Abstract: Over the past decade much attention has been directed towards futuristic training models. It is felt by many that virtual (VR) and augmented (AR) reality training modules can be tailored to medical training. Virtual and augmented reality training can be utilized to teach important critical thinking as well as procedural proficiency. VR/AR may also be used to ensure longitudinal goals are maintained as training curriculums are altered. As educators and researchers see the value of VR/AR training, the question remains, do the participants find value in VR/AR training? In this study, we looked at the learner perspective of 23 paramedic students who recently completed a National Registry Paramedic-approved curriculum. Overall, 87% of paramedic students felt the VR/AR experience provided was beneficial to their training. Given the high rate of value applied to this training by the students, we feel additional studies and VR/AR training should be tailored to paramedic education during initial and proficiency training events.

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Bakgrund: Kvinnliga idrottare drabbas i hög grad av främre korsbandsskador och under efterföljande rehabilitering har fysioterapeuten en viktig roll. En stor skillnad mellan kvinnor och män är menstruationscykeln. Den kvinnliga idrottaren påverkas av menstruationscykelns olika faser och intag av preventivmedel. Genom ett biopsykosocialt helhetsperspektiv kan en fysioterapeut ta hänsyn till flera olika faktorers påverkan på ett beteende. Detta kan möjliggöra vad som eventuellt kan påverka en elitidrottande kvinna kopplat till menstruationscykel under en pågående främre korsbandsrehabilitering.Syfte: Studiens syfte var att undersöka kvinnors upplevda motivation, self-efficacy och träningskvalité kopplat till menstruationscykeln under pågående främre korsbandsrehabilitering.Metod: Beskrivande fallstudier med deskriptiv och visuell analys. Sju kvinnliga elitidrottare som genomgick främre korsbandsrehabilitering rekryterades, varav en exkluderades. Datainsamlingen genomfördes med hjälp av ett frågeformulär och en dagbok. Datainsamlingen pågick i 33 dagar.Resultat: Resultatet visar att var och en av deltagarna upplevde variation i sina skattningar inom varje frågeställning under studiens gång. En deltagares variation kan eventuellt ha påverkats av menstruationscykeln och dess fluktuationer av hormoner.Slutsats: Uppsatsens resultat visar på variation av skattningar under menstruationscykeln hos samtliga deltagare. Denna studie kan dock inte påvisa om den påverkade faktorn är menstruationscykelns olika faser och intag av preventivmedel.Nyckelord: Främre korsbandsskada, fysioterapi, kvinnliga elitidrottare, rehabilitering, socialkognitiv teori

Calciphylaxis is a poorly-understood condition whose pathogenesis involves systemic calcification of arteries and arterioles. It is usually seen in patients end-stage renal disease, with an incidence of approximately 5% in dialysis patient and patients with calcium-phosphate dysregulations.1,2 However, there have also been reports of patients with biopsy-proven calciphylaxis with normal calcium-phosphate balance and renal function. We report a morbidly obese 45-year-old female with significant past medical history of necrotizing fasciitis with superimposed pseudomonas infections requiring multiple rounds of antibiotics and debridement. She presented to hospital due to chronic thigh wounds and debilitating pain. Patient developed tender and ulcerated lesions on her bilateral inner thighs spontaneously and was treated with trimethoprim-sulfamethoxazole and doxycycline. Wound cultures grew pseudomonas and Methicillin-Resistant Staphylococcus aureus. Rheumatologic work up including antinuclear antibody, rheumatoid factor, anti-double stranded DNA, anti-ribonucleoprotein and complement levels were all within normal limits except for elevated erythrocyte sedimentation rate and c-reactive protein. Patient was given multiple analgesics of which ketorolac helped the most. She was referred to dermatology after which excisional biopsy of wound was performed. Biopsy result revealed tissue necrosis and calciphylaxis. Patient was started on sodium thiosulfate (STS) infusions after discussing with dermatology and was discharged in stable conditions from hospital. The exact cause of calciphylaxis still remains unknown. It is thought to be due to intravascular calcium deposition in the media of the epidermal and subcutaneous arterioles causing medial calcification and intimal fibrosis of the arterioles resulting in thrombosis and occlusions. This leads to ischemic skin necrosis which is the most common clinical finding in calciphylaxis.3 For non-uremic calciphylaxis, there appears to be a predilection of Caucasian females, primary hyperparathyroidism, obesity, malignancy, connective tissue disease and vitamin D deficiency.4-5 Our patient had some of the risk factors including morbid obesity, middle aged Caucasian female and Vitamin D deficiency. Calciphylaxis has two-year mortality rate of 50-80% secondary to sepsis, hence preventing patients with known risk factors from developing calciphylaxis is imperative.6 The lesions of calciphylaxis are often debilitating and wound care with debridement of necrotic tissue as well as systemic antibiotics are of utmost importance, if indicated. In recent years, treatment include the use of STS, which chelate calcium from tissue deposits and bisphosphonates which are thought to help in removing arterial calcifications.7 It is important to understand that calciphylaxis may occur in patients without renal impairment and early interventions may be helpful to decrease debilitation and mortality.

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Summary Autonomous vehicles are a growing trend in society and are anticipated to change the wholetransportation system as we know it today. Many vehicle manufacturers are focusing ondevelopment of different kinds of self-driving vehicles. The variety of automation in vehiclescan be divided into six levels of automation, according to the Society for Automotive Engineers(SAE) International’s division. As the level of automation varies between vehicles, the level ofneeded driver action also varies. As the automation level gets higher the drivers role changesmore and more towards being a supervisory controller for the automation. This leads to adifferent need of information presented to the driver in an autonomous vehicle compared towhat is provided in a manual vehicle. The driver must be able to understand what the automationis doing and predict how it will behave in different situations. Hence, the design of the Human-Machine Interface (HMI) is utterly important for the safety of autonomous driving. The main objective for the thesis work was to evaluate the driving compartment, from acognitive ergonomics point of view, for a special type of professional autonomous road vehicle. A literature study focusing on evaluation and testing of HMIs in autonomous vehicles wereperformed and the evaluation was done through user tests in a simulator with 22 professionaldrivers. The tests were followed by questionnaires and interviews about the test participants’experience of the designed HMI. In the literature study, only a few publications, were found addressing the validation of thewhole human machine interaction in autonomous vehicles. Most of the references had focus ontesting of limited subparts of the HMI, such as trust in automation, situational awareness andtransitions between manual and automatic driving mode. The designed HMI worked as intended, since the test participants noticed and acted upon allHMI signals and were able to takeover and handover the control from/to the automation. Somerecommendations were, however, provided for the future development work of the evaluatedautonomous vehicle. For example, since there were some limitations in the simulator used andin the test design, a next iteration of the test was recommended for future development. This evaluation was done as a first exploratory test and the aim of the thesis work has beenfulfilled. The design of the HMI, the manoeuvring devices for the autonomous vehicle and theconcept of two driver roles are, at this stage, considered adequate for continuing the project. It was also concluded that the driving behaviour of the automation is a crucial aspect forfacilitation of user-trust in the autonomous vehicle and that clear procedures for communicationare needed to ensure traffic safety. Further, it was concluded that standardization of frameworks and methods for evaluatingautonomous vehicles is beneficial for developers, authorities as well as end-users.

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Neuroblastoma is a form of embryonal neuroendocrine tumor that arises from neural crest progenitor cells, which can differentiate into multiple cell types. It is caused by genetic abnormalities such as MYCN oncogene amplification and 11q deletion, both of which can deregulate neuroblastoma suppressor genes located on chromosome 11q. MiRNAs are noncoding RNAs with an average length of 22 nucleotides. By binding to the 3′ untranslated regions of target messenger RNA, the RISC represses protein synthesis. The aim of this experimental project was to determine the effects of MYCN amplification or 11q deletion on the expression level of the miRNA, hsa-miR-34b-3p in neuroblastoma. The total RNA was extracted from the neuroblastoma cell lines, NB69 without MYCN amplification and 11q deletion, Kelly with 11q deletion and SK-NBE(2) with MYCN amplification. cDNAs were generated from the miRNA, hsa-miR-34b-3p located on chromosome 11q and the reference gene, RNU6B. The cDNAs were amplified and quantified by qPCR. The qPCR data were analysed using the comparative Ct method, Kruskal-Wallis test with multiple comparisons to determine whether or not hsa-miR-34b-3p was significantly differentially expressed in Kelly and SK-N-BE(2) compared to NB69. The results showed that hsa-miR-34b-3pwas significantly downregulated in the cell lines, Kelly and SK-N-BE(2) compared to NB69. In conclusion, the findings of this study showed that hsa-miR-34b-3p is downregulated in Kelly and SK-N-BE(2) compared to NB69, and call for further research to investigate its clinical potential in the therapy of neuroblastoma.