Stress responses in high-fidelity simulation and standard simulation training among medical students.

BACKGROUND: Simulation has been recognized as a shift in healthcare education that can improve skills and patient safety and outcomes. High-fidelity simulation of critical medical situations can be a source of stress among participants that can interfere with students' abilities leading to unexpected emotional responses. The aim of this study is to determine if two simulation methods, high-fidelity (HF) and procedural simulation (PS), may be associated with stress responses at a self-perceived and biological level (salivary cortisol variations), and to compare stress levels of the two different simulation method. We also wanted to find independent variables associated with cortisol total hormonal output. METHODS: A quasi-experimental before-after study was used including the administration of questionnaires, and biomarkers evaluation by salivary cortisol samples before and after simulation. A total of 148 students were eligible and agreed to participate in the study. We used paired T-test for mean comparison regarding State-trait anxiety for both HF and PT simulations. For NASA-TLX we performed a T-test mean comparison between groups. We used paired T-test mean comparison for cortisol analysis. Multivariable linear regression has been used to assess variables associated with AUCg values and perceived stress. RESULTS: values of STAI-Y scores were relatively higher at the end of the HF and PS sessions. NASA-TLX was significantly higher at baseline for the HF simulations, with respect to the PS simulation. Cortisol fold increase was significantly different in the two groups. Linear regression showed that cortisol AUCg was related to the STAI-Y score in both groups. CONCLUSION: Participating students developed a stress response both after in the HF and PS training, testified by psychological and biological outputs. According to our results, stress levels were increased for simply being in a simulation scenario than to the intrinsic complexity of the task required. More studies are needed to confirm this trend and to clarify the role of simulated stress response in a long-term learning scenario.

Development of the optimal touchscreen interface for patients with scleroderma.

Impaired hand function is a major contributor to overall disability and reduced health-related quality of life in scleroderma patients. A relevant issue concerns interaction of scleroderma subjects with touchscreen interfaces. This study aims at investigating this problem assessing scleroderma patients' performance with a novel, aptly designed, touchscreen application in order to identify critical items of touchscreen technology which may impair or facilitate the use by scleroderma subjects. Eighty scleroderma patients performed this novel application including three games, each of which tested a different gesture: tapping, dragging/dropping, and pinching-to-zoom. Eighty healthy subjects without hand impairments were recruited as controls. Scleroderma patients performed worse than healthy users in each game, and statistically significant negatively impacting items were identified. In the second phase of the study, the 10 worst touchscreen performers within the scleroderma cohort were recruited for a physio-rehabilitation trial based on the daily use at home of a modified version of the software application downloaded into the personal devices of patients. The results of this study allow introduction of guidelines to design accessible touchscreen interfaces for subjects with scleroderma and suggest that touchscreen technology may be included in self-administered physio-rehabilitation programs for scleroderma hand.

Preliminary simulation model toward the study of the effects caused by different mandibular advancement devices in OSAS treatment.

The paper aims to evaluate the effects caused by a Mandibular Advancement Device (MAD) for Obstructive Sleep Apnoea Syndrome (OSAS) treatment. This study is based on Finite Element Method (FEM) for evaluating the load distribution on temporomandibular joint, especially on the mandibular condyle and disc, and on periodontal ligaments. The stress values on condyle and periodontal ligaments lead authors to consider MAD a safe procedure even for a long period. The obtained results also show the relationship between MAD material and load distribution at the periodontal ligaments. The paper is a step toward future analyses for studying and comparing the effects of MAD features, such as material, shape and dimensions, in order to allow the clinician prescribing the most fitting device.

Investigating the feasibility of a reuse scenario for textile fibres recovered from end-of-life tyres.

The management of end-of-life tyres (ELTs) is regulated by several national and international legislations aiming to promote the recovery of materials and energy from this waste. The three main materials used in tyres are considered: rubber (main product), which is currently reused in other closed-loop applications; steel, which is used for the production of virgin materials; and textile fibres (approximately 10% by weight of ELTs), which are mainly incinerated for energy recovery (open-loop scenario). This study aims to propose and validate a new closed-loop scenario for textile fibres based on material reuse for bituminous conglomerates. The final objective is to verify the technical, environmental, financial, and economic feasibility of the proposed treatment process and reuse scenario. After characterization of the textile material, which is required to determine the technological feasibility, a specific process has been developed to clean, compact, and prepare the fibres for subsequent reuse. A life cycle assessment (LCA) has been carried out to quantify the environmental benefits of reusing the fibres. Finally, a cost benefit analysis based on the LCA results was conducted to establish the long-term financial and economic sustainability. From a technological point of view, the tyre textile fibres could be a promising substitute to the reinforcement cellulose commonly used in asphalts as long as the fibres are properly prepared (compaction and pellet production) for application in the standard bituminous conglomerate production process. From an environmental point of view, relevant benefits in terms of global warming potential and acidification potential reduction were observed in comparison with the standard incineration for energy recovery (respectively -86% and -45%). Moreover, the proposed scenario can be considered as financially viable in the medium to long term (cumulative generated cash flow is positive after the 5th year) and economically sustainable (expected net present value of more than €3,000,000 and economic rate of return of approximately 30%). Finally, the sensitivity and risk analyses show that no specific issues are foreseen for the future implementation in real industrial applications.

Evaluation of 3D technologies in dentistry.

Quality of service, in terms of improvement in patient satisfaction, is an increasingly important objective in all medical fields, and is especially imperative in orthodontics due to the high numbers of patients treated. Information technology can provide a meaningful contribution to bettering treatment processes, and we maintain that systems such as CAD, CAM and CAE, although initially conceived for industrial purposes, should be evaluated, studied and customized with a view to use in medicine. The present study aims to evaluate Reverse Engineering (RE) and Rapid Prototyping (RP) in order to define an ideal chain of advanced technological solutions to support the critical processes of orthodontic activity.