Augmented Reality Integration in Manikin-Based Simulations: Bringing Basic Science to the Critical Care Bedside with Limited Augmented Reality Resources.

Immersive simulation and augmented reality (AR) are powerful educational tools in high-risk medical professions. Basic science AR, such as anatomic holograms, are gaining popularity. Many educators want to adopt AR and integrate basic science review in high-risk clinical decision-making but cannot afford it. In this project, we designed three AR integrated manikin-based simulations (ARI-MBS) by combining critical care scenarios with commercially available AR programs. Using a single headset and limited equipment, we technically integrated AR into MBS in a way that both students and faculty found rewarding. We present our design, so that others may replicate it. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01821-z.

Ready Patient One: How to Turn an In-Person Critical Care Simulation Scenario Into an Online Serious Game.

Introduction Serious gaming has become popular in healthcare education as an engaging way to train learners. When coronavirus disease 2019 (COVID-19) forced the cancellation of in-person simulation sessions, we designed a serious game to deliver content in an interactive format with no out-of-pocket expense. We describe the design process and game reception so that others may replicate it. Methods We designed an online game using Choose-Your-Own-Adventure (CYOA) and Escape Room concepts. Using online survey software, we presented an interactive story based on an existing simulation scenario and included interactive puzzles as roadblocks to scenario progression. Each puzzle represented a critical care concept, and many contained hyperlinks to prior basic science lecture material to reinforce learning. A post-game survey assessed students' experience. Results All (N=88) students enrolled in a scheduled simulation session participated in the game, and 75% (66/88) responded to a post-participation survey. All respondents (100%) were able to complete the game. The majority (57.6%) completed the game in 30 minutes to 1 hour. Most students strongly agreed or agreed that the game enhanced their understanding of critical care concepts (93.9-97.0%), and that they were interested in doing more CYOA games (90.9%). Conclusion The game was well-received, delivered critical care content, and challenged students to apply basic science principles to medical decision-making from the safety of their own homes. The game was self-guided, requiring minimal active facilitator involvement. We plan to expand the use of the game to other settings and explore its use in formative/summative assessment and remediation.

Discovery of a NAPE-PLD inhibitor that modulates emotional behavior in mice.

N-acylethanolamines (NAEs), which include the endocannabinoid anandamide, represent an important family of signaling lipids in the brain. The lack of chemical probes that modulate NAE biosynthesis in living systems hamper the understanding of the biological role of these lipids. Using a high-throughput screen, chemical proteomics and targeted lipidomics, we report here the discovery and characterization of LEI-401 as a CNS-active N-acylphosphatidylethanolamine phospholipase D (NAPE-PLD) inhibitor. LEI-401 reduced NAE levels in neuroblastoma cells and in the brain of freely moving mice, but not in NAPE-PLD KO cells and mice, respectively. LEI-401 activated the hypothalamus-pituitary-adrenal axis and impaired fear extinction, thereby emulating the effect of a cannabinoid CB1 receptor antagonist, which could be reversed by a fatty acid amide hydrolase inhibitor. Our findings highlight the distinctive role of NAPE-PLD in NAE biosynthesis in the brain and suggest the presence of an endogenous NAE tone controlling emotional behavior.

Individual Vulnerability to Stress Is Associated With Increased Demand for Intravenous Heroin Self-administration in Rats.

Opioid use is a widespread epidemic, and traumatic stress exposure is a critical risk factor in opioid use and relapse. There is a significant gap in our understanding of how stress contributes to heroin use, and there are limited studies investigating individual differences underlying stress reactivity and subsequent stress-induced heroin self-administration. We hypothesized that greater individual vulnerability to stress would predict higher demand for heroin self-administration in a within-subjects rodent model of stress and heroin use comorbidity. Male rats were exposed to inescapable intermittent swim stress (ISS) and individual biological (corticosterone) or behavioral [open field, social exploration, and forced swim tests (FSTs)] measures were assessed before and after the stress episode. Individual demand for self-administered heroin (0.05 mg/kg/infusion; 12-h sessions) was assessed using a behavioral economics approach followed by extinction and reinstatement tests triggered by stress re-exposure, non-contingent cue presentations, and yohimbine (0, 1.0, or 2.5 mg/kg). We found that behavioral, biological, and a combination of behavioral and biological markers sampled prior to and after the stress episode that occurred weeks before the access to heroin self-administration predicted the magnitude of individual demand for heroin. Non-contingent presentation of cues, that were previously associated with heroin, reinstated heroin seeking in extinction. For the first time, we show that individual biological response to an ecologically relevant stressor in combination with associated behavioral markers can be used to predict subsequent economic demand for heroin.