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• Learning skills for operative vaginal delivery. • Residency programme on labour and delivery simulators. • Retention of acquired skills. • Obstetric emergency and simulator training. To assess the effect of two modalities of simulation training on acquisition/retention of skills for performing operative vaginal delivery. Randomized, controlled, single-centre study. A tertiary referral hospital in Italy. Twenty residents from a single university programme and two young specialists. Group 1 had an individual training session with a single senior specialist using a fixed simulator model. After the session, trainees watched a pre-recorded 1-h lecture on vacuum-assisted operative vaginal delivery. Group 1 repeated the simulator session using the same test after 8–12 weeks and 12 months. Group 2 watched the pre-recorded lecture then undertook the same sessions as Group 1. Video recordings of all test performances were evaluated by five specialists in a blinded manner. Each procedure was evaluated using a Global Rating Scale (GRS), scored with 0–5 points for each item on an Objective Structured Assessment of Technical Skills (OSATS) dataset with seven items (total 35 points). OSATS were evaluated over time, compared for the whole population, and weighted for route and year of residency. The primary outcome was comparison of the effectiveness of training between the two groups based on year of residency by assessing videos of the baseline test and GRS for OSATS scores. The secondary outcome was overall retention of skills at 8–12 weeks and 12 months. Twenty-two participants were recruited and randomized to either Group 1 (n = 11) or Group 2 (n = 11). Five participants did not complete follow-up. The primary outcome of GRS for OSATS scores at time 0 differed significantly between groups for total GRS score, and 'Call for help' and 'Explanation to woman and relatives' item scores (p = 0.002 and p = 0.007, respectively). In a multiple linear regression analysis, OSATS scores were not independently influenced by year of residency. At 8–12-week follow-up, the 'Call for help' item score showed a significant improvement in Group 1 (p = 0.018), although this was not confirmed when year of residency was included as an independent variable. At 12-month follow-up, none of the item scores demonstrated a significant change (p = 0.033). Year of residency did not influence the difference between groups. One-way analysis of variance found significant differences between the groups for 'Localization of the flexion point' (p = 0.005), 'Traction of vacuum cup' (p = 0.039) and 'Use of second hand of the operator' (p = 0.009) item scores and total GRS score (p = 0.007). The values weighted by year of residency did not demonstrate any significant difference. The secondary outcomes evaluated all the candidates of both groups for retention of technical skills over time. A significant effect of time was found for total GRS score (p < 0.001) and OSATS item scores. Independent of the sequence of theoretical teaching and simulation training, trainees demonstrated high retention – and, actually, improvement – of technical skills for operative vaginal delivery at 12-month follow-up. [ABSTRACT FROM AUTHOR]

The main objective of this study was to test the feasibility of measuring minimum audible angle in headphones with different reference positions in the horizontal plane, and comparing different types of pre-recorded head-related transfer functions. The secondary objective was to assess spatial discrimination performance in simulated unilateral hearing loss by measuring the minimum audible angle under monaural conditions using headphones. Minimum audible angle was assessed in 27 normal-hearing subjects, to test their spatial discrimination abilities, using 4 datasets of pre-recorded head-related transfer functions: 2 recorded on mannequins (KU100, KEMAR), and 2 individualized head-related transfer function datasets (TBM, PBM). Performance was evaluated at 3 reference positions (0°, 50° and 180°) in 1 binaural and 2 monaural conditions. KU100 generated minimum audible angle values smaller than KEMAR in frontal and lateral position P < 0.005), with a suggestive difference (P < 0.05) compared to TBM and PBM in the frontal and lateral planes. Comparison between binaural and monaural conditions showed significant differences in frontal position for MON-c (contralateral) and MON-i (ipsilateral) (P < 0.001), in lateral position for MON-c only (P < 0.001) and in posterior position for MON-c and MON-i (P < 0.001). This study suggests that evaluation of spatial discrimination capacity using minimum audible angle with the KU100 head-related transfer dataset was reliable and robust. [ABSTRACT FROM AUTHOR]

There is no clear evidence on the relationship between nursing student learning outcomes and the type of simulator used or its cost-effectiveness. Compare nursing student learning outcomes using either the hybrid patient or mannequin and the cost-utility of both simulators. A randomised experimental study with an experimental group (hybrid patient = 99) and a control group (mannequin = 97). A training intervention was carried out for polytrauma patients. Statistically significant differences were found between the simulator used and the performance results for tourniquet (hybrid 5.37 ± 1.33, mannequin 4.95 ± 1.09; p =.008) and spinal board (hybrid 6.18 ± 2.02, mannequin 6.97 ± 20.2; p =.001) application. The cost-utility ratio was estimated to be 3.29 for the hybrid patient and 1.92 for the mannequin. The use of a hybrid patient or mannequin has not been shown to be a determinant of performance outcomes or student perceptions in training interventions in polytrauma patient care. However, as the cost per participant with a mannequin is almost twice as high, the hybrid patient has a better cost-utility ratio. • Comparison of two training interventions on polytrauma with high fidelity simulation • The cost-utility ratio of the hybrid patient is twice that of the manikin. • Perception scores on satisfaction are similar for both simulators. • Perception scores on self-confidence and anxiety are similar for both simulators. [ABSTRACT FROM AUTHOR]

Evaluating the potential health risks from exposure to the air contaminants and evaluating the inhalability of micro-particles through the human nose or mouth is a crucial subject in designing ventilation systems. Using a realistic human body with detailed facial features, the effects of turbulent airflow field generated by the human thermal plume on the aspiration efficiency of the nasal airway for different ambient conditions were investigated. For the rest breathing rate of 7.5 l/min, the airflow was first simulationed by solving the mean continuity, momentum and energy equations using the RNG k-ε turbulence model for the buoyancy-driven flow around the heated mannequin. Then a continuous random walk (CRW) stochastic model utilizing the normalized Langevin equation was used to investigate the effect of turbulence fluctuations on particle trajectories released in the domain around the mannequin. Particular attention was given to the aspiration of the inhaled micro-particles under various conditions. In addition to the common case that the body temperature is higher than the ambient condition, the special case that the situation is reversed is also studied. The simulations results showed that the thermal plume around the human body and stochastic behavior of particles due to turbulence significantly affect the aspiration of inhaled particles through nostrils. [ABSTRACT FROM AUTHOR]

Introduction Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. Intervention Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. Methods Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. Results Students who participated in the simulation activity identified and reported significantly increased confidence , knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning . There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. Discussion This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care. [ABSTRACT FROM AUTHOR]

Background: Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compression, even for endotracheal intubation.Objective: We compared the utility of application of a gum-elastic bougie (GEB) plus Miller laryngoscope (Mil) with the Mil alone during chest compression on an infant mannequin.Methods: Sixteen anesthesiologists with more than 2 years of experience performed tracheal intubation on an infant mannequin using the Mil or Mil plus 6Fr GEB, with or without chest compression. Intubation success rate, intubation time, and subjective difficulty scores of laryngoscopy and tube passage through the glottis were measured.Results: In Mil trials, none of the participants failed without compression, whereas four failed with compression (p = 0.03). In Mil-plus-GEB trials, all participants succeeded regardless of chest compression. Intubation time was significantly longer with chest compression in both Mil and Mil-plus-GEB trials (p < 0.001). The intubation time during chest compression was significantly longer in Mil than in Mil-plus-GEB trials (p < 0.001). Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not significantly differ between Mil and Mil-plus-GEB trials during chest compression, whereas the VAS for tube passage through the glottis was significantly higher in Mil than in Mil-plus-GEB trials.Conclusions: GEB use shortened the intubation time and improved the success rate of infant tracheal intubation during chest compression by anesthesiologists in simulations. [ABSTRACT FROM AUTHOR]

• Commonly available syringes can be used for epidural insertion. • This mannequin study compares loss of resistance syringes and normal syringes. • Tactile feedback offered by these syringes during epidural insertion was assessed. The Obstetric Anaesthetists' Association has released a statement outlining the disruption to supply of the Portex® Loss of Resistance Syringe (Smiths Medical, UK) which is commonly used for epidural insertion within our Trust. We sought to investigate the use of standard available syringes for epidural insertion and whether tactile feedback when getting loss of resistance was similar. Using an epidural trainer model, we asked anaesthetists regularly working in the maternity unit to trial three alternative syringes (10 mL BD Emerald, 10 mL BD syringe from our epidural packs, and 20 mL BD Plastipak) (Becton Dickinson U.K. Limited, UK) and to complete a qualitative questionnaire about their experience. Responses from 16 anaesthetists, including individuals with a range of obstetric anaesthetic experience who regularly provide obstetric anaesthesia, were collected. With the BD Emerald 10 mL syringe, 81% considered there was no difference or only a slight difference when feeling for loss of resistance. For the BD 10 mL syringe, this figure was 75%. With the 20 mL syringe 66% reported either a reasonable or marked difference in tactile feel. The most popular syringe was the 10 mL BD Emerald syringe. Using an epidural training mannequin, this study suggests that it is still possible to elicit clear loss of resistance using alternative syringes. Of the three alternative syringes commonly available in our organisation, the BD Emerald 10 mL syringe was the most popular. [ABSTRACT FROM AUTHOR]

A 3-D realistic computational model of the airway system integrated into a standing male mannequin was developed. The computational domain includes the regions around the mannequin and the inside of the airway passages. The simulation was performed for low activity breathing rates with calm air around the mannequin. The flowfield of the inhaled air was first obtained from solving the Navier-Stokes and continuity equations. Then the particles were released in the domain around the mannequin and their trajectories were evaluated by using the Lagrangian approach for solving the particle equation of motion. The regional aerosols deposition was evaluated for different parts of the human airway system and the results were compared with those obtained from the separate modeling of the airway system without the interaction of the airflow with the mannequin external face. The results showed when the upper airway is integrated into the mannequin, the regional deposition of inhaled particles mainly changes in the airway system. [ABSTRACT FROM AUTHOR]

Abstract: Three-dimensional surface imaging technologies have been used in the planning and evaluation of breast reconstructive and cosmetic surgery. The aim of this study was to develop a 3D surface imaging system based on the Microsoft Kinect and assess the accuracy and repeatability with which the system could image the breast. A system comprising two Kinects, calibrated to provide a complete 3D image of the mannequin was developed. Digital measurements of Euclidean and surface distances between landmarks showed acceptable agreement with manual measurements. The mean differences for Euclidean and surface distances were 1.9mm and 2.2mm, respectively. The system also demonstrated good intra- and inter-rater reliability (ICCs>0.999). The Kinect-based 3D surface imaging system offers a low-cost, readily accessible alternative to more expensive, commercially available systems, which have had limited clinical use. [Copyright &y& Elsevier]

Study Objective: To compare the GlideScope Groove (GG) with conventional GlideScope videolaryngoscopy (GVL) and direct laryngoscopy (DL) on intubation times, intubation attempts, and glottic visualization of an airway mannequin by medical students. Design: Randomized crossover trial. Setting: Intensive care unit of an academic tertiary-care hospital. Participants: 34 medical students with no airway management experience. Measurements: Each participant received standardized video instruction on all three laryngoscopes and was given 10 minutes to practice with each device. The participants had two attempts using DL, and then had two attempts each with either the GG or GVL in random order. Measurements: Time-to-intubate the mannequin in seconds was recorded. Secondary outcomes were Cormack-Lehane grade and number of intubation attempts, also recorded. Main Results: The median number of seconds required to successfully intubate the mannequin with DL, GVL, and GG were 17.4 seconds [interquartile range (IQR) 13.2 - 22.1)], 17.7 seconds (IQR 14.9 - 21.0), and 21.7 seconds (IQR 15.4 - 37.0), respectively. No differences in time-to-intubate was noted among the three devices (P = 0.45). A Cormack-Lehane grade 1 view was obtained for 25 of 34 participants (74%) with DL, 32 of 34 participants (94%) with GVL, and 34 of 34 participants (100%) with GG. First-attempt intubation success was 30 of 34 participants (88%) with DL, 34 of 34 participants (100%) with GVL, and 11 of 34 participants (32%) with GG. Using the GG, 6 of 24 participants (18%) required three attempts. More attempts were required for the GG than for DL (P < 0.001) or GVL (P < 0.001). Conclusions: GG was not superior to DL or GVL in time-to-intubate an airway mannequin. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: L’objectif de cette étude expérimentale était de comparer les performances pour l’intubation trachéale de 3 vidéo-laryngoscopes (VL) comparativement à la laryngoscopie directe (LD). Type d’étude: Étude expérimentale sur mannequin nourrisson. Méthodes: Cette étude prospective, réalisée au sein de l’hôpital Necker-Enfants Malades, a inclus 77 opérateurs ayant une expérience variable de l’intubation pédiatrique. Ils ont réalisé chacun 10 tentatives d’intubation orotrachéale avec chaque dispositif : LD, GlideScope®, Airtraq® et McGrath®. Le critère de jugement principal était la durée totale d’intubation trachéale (DTIT). Les critères de jugement secondaires incluaient : la durée d’exposition glottique (DEG), la durée d’exposition glottique-intubation (DEI) et le taux d’échec d’intubation. Résultats: Il existait une décroissance significative des DTIT entre le 1er et le 10e essai avec tous les dispositifs (p <0,05). Cette décroissance n’était plus significative après le 3e essai pour les VL et après le 5e essai pour la LD. Au 10e essai, la DTIT était significativement plus courte avec l’Airtraq®, mais les différences avec les autres dispositifs étaient faibles (p <0,05). Les échecs prédominaient avec la LD (p <0,05), alors qu’ils étaient rares avec les autres dispositifs. Conclusion: Sur ce modèle de mannequin nourrisson, la courbe d’apprentissage des VL semble rapide, de l’ordre de 3 utilisations. L’Airtraq® semble le dispositif le plus performant, associant la durée totale d’intubation la plus courte et le taux d’échec le plus bas. Ces résultats obtenus sur mannequin nécessitent d’être confirmés par des études cliniques en pédiatrie. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are multiple techniques for face-mask (FM) ventilation. To our knowledge, the one-handed vs. two-handed C-E technique has been compared in children and adults, but no studies have compared the various two-handed methods. Objective: To compare the effectiveness of mask seal using three different FM techniques on a model intended to simulate difficult FM ventilation and measure ventilation performance. Methods: This was a prospective randomized study of health care providers. A standard airway-training mannequin was modified to produce variable airway resistance and allow measurements of ventilation volume and pressure. Each subject performed FM ventilation for 3 min per technique (30 breaths) in a randomized order. Median exhaled tidal volume and proximal peak flow pressure were determined and compared. Results: Seventy subjects were enrolled. Both two-handed ventilation techniques were more effective than the one-handed technique by both volume and pressure measurements. The one-handed C-E technique yielded a median volume of 428.4 mL, vs. the two-handed C-E technique with 550.8 mL, and the two-handed V-E technique with 538 mL (p < 0.001). Peak pressure measurements revealed a median of 54.6 cm H2O for the one-handed C-E technique, 66 cm H2O for the two-handed C-E technique, and 66.6 cm H2O for the two-handed V-E technique (p < 0.001). There was not a difference between the various two-handed techniques. Conclusions: This model for FM ventilation is able to differentiate the efficacy of FM techniques. Both two-handed ventilation methods were superior to one-handed ventilation, both of which should perhaps be included in airway training for health care providers. [Copyright &y& Elsevier]

Résumé: L’apprentissage d’une technique de traitement nécessite des connaissances théoriques permettant de porter la bonne indication pour le bon traitement, mais aussi des connaissances pratiques permettant de réaliser ce geste thérapeutique dans les meilleures conditions pour un résultat optimal dans un contexte de sécurité maximale. L’évolution des techniques en curiethérapie nécessite la mise en place de formations spécifiques à la fois théoriques et pratiques. Le présent article fait le point sur l’importance de la formation en curiethérapie ainsi que les moyens actuellement mis à la disposition des oncologues radiothérapeutes juniors pour parfaire leur apprentissage de cette technique. Les enseignements nationaux et internationaux sont présentés. L’intérêt de l’utilisation du principe de simulation en curiethérapie est aussi présenté. Même si la curiethérapie n’est pas toujours une technique facile, son efficacité et son intérêt médicoéconomique nécessitent d’être transmis à des étudiants motivés avec la mise en œuvre de moyens pédagogiques pertinents. [ABSTRACT FROM AUTHOR]

Summary: With concerns about the potential for the aerosol and airborne transmission of infectious agents, particularly influenza, more attention is being focused on the effectiveness of infection control procedures to prevent hospital-acquired infections by this route. More recently a number of different techniques have been applied to examine the temporal–spatial information about the airflow patterns and the movement of related, suspended material within this air in a hospital setting. Closer collaboration with engineers has allowed clinical microbiologists, virologists and infection control teams to assess the effectiveness of hospital isolation and ventilation facilities. The characteristics of human respiratory activities have also been investigated using some familiar engineering techniques. Such studies aim to enhance the effectiveness of such preventive measures and have included experiments with human-like mannequins using various tracer gas/particle techniques, real human volunteers with real-time non-invasive Schlieren imaging, numerical modelling using computational fluid dynamics, and small scale physical analogues with water. This article outlines each of these techniques in a non-technical manner, suitable for a clinical readership without specialist airflow or engineering knowledge. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to assess airway management by emergency physicians in case of a simulated situation where intubation and ventilation were both impossible. Study design: Observational manikin study. Methods: A manikin (Airman®; Laerdal) allowing simulating difficult airway situations was used. The scenario assessed concerned a patient needing tracheal intubation for severe traumatic brain injury. The manikin was settled to make tracheal intubation under direct laryngoscopy impossible at the first attempt and to make facemask ventilation impossible after the second attempt. Manikin could initially be ventilated through the intubating laryngeal mask Airway (ILMA) but became impossible few seconds after its insertion. With impossible ventilation through the ILMA, arterial oxygen saturation decreased during 2minutes before an hypoxic cardiac arrest occurred. Physicians could use classic laryngoscope with Macinthosh blade, a Gum Elastic Bougie, an ILMA and a cricothyrotomy set. Adhesion to the national airway management algorithm was assessed. Time to cricothyroidotomy decision after ventilation through ILMA became impossible was measured. Results: Twenty-five emergency physicians were assessed. For 14 of them, national expert conference algorithm was perfectly followed. For ten physicians, cricothyroidotomy decision was taken after hypoxic cardiac arrest occurred. Conclusion: Simulation with a manikin is useful to assess the adhesion rate to difficult intubation algorithms. Our study shows that the decision making process for cricothyrotomy is too often delayed as soon as ventilation became impossible and oxygenation compromized. [Copyright &y& Elsevier]

Abstract: Introduction: Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education. Method: An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age ≤5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians. Results: 72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively). Discussion and conclusion: Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership. [Copyright &y& Elsevier]

Abstract: The historical roots of simulation might be described with the broadest definition of medical simulation: “an imitation of some real thing, state of affairs, or process” for the practice of skills, problem solving, and judgment. From the first “blue box” flight simulator to the military''s impetus in the transfer of modeling and simulation technology to medicine, worldwide acceptance of simulation training is growing. Large collaborative simulation centers support the expectation of increases in multidisciplinary, interprofessional, and multimodal simulation training. Virtual worlds, both immersive and Web-based, are at the frontier of innovation in medical education. [Copyright &y& Elsevier]

Abstract: Introduction: Recently, the French Society for Anaesthesia and Intensive Care (SFAR) has updated algorithms for difficult airway management, in which, the place of the intubating laryngeal mask (ILMA) is well defined. Moreover, in the guidelines, the SFAR recommended that the training for the different techniques for difficult intubation should initially be achieved on manikins. However, few data are available for disposable ILMA learning process on manikins. Study design: To compare, on manikin, the learning curves of the disposable and reusable ILMA. Materials and method: Forty operators (anaesthesiologist, nurse, resident), experienced with conventional tracheal intubation but novice to commercially available ILMAs (Sebac, Pantin, France), underwent videotape learning and manikin training. After randomisation, each participant had to perform 10 timed consecutive tracheal intubations with either reusable or disposable ILMA. The learning curve was built according to the duration of successful procedure. Failure was considered if tracheal intubation could not be achieved or if the procedure lasted more than five minutes. Results: No difference was noted between the two groups in terms of learning curves, number and repartition of the failed attempts during the learning process. Conclusion: This study shows that both disposable and reusable ILMA share similar learning process on manikins. Further studies are needed to evaluate the efficiency of the disposable ILMA in the clinical field of difficult intubation. [Copyright &y& Elsevier]

Abstract: Computational fluid dynamics has become an important tool in the prediction of thermal comfort in occupied spaces. Despite its ability to predict temperature and velocity fields, it is more difficult to evaluate the degree of thermal comfort experienced by an occupant. This article describes the construction of a new numerical thermal manikin, with new comfort evaluation methods based on data from thermal manikin measurements as well as subjective results from several hundred experiments. The level of thermal comfort is highly dependent on the local environment. Human beings respond differently to local heat transfer in different parts of their bodies. It is suggested for that reason that local results from manikins should be presented in new clothing independent comfort zone diagrams. The research presented in here is intended to be used to evaluate system solutions that provide improved thermal climate in many different everyday situations, e.g. all types of buildings and vehicles. [Copyright &y& Elsevier]

Objective.—In objective standardized clinical examination (OSCE) of infants, real infants are generally not used. Instead, the standardized patient portrays a parent who answers a student's questions, and there is no physical examination. One way to assess physical examination skills in these encounters is to have students demonstrate the appropriate examination on a mannequin. But before using this approach, we wanted to assess whether having students examine mannequins affects their history-collecting or communication skills. Methods.—Third-year medical students were randomized to 2 versions of an infant OSCE case. During the encounter, controls were handed a printed listing of all physical examination (PE) findings. Students in the mannequin group were told relevant PE findings only after the students had examined a part of the mannequin. Student performances on the OSCE case and perceptions about the case were compared. Results.—Thirty-two students were in the control group, and 35 students examined mannequins. No differences were found in total case score (P = .78), or on history-gathering skills (P = 86) and communication skills subscales (P = .78). In addition, questionnaires completed by students after the encounter indicated that the infant mannequins did not affect student perceptions about the realism of the case (P = .91). Conclusions.—Student performances at collecting the clinical history or communicating with the standardized patient were not adversely affected by inclusion of an infant mannequin. This suggests mannequins can be used to assess students' knowledge of the relevant case-specific PE without adverse effect. [ABSTRACT FROM AUTHOR]

Abstract: Aims:: Current guidelines for chest compressions in CPR advocate a one handed technique in children (1–8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin. Methods:: Randomised crossover design. Subjects performed both types of chest compressions on an adapted paediatric resuscitation manikin connected to a pressure transducer and personal computer. Ethical approval was granted. Results:: A 30 volunteer subjects (9 male, 21 female) participated in the study. Their mean age was 30.8 years (S.D. 8.6), and mean weight was 70.5kg (S.D. 12.8). The mean compression pressure was 86.6mmHg (S.D. 13.68) for two handed and 75.1mmHg (S.D. 12.02) for one handed (P < 0.001, paired t-test). The average peak compression pressure was 133.5mmHg (S.D. 26.36) for two handed and 116.8mmHg (S.D. 21.48) for one handed (P = 0.001, paired t-test); 29 found the two handed technique easier to perform. Conclusion:: Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes. [Copyright &y& Elsevier]

Résumé: Les pertes de chaleur des nouveau-nés prématurés avec leur environnement restent très difficiles à mesurer en raison de la morphologie de l’enfant. Pour résoudre ce problème, des mannequins thermorégulés ayant les dimensions anthropométriques de nouveau-nés ont été développés. Le but de ce travail est de montrer les applications biomédicales de ces modèles en décrivant deux études, l’une sur la relation entre le stress thermique et la position de couchage dans la Mort Subite du Nourrisson (MSN) et l’autre sur l’évaluation des dispositifs de réchauffement en chirurgie néonatale. Un mannequin simulant les dimensions anthropométriques d’un nouveau-né de 1400 g a été développé. Dans la première étude, il était couché sur le dos ou sur le ventre dans un incubateur fermé à des températures d’air comprises entre 25 °C et 37 °C. Les résultats ont montré que les pertes de chaleur sont indépendantes de la position de couchage. Ceci réfute l’hypothèse selon laquelle la position de couchage sur le ventre peut provoquer un stress thermique expliquant une mortalité plus grande. Dans la seconde étude, le mannequin couché sur le dos était placé dans des conditions simulant un champ opératoire. L’efficacité d’un matelas chauffant associé ou non à un système de réchauffement convectif de type Bair Hugger® a été testée (température d’air comprises entre 20 °C et 30 °C). Les résultats ont montré l’efficacité du Bair Hugger®. L’association du Bair Hugger® soufflant un air à 38 °C et du matelas chauffant à 39 °C montre qu’il serait alors possible de réduire la température de l’air de la salle de chirurgie de 27 °C à 20 °C, afin d’améliorer le confort thermique des intervenants sans déséquilibrer de façon importante le bilan thermique de l’enfant. [Copyright &y& Elsevier]

In this study, the inhalability of microparticles through a human nasal passage under various ambient airflow conditions is calculated. As megacities are becoming polluted and being exposed to the polluted windy outdoor environments is inevitable nowadays, from the toxicological point of view, it would be wise to investigate the impact of air pollution on human health. Though, as few studies have attempted to address this concern, especially for high free-stream velocities comprehensively, the main emphasis was placed on assessing the impact of both inhalation and Total Deposition Fraction (TDF) of particles. Several free stream airflow velocities from 1 to 70 km/h are simulated to cover almost all stormy outdoor conditions that could typically happen. RANS models and stochastic models for turbulent particle dispersion were examined to simulate the particle motions properly in such turbulent conditions. The impact of high ambient airflow velocities on the aspiration efficiency and the TDF of micro-particles were assessed for a wide range of particle sizes. The results reveal that TDF of the integrated airway is mostly higher than that of the detached airway system due to the non-uniformity of both airflow field and particle distribution which happens at the nostrils, similar to the work of Naseri et al. (Anderson and Anthony, 2013) [24]. Yet, contrary to that study in which the flow field was laminar, and there were no notable differences between the TDF of these two cases at different breathing flow rates, the differences become more notable when the breathing regime becomes fully turbulent. • Aspiration efficiency of large micro-particles decreases with increase in wind velocity. • Being exposed to windy conditions affects the deposition of micro-particles within the human extrathoracic airway system. • Total deposition of particles in the case of the integrated airway is mostly higher than that of the detached airway system. • CRW model predicts well the stochastic fluctuations. [ABSTRACT FROM AUTHOR]