGIUM
-Blue Marble – TBI
Rehabilitation Surface TRIPLER
HONOLULU, HI TATRC South
AUGUSTA, GA
-Breakaway Games –
Hospital Disaster Simulator
for CBRNE
-Institute for Creative
Technologies – SimCoach,
other projects
UNCLASSIFIED
10. TATRC Funding History
Since FY98, $2.10B managed R&D projects
Millions
400
350
300 Demonstrations
& Field T-Med (P8)
250
200
150
100
50 Congressional Special
Appropriations – RDT&E
0
'98 '00 '02 '04 '06 '08
FY 2009 Total
$454.8M
UNCLASSIFIED
11. TATRC Portfolios
Medical Information & Training Technologies Military Operational Medicine
Infectious Diseases Combat Casualty Care
Clinical & Rehabilitative Medicine
Advanced
Simulation Prosthetics
Resilience & & Training Medical
Bio-Monitoring & Human
Human Reintegration Technology Robotics
Psych Health Technologies Performance
Performance
Optimization MAJ Talbot Dr. Lai Dr. Gilbert
Dr. Shore Mr. Turner
Dr. Cardin
Medical Health
Imaging Information
Genomics International Technologies Technologies Computational Nano-Medicine & Regenerative
/ Proteomics Health Biology Biomaterials Medicine
LCDR Steffensen Dr. Lai
Dr. Nisson Ms. Barrigan Dr. Reifman Dr. Grundfest
Dr. Pacifico
Medical
Infectious Logistics
Blood Products Trauma Neurotrauma Vision Research
Disease Acoustic
& Safety Trauma
Dr. Broderick Dr. Golanov Mr. Read
Dr. Carney
Mr. DePasquale Mr. Malloy Dr. Holtel
Slide 11 of 37
UNCLASSIFIED
13. Opportunity-Driven Model - Examples
• Congressionals - a “Line Item” appears in DOD
Authorization / Appropriation Bills
• Opportunity / obligation: to shape it to maximize military &
scientific relevance while honoring congressional language
• SBIR - Authoring of Small Business Innovative Research
“topics”
• Opportunity: proactively submit research topics to DOD /
Army to “fill gaps”
• Augmentation funding - Someone submits a hot,
innovative idea
• AAMTI - Army Med Dept Medical Training Initiative
• JPC1-MedSim - Joint Program Committee 1-MedSim
UNCLASSIFIED
15. Why We Started – Reason #1
To Improve Trauma Training
•100,000 military medical personnel must
practice battlefield trauma care skills*
(Source: GAO Rpt, NSIAD-98-75, DOD Training in Civilian
Trauma Centers)
•Good News – not enough trauma patients
•Bad News – not enough trauma patients,
for they ARE a training opportunity
•Solution: Virtual patients
UNCLASSIFIED
16. Why we Started – Reason #2
To Reduce the Errors
• IOM report - 1999:
>45,000 deaths due to
errors - Medical errors 7th
leading cause of U.S.
death…
• HealthGrades, 27 Jul
04: 195,000 deaths/yr,
$6B annual costs, 6th
most common death
• ENT: 45 % report errors
committed: 37%
“Classification and Consequences of Errors in
Otolaryngology “
serious harm, 9% fatal
-Rahul K. Shah, et al, The Laryngoscope, August 2004
Slide courtesy of Dr. Steve Dawson, CIMIT Simulation Group
UNCLASSIFIED November 09
17. Long-Term Vision for
Simulation-based Training
• To facilitate a paradigm shift in medical training, a Grand
Challenge revolution…
• FROM subjective assessment of clinical skills
• TO a curriculum-aligned, metrics-driven, objective
system of assessment based on demonstrated proficiency
to perform skills for which health care personnel have been
trained.
UNCLASSIFIED
18. Integrated Research Team – Feb 00
•70-person IRT (government, academia, & industry)
• Strategic ROAD MAP resulted
• 4 general areas for research identified
• Became basis of TATRC portfolio to this day
UNCLASSIFIED
19. Basis for Road Map:
Multiple Needs, Multiple Technologies
PC-based Interactive Multimedia
Digitally Enhanced
Mannequins
Part-
Task
Trainers /
Virtual
Workbench
es
Total Immersion Virtual
Reality UNCLASSIFIED
20. PC-Based Interactive Multimedia
Maintenance of Certification
Social Behavior – Combat Casualty – Chemical War - SimQuest
AVESSS / Second Life - Forterra (now SAIC) CBRNE
Interactive Psychological Health Education Cognitive Learning & Logistics - Patient Interactions & Logistics
- Total Immersive Software, Inc (JESSEY) Office of Naval – Applied Research Associates, Inc,
Research (PULSE) Virtual Heroes Division (HumanSim)
UNCLASSIFIED
21. Digitally Enhanced Mannequins
Next Generation Injury Creation
-
The Virtual Reality Medical
Center
Combat Medic Training System
– Center for Integration of
Medicine & Innovative
Technologies (CIMIT) -
(COMETS)
Compartment Syndrome Task
Trainer
- Operative Experience
UNCLASSIFIED
22. Part-Task Trainers / Virtual Reality
Systems
Burr Hole Simulator -
SimQuest
Virtual Cricothyroidotomy -
National Capital Area Medical Simulation Center
3-D Anatomical Model -
ArchieMD, Inc.
Compartment Syndrome Sim & Didactics
- Touch of Life (ToLTECH)
UNCLASSIFIED
23. Total Immersive Virtual Reality System
Wide Area Virtual Environment (WAVE)-
National Capital Area Medical Simulation
Image from
www.simcen.org/VME%20Lab/projects/wave/index.html iGlove Robotic Controller
- AnthroTronix
Tactical Digital Holograms: technology
Ultra High Resolution Display matured under contract with the Army
- eMagin -Zebra Imaging
UNCLASSIFIED
24. Technical Strategy
• Identify Enabling Technologies
• R&D them into components that can be…
• Integrated into…
• Systems of simulation-based training that can be…
• Validated to determine their training effectiveness, so
OTHER military organizations can…
• Transition / sustain them for military health care, from the
foxhole to the operating room and beyond
UNCLASSIFIED
25. Enabling Technologies
•Real-time in vivo tissue property measurement
•Haptics
•Tissue-tool interactions
•Graphics, visualization
•Augmented Reality
•Learning systems
•Metrics development
•Learning transfer & assessment
•Open source architecture
•Olfactory technologies
•Gaming Technologies
UNCLASSIFIED
26. AFSIM:
Introduction to the
Armed Forces Simulation
Institute for Medicine
Director: Thomas B. Talbot, MAJ, USA, MC
Telemedicine and Advanced Technology Research Center (TATRC)
United States Army Medical Research & Materiel Command
(USAMRMC)
UNCLASSIFIED
27. AFSIM ORIGINS
• Department of Defense Health Affairs Initiative
• Defense Health Program Dollars ~$30-45M/year
(contingent on receipt of funding)
• Improve medical education & readiness for all services
• ULAMET – JAT Report
• ASBREM Committee
• JTCG-1
• JPC-1
• Initial Mandate
1. Live Tissue/Sim Research,
2. Curricula and Standards,
3. Virtual Human Coaching for OIF/OEF Veterans,
4. Ophthalmology & Anesthesia, and
5. Medical Simulation Systems.
UNCLASSIFIED
28. Joint Program Committee 1
• JPC-1 Tri-Service
• Chair: COL Karl Friedl, PhD
• Tri-Service Programmatic Committee Transparent
• TATRC is primary execution agent
Ethical
• JPC-1a Medical Simulation & Training
• Chair: MAJ Thomas B. Talbot, MD Visionary
• Efforts spawned AFSIM
• JPC-1b Health Information Technology Collaborative
• Chair: Steve Steffensen, MD (Former Navy)
Responsive
• JPC-1c Decision Support Tools & Modeling
• Chair: Jaques Reifman, PhD
Strategic
UNCLASSIFIED
29. JPC-1a Voting Members
US Army - PEOSTRI
US Air Force - Air Education Training Command
US Army - Central Simulation Committee
USUHS - Natl Capital Area Med Sim Cen
AMEDD C&S - Directorate, Combat Medic Training
AMEDD C&S - US Army EMS Office
US Navy - Office of Naval Research
US Air Force - Air Education Training Command
US Army - RDECOM / STTC
DARPA
Medical Education and Training Campus (METC)
Office of Naval Research
UNCLASSIFIED
30. JPC-1a Advisors
US Navy - Naval Postgraduate School Monterey
Dept of Homeland Security
DOD; USA OTSG
DOD Patient Safety Office
TATRC / Brussels Belgium
USUHS - Natl Capital Area Med Sim Cen
Defense Center of Excellence for Psych Health & TBI
DOD Patient Safety Office
HQ USAMRMC
OASD (HA)
UNCLASSIFIED
31. Ground Rules
• NO PROMISES
• We cannot obligate the US Government to anything based
upon discussions during this event
• Decisions, plans and budgets are subject to approval and
changes by headquarters at any time
• The steering committee can and will change plans
• Pending Awards
• We cannot provide details on programs under review for
selection or projects pending award
• We want your input
• We shall inform industry and academia of our efforts and
wish to glean your insights on how you think we can
accomplish our strategic objectives
UNCLASSIFIED
32. JPC-1a Structure
Combat Casualty Medical Practice
Training Initiative Initiative
AFSIM
Developer Tools
Patient Focused
for Medical
Initiative
Education
UNCLASSIFIED
33. Combat Casualty Training Initiative
Strategic Building Blocks (CCTI)
Systems & research to improve
pre-hospital trauma training and
maintain lifesaver resilience
Superior
Battlefield
Integrate very advanced training technology Lifesaving DTME
Capability
into medical training & simulation facilities of PFI
all services
Advanced
Training
Virtual Reality individual and team training to
MPI Systems
replicate chaotic and mass casualty
scenarios in a safe environment
Tri- Service Resilience
Compatible Research &
Curricula Integration
Real world benefits:
-Pre-hospital assets continuously in a
high state of readiness Simulator
Olfaction &
Gap R&D to
-Potential to replace animal training equal animal
PTSD
Research
efficacy
-Training geared towards psychological
Animal / Improved
resilience during and after deployments Simulator Task
Improved
Learning
-Improved safety by statistically valid Comparison
(CCTC)
Trainers &
Manikins
Metrics
recognition of lost skills
UNCLASSIFIED
34. FY11 Combat Casualty Training Initiative
• Combat Casualty Training Consortium Program Announcement - $15.2M
• Timeline
Released Summer 2010
Closed November 19th, 2010
Scientific Review Complete
Programmatic Review Underway
Selection Board February 24th, 2011
Award(s) Anticipated Late Summer 2011
• Critical Research Areas
• Trauma Airway
• Hemorrhage
• Emergency Medical Skills (Nerve Agent Casualty)
• Goals
• Live Animal / Simulator Comparative Research
• Curriculum Development
• Simulator System Gap Analysis
UNCLASSIFIED
35. FY10 Combat Casualty Training Initiative
Combat Casualty Training Initiative Project Perfomer Budget
Live tissue / sim - metrics research NAVAIR $ 369,835
BCT-3 live tissue / sim study Brooke Army Medical Center $ 250,000
Multiple Amputee Trauma Trainer STTC Orlando $ 756,000
Rapid trauma skills training Operative Experience $ 497,750
COMETS improved capabilities for combat
medics CIMIT Sim Group $ 449,901
Maxillofacial & Ophthalmology Trauma
Trainer Pending Extramural Award Pending Award
TOTAL: ~$ 5,550,000
UNCLASSIFIED
36. CCTI FY11 Plans
• CTCC PA Award $15.2 M
• Extend BCT-3 research efforts ($1.8M)
~$17 Million
UNCLASSIFIED
37. CCTI FY12 Plans
• No Program Announcement Plans for FY12
• Consider PA in FY13
• CTCC is just starting and will not produce feedback by FY12 to
know where to add additional funding to CTCC
• Should we start a new advanced training platform in FY12?
• Advanced open architecture manikin
• Possible, but we don’t have research data to know everything it will need
• Advanced talking task trainers
• It is a stronger possibility. What would we do?
UNCLASSIFIED
38. Medical Practice Initiative
Strategic Building Blocks (MPI)
Development of medical training
systems & competency
assessment for sustained military
medical readiness. Advanced
Doctor
Education
PFI
Continuous Observation of Medical
System
(COMRADE
DTME
Records for Advanced Doctor Education )
(COMRADE)
Virtual
Human
Standardize
Real-time specialty specific evaluation for d Patients
loss of skills & knowledge
JPC-1b EHR JPC-1c
Education & Decision
Real world benefits: CCTI Reference Support
Integration Integration
-Reduced cost for training Educational
-Reduced liability Content Military
Serious Medical
-Cost savings by replacing expensive Games for Lifecycle
standardized live patient teaching Training Counselor
cases with reusable virtual human (DKO)
patients Loss of Common
Curricula & Military
Skills.
-Improved Tri-Service medical Retraining Metrics Medical
Simulation
interoperability & (Tri Service Masters
Competence Consortium)
-Leverages Electronic Health Record
system as training portal
-Can use AHLTA or another EHR
UNCLASSIFIED
39. Continuous Observation
of Medical Records for Advanced
Doctor Education (COMRADE)
Medical Record EHR Development
Extensive hyper-linking and floating reference info
Meaningful visual formats
Advanced Clinical practice guideline based formats when appropriate
Doctor Intelligent summarization of data
Education
System Health records that communicate
(COMRADE) Visual decision support tools
Intelligent Assessment & Tutoring
System tracks procedures, CME, findings & assessments
to determine physician exposures against list of
expected knowledge by their specialty board
System determines if lack of exposure is sufficient for a
refresher in a certain area
System schedules a teaching case or a virtual patient into
the physicians patient schedule
System recommends periodic procedure observed training
Automatic & documented maintenance of certification
UNCLASSIFIED
40. FY10 Medical Practice Initiative
Medical Practice Initiative Project Perfomer Budget
Medical Training Evaluation and Review
(MeTER) RDECOM / STTC $515,000
Training Outcomes Research Metrics UCLA / CRESST $450,000
Hospital disaster simulator - CBRNE Based Breakaway Games $2,671,322
Redeployment skills evaluation Madigan Army Medical Center $800,000
Tri Service Medical Simulation Training
Consortium Air Force / ONR / USUHS $2,500,000
Anesthesia and Anaphylaxis for Physicians Applied Research Associates $1,900,000
Virtual Sick Call RDECOM / STTC $773,000
TOTAL: $ 9,609,322
UNCLASSIFIED
41. MPI FY11 Plans
• Navy Redeployment Skills Degradation
• Multiple Amputee Trainer (MATT) final year
• Olfaction training device & study
• Medical Simulation Training Consortium Years 2-3
• Simulation for Futuristic Surgery (VR Urology)
• CBRNE Hospital Incident Management Radiological Scenarios
• Ocular Craniofacial Manikin Advanced Development
• Medical Simulation Master’s Degree Program
• Student Innovations in Medical Simulation (Skunk Works)
• Unfunded request for large web portal hosted by Air Force
~$13.5 Million
UNCLASSIFIED
42. MPI FY12 Plans
• We would like a program announcement for FY12
• PA would be major effort for AFSIM for the year
• Things we are thinking about:
• How can electronic health record data be used to discern a physician’s
educational needs?
• Military Medical Career Training Guidance
• How can we deliver training content with all the things we want to do on
government computer systems?
• For what applications are Virtual Reality & networked training appropriate
and efficacious?
• Are there things going on in the civilian world that we can leverage?
UNCLASSIFIED
43. Patient Focused Initiative
Strategic Building Blocks (PFI)
Advanced user interface and
interactive technologies for
healthy living, medical practice , MPI
patient rehabilitation & training Advanced CCTI
Virtual Reality &
Augmented
Reality Training
Advanced technology for training Technology
applications leveraging investments of
DoD and Government Partners
Virtual Human
Patients &
Coaches
Adapts therapeutic technology targeting
warfighter readiness and mental health
Mobile
Physical &
Technology
Neurocognitive
Integration for
Therapy
Real world benefits: Health &
Applications
Training
-High impact development at reduced
costs, especially for VR-based training JPC-8
NIH – Virtual
Rehabilitation,
-Technology highly adaptable to Reality for
Obesity &
Physical and
Neurocognitive
training Diabetes
Rehabilitation
-Direct injured warfighter benefit
-Traumatic Brain Injury ICT simCoach
-Psychological Health (PTSD, Suicide) DARPA – Game Industry & Emotionally
Healing Heroes Technology Expressive
-Physical Therapy Characters
-Adaptation of mobile and tele-health
technology PARTNERSHIPS
UNCLASSIFIED
44. FY10 Patient Focused Initiative
Patient Focused Initiative Project Perfomer Budget
Vitalize Game Based Wellbeing (Kinect-based
Physical Therapy Coach) Blitz Games Studios $4,325,024
Refining medical outcomes deployment: Naval Health Research Center $500,055
TBI Rehabilitation Surface Blue Marble $1,374,447
Olfaction & Resilience Research (10 studies 6.1) Monell Chemical Senses Center $4,000,000
TOTAL: $10,199,526
UNCLASSIFIED
45. PFI FY11 Plans
• Natural Language Processing for Virtual Humans
• 3D motion tracking for rehabilitation
• DARPA: Healing Heroes
~$5 Million
UNCLASSIFIED
46. PFI FY12 Plans
• We want to consider a program announcement in FY12
• Things we are thinking about:
• Virtual Humans for Coaching
• Assessment of off the shelf and easily hacked technology for the
rehabilitation, assessment and therapy environments
• Mobile Technology
• Constantly proposing SBIR topics in this area
UNCLASSIFIED
47. Developer Tools for Medical Education
Strategic Building Blocks (DTME)
Transformational open source
advanced developer tools to reduce MPI
development costs and democratize
access to technology.
CCTI
Affordable
Training
Based on the need to greatly reduce the Content
Creation
burden to develop interactive medical & CCTI
surgical training content.
Character AI
Open Source (OS) promotes low cost and
innovation
Surgical VR
Advanced
Training
Real world benefits: System
Displays &
Interfaces
-Greatly reduced development costs Standards
Online
-Saves development time Portal
-Facilitates content creation OS Practical
Physiology
OS Speech
& Motion
-Greatest need as program matures Engine Recognition
-Opens development to a more diverse
and wider community OS VR
OS Natural OS Medical
-Reduced system procurement costs Language
Anatomy &
Haptic
Asset
Processing Library
-Reduces redundant development Platform
UNCLASSIFIED
48. FY10 Developer Tools for Medical Education
Developer Tools For Medical Education Perfomer Budget
Dynamic Holographic Displays & 3D in
medical education RDECOM & PEOSTRI $ 3,000,039
Tri-Service Open Platform for Simulation USUHS $ 2,000,000
TOTAL: $ 5,000,039
UNCLASSIFIED
50. DTME FY12 Plans
• We want to consider a program announcement in FY12
• Things we are thinking about in the near term:
• Open Source Practical Physiology Engines
• Open Source Visual Human toolkit for VR surgical applications
• Things we are thinking about down the road
• Open Source Virtual Character Behavior Engine
• Medical Asset Exchange (Radiographs, sounds, slides, etc.)
• Character emotional display, speech & movement tools
• Natural Interface Tools, Facial Recognition for Emotion, etc.
UNCLASSIFIED
51. Summary
• Many thanks to the Games for Health community. You are
part of an unprecedented opportunity to shape the future of
medical training
• We welcome your input
• Make the most of the week!
• Harvey.magee@tatrc.org
UNCLASSIFIED
52. Opportunity-Driven Model - Examples
• Congressionals - a “Line Item” appears in DOD
Authorization / Appropriation Bills
• Opportunity / obligation: to shape it to maximize military &
scientific relevance while honoring congressional language
• SBIR - Authoring of Small Business Innovative Research
“topics”
• Opportunity: proactively submit research topics to DOD /
Army to “fill gaps”
• Augmentation funding - Someone submits a hot,
innovative idea
• AAMTI - Army Med Dept Medical Training Initiative
• JPC1-MedSim - Joint Program Committee 1-MedSim
UNCLASSIFIED
53. Congressional Process
• Our role is to manage congressionally supported
research as directed.
• Constituents’ opportunity is to educate and inform
your congressional representative . Government
officials are prohibited from involvement with
constituents in seeking to influence Congress.
•If you have questions, contract Mr Tony Story,
TATRC’s congressional liaison.
•301-619-7033
•tony.story@tatrc.org
UNCLASSIFIED
54. Locate the USAMRMC
Broad Agency Announcement
(the “BAA”)
• http://www.tatrc.org
• Click “Funding” at top-line menu.
• On Funding Opportunity page, click “USAMRMC BAA 10-1”.
• Click “Click here to visit the USAMRMC Broad Agency
Announcements (BAA) Website”.
• Or just go here:
http://www.usamraa.army.mil/pages/baa_forms/index.cfm
• READ and UNDERSTAND IT!
• You can take it from there.
UNCLASSIFIED