Adaptation of non-technical skills behavioural markers for delivery room simulation

Background: Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room). Methods: The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected. Results: The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories. Conclusion: The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation

BSA Aggregation in Trehalose-Water Systems

Introduction Recent studies [1] on ternary protein-trehalose-water samples have shown that the protein thermal denaturation temperature is linearly correlated with the glass transition temperature of the system, despite the quite large temperature difference between the two processes. In such studies it is stated that the collective, long range properties of the matrix that regulate the glass transition are strictly correlated with local features on which the denaturation of the protein depends. In order to ascertain whether an analogous correlation exists between the effects of trehalose on the protein’s aggregation process and the glass transition temperature of the system, we performed Light Scattering measurements on thermal aggregation of Bovine Serum Albumin (BSA) in presence of trehalose at various concentrations. Experimental We used Static and Dynamic Light Scattering to study the thermal aggregation of BSA in buffered aqueous solution, at 0.1% w/w protein concentration and in presence of trehalose, whose weight concentration was varied from 0 to 50 % trehalose/(trehalose+water). Measurements were performed in the temperature range 50 °C – 80 °C. Results Addition of trehalose appears to cause temperature shifts of the entire process towards higher values. In particular, the effects of trehalose on the temperature of the aggregation process appear to be linearly correlated with the effects of the sugar on the glass transition temperature. The latter quantity was estimated through the Gordon-Taylor equation [2] with already reported parameters [1]. Addition of sugar is also responsible for shape changes in plots of scattered light intensity versus temperature during temperature scan. Such changes reflect differences in the aggregation process, which can be sorted out through a suitable analysis of the increase of the hydrodynamic radius during the temperature scans. In particular, we determined the fractal dimension of the aggregates, which gives information on their packing. References 1. G. Bellavia, G. Cottone, S. Giuffrida, A. Cupane, L. Cordone, J. Phys. Chem. B. 113, (2009) 11543–11549. 2. M. Gordon, J. S. Taylor, J. Appl. Chem. 2, (1952) 493–500

Thermal Aggregation of Bovine Serum Albumin in Trehalose and Sucrose Aqueous Solutions

We report results of static and dynamic light scattering measurements performed on bovine serum albumin (BSA) in saccharide (trehalose and sucrose) solutions. Our aim is to study the effects of the two disaccharides on the first steps of thermal aggregation of BSA in aqueous solutions at two protein concentrations (1 and 30 mg/mL) at increasing sugar/water ratio. Results show that sugars modify early stages of aggregation mainly by perturbing the thermodynamic behavior of the solvent (i.e., general solvent effects) without involving direct, specific sugar–protein interactions. This agrees with current hypotheses on sugar action in protein solutions.(1-3) The linear correlation detected between the characteristic temperature of the aggregation process and the glass transition temperature of the water–sugar solvent strengthens the above suggestions

eBSim: Development of a low-cost obstetric simulator

This work presents the design a low cost obstetric simulator allowing precise identification of the fetal position in a simulated birth canal. The system consists on a female pelvis, a custom-made fetal mannequin, a virtual 3d representation, a visual display and an user interface to show in real time what happens inside the birth canal. Students are often unable not only to identify correctly the fetal head position, but also to discriminate between the two fontanels, for this reason the simulator eBSim can help them to train this ability and could be an important instrument for the instructors to objectively assess the clinical skill of each student

Impairment of Caveolae Formation and T-System Disorganization in Human Muscular Dystrophy with Caveolin-3 Deficiency

Caveolin-3, a muscle specific caveolin-related protein, is the principal structural protein of caveolar membranes. We have recently identified an autosomal dominant form of limb girdle muscular dystrophy (LGMD-1C) that is due to caveolin-3 deficiency and caveolin-3 gene mutations. Here, we studied by electron microscopy, including freeze-fracture and lanthanum staining, the distribution of caveolae and the organization of the T-tubule system in caveolin-3 deficient human muscle fibers. We found a severe impairment of caveolae formation at the muscle cell surface, demonstrating that caveolin-3 is essential for the formation and organization of caveolae in muscle fibers. In addition, we also detected a striking disorganization of the T-system openings at the sub-sarcolemmal level in LGMD-1C muscle fibers. These observations provide new perspectives in our understanding of the role of caveolin-3 in muscle and of the pathogenesis of muscle weakness in caveolin-3 deficient muscle