Technical Report Research Articles

High-resolution intraoperative infrared thermography for the functional imaging and tumor resection maximization of a low-grade glioma: Technical case report

Currently, it is widely recognized the role of the extent of resection on overall and progression-free survival for gliomas surgery. Brain mapping and intraoperative image guidance are generally required to attain such an objective. Infrared Thermography (IRT) has a potential role in the identification of surgical margins, but it has not been consistently assessed in the literature. We aim to demonstrate the use of intraoperative IRT to detect superficial and deep tumoral margins of low-grade glioma, to identify adjacent functional motor cortex, and to maximize surgical resection in a 45-year-old lady with a long history of partial and secondary generalization seizures.

Technical Report Column

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Genre analysis of introduction section in electrical engineering undergraduate laboratory reports.

This study examines the genre of Engineering Laboratory Reports (ELR) introduction section written by Electrical Engineering Undergraduates in a higher learning institution. The aims of this study are to identify the rhetorical moves and combinations of move patterns used by electrical engineering (EE) students to write introduction section. A genre analysis was conducted to identify writing patterns and convention practices of engineering undergraduate students thus a corpus of N = 35 was selected from electrical engineering students in their final year of study. This study adopted Genre Theory as its theoretical framework, Ngowu 1997 analytical framework and BCU approach for analysis procedure. A pilot test was conducted to determine the model that fits the best to describe moves and steps of ELR. Coding scheme was developed and intercoder reliability showed a significance of 0.91 The study benchmarks a move or step to be present in at least 60% of the reports. The finding shows the introduction consists of one main move which is providing background information of the experiment and followed by four subsequent steps which are reference to research purposes, reference to theoretical knowledge in the field, providing an overview of the study and identification of main research apparatus. The move 1 and all four steps identified above are viewed as obligatory, conventional and optional move and steps in introduction section among undergraduates in academic context. The exemplification of finding shows lack of compliance among undergraduates to produce EELR based on university's guideline in discussing previous literature and underpinning theories, lack of referencing and citation, absence in describing apparatus used and non-sequential moves steps. This study posits the importance of collaboration between English for Academic (EAP) practitioners such as English-writing instructors and discipline specific specialist from engineering field to further improve on genre-based writing instruction, and to identify student learning needs. The method employed in this study may be replicated to analyse other sections of scientific and technical reports such as method, result, discussion and conclusion (MRDC) that may pave ways to address grey areas for improvement in this genre.

OCCUR Shiny application: A user‐friendly guide for curating species occurrence records

Abstract Ecology increasingly relies on a massive volume of biodiversity occurrence records to draw insights into large‐scale biogeographical, ecological and evolutionary phenomena. This often involves defining a set of criteria that guides the collection, filtering and standardising of available records. These curation processes are often neither described in detail nor well documented. This hampers the comparability and reproducibility of studies and thus undermines the robustness of any ecological result. Yet, to date, there is no guide providing a friendly way to reason and document a complete data curation process. We reviewed the available literature on data curation, including tools such as R packages and workflows. From this assessment, we created a complete guide organised into five modules that allows users to consciously select and validate occurrence records based on these curation criteria. This is presented in the user‐friendly Shiny R OCCUR application, available at https://ecoinformatic.shinyapps.io/OCCUR/. OCCUR application provides a guide for researchers to deal with the trade‐off between data certainty and coverage generated in each data curation step. An interactive graph of these changes is provided within each module. OCCUR also produces a custom‐made final report including all steps used for data filtering. This report helps to streamline the writing of the methods section of manuscripts and technical reports, thus promoting the reproducibility of data curation processes. This Shiny application provides an interactive overview of the data curation methods and their use for handling occurrence records from public repositories. It brings together the taxonomic, temporal and spatial dimensions of data and also the identification of duplicates of the records. OCCUR can be applied for multiple purposes, such as teaching R to ecologists or enhancing reproducibility of macroecology and biogeography.

Sustainable Transportation in The Brazilian Agroindustrial Supply Chain: A Literature Review

Objective: This article aims to discuss the importance of incorporating sustainable transportation practices into the supply chains of the Brazilian agro-industry, highlighting their potential to reduce costs, increase operational efficiency, and enhance companies' reputation in an increasingly sustainability-focused global context. Theoretical framework: Agribusiness plays a vital role in the Brazilian economy, converting agricultural raw materials into higher value-added products and driving economic gains and job creation. However, transportation in this chain has a significant environmental impact, with Brazil heavily reliant on road transport, contributing to carbon emissions. Companies from various sectors are adopting sustainable transportation practices to address these challenges, recognizing the growing importance of sustainability as a business strategy to ensure competitive advantage in the global market. Method: The literature review was conducted in five detailed stages: formulation of the research question, identification and careful selection of relevant studies, analysis and synthesis of data, and description and dissemination of results. Scientific articles, book chapters, and technical reports published between 2015 and 2023 were considered, ensuring a solid and updated basis for analysis. Results and conclusion: The analysis of 102 studies highlighted the relevance of implementing sustainable transportation practices, such as the use of electric vehicles and bioenergy, in reducing greenhouse gas emissions and optimizing logistics costs. Intermodality also emerged as an effective strategy adopted to mitigate environmental impacts and strengthen competitiveness. However, there is a continuous need for future research to understand the nuances of sustainable transportation strategies in different segments and regions of the Brazilian agro-industrial supply chain. Research implications: This study emphasizes the urgency and importance of transitioning to sustainable transportation practices in the Brazilian agro-industry, highlighting the need for government intervention and investment in research to develop approaches tailored to the specific challenges of each sector and region. Additionally, it underscores the importance of public policies that incentivize and promote sustainability in supply chains. Originality/value: It significantly contributes to understanding the complexities of sustainable transportation in the Brazilian agro-industry, providing insights for companies and policymakers interested in promoting sustainability in supply chains. By filling knowledge gaps and presenting innovative perspectives, this study stands out for its original contribution and practical value.

Machine Learning Approaches to Predict Symptoms in People With Cancer: Systematic Review.

People with cancer frequently experience severe and distressing symptoms associated with cancer and its treatments. Predicting symptoms in patients with cancer continues to be a significant challenge for both clinicians and researchers. The rapid evolution of machine learning (ML) highlights the need for a current systematic review to improve cancer symptom prediction. This systematic review aims to synthesize the literature that has used ML algorithms to predict the development of cancer symptoms and to identify the predictors of these symptoms. This is essential for integrating new developments and identifying gaps in existing literature. We conducted this systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. We conducted a systematic search of CINAHL, Embase, and PubMed for English records published from 1984 to August 11, 2023, using the following search terms: cancer, neoplasm, specific symptoms, neural networks, machine learning, specific algorithm names, and deep learning. All records that met the eligibility criteria were individually reviewed by 2 coauthors, and key findings were extracted and synthesized. We focused on studies using ML algorithms to predict cancer symptoms, excluding nonhuman research, technical reports, reviews, book chapters, conference proceedings, and inaccessible full texts. A total of 42 studies were included, the majority of which were published after 2017. Most studies were conducted in North America (18/42, 43%) and Asia (16/42, 38%). The sample sizes in most studies (27/42, 64%) typically ranged from 100 to 1000 participants. The most prevalent category of algorithms was supervised ML, accounting for 39 (93%) of the 42 studies. Each of the methods-deep learning, ensemble classifiers, and unsupervised ML-constituted 3 (3%) of the 42 studies. The ML algorithms with the best performance were logistic regression (9/42, 17%), random forest (7/42, 13%), artificial neural networks (5/42, 9%), and decision trees (5/42, 9%). The most commonly included primary cancer sites were the head and neck (9/42, 22%) and breast (8/42, 19%), with 17 (41%) of the 42 studies not specifying the site. The most frequently studied symptoms were xerostomia (9/42, 14%), depression (8/42, 13%), pain (8/42, 13%), and fatigue (6/42, 10%). The significant predictors were age, gender, treatment type, treatment number, cancer site, cancer stage, chemotherapy, radiotherapy, chronic diseases, comorbidities, physical factors, and psychological factors. This review outlines the algorithms used for predicting symptoms in individuals with cancer. Given the diversity of symptoms people with cancer experience, analytic approaches that can handle complex and nonlinear relationships are critical. This knowledge can pave the way for crafting algorithms tailored to a specific symptom. In addition, to improve prediction precision, future research should compare cutting-edge ML strategies such as deep learning and ensemble methods with traditional statistical models.

Effect of Radiation Position of Photon Beam at Axis Point and Field Edge on Absorbed Dose on Linear Accelerator (Linac)


 
 
 
 Radiotherapy is a medical treatment that uses ionizing radiation to kill cancer cells using a Linear Accelerator (Linac). One of the errors in radiotherapy irradiation can occur because the radiation beam that comes out is not in accordance with the planning. Therefore, radiation absorbed dose measurement is needed to carry out as a quality assurance to control the accuracy and suitability of the dose to be received by the patient by following the standards of the Technical Report Series (TRS) 398. This study was conducted at Radiotherapy Installation of RSUD A.W. Sjahranie Samarinda. In the measurement of radiation absorbed dose, the detector was placed in the center of the water phantom with a certain depth and placed in an axis position perpendicular to the radiation source. The detector is not only placed in the axis position, but also placed on the 4 edges of the field with the aim of knowing the effect of the location of the detector on the absorbed dose on the Linac plane. Medium water phantom, Farmer type ionization detector with a depth of 10 cm, and radiation source distance to the phantom surface of 100 cm were applied in this study. The measurement deviation results at the axis position and 4 field edges are 0.01%, 0.06%, 0.03%, 0.05%, and 0.05%. These values are within the tolerance limits written in the IAEA TRS 398 protocol, which is ± 2%. This states that the radiation absorbed dose by the water phantom is homogeneous in all directions.
 
 
 

Investigation of the subsurface structure at the target site in Kumamoto, Japan, and the distributed data of the blind prediction exercise: report for the experiments for the 6th international symposium on effects of surface geology on seismic motion

This technical report explains details on the results of the investigation to build a subsurface structural model and a selection of earthquake data at the target site of the blind prediction exercise for “The 6th International Association of Seismology and Physics of the Earth’s Interior/International Association of Earthquake Engineering International Symposium on the Effect of Surface Geology on Seismic Motion (ESG6).” The selection process of the target site in the Kumamoto Plain, Japan, in ESG6 was explained with a historical review of the blind prediction tests in the previous ESG conferences. We have collected existing subsurface structural and earthquake data and conducted geophysical and geotechnical surveys in and around the target site to generate important velocity structure and the earthquake data used in the blind test. Microtremor data were obtained in triangular arrays ranging in side lengths from 1 to 962 m, and active surface wave data were derived along a 36-m line at the site. These data were provided for the prediction of a subsurface structural model in the first step of the blind prediction exercise. We also conducted a velocity logging in a borehole to a bottom depth of 39 m at the site and laboratory tests of soil samples from the borehole. We constructed a velocity profile of the shallow and deep sedimentary layers from a combination of the geophysical and geotechnical data at the site, and validated it by comparing the characteristics of the ground motion data from the moderate event. This “preferred velocity model” was provided as a standard model to the participants in the second and third steps of the blind prediction test to predict the earthquake ground motions of a moderate event and the mainshock of the 2016 Kumamoto earthquake.Graphical

Benefits of Photon-Counting CT Myelography for Localization of Dural Tears in Spontaneous Intracranial Hypotension.

Photon-counting CT is an increasingly used technology with numerous advantages over conventional energy-integrating detector CT. These include superior spatial resolution, high temporal resolution, and inherent spectral imaging capabilities. Recently, photon-counting CT myelography was described as an effective technique for the detection of CSF-venous fistulas, a common cause of spontaneous intracranial hypotension. It is likely that photon-counting CT myelography will also have advantages for the localization of dural tears, a separate type of spontaneous spinal CSF leak that requires different myelographic techniques for accurate localization. To our knowledge, prior studies on photon-counting CT myelography have been limited to techniques for detecting CSF-venous fistulas. In this technical report, we describe our technique and early experience with photon-counting CT myelography for the localization of dural tears.

Atlantoaxial facet fixation using cervical facet cage: technical case report and review of the literature.

In 1994, the use of interfacet spacer placement was for joint distraction, reduction, and fusion to supplement atlantoaxial or occipitocervical fixation. Here, we present a unique case of bilateral atlantoaxial interfacet fixation using cervical facet cages (CFC) in a pediatric patient with basilar invagination. In addition, we review the literature on atlantoaxial facet fixation. We present a 12-year-old boy with Wiedemann-Steiner syndrome who presented with multiple episodes of sudden neck jerking, described as in response to a sensation of being shocked, and guarding against neck motion, found to have basilar invagination with cervicomedullary compression. He underwent an occiput to C3 fusion with C1-C2 CFC fixation. We also conducted a literature review identifying all publications using the following keywords: "C1" AND "C2" OR "atlantoaxial" AND "facet spacer" OR "DTRAX." The patient demonstrated postoperative radiographic reduction of his basilar invagination from 6.4 to 4.1mm of superior displacement above the McRae line. There was a 4.5mm decrease in the atlantodental interval secondary to decreased dens retroflexion. His postoperative course was complicated by worsening of his existing dysphagia but was otherwise unremarkable. His neck symptoms completely resolved. We illustrate the safe use of CFC for atlantoaxial facet distraction, reduction, and instrumented fixation in a pediatric patient with basilar invagination. Review of the literature demonstrates that numerous materials can be safely placed as a C1-C2 interfacet spacer including bone grafts, titanium spacers, and anterior cervical discectomy and fusion cages. We argue that CFC may be included in this arsenal even in pediatric patients.

Laparoscopic Management of Abdominal Echinococcosis: A Technical Report on Surgical Techniques and Outcomes.

This technical report explores the efficacy and methodology of laparoscopic surgery for treating abdominal echinococcosis, a parasitic infection caused by Echinococcus granulosus. We highlight the zoonotic nature of the disease, which predominantly affects the liver and occasionally other organs, noting the challenge of its asymptomatic progression that complicates timely diagnosis and intervention. We detail our surgical technique using a standard laparoscopy kit to address abdominal hydatid cysts, emphasizing the critical importance of preventing cyst rupture and spillage to avoid recurrence and anaphylactic shock. We discuss considerations for opting for laparoscopy over open surgery, such as reduced postoperative morbidity, faster patient recovery, and lower costs, while also acknowledging limitations like restricted instrument movement and the absence of haptic feedback. We advocate hypertonic saline as the preferred scolicidal agent and strategies to minimize spillage and manage the residual cavity. In conclusion, we assert that laparoscopy offers a viable and effective treatment option for abdominal echinococcosis, emphasizing that optimizing outcomes for this benign condition hinges on careful patient selection and a conservative surgical approach.

Refinement of nBCA embolization technique in treatment of metastatic spinal tumors: Case series and technical report.

Preoperative embolization of metastatic spinal tumors (MSTs) has proven advantageous in limiting intraoperative blood loss (IBL) during resection. N-butyl cyanoacrylate (nBCA) is a liquid embolic agent known for its rapid hemostatic effects. However, nBCA is associated with a higher risk of distal nontarget embolization. This study highlights the refinement of the embolization technique and assesses its efficacy in performing an initial distal segmental artery plug with concentrated nBCA followed by proximal diluted nBCA for MSTs. A retrospective review of patients with MST (2018-2023) was performed. Patients who underwent preoperative nBCA endovascular embolization prior to tumor resection and spinal instrumentation were included. Baseline standard spinal angiography was performed. Sixteen patients (13 men, 3 women; 56.0 ± 12.4 years) met inclusion criteria. And 43.75% (7 of 16) had thoracic levels, 37.5% (6 of 16) lumbar, and 18.75% (3 of 16) sacral. The most common primary tumor was renal cell carcinoma (43.75%, 7 of 16). A total of 43 pedicles were embolized (median 3), resulting in complete/near complete obliteration of the tumor blush. Most pedicles (83.7%, 36 of 43) received a single dilute concentration of nBCA; however, 16.3% (7 of 43) received two separate concentrations of nBCA, a denser concentration distally into the segmental artery and a diluted concentration proximally into the tumor bed. Mean IBL was 1150 ± 1201 mL in 3 distal plug patients distal plug patients versus 1625 ± 681 mL in 12 other patients. There were no complications related to embolization. Performing a distal, concentrated nBCA plug during preoperative nBCA embolization of MSTs may increase tumor penetration and reduce IBL.

Safety of intracranial electrodes in an MRI environment: a technical report.

Intracranial electroencephalography (iEEG) involves placing intracranial electrodes to localise seizures in patients with medically refractory epilepsy. While magnetic resonance imaging (MRI) enables visualisation of electrodes within patient-specific anatomy, the safety of these electrodes must be confirmed prior to routine clinical utilisation. Therefore, the purpose of this study was to evaluate the safety of iEEG electrodes from a particular manufacturer in a 3.0-Tesla (3.0T) MRI environment. Measurements of magnetically induced displacement force and torque were determined for each of the 10 test articles using standardised techniques. Test articles were subsequently evaluated for radiofrequency-induced heating using a Perspex phantom in both open and 'fault' conditions. Additionally, we assessed radiofrequency (RF)-induced heating with all test articles placed into the phantom simultaneously to simulate an implantation, again in both open and 'fault' conditions. Finally, each test article was evaluated for MRI artefacts. The magnetically induced displacement force was found to be less than the force on the article due to gravity for all test articles. Similarly, the maximum magnetically induced torque was less than the worst-case torque due to gravity for all test articles apart from the 8-contact strip - for which it was 11% greater - and the depthalon cap. The maximum temperature change for any portion of any test article assessed individually was 1.7°C, or 1.2°C for any device component meant to be implanted intracranially. In the implantation configuration, the maximum recorded temperature change was 0.7°C. MRI may be safely performed for localising iEEG electrodes at 3.0T under certain conditions.

The LHCb VELO Upgrade II: Design and development of the readout electronics

In 2032–2034, the LHCb will be upgraded to efficiently explore the new HL-LHC conditions. The increased number of interactions per event and radiation level brings several challenges including high non-uniform radiation doses (up to 6×1016MeVneq/cm2), operation under vacuum (power dissipation below 1.5 W/cm2), high data rates (up to order of 100 Gbps/ASIC) and ASIC timing resolution (30 ps or better). This proceedings describes the requirements for two different upgrade scenarios (different pixel pitch, radiation doses and material budget while keeping the same scattering terms), application specific integrated circuit status to readout the sensor pixels (PicoPix and IGNITE), electronic integration (Anisotropic Conductive Bonding) and data transmission (FALAPHEL). In summary, the open challenges mentioned before are being addressed in the current R&D phase and the most suitable candidate solutions will be consolidated in the technical design report in the coming years.

Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency.

Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.

The Practice of Forensic Structural Engineering in IABSE's Member Countries

The IABSE Task Group 5.1 on Forensic Structural Engineering aims to examine and to mitigate structural failures by sharing knowledge of technical, human and organizational causes of failure, in addition to methods and techniques in forensic investigation processes. Forensic engineering expertise has yet to be recognized worldwide as a specific domain of civil engineering practice, and this paper amends previously published technical reports in 2012, 2014 and 2015 by former IABSE Working Group 8 following a new survey carried out in 2020–2022. This new survey has been developed with the lessons learnt from the previous survey in 2013–2014, including the validation of the results obtained by eliminating potential subjectivity in the former assessment. This survey also includes further understanding of the institutional and national regulatory framework. The survey was completed by 22 IABSE member countries whose responses were provided by national experts on forensic structural engineering. This paper will allow the reader to familiarize him/herself with the state of the art in forensic structural engineering practice across 22 countries, allowing a national-level diagnosis. The survey will also help to identify the main challenges within each country related to forensic engineering. Furthermore, recommended steps, as suggested by the national experts, for the awareness and/or development of good industry practice within forensic structural engineering are highlighted in this paper. Online supplemental data for this article can be accessed at https://doi.org/10.1080/10168664.2024.2307411.

Why Is the Baker Classification Inadequate for Classifying Silicone Implant Fibrous Capsules?

Baker's clinical classification is adopted as the gold standard for grading complications related to silicone implants. Despite being widely used for this purpose, the classification has several limitations, highlighting subjectivity, reproducibility, and interobserver agreement. In this technical report, we aim to present the reasons for the inadequacy of the Baker classification for breast implants and the main factors contributing to false-negative results using recent theories of surface tension of fluids and gel bleeding. We also present an alternative classification proposal using magnetic resonance imaging of the breasts.

Of editorial processes, AI models, and medical literature: the Magnetic Resonance Audiometry experiment.

The potential of artificial intelligence (AI) in the field of medical research is unquestionable. Nevertheless, the scientific community has raised several concerns about a possible fraudulent use of these tools that might be used to generate inaccurate or, in extreme cases, erroneous messages that could find their way into the literature. In this experiment, we asked a generative AI program to write a technical report on a non-existing Magnetic Resonance Imaging technique called Magnetic Resonance Audiometry, receiving in return a full seemingly technically sound report, substantiated by equations and references. We have submitted this report to an international peer-reviewed indexed journal, passing the first round of review with only minor changes requested. With this experiment, we showed that the current peer-review system, already burdened by the overwhelming increase in number of publications, might be not ready to also handle the explosion of these techniques, showing the urgent need for the entire community to address both the issue of generative AI in scientific literature and probably a more profound discussion on the entire peer-review process. CLINICAL RELEVANCE STATEMENT: Generative AI models are shown to be able to create a full manuscript without any human intervention that can survive peer-review. Given the explosion of these techniques, a profound discussion on the entire peer-review process by the scientific community is mandatory. KEY POINTS: • The scientific community has raised several concerns about a possible fraudulent use of AI in scientific literature. • We asked a generative AI program to write a technical report on a non-existing technique, receiving in return a full technically sound report, substantiated by equations and references, that passed peer-review. • This experiment showed that the current peer-review system might be not ready to handle the explosion of generative AI techniques, advising for a profound discussion on the entire peer-review process.

Supraclavicular Artery Island Flap for Treatment of Cervical Wound Defects and Persistent Cerebrospinal Fluid Leaks: A Technical Note and Systematic Review of the Literature

BackgroundSoft tissue defects and persistent cerebrospinal fluid (CSF) leaks can create complications after cervical spinal surgery. The supraclavicular artery island (SAI) flap is useful in closing tissue defects, particularly in these complex surgeries and multiple reinterventions. However, technical reports in this context are scarce. We describe application of the SAI flap technique to control persistent CSF leak in the first documented instance (to our knowledge) of a low-grade fibromyxoid sarcoma (LGFMS) in the cervical epidural space. Additionally, we conducted a comprehensive review of PubMed, Embase, and Google Scholar from their earliest records through December 17, 2023 using combined terms, “supraclavicular artery island flap AND spine” and “supraclavicular AND flap AND spine”. Technical NoteA 56-year-old woman with arm pain and weakness presented with a cervical epidural mass extending from C4–C6 and associated spinal cord compression. She underwent a 3-level corpectomy and tumor resection. Primary dural closure was impossible due to the dural invasion, and reintervention with an SAI flap and definitive lumboperitoneal shunting were required to control and seal the CSF leak. Systematic Literature ReviewSeven case reports describing SAI flap for spinal surgery complications were identified. The indications in those cases were correcting esophageal and hypopharyngeal perforations after cervical fusion and discectomy and persistent soft tissue coverage after cervical instrumentation. ConclusionThe SAI flap technique provided wound defect coverage in this case and is suitable for addressing issues such as persistent CSF leaks or soft tissue coverage after cervical spine surgery.

Adapting the Gamified Educational Networking Online Learning Management System to Test a Decentralized Simulation-Based Education Model to Instruct Paramedics-in-Training on the Emergency Intraosseous Access and Infusion Skill.

Intraosseous (IO) access and infusion is a safe and rapid alternative to intravenous access in obtaining vascular access for administering fluids and drugs. Healthcare professionals, such as primary and advanced care paramedics, use IO access and infusion in emergency circumstances where peripheral intravenous routes are inaccessible. IO access skills require hands-on training, which can be done remotely if the participants have access to simulation, instructions, guidance, and feedback. For the purpose of moving the training outside of the simulation laboratories, we have developed (1) an inexpensive and scalable three-dimensional (3D) printed and silicone-based advanced adult proximal tibial IO access and infusion simulator and (2) a unique learning management system (LMS) for remote simulation-based training. The LMS was built using the Django platform and supports experiential learning by providing access to educational and instructional content (including virtual simulation and serious games), allowing peers to communicate among themselves and with subject-matter experts, provide and receive feedback asynchronously, and engage in learning using gamification elements. The aim of this technical report is to describe the process of development and the final product of the LMS as a research and educational tool to scaffold remote learning of emergency IO skills by paramedics-in-training.