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ce. The metrics could be surrogate end points in research to optimize simulated laryngoscopy training.

Resuscitation simulations immerse learners into the complexity of emergency patient management. Head-Mounted Display Virtual Reality (VR) has been used for stress inoculation therapy for phobias and posttraumatic stress disorder. However, VR for stress inoculation in resuscitation leadership training has not been studied. We sought to develop VR simulation for stress inoculation, as exposure therapy training, for resuscitations.

We explain the conceptual design, development, production, and initial evaluation process for 2 VR simulations in infant status epilepticus and pediatric anaphylactic shock. We further describe deliberate game mechanic choices to maximize psychological fidelity. In-virtual reality performance data for time-to-critical actions and stress physiology markers (heart rate, salivary cortisol) were collected from expert pediatric emergency physicians and novice pediatric residents. Data were analyzed to examine differences between the 2 groups for both outcome types to determine the exte of VR simulation as longitudinal stress inoculation for healthcare providers.

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Objective Structured Clinical Examinations (OSCEs) are an accepted technique for evaluation of clinical competence in healthcare. However, the economic imperative requires faculty to control cost, using innovative educational strategies such as virtual simulation. The objective of this study was to evaluate the cost implications of implementing an online interactive learning module [Monash OSCE Virtual Experience (MOVE)].

All fourth-year pharmacy students enrolled in Monash University in 2017 were provided access to MOVE. Cost-minimization analyses were performed to evaluate the cost of introducing MOVE in the pharmacy course using the smallest cohort size (Malaysia campus) of 40 students as the base case. We also determined under what circumstances MOVE would be more cost-effective, considering the different operational situations such as when student numbers increased or when the number of simulation modules created were increased.

The overall cost of setup and implementation of MOVE in the first year of implementation among 40 students was US $94.38 per student. In comparison, the face-to-face workshop cost was US $64.14 per student. On the second year of implementation, the ongoing cost of operation of MOVE was US $32.86 per student compared with US $58.97 per student using face-to-face workshop. A net benefit using MOVE was observed after the third year of implementation. Larger savings were noted when the cohort size extends larger than 100 students.

Monash OSCE Virtual Experience was a flexible and cost-effective approach to aid students in preparation for an OSCE and enhanced students' learning experience. The wider applicability of these findings will need to be explored in other settings.

Monash OSCE Virtual Experience was a flexible and cost-effective approach to aid students in preparation for an OSCE and enhanced students' learning experience. The wider applicability of these findings will need to be explored in other settings.Metabolic dysfunction has been suggested to be involved in musculoskeletal pain; however, few studies have identified metabolic markers associated with multisite musculoskeletal pain (MSMP). This study sought to identify metabolic marker(s) for MSMP by metabolomic analysis. The Tasmanian Older Adult Cohort Study (TASOAC) provided the discovery cohort with the Newfoundland Osteoarthritis Study (NFOAS) providing the replication cohort. MSMP was assessed by a self-reported pain questionnaire and defined as painful sites ≥4 in both TASOAC and NFOAS. Further, MSMP was also defined as painful sites ≥7, while non-MSMP was defined as either painful sites less then 7 or ≤1 in NFOAS. Serum samples of TASOAC received metabolic profiling using The Metabolomics Innovation Centre (TMIC) Prime Metabolomics Profiling Assay. COX inhibitor The data on the identified metabolites were retrieved from NFOAS metabolomic database for the purpose of replication. A total of 409 participants were included in TASOAC, 38% of them had MSMP. Among the 143 metabolites assessed, 129 passed quality control and were included in the analysis. Sphingomyelin (SM) C181 was significantly associated with MSMP (OR per log µM increase=3.96, 95%CI, 1.95-8.22; p=0.0002). The significance remained in multivariable analysis (OR per log µM increase=2.70, 95%CI, 1.25-5.95). A total of 610 participants were included in NFOAS and the association with SM C181 was successfully replicated with three MSMP definitions (OR ranging from 1.89 to 2.82; all p less then 0.03). Our findings suggest that sphingomyelin metabolism is involved in the pathogenesis of MSMP and circulating level of SM C181 could serve as a potential marker in the management of MSMP.