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BackgroundSurgical trauma care requires excellent multidisciplinary team skills and communication to ensure the highest patient survival rate. This study investigated the effects of Hyper-realistic immersive surgical team training to improve individual and team performance. A Hyper-realistic surgical training environment is defined as having a high degree of fidelity in the replication of battlefield conditions in a training environment, so participants willingly suspend disbelief that they become totally immersed and eventually stress inoculated in a way that can be measured physiologically.MethodsSix multispecialty member US Navy Fleet Surgical/US Army Forward Surgical Teams (total n=99 evaluations) underwent a 6-day surgical training simulation using movie industry special effects and role players wearing the Human Worn Surgical Simulator (Cut Suit). The teams were immersed in trauma care scenarios requiring multiple complex interventions and decision making in a realistic, fast-paced, intensive combat trauma environment.ResultsHyper-realistic immersive simulation training enhanced performance between multidisciplinary healthcare team members. Key efficacy quantitative measurements for the same simulation presented on day 1 compared with day 6 showed a reduction in resuscitation time from 24 minutes to 14 minutes and critical error decrease from 5 to 1. Written test scores improved an average of 21% (Medical Doctors 11%, Registered Nurses 25%, and Corpsman/Medics 26%). Longitudinal psychometric survey results showed statistically significant increases in unit readiness (17%), combat readiness (12%), leadership quality (7%), vertical cohesion (7%), unit cohesion (5%), and team communication (3%). An analysis of salivary cortisol and amylase physiologic biomarkers indicated an adaptive response to the realistic environment and a reduction in overall team stress during performance evaluations.ConclusionsHyper-realistic immersive simulation training scenarios can be a basis for improved military and civilian trauma training.Level of evidenceLevel III.

I am grateful to the publishers for permission to reprint these essays in this form. I would also like to take this occasion to acknowledge in print my obligation to friends and colleagues who have been responsible-whether they like it or not-for the course that my work has taken over the past decade:

Pornography is writing about prostitutes. "Story of the eye" reveals the Prostitution of the seif at stake in the gender roles advocated by the ideologies of the Church, Capitalism, and Fascism. Bakhtin's dialogism allows us to explore the contexts of Bataille's story to portray the r öle of humor in leveling the hierarchical pretensions of ideologies. Once the carnival traditions expose the explosive potential of Ms story's eroticism, the narrator's selfis laid barefor its creative sense ofnever completing the questioning of its existential Community.

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