The software you are about to access is provided to you pursuant to the purchase of the Product by the legal entity which employs you, or which you represent (the “Licensee” or You”), from CAE, Inc., a corporation having a place of business in Sarasota, Florida, USA. This purchase of the Product is subject to CAE’s Healthcare Education Products General Terms and Conditions (the “HEPGTC”) and...
Page 4
Product and components thereof shall remain with CAE and, if applicable, its suppliers. For clarification, Licensee agrees that the source code for the Software is a trade secret of CAE and only CAE shall have the right to alter, maintain, enhance or otherwise modify the Software.
Page 5
Work remain the exclusive property of CAE. Licensee shall not modify such Work in any way whatsoever and shall not remove or alter any CAE notices. However, Licensee is permitted to produce and reproduce such Work only for non-commercial educational purposes.
Page 6
Product contained herein, or b) if required to be disclosed by law, and only to the extent of such disclosure and limited to the purpose requested, with prior notice to CAE to permit it to seek an appropriate remedy to prevent the disclosure, or alternatively to agree to the terms of such disclosure.
Page 7
9.2 Amendment. This License may only be amended by the duly authorized representatives of CAE. 9.3 No Waiver: The failure of CAE to enforce at any time any of the provisions of this License, or to require at any time the performance by Licensee of any of the provisions hereof, shall not be construed to be a waiver of such provisions, nor in any way affect the validity of this License or any part thereof, or the right of CAE thereafter to enforce any such provision.
Page 8
PROPRIETARY NOTICE: This document, including the information contained herein is confidential and/or proprietary to CAE Inc., and shall not be reproduced or disclosed in whole or in part, or used for any purpose whatsoever unless authorized in writing by CAE Inc. Information on copyright and trademarks.
Page 9
Front Matter/Product Specifications YSTEM PECIFICATIONS Hardware Equipment Two 22” flat LCD touchscreen monitors Haptics device Scope holder Dual foot pedal Dimensions 40.5” W x 35” D x 72” H (Adjustable) 103cm W x 89cm D x 183cm H (Adjustable) Weight 245 lb (111 kg) Electrical 100-120 V, 50-60 Hz, 10A...
Page 10
CAEEndoVR Front Matter/Product Specifications viii PN: 165K400300...
CAEEndoVR Front Matter/Cautions & Warnings AUTIONS AND ARNINGS Please read and understand these cautions and warnings before you begin using the simulator. Operations • Do not operate your equipment with any covers removed • Do not use your equipment in a wet environment. Protect equipment for liquid intrusion •...
Page 12
CAEEndoVR Front Matter/Cautions & Warnings PN: 165K400300...
Table of Contents ABLE OF ONTENTS CAE End-User License Agreement ..............i System Specifications ................vii Cautions and Warnings ................ix Operations..................... ix Ergonomics....................ix Table of Contents..................1 Introduction ....................1 Equipment Overview ................3 EndoVR Device ....................3 Monitor Pole and Monitor Arms..............3 Monitors ......................3...
Table of Contents Using the Upper GI and Lower GI Accessory Tool ......43 Using the Pedals..................45 Ending a Simulation..................46 Viewing Results ....................48 Viewing Personal Data................49 Viewing Usage Summaries .................50 Viewing Reports ...................51 Printing Data to a Network Printer ............54 Printing Data to a PDF File ..............56 Modifying Language Preferences ..............59 Adjusting the Volume..................60 Hiding the Available Tasks Panel ...............60...
Introduction NTRODUCTION Welcome to the CAE EndoVR Simulator user guide. This guide provides instructions on how to use the EndoVR simulator. The EndoVR simulator provides a safe, virtual environment for learners to practice endoscopic techniques and skills. Learners can range from medical students to licensed medical professionals.
The EndoVR device comes as a single entity. The haptic device (including external anatomy plates), keyboard, mouse and lifting mechanism are all part of the EndoVR device. The device is secured to a four-wheel platform for convenient mobility when storing the simulator.
Equipment Overview Computer The computer for the EndoVR simulator is shipped inside the EndoVR device. To access the computer, press on the access door located on the side of the simulator. The Computer Access Door Additional Equipment For modules, which are sold separately, users must purchase additional equipment to fully utilize the curriculum and simulation procedures.
Equipment Overview Before Using the Simulator Proper operation of the EndoVR simulation requires correct configuration. Before setting up the system, keep in mind these basic guidelines: • Read and understand the Cautions and Warnings in the beginning of this User Guide •...
SING THE IMULATOR The EndoVR simulator integrates replica gastrointestinal and bronchoscopic scope heads, accessories and pedals with an interactive software to provide learners with a comprehensive and quantitative training experience. Administrators and trainers are responsible for setting up the user accounts, managing the learners’...
CAEEndoVR Using the Simulator Power On the Simulator Before starting the software, ensure that the simulator is powered on. In the case that the simulator is not powered on, follow the instructions below. To power on the simulator: a. Ensure the top of the master power button, located on the back of the simulator, is pressed in The top of the master power...
Using the Simulator Starting the Software Once the EndoVR simulator is powered on, the software launches automatically and the Login screen appears. The Username field The Password field The Login button The Login Screen To log in to the software: 1.
Page 24
CAEEndoVR Using the Simulator The Home Screen From the Home screen, users can select and start a simulation exercise, view personal data and print usage summaries and reports. Users are also able to modify language preferences and access the user guide from the Home screen. PN: 165K400000...
Using the Simulator Interface Overview The EndoVR user interface contains a dashboard of icons that represent the tools available to users. The Icon Dashboard When an icon is selected, the icon will appear blue and the associated content will appear in the main screen on the interface.
Page 26
CAEEndoVR Using the Simulator My Tasks From the My Tasks screen, users can choose a simulation, review didactic content, run a simulation and review results. The My Tasks icon The My Tasks Screen My Profile From the My Profile screen, users can review their personal data including username, registration and contact information and privileges.
Page 27
Using the Simulator Usage From the Usage screen, review and print their usage summaries for completed simulations. The Usage icon The Usage Screen Reports From the Reports screen, users can review and print reports for completed simulations. The Reports icon The Reports Screen PN:165K400000...
CAEEndoVR Using the Simulator Selecting a Simulation Each module in the software contains a specially-developed curriculum to test learners on their ability to perform acute endoscopic procedures. Based on the courses and tasks assigned to the learner by the administrator, the training experience is customized to help the learner meet the necessary educational objectives.
Page 29
Using the Simulator 2. From the Available Tasks panel on the left side of the screen, click the desired module The desired module The Home Screen 3. Click the desired course The desired course The My Tasks Screen PN:165K400000...
Page 30
CAEEndoVR Using the Simulator 4. Click the desired task The desired task The main screen The My Tasks Screen The didactic content appears in the main screen of the software. PN: 165K400000...
Using the Simulator Reviewing the Didactic Content Before beginning a simulation, users should review the didactic content for the selected procedure. The didactic content contains information users need to know before and after performing a specific procedure. The didactic content for tasks may include Training Objectives, Didactics, Instructions, Case History, Diagnostic Images, Pre-Procedures, Parameters and Post-Procedures.
Page 32
CAEEndoVR Using the Simulator Training Objectives To access the Training Objectives screen, click the Training Objectives tab. When selected, the tab appears blue and the Training Objectives screen appears. Training Objectives The Training Objectives Screen The Training Objectives screen outlines the training goals and objectives users meet upon successful completion of the procedure.
Page 33
Using the Simulator Instructions To access the Instructions screen, click the Instructions tab. When selected, the tab appears blue and the Instructions screen appears. Instructions The Instructions Screen The Instructions screen provides an overview of the procedure and directions for navigating through and performing the procedure.
Page 34
CAEEndoVR Using the Simulator Demos To access the Demos screen, click the Demos tab. When selected, the tab appears blue and the Demos screen appears. The Demos The Demos Screen The Demos screen provides users with a tutorial on how to perform the selected procedure. PN: 165K400000...
Page 35
Using the Simulator Didactics To access the Didactics screen, click the Didactics tab. When selected, the tab appears blue and the Didactics screen appears. Didactics Anatomy Procedure Atlas link Overview link The Didactics Screen The Didactics screen contains two outlines of content for the user to navigate: Procedure Overview and Anatomy Atlas (or Pathology Atlas).
Page 36
CAEEndoVR Using the Simulator Procedure Overview The Procedure Overview screen contains an outline of procedural information, videos and instructions created by endoscopy specialists and physicians. The scroll Procedure Overview outline The Procedure Overview Screen Learners can select the content to review by clicking on the outline hyperlinks or scrolling down the Procedure Overview screen.
Page 37
Using the Simulator Anatomy Atlas The Anatomy Atlas screen contains images of specific parts of the anatomy for the learner to review prior to beginning a procedure. The scroll Anatomy Atlas outline The Anatomy Atlas Screen Learners can select the content to review by clicking on the outline hyperlinks or scrolling down the Anatomy Atlas screen.
Page 38
CAEEndoVR Using the Simulator Pathology Atlas The Pathology Atlas screen contains images of pathologies for the learner to review prior to beginning a procedure. The scroll Pathology Atlas outline The Pathology Atlas Screen Learners can select the content to review by clicking on the outline hyperlinks or scrolling down the Pathology Atlas screen.
Page 39
Using the Simulator Diagnostic Images To access the Diagnostic Images screen, click the Diagnostic Images tab. Note: In some modules, the Diagnostic Images tab replaces the Didactics tab. When selected, the tab appears blue and the Diagnostic Images screen appears. Diagnostic Images tab The image...
Page 40
CAEEndoVR Using the Simulator Case History To access the Case History screen, click the Case History tab. When selected, the tab appears blue and the Case History screen appears. The Case History tab The Case History Screen The Case History screen provides users with background information about the patient including symptoms, medical history and documentation of previous conditions and procedures.
Page 41
Using the Simulator Pre-Procedures To access the Pre-Procedures screen, click the Pre-Procedures tab. When selected, the tab appears blue and the Pre-Procedures screen appears. The Pre- Procedures The Pre-Procedures Screen The Pre-Procedures screen provides steps the user needs to complete prior to beginning the procedure.
Page 42
CAEEndoVR Using the Simulator Post-Procedures To access the Post-Procedures screen, click the Post-Procedures tab. When selected, the tab appears blue and the Post-Procedures screen appears. The Post- Procedures The Post-Procedures Screen The Post-Procedures screen provides actions users should perform after the procedure is complete. PN: 165K400000...
Using the Simulator Changing User Parameters Every task available on the simulator contains parameters for determining if the learner performed a procedure successfully. For some procedures, the administrator can provide users with the ability to change certain parameters such as timeouts, bleeding, and virtual aids. However, some modules do not contain any adjustable user parameters.
Page 44
CAEEndoVR Using the Simulator The adjusted parameter appears yellow and the changes are recognized until the user navigates to a different task or completes the simulation. Users can also cancel the parameter changes by clicking the Revert Changes button. The Start Simulation button The Revert...
Using the Simulator Running a Simulation Prior to running a simulation, prepare for the simulation by completing the following steps: 1. Select the desired task 2. Review the associated didactic content 3. Complete any parameter adjustments, if applicable After the preparation steps are complete, start the simulation To start a simulation: 1.
Page 46
CAEEndoVR Using the Simulator The Simulation Start Screen IMPORTANT: Some modules contain different content related to the simulation, which may display on both the left and right monitors. When a task from the upper GI bleeding module is selected, the simulation start screen appears on the left monitor.
Page 47
Using the Simulator The vitals and external view appear on the right monitor. The Right Monitor Start Screen Note: Be sure to observe the content on both monitors while performing procedures. PN:165K400000...
CAEEndoVR Using the Simulator Selecting a Scope The corresponding scopes and scope tubes are provided for purchased modules. Different scopes are used for different procedures. Bronchoscope The bronchoscope is used in the Bronchoscopy modules including Pediatric Difficult Airway, Endobronchial Sampling and Transbronchial Needle Aspiration (TBNA). The Freeze button The Screen An unassigned...
Page 49
Using the Simulator Endoscope The endoscope is used for the Lower GI and Upper GI modules, including Introduction to Colonoscopy, Colonoscopy: Biopsy, Colonoscopy: Basic Polypectomy, Introduction to Flexible Sigmoidoscopy, Flexible Sigmoidoscopy: Supplementary Cases, Introduction to ERCP, Introduction to EGD and UGI Bleeding. The Endoscope Diagram Stand directly in front of the simulator when inserting the endoscope unless otherwise informed when reviewing the didactic content prior to beginning the module.
CAEEndoVR Using the Simulator Connect the Scope When the chosen task requires a different scope from the scope that is currently connected, learners can disconnect the current scope and connect the new scope. Note: Do not disconnect scope during a running simulation. To disconnect a scope: a.
Page 51
Using the Simulator To connect a scope: a. Choose the desired scope from the scope holder located on the back of the simulator b. Align the prongs in the connector with the scope port located on the back left side of the simulator The scope port The Back of the Simulator...
To use the scope on the simulator: 1. Turn the anatomy plate to the correct anatomical part for the procedure, if applicable 2. Stand to the left or directly in front of the EndoVR device (depending on the appropriate orientation for the chosen procedure) 3.
Using the Simulator Troubleshooting Guide Table 1: Problem Resolution The simulator is unable Select the Reset Endoscope button in the RESET menu on the right to detect the endoscope screen and wait to be prompted to insert the scope a depth of 40 cm during simulation.
CAEEndoVR Using the Simulator Connect the Accessory Tool (Optional) To connect the accessory tool for specific procedures: 1. Select the desired accessory tool for the procedure The EBUS-TBNA accessory tool is used for EBUS-TBNA module tasks. The EBUS-TBNA Accessory Tool The Upper GI/Lower GI accessory tool is used for certain Upper GI and Lower GI module tasks.
Page 55
Using the Simulator 2. Locate the accessory tool port on the back of the simulator The accessory tool port The Back of the Simulator 3. Press the accessory tool connector into the accessory tool port The Accessory Port PN:165K400000...
CAEEndoVR Using the Simulator Using the EBUS-TBNA Accessory Tool After the desired task is selected, the simulation is started and the accessory tool is connected, the EBUS-TBNA accessory tool is ready to be used. To use the EBUS-TBNA accessory tool: 1.
Using the Simulator Using the Upper GI and Lower GI Accessory Tool After the desired task is selected, the simulation started and the accessory tool is connected, the Upper GI and Lower GI accessory tool is ready to be used. To use the Upper GI and Lower GI accessory tool: 1.
Page 58
CAEEndoVR Using the Simulator 3. Insert the plastic filament from the accessory tool into the working channel of the scope The Insertion of the Accessory Tool Filament 4. Pull the single finger loop away to deploy the selected tool. This position is known as the deployed (open) position The Accessory Tool in the Deployed Position Note: If an accessory tool is unavailable, learners may use the virtual substitutes in the software.
Using the Simulator Using the Pedals The pedals provide energy for electro-cautery instruments and are only available for use in certain modules. To use the pedals: 1. Remove the pedals from the storage tray located underneath the simulator 2. Place the pedals directly in front of the simulator The Simulation Pedals 3.
Using the Simulator Ending a Simulation The EndoVR simulator has multiple ways in which a simulation can end. In some cases, the learner makes a procedural error and is unable to correct the error within the allotted time for the simulation. Certain task parameters affect what types of injuries or errors are acceptable and correctable within a simulation.
Page 61
Using the Simulator To end the simulation manually in modules without a Continue button, click the End Simulation button. The End Simulation button The Simulation Screen PN:165K400000...
CAEEndoVR Using the Simulator Viewing Results Once the simulation is complete, the Results screen appears. If the learner meets all of the parameters for the simulation, the Successful Completion message displays. Successful Completion message The Results Screen If the learner did not meet all of the parameters for the simulation, the Unsuccessful Completion message displays.
Using the Simulator Viewing Personal Data To view personal data, click the My Profile icon. The My Profile icon The Icon Dashboard The Personal Data Screen PN:165K400000...
CAEEndoVR Using the Simulator Viewing Usage Summaries To view usage summaries, click the Usage icon. Usage icon The Icon Dashboard The Usage Summary Screen PN: 165K400000...
Using the Simulator Viewing Reports Learners can view customized reports from the Reports screen. To view reports: 1. Click the Reports icon Reports icon The Icon Dashboard The Reports Screen PN:165K400000...
Page 66
CAEEndoVR Using the Simulator 2. From the Tasks options, select the desired tasks to include in the report or select All Tasks The Tasks options The Reports Screen The Reports options appear. 3. From the Reports options, select the desired reports to include in the report or select All Reports Reports options...
Page 67
Using the Simulator The report appears in the Print Preview panel. The Print Preview panel The Reports Screen PN:165K400000...
CAEEndoVR Using the Simulator Printing Data to a Network Printer A network connection is required for printing to a network printer. Contact your administrator for further assistance. To print data to a network printer: 1. From the selected screen, click the Print button located near the bottom right corner of the screen The Print button...
Page 69
Using the Simulator The Print button The Print Window 2. Select the desired network printer 3. Click Print PN:165K400000...
CAEEndoVR Using the Simulator Printing Data to a PDF File If network connection is not available or no network printers are available, users can print data to a PDF file and save the file to an external device to print on a computer with a network printer connection.
Page 71
Using the Simulator 3. Click Print The PDF Complete Document Creation Options Window 4. Select the desired folder where the file will be saved Notre: If the location is on an external device, use the USB port located on the back of the simulator to connect the external device to the simulator.
Page 72
CAEEndoVR Using the Simulator The PDF Complete Special Edition window appears with the completed PDF. The PDF Complete Window PN: 165K400000...
2. Select the preferred language from the drop-down menu A checkmark appears next to the selected language and the language is applied to the software. Note: Since the EndoVR software is currently only available in English, no other options are available to set as the default language. PN:165K400000...
CAEEndoVR Using the Simulator Adjusting the Volume Learners can adjust the volume of the simulator sounds by using the hotkeys on the simulator keyboard. To increase the volume, press the Ctrl key and the Up arrow on the simulator keyboard simultaneously until the desired volume is achieved.
Using the Simulator Exiting the Software Learners should log out of the software once they are completed with their training session. To exit the software: 1. Click on the username in the top right corner of the screen The Logout drop-down menu The Home Screen with Logout Drop-Down Menu...
Page 76
CAEEndoVR Using the Simulator PN: 165K400000...
Starting an ESD Simulation Starting an Endoscopic Submucosal Dissection Simulation CAUTION: DO NOT TRY TO INSERT THE SCOPE BEFORE YOU SEE THE INDICATION ON THE SCREEN. ATTEMPTS TO INSERT THE SCOPE PRIOR TO THIS INDICATION CAN SEVERELY DAMAGE THE EQUIPMENT. Prior to starting the simulation, you should ensure that the large oral anatomy plate is mounted on the front of the simulator with the chin pointed right.
Page 78
CAEEndoVR Starting an ESD Simulation When the desired case is selected and the simulation is started, a message on the left LCD touchscreen monitor will prompt you to insert the endoscope a depth of 40 centimeters in order to start the procedure.
Page 79
Starting an ESD Simulation Note: If you are not properly oriented to the simulator manikin when inserting the scope, it will not the simulation will not respond appropriately to scope manipulation. If this occurs, catch correctly and solve the problem by pressing the Reset button (Below) The Reset Button You can navigate the simulator with both LCD touchscreen monitors.
CAEEndoVR Starting an ESD Simulation Scope Controls The scope has five controls composed of three buttons and two deflection knobs. It also has a working channel to insert the filament of the snare tool (refer to Using the Snare Tool section). Up/down deflection knob Button to toggle between (larger knob)
Starting an ESD Simulation Left LCD Touchscreen Monitor The Left Screen Simulation Configuration The left LCD touchscreen monitor displays different views depending on the selected camera mode. The left LCD touchscreen monitor has three menus along the left side of the screen: depending on the camera mode selected.
Page 82
CAEEndoVR Starting an ESD Simulation The CAMERA button allows you to toggle between the different view modes which impacts the view that is presented on the left-hand-side monitor. When you select the Third-Person Camera button, arrow controls will appear to the right of the Third-Person Camera button.
Page 83
Starting an ESD Simulation The IMAGING menu has the following simulation software buttons: The Narrow Band Imaging button enables narrow band imaging modality. The Chromoendoscopy button applies indigo carmine contrast stain to the surface of the mucosa layer. Sample Anatomy With Narrow Band Imaging Off Sample Anatomy With Narrow Band Imaging On PN:165K400000...
Page 84
CAEEndoVR Starting an ESD Simulation Sample Anatomy With Chromoendoscopy On The CAPS menu has the following ESD cap options: The No Cap option removes the selected ESD cap on the distal end of the scope in simulation. The Oblique Cap option adds the oblique ESD cap on the distal end of the scope in simulation.
Page 85
Starting an ESD Simulation You must retract the scope until the ENDOSCOPIC VIEW is no longer visible prior to selecting one of the ESD cap options above. A message will appear on both the left and right screens if this sequence of steps is not followed.
Page 86
CAEEndoVR Starting an ESD Simulation The PEDALS menu will only appear when a tool (except for the endo clips) is selected from the TOOLS menu. When a tool is selected, the tool’s default configuration of the left and right pedals will be visible.
Page 87
Starting an ESD Simulation The ENERGY menu will appear when a tool (except for the endo clips and the injection needle) is selected from the TOOLS menu. The ENERGY menu contains the following available coagulation energy options: The Soft Coagulation option sets the tool’s coagulation energy to soft coagulation. Note: the Soft Coagulation option is the default coagulation energy option The Swift Coagulation option sets the tool’s coagulation energy to swift coagulation.
CAEEndoVR Starting an ESD Simulation Right LCD Touchscreen Monitor The Right Screen Simulation Configuration The right LCD touchscreen monitor displays control functions available during the simulation. The right LCD touchscreen monitor has three menus along the left side of the screen: 1.
Page 89
Starting an ESD Simulation The SNAPSHOT menu has the following simulation software buttons: The Snapshot button takes a snapshot of the ENDOSCOPIC VIEW and saves the image in the Taking a snapshot adds the most default directory C:\Users\UniVR\Pictures\ESDSnapshots. recent snapshot to the right-hand-side monitor. There are also arrows on the right-hand-side monitor that allow you to navigate between the captured snapshots.
Page 90
CAEEndoVR Starting an ESD Simulation The PROCEDURE menu has the following simulation software buttons: The End Procedure button displays the following warning message on the LEFT screen before ending the simulation: You can choose to either end the simulation by selecting ‘OK’ or continue the simulation by selecting ‘Cancel’.
Starting an ESD Simulation Using the Snare Tool The Snare tool is used to simulate a variety of ESD tools that can be used during the simulated cases. The following tools can be selected from the Tools menu on the left screen and they can only interact with the region of operative interest (ROI): Coagrasper Dual Knife...
Page 92
CAEEndoVR Starting an ESD Simulation There is a sequence of steps required to use the tools: 1. Select the desired tool in the TOOLS menu on the left screen 2. Insert the plastic filament in the working channel of the endoscope until the tool appears in the ENDOSCOPIC VIEW or EXTERNAL VIEW 3.
Starting an ESD Simulation Ending the Procedure At any time during the simulation, you can choose to end the procedure by clicking the End Procedure button. The Stop Procedure Button The following warning message will appear on the left screen before ending the simulation with the End Procedure button: Warning message that is displayed on left screen before ending the simulation You can choose to either end the simulation by selecting ‘OK’...
Page 94
CAEEndoVR Starting an ESD Simulation PN: 165K400000...
PPENDIX ODULE ESCRIPTIONS The EndoVR simulator contains several modules for learners to practice performing endoscopic and bronchoscopic procedures using different techniques and tools. Modules are bundled in three packages: Bronchoscopy, Lower GI and Upper GI. The following table outlines the various modules offered for the EndoVR simulator.
CAEEndoVR Appendix A - Module Descriptions Module Instruments and Required Equipment In each of the modules, different instruments, medication and equipment are used to complete the selected task. Bronchoscopy The Bronchoscopy modules present the learners with different scenarios and cases to complete using the bronchoscope and related tools Module Available...
Appendix A - Module Descriptions Lower GI The Lower GI modules present the learners with different scenarios and cases related to the lower GI tract. Learners use an endoscope and related tools to complete the procedures. Module Available Medications Required Instruments Equipment Biopsy...
CAEEndoVR Appendix A - Module Descriptions Upper GI The Upper GI modules present the learners with different scenarios and cases related to the upper GI tract. Learners use an endoscope and related tools to complete the procedures. Module Available Medications Required Instruments Equipment...
Page 100
For more information about CAE products, contact your regional sales manager or the CAE distributor in your country, or visit caehealthcare.com. Tel +1 941-377-5562 or 866-233-6384 For customer service, please contact CAE. United States Monday - Friday from 7:00 a.m. to 6:00 p.m. ET Phone 1-866-462-7920 Email: customerservice@caehealthcare.com...
Need help?
Do you have a question about the EndoVR and is the answer not in the manual?
Questions and answers