High-intensity Scenarios Research Articles

Improving communication during damage control surgery: a survey of adult major trauma centres in England.

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. An online survey was devised and distributed via the national programme of care for trauma in November 2020. Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

Biological factors and self-perception of stress in relation to freeze-like response in humans

Many animals react to threatening stimuli such as a predator attacks by freezing. However, little experimental research investigated freeze response in humans. Here, we have employed practices commonly used in self-defense training to create two unique scenarios simulating armed physical threat. Sixty healthy men volunteers divided into three groups of twenty (untrained, trained but unexperienced, trained and experienced) underwent these scenarios accompanied by measurement of biochemical, physiological, and psychological markers of stress. Our results show that untrained individuals exhibit stronger freezing reactions, while highly skilled participants display the lowest propensity for freezing, especially in high-intensity scenarios. Moreover, the study shows variations in anxiety levels and selected biomarkers, with cortisol and osteocalcin showing different patterns in low and high-intensity scenarios, and suggests a complex interplay between these factors, electrodermal activity, and stress perception. The project was primarily supported by the project 22-36623S from the Grant Agency of the Czech Republic. The project was supported by the project MUNI/A/1403/2018 Evaluation of self-defense scenario training and stress tolerance among students of study program SESB and ASESB by Masaryk University, Grant Agency of Masaryk University, Faculty of Sports Studies. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Biological factors and self-perception of stress in relation to freeze-like response in humans

Many animals react to threatening stimuli such as a predator attacks by freezing. However, little experimental research investigated freeze response in humans. Here, we have employed practices commonly used in self-defense training to create two unique scenarios simulating armed physical threat. Sixty healthy men volunteers divided into three groups of twenty (untrained, trained but unexperienced, trained and experienced) underwent these scenarios accompanied by measurement of biochemical, physiological, and psychological markers of stress. Our results show that untrained individuals exhibit stronger freezing reactions, while highly skilled participants display the lowest propensity for freezing, especially in high-intensity scenarios. Moreover, the study shows variations in anxiety levels and selected biomarkers, with cortisol and osteocalcin showing different patterns in low and high-intensity scenarios, and suggests a complex interplay between these factors, electrodermal activity, and stress perception.

Moral Injury and the βασιλικός of John 4:46–54

Abstract Still emerging from infancy, the developing field of trauma theory called “moral injury” (MI) has opened fresh vistas for biblical studies. Scholars are now beginning to employ MI theory as an interpretive frame of reference to biblical scenes depicting high intensity scenarios where moral values are challenged. Surprisingly, engagement of MI theory to the Fourth Gospel has yet to be done despite its specified portrayal of individual scenes of mental suffering. Attempting to fill the void, this article examines and appropriates recent MI research to propose a fresh reading of a significant, yet often overlooked, Johannine narrative of trauma: the βασιλικός (“royal official”) of John 4:46–54. Perhaps plagued by parental guilt over his dying son and tensions caused by a career forcing him to hold in balance conflicting Jewish and gentile sensibilities, the article engages insights borrowed from MI theory, posing a horizontal reading of the text that sheds light on this father’s inner trauma. In doing so, it invites similar sufferers today to rely on the Jesus in whom the βασιλικός sought relief.

Impacts of marine heatwaves on byssus production in highly invasive fouling mussels

Marine heatwaves (MHWs) are projected to increase in their frequency, intensity, and duration, causing irreversible and catastrophic consequences for intertidal ecosystems around the world. The highly invasive fouling mussel, Arcuatula senhousia, can cause marked habitat alteration by constructing extremely intense byssal mats, devastating the biodiversity of many intertidal systems, yet very little is known about its fate under conditions of more frequent, hotter and longer MHWs. Here, we assessed impacts of two scenarios of MHWs (low-intensity with 4 °C rise of seawater temperature and high-intensity with 8 °C rise, respectively) on the byssal production of A. senhousia. Mussels exposed to low-intensity MHWs did not show any significant differences in the number, length and diameter of byssal threads, compared with those not thermally stressed. Under high-intensity scenario, the byssus production was significantly depressed, and byssal threads became fewer, shorter and finer, in line with significant decreases in cumulative length and volume. These findings provide a better understanding of responses of invasive fouling mussels such as A. senhousia to MHWs and make a leap forward in linking climate change and biological fouling in marine ecosystems.

Unpaved road conservation planning at the catchment scale.

In addition to soil losses on hillslopes, unpaved rural roads, especially when poorly designed and maintained, can be a significant contributor to the erosive processes seen at the catchment scale. In areas with deep soils, the solutions primarily focus on channeling excess surface runoff into settling ponds or terraces. However, few studies have addressed runoff control from roads on steep slopes in areas of shallow soil. Modeling hydrological processes at the catchment scale is a useful strategy for choosing the most effective and least costly conservation practices to control surface runoff. This study applies a mathematical model to a monitored catchment in southern Brazil to better understand the effects of conservation practices on unpaved roads and their impact on the hydrological and erosive dynamics of a small rural catchment. We calibrated the LISEM model using data from eight stormwater events and evaluated how three different road conservation scenarios-low (LI), medium (MI), and high intensity (HI)-contributed to sediment yield (SY), surface runoff volume (Qe), and peak flow (Qp) reduction. The LI and MI scenarios involved installation of hydraulic structures to control the road surface runoff (i.e. road ditch graveling, diversion weirs and grass waterways) while the HI scenario added surface runoff control practices (grass strips) to surrounding crop fields, in addition to the practices included in the MI scenario. Based on these scenarios, the results showed a Qe reduction at the catchment outlet from - 3.5% (LI) to - 22.5% (HI). The Qp and SY varied from + 6.0% (LI) to - 292.5% (HI) and from + 20.0% (LI) to - 963.9% (HI), respectively. These results show that the low- and medium-intensity practices were not effective in controlling surface runoff from roads, based on the Qe, Qb, and SY observed at the catchment's outlet. On the other hand, when MI scenarios were complemented with practices to control surface runoff in the cultivated areas, a significant reduction in surface runoff (Qe and Qp) and SY was verified.

Radiation beaming in the quantum regime

Classical theories of radiation reaction predict that the electron motion is confined to the plane defined by the electron's instantaneous momentum and the force exerted by the external electromagnetic field. However, in the quantum radiation reaction regime, where the recoil exerted by individual quanta becomes significant, the electron can scatter `out-of-plane', as the photon is emitted into a cone with finite opening angle. We show that Monte Carlo implementation of an angularly resolved emission rate leads to substantially improved agreement with exact QED calculations of nonlinear Compton scattering. Furthermore, we show that the transverse recoil caused by this finite beaming, while negligible in many high-intensity scenarios, can be identified in the increase in divergence, in the plane perpendicular to the polarization, of a high-energy electron beam that interacts with a linearly polarized, ultraintense laser.

A physiology based model of heart rate variability.

Heart rate variability (HRV) is governed by the autonomic nervous system (ANS) and is routinely used to estimate the state of body and mind. At the same time, recorded HRV features can vary substantially between people. A model for HRV that (1)correctly simulates observed HRV, (2)reliably functions for multiple scenarios, and (3)can be personalised using a manageable set of parameters, would be a significant step forward toward understanding individual responses to external influences, such as physical and physiological stress. Current HRV models attempt to reproduce HRV characteristics by mimicking the statistical properties of measured HRV signals. The model presented here for the simulation of HRV follows a radically different approach, as it is based on an approximation of the physiology behind the triggering of a heart beat and the biophysics mechanisms of how the triggering process-and thereby the HRV-is governed by the ANS. The model takes into account the metabolisation rates of neurotransmitters and the change in membrane potential depending on transmitter and ion concentrations. It produces an HRV time series that not only exhibits the features observed in real data, but also explains a reduction of low frequency band-power for physically or psychologically high intensity scenarios. Furthermore, the proposed model enables the personalisation of input parameters to the physiology of different people, a unique feature not present in existing methods. All these aspects are crucial for the understanding and application of future wearable health.

How might Shandong achieve the 2030 CO<SUB align="right">2 emissions target A system dynamics analysis from the perspective of energy supply-side structural reform in China

This paper takes Shandong Province as an example to forecast the CO2 emission from 2017 to 2030 by system dynamics under four designed scenarios. The results indicate that despite the coal consumption, CO2 emission and the CO2 emission intensity of low intensity scenario and medium intensity scenario both decrease compared to the results of current scenario. However, neither the coal consumption peak year nor the CO2 emission peak year is before 2030. We find that with the high intensity scenario, the CO2 emission would peak on 2027 and the coal consumption would peak on 2021. Besides, the CO2 emission intensity of 2030 is reduce by almost 80% of 2005 level. Finally, conclusions and policy implications are concluded based on the simulations results.

A Preliminary Forecast of the Production Status of China’s Daqing Oil field from the Perspective of EROI

Energy return on investment (EROI) and net energy are useful metrics for analyzing energy production physically rather than monetarily. However, these metrics are not widely applied in China. In this study, we forecast the Daqing oilfield’s EROI from 2013 to 2025 using existing data for crude oil and natural gas production and the basic rules of EROI. Unfortunately, our calculations indicate that the oilfield’s EROI will continuously decline from 7.3 to 4.7, and the associated net energy will continuously decline from 1.53 × 1012 MJ to 1.25 × 1012 MJ. If China’s energy intensity does not decline as planned in the next ten years, then the EROI of Daqing will be even lower than our estimates. Additionally, relating the EROI to the monetary return on investment (MROI) in a low production and high intensity scenario, Daqing’s EROI will decline to 2.9 and its MROI will decline to 1.8 by 2025. If the “law of minimum EROI” and the assumed “minimum MROI” are taken into account, then we estimate that both energy pressure and economic pressure will restrict Daqing’s production by 2025.

SIMULATED TEAM-BASED CPB EMERGENCY PREPAREDNESS TRAINING

s S237 upon their lived experiences during a realistic but riskfree environment. Additionally, these exercises serve as an ice-breaker that helps dissolve preconceived notions and expectations of interprofessional relationships. The benefits of offering this type of training with simulated exercises to existing surgical teams may also realize similar improvements. 357 SECONDARY PREVENTION AFTER CORONARY ARTERY BYPASS GRAFT SURGERY: PRESENTATION OF A SCIENTIFIC STATEMENT

High Intensity Scenario Training of Military Medical Students to Increase Learning Capacity and Management of Stress Response

A delicate balance exists between a beneficial stress response that enhances memory and recall performance and a detrimental high stress response that impairs memory and learning. Repetitive training in stressful situations enables people to lower their stress levels from the detrimental range to a more beneficial one.1 This is particularly true for physicians in training as they seek to achieve advanced skills and knowledge in the fields of triage, emergency medicine, and surgery prior to graduation. This need is significant for medical students entering military service after graduation. We theorize that military medical students can advance their proficiencies through an Intensive Skills Week (ISW) prior to entering their third and forth year rotations. To test this theory, Rocky Vista University will hold a week long high-intensity first-responder, emergency medicine and surgical training course, facilitated by military medical physicians, to further students? skills and maximize training using the Human Worn Partial Surgical Task Simulator (Cut Suit). We also see the possible benefit to physician and non-physician military personnel, especially Special Operations Forces (SOF) medical personnel, from developing and implementing similar training programs when live tissue or cadaver models are unavailable or not feasible.Stress, cortisol, medical student, enhanced learning, scenario, high intensity.