The European Trauma Course: Transforming systems through training.

The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries.

The influence of fluorination on the dynamics of the F- + CH3CH2I reaction.

The competition between the bimolecular nucleophilic substitution (SN2) and base-induced elimination (E2) reaction and their intrinsic reactivity is of key interest in organic chemistry. To investigate the effect of suppressing the E2 pathway on SN2 reactivity, we compared the reactions F- + CH3CH2I and F- + CF3CH2I. Differential cross-sections have been measured in a crossed-beam setup combined with velocity map imaging, giving insight into the underlying mechanisms of the individual pathways. Additionally, we employed a selected-ion flow tube to obtain reaction rates and high-level ab initio computations to characterize the different reaction pathways and product channels. The fluorination of the ß-carbon not only suppresses the E2-reaction but opens up additional channels involving the abstraction of fluorine. The overall SN2 reactivity is reduced compared to the non-fluorinated iodoethane. This reduction is presumably due to the competition with the highly reactive channels forming FHF- and CF2CI-.

Inverse ISAsomes in Bio-Compatible Oils-Exploring Formulations in Squalane, Triolein and Olive Oil.

In contrast to their more common counterparts in aqueous solutions, inverse ISAsomes (internally self-assembled somes/particles) are formulated as kinetically stabilised dispersions of hydrophilic, lyotropic liquid-crystalline (LC) phases in non-polar oils. This contribution reports on their formation in bio-compatible oils. We found that it is possible to create inverse hexosomes, inverse micellar cubosomes (Fd3m) and an inverse emulsified microemulsion (EME) in excess squalane with a polyethylene glycol alkyl ether as the primary surfactant forming the LC phase and to stabilise them with hydrophobised silica nanoparticles. Furthermore, an emulsified L1-phase and inverse hexosomes were formed in excess triolein with the triblock-copolymer Pluronic® P94 as the primary surfactant. Stabilisation was achieved with a molecular stabiliser of type polyethylene glycol (PEG)-dipolyhydroxystearate. For the inverse hexosomes in triolein, the possibility of a formulation without any additional stabiliser was explored. It was found that a sufficiently strong stabilisation effect was created by the primary surfactant alone. Finally, triolein was replaced with olive oil which also led to the successful formation of inverse hexosomes. As far as we know, there exists no previous contribution about inverse ISAsomes in complex oils such as triolein or plant oils, and the existence of stabiliser-free (i.e., self-stabilising) inverse hexosomes has also not been reported until now.

MUG500+: Database of 500 high-resolution healthy human skulls and 29 craniotomy skulls and implants.

In this article, we present a skull database containing 500 healthy skulls segmented from high-resolution head computed-tomography (CT) scans and 29 defective skulls segmented from craniotomy head CTs. Each healthy skull contains the complete anatomical structures of human skulls, including the cranial bones, facial bones and other subtle structures. For each craniotomy skull, a part of the cranial bone is missing, leaving a defect on the skull. The defects have various sizes, shapes and positions, depending on the specific pathological conditions of each patient. Along with each craniotomy skull, a cranial implant, which is designed manually by an expert and can fit with the defect, is provided. Considering the large volume of the healthy skull collection, the dataset can be used to study the geometry/shape variabilities of human skulls and create a robust statistical model of the shape of human skulls, which can be used for various tasks such as cranial implant design. The craniotomy collection can serve as an evaluation set for automatic cranial implant design algorithms.

Robotic-assisted repair of complex ventral hernia: can it pay off?

Pressure on health care providers is growing due to capping of remuneration for medical services in most Western European countries. We wanted to investigate, if robotic-assisted ventral hernia repair is reasonable from an economic point of view in our setting. Patients undergoing open or robotic-assisted repair for complex abdominal wall hernia using a Transversus Abdominis Release (TAR) between September 2017 and January 2019 were included. Procedure-related costs were calculated exact to the minute and cost unit accounting for the postoperative in-patient stay was done. Abdominal wall reconstruction using the TAR-technique was done in a total of 26 (10 female) patients via an open (n = 10) or robotic-assisted (n = 16) approach. No significant difference was seen in regard to age, BMI and ASA scores between subgroups. Time for operation was longer (253.5 vs 211.5 min; p = 0.0322), while postoperative hospital stay was shorter for patients operated with a robotic-assisted approach (4.5 vs 12.5 days; p < 0.005). Procedure-related costs were 2.7-fold higher when a robotic-assisted reconstruction was done (EUR 5397 vs. 1989), while total costs for in-patient stay were about 60% lower (EUR 2715 vs 6663). Currently, revenues by national insurance account for a total of EUR 9577 leading to a profit of EUR 1465 and 925 for the robotic-assisted and open myofascial release, respectively. In addition, 30-day re-admission rate was in favor of the robotic-assisted approach as well (6.3% vs 20%). From an economic point of view, robotic-assisted TAR for complex ventral hernia repair is a viable option in our setting. Higher procedure-related costs are offset by a significant shorter hospital stay. The economic advantage goes along with improvement in outcome of patients.