Beckers (United Kingdom)

Physical assessment of obese patients is an essential clinical skill for identifying the numerous health problems of obese patients and monitoring treatment effectiveness. Use of simulation mannequins facilitates teaching and learning of physical assessment. Available bariatric simulation mannequins have poor functional design, unrealistic appearance, and limited assessment functions. We developed a bariatric mannequin simulation system and an associated education curriculum of seven case scenario and debriefing exercises focused on health problems experienced by individuals who are obese. An innovation of our mannequin is inclusion of programmable electronics that can be used with clinical tools that receive the electronic signals; together they provide ability to assess normal and abnormal signs of a wide variety of health problems. Ten nursing faculty and 51 nursing and medical students at a Midwestern university evaluated the features and satisfaction of a prototype bariatric mannequin in separate simulation sessions using Likert-scale questionnaires. Results showed that the majority of faculty (60%) and student participants (70%+) agreed/highly agreed that the bariatric mannequin was innovative, engaging, user-friendly, useful, and likely effective for teaching or learning. Satisfaction ratings of both groups were similar. Feedback from participants was incorporated into a final refined product that improved its realistic appearance.

Abstract Background A combination of conventional computed tomography and single photon emitted computed tomography (SPECT/CT) provides simultaneous data on the intensity and location of osteoblastic activity. Currently, since SPECT/CT scans are not spatially aligned, scans following knee arthroplasty are compared by extracting average and maximal values of osteoblastic activity intensity from large subregions of the structure of interest, which leads to a loss of resolution, and hence, information. Therefore, this paper describes the SPECT/CT registration platform (SCreg) based on the principle of image registration to spatially align SPECT/CT scans following unicondylar knee arthroplasty (UKA) and allow full resolution intra-subject and inter-subject comparisons. Methods SPECT-CT scans of 20 patients were acquired before and 1 year after UKA. Firstly, scans were pre-processed to account for differences in voxel sizes and divided in volumes of interest. This was followed by optimization of registration parameters according to their volumetric agreement, and alignment using a combination of rigid, affine and non-rigid registration. Finally, radiotracer uptakes were normalized, and differences between pre-operative and post-operative activity were computed for each voxel. Wilcoxon signed rank sum test was performed to compare Dice similarity coefficients pre- and post-registration. Results Qualitative and quantitative validation of the platform assessing the correct alignment of SPECT/CT scans resulted in Dice similarity coefficient values over 80% and distances between predefined anatomical landmarks below the fixed threshold of (2;2;0) voxels. Locations of increased and decreased osteoblastic activity obtained during comparisons of osteoblastic activity before and after UKA were mainly consistent with literature. Conclusions Thus, a full resolution comparison performed on the platform could assist surgeons and engineers in optimizing surgical parameters in view of bone remodeling, thereby improving UKA survivorship.

Introduction Quality of external chest compressions (ECC) is of paramount relevance within Basic Life Support (BLS). Recent guidelines describe the so called 4-Stage-Approach for teaching practical skills within resuscitation training. However, this methodology was questioned in recent studies when used for simple skills teaching. Hypothesis To observe whether a structured 2-Stage-Approach leads to sufficient practical performance in BLS-Training compared to the standard 4-Stage-Approach. Methods Overall 270 Laypersons were trained in BLS after randomization either to the standard method group using a 4-Stage-Approach (4S) or a modified 2-Stage-Approach-group (2S) lasting the same course duration. All participants were tested on a manikin (Skillreporter ResusciAnne® with PC SkillReporting Software (Version 1.3.0), Laerdal, Stavanger, Norway) in the same cardiac arrest mock scenario prior to the BLS-course and after one week with each time 2 min of continuous ECC each. Practical Endpoints: mean compression rate; mean compression depth. Results Data from 255 subjects (4S: n=127; 2S: n=128) was analyzed. The standard group (4S) as well as the intervention group (2S) improved significantly compared to baseline testing after one week concerning compression depth (4S: 47.8±10.4 mm to 52.4±7.6 mm, p<0.0001; 2S: 47.7±10.7 mm to 55.8±5.4 mm; p<0.0001) and compression rate (4S: 116.1±23.4 min-1 to 118.7±16.0 min-1, p<0.0001; 2S: 114.1±22.8 min-1 to 119.6±13.8 min-1; p<0.0001). The participants trained with the 2-Stage-Approach showed superior performance one week after training in respect of the mean compression depth (4S: 52.4±7.6 mm vs. 2S: 55.8±5.4 mm; p<0.0001). Conclusions Teaching ECC within BLS is sufficiently accomplished with a structured 2-Stage-Approach. Compared to the standard 4-Stage-Approach this methodology leads to comparable skill performance with significantly improved compression depth. Therefore this approach should be further evaluated and offers the option to standardize instructors performance more easily.

The self-renewal and differentiation capacity of hematopoietic stem and progenitor cells (HSPCs) is an important regulator of the way the mature immune system behaves and how it reacts upon challenges. The co-stimulatory protein CD40L is well-known for its role in immune activation and chronic inflammatory diseases, especially in atherosclerosis. We hypothesized that CD40L not only regulates mature immune cell activation, but also plays a role in the development of these cells by regulating HSPC biology. Here we show that CD40L deficiency increased the colony-forming potential of HSPCs by 62,1%. FACS analysis revealed that the bone marrow of CD40L -/- mice contained 34,4% more myeloid-biased (Lin-cKit+) progenitors, 147,2% more myeloid/lymphoid-biased (Lin-Sca-1+) progenitors and 46,6% more primitive (Lin-Sca-1+-cKit+) HSPCs. Competitive bone marrow transplantation demonstrated that the abscence of CD40L resulted in a 13.4% increased reconstitution of peripheral blood leukocytes. Lineage analysis showed an advantage towards the lymphoid lineage, as B cells were increased by 14.6%, T cells by 41.3%, and NKT cells by 50.9%. The adhesion of HSPCs on CD40L -/- bone marrow stroma was reduced by 58%. Cell cycle analysis revealed that CD40L -/- HSPCs were less quiescent compared to WT cells. CD40L -/- mice had delayed hematopoietic recovery and a 37.5% reduced survival rate after 5-FU treatment. CD40L -/- mice did not survive a bone marrow transplantation. All effects were independent from CD40, the classical receptor of CD40L. In conclusion, our data suggest that CD40L regulates adhesion-mediated quiescence of HSPCs. These results provide a novel CD40L-mediated mechanism of protecting the HSPC compartment against exhaustion during immune activation and chronic inflammatory disease like atherosclerosis, thereby securing long term hematopoiesis.