Objective Response of Saliva Biomarkers After High-Stress and Mass Casualty Scenarios: A Pilot Study.

Introduction: Surgeons and military personnel are subjected to high-stress scenarios, which leads to greater rates of burnout. There is room to optimize performance and longevity in these careers by better understanding the body's stress response and applying it to stress management training. This study aims to understand the physiological response in those engaged in trauma scenarios by examining 6 hormones and 42 cytokines during the Intensive Surgical and Trauma Skills Course held at Strategic Operations Inc in San Diego, CA.

Using Full Dive Virtual Reality to Operationalize Warfighter Resilience: From Proof of Concept and Usability of Hardware and Software to Upcoming Integrated Psychological Skills Training.

Introduction: Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure.

A distinct immune cytokine profile is associated with morning cortisol and repeated stress.

Objective: The objective of this study was to investigate possible immune cytokine trends throughout a week-long surgical simulation mass-casualty training session in order to determine the effects of stress inoculation on the immune system.

Methods: Thirty-seven military medical students participated in a hyper-realistic surgical simulation training event conducted at Strategic Operations site in San Diego, California. Salivary samples were collected every morning of the stress training exercise for 4 consecutive days.

Analytical modelling of the transport in analog filamentary conductive-metal-oxide/HfO ReRAM devices.

The recent co-optimization of memristive technologies and programming algorithms enabled neural networks training with in-memory computing systems. In this context, novel analog filamentary conductive-metal-oxide (CMO)/HfO redox-based resistive switching memory (ReRAM) represents a key technology. Despite device performance enhancements reported in literature, the underlying mechanism behind resistive switching is not fully understood.

Cytokine fluctuation during acute stress is correlated to life trauma.

Background: Multiple studies have demonstrated that human neurobiology and behavior are inextricably linked to the activity of our immune systems. Trauma is associated with a multitude of immune system changes; reflecting this, posttraumatic stress disorder (PTSD) is often comorbid with immune-related conditions such as autoimmune disorders. To further investigate this phenomenon, we tested our hypothesis that cytokine fluctuations during and after an acute stress response correlates with experienced life trauma.

A Mixed Methods Investigation on the Relationship Between Perceived Self-Regard, Self-Efficacy, and Commitment to Serve Among Military Medical Students.

Introduction: Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures.

Principal component analysis of salivary cytokines and hormones in the acute stress response.

The acute stress response is characterized by activation of multiple interconnected systems in the body, resulting in the release of a flood of hormones and immune mediators into circulation. In addition to detection of these molecules in the serum, saliva can serve as a source of these markers as well and can be collected in a non-invasive way. The complete profile of salivary biomarkers associated with the hypothalamic pituitary adrenal/gonadal axes and the immune system during the acute stress response has not been fully elucidated.

Website Usability Analysis of U.S. Military Residency Programs.

Introduction: The Military Match is the residency matching system for medical students attending the Uniformed Services University of Health Sciences, and the students were funded by the Health Professions Scholarship Program through the U.S. Army, Air Force, and Navy.

The environmental impacts of different mask options for healthcare settings in the UK.

During the COVID-19 pandemic, different strategies emerged to combat shortages of certified face masks used in the healthcare sector. These strategies included increasing production from the original manufacturing sites, commissioning new production facilities locally, exploring and allowing the reuse of single-use face masks via various decontamination methods, and developing reusable mask alternatives that meet the health and safety requirements set out in European Standards. In this article, we quantify and evaluate the life-cycle environmental impacts of selected mask options available for use by healthcare workers in the UK, with the objective of supporting decision- and policy-making.

Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control.

Background: Early hemorrhage control after interpersonal violence is the most urgent requirement to preserve life and is now recognized as a responsibility of law enforcement. Although earlier entry of first responders is advocated, many shooting scenes remain unsafe for humans, necessitating first responses conducted by robots. Thus, robotic hemorrhage control warrants study as a care-under-fire treatment option.

Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest.

Aim: Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence.

Delayed care in myocardial infarction and ischemic stroke patients during the COVID-19 pandemic.

Unlabelled: COVID-19 has profound direct health consequences, however secondary effects were much broader as rates of hospital visits steeply declined for non-COVID-19 concerns, including myocardial infarction (MI) and stroke, with patients choosing to wait longer before symptoms convince them to seek medical attention. Thus, patients where ischemia leads to tissue loss should be a major concern.

Methods: The months of March to June 2019 and 2020 were compared to each other at 4 Denver area hospitals.

Ultrasound-Guided Meniscal Injection of Autologous Growth Factors: A Brief Report.

Meniscal degeneration is a common finding even in young patients' knees, and it is regarded as a predictor for the onset of early osteoarthritis (OA). When symptomatic, it represents a challenge since arthroscopic surgery provides unpredictable results: recent evidence has shown that partial meniscectomy is not better than conservative management up to 2 years of follow-up, and the removal of meniscal tissue may accelerate OA progression toward OA. Intra-articular injection of corticosteroids or hyaluronic acid may help in providing temporary symptomatic relief, but no influence should be expected on the quality of the meniscal tissue.

Emotional intelligence, cortisol and α-amylase response to highly stressful hyper-realistic surgical simulation of a mass casualty event scenario.

Lifetime exposure to stress leads to risk of suffering from cumulative detrimental physiological and psychological ailments. Due to the nature of healthcare and exposure to trauma, medical professionals are particularly susceptible to the negative impacts of high stress environments. emotional intelligence plays a role in ameliorating the risk of being negatively impacted by these stressors.

The next nine minutes: Lessons learned from the large-scale active shooter training prior to the STEM school shooting.

Objective: As the incidence of active shooters increase, local emergency response has also changed. South Metro Fire Rescue coordinated a series of hyper-realistic active shooter simulation drills involving multiple agencies.

Methods: "The Next Nine Minutes" was one of the largest active shooter drills performed to date with 904 personnel that were trained in 18 mass casualty active shooter drills.

Medical Students Immersed in a Hyper-Realistic Surgical Training Environment Leads to Improved Measures of Emotional Resiliency by Both Hardiness and Emotional Intelligence Evaluation.

Background: Burnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously.

Strategies to improve communication in telementoring in acute care coordination: a scoping review.

Background: Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring.

Methods: Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers.

Knee Intraosseous Injections: A Systematic Review of Clinical Evidence of Different Treatment Alternatives.

Objective: To systematically review the available clinical evidence regarding the safety and efficacy of knee intraosseous injections for the treatment of bone marrow lesions in patients affected by knee osteoarthritis.

Design: A literature search was carried out on PubMed, Embase, and Google Scholar databases in January 2020. The following inclusion criteria were adopted: (1) studies of any level of evidence, dealing with subchondral injection of bone substitute materials and/or biologic agents; (2) studies with minimum 5 patients treated; and (3) studies with at least 6 months' follow-up evaluation.

The Effect of Hyper-Realistic Trauma Training on Emotional Intelligence in Second Year Military Medical Students.

Intro: This project expanded upon previous exploration of emotional intelligence during the habituation for military second year medical students undergoing high-stress simulation with trauma and surgical skill training. The objective was to interpret emotional intelligence data before and after hyper-realistic immersion trauma training and to include a larger sample size than previously investigated.

Methods: Fifty increasingly intense mass casualty scenarios with simulated Emergency Department (ED) and Operating Room (OR) procedures were performed while students lived as if deployed in an Afghan village.

Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France.

Background And Purpose: To date, no study has attempted to quantify the impact of the COVID-19 outbreak on the incidence and treatment of acute stroke.

Methods: This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1-31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume.

Hyper-realistic and immersive surgical simulation training environment will improve team performance.

Background: Surgical trauma care requires excellent multidisciplinary team skills and communication to ensure the highest patient survival rate. This study investigated the effects of Hyper-realistic immersive surgical team training to improve individual and team performance. A Hyper-realistic surgical training environment is defined as having a high degree of fidelity in the replication of battlefield conditions in a training environment, so participants willingly suspend disbelief that they become totally immersed and eventually stress inoculated in a way that can be measured physiologically.

Assessing Surgical Task Load and Performance: A Comparison of Simulation and Maritime Operation.

Introduction: This study examined the effects of simulated and actual vessel motion at high seas on task load and surgical performance.

Methods: This project was performed in phases. Phase I was a feasibility study.

Efficacy of Medical Operations and Layout Planning Onboard Nontraditional US Navy Vessels at High Seas.

Introduction: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures.

Methods: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California.