A multiphasic constitutive model of the skin that implicitly accounts for the process of intrinsic (i.e. chronological) ageing via variation of the constitutive parameters is proposed. The structurally-motivated constitutive formulation features distinct mechanical contributions from collagen and elastin fibres. The central hypothesis underpinning this study is that the effects of ageing on the mechanical properties of the tissue are directly linked to alterations in the microstructural characteristics of the collagen and elastin networks. Constitutive parameters in the model, corresponding to different ages, are identified from published experimental data on bulge tests of human skin. The numerical results demonstrate that degradation of the elastin meshwork and variations in anisotropy of the collagen network are plausible mechanisms to explain ageing in terms of macroscopic tissue stiffening. Whereas alterations in elastin affect the low-modulus region of the skin stress-strain curve, those related to collagen have an impact on the linear region.
| WHAT WA S TRIED?As part of our resilience training, we developed an activity called 'Emotional Speed-Dating.' At this point in the training, students had been working in groups of 10-15 peers over a period of 4 weeks. We asked the students to build two rows of chairs facing each other. After all students had found a seat, we passed out sheets of paper containing six questions. Students in one row were assigned the role of interviewer and were asked to put the questions to the peer in the row opposite them. After 3 minutes, the interviewers and interviewees switched roles. After another 3 minutes, all students moved one seat to the right, and the person in the outermost seat moved to the empty chair at the beginning of the opposite row. Then the interviewing process began again and roles continued to switch every 3 minutes. After four rounds, the process was ended and the chairs moved into a circle to allow for reflection on the experience as a whole group.This approach allows us to offer guidance to the students in the form of questions without intruding as facilitators. The questions we developed are ordered in ascending emotional difficulty, and students are repeatedly instructed not to change the order of the questions. Various educational options can be developed from this exercise, such as how to deal with emotions and understanding the relationship between patients' and physicians' emotions.The questions provided to participants were:1. How many patients do you estimate you saw last week/month/ year? What experiences do you have with patients' emotions?3. Which emotions do you interpret as being the strongest in patients? 4. Of the patients' emotions, which are the easiest for you to deal with? 5. Of the patients' emotions, which are the most difficult for you to deal with? 6. Which emotions in patients have you been surprised to see? | WHAT LE SSON S WERE LE ARNED?To date, four cohorts have taken part in the Emotional Speed-Dating sessions. From these students, we have learned that dialogue fostered by the questions enables the group to learn from each other and to normalise shared difficulties in dealing with emotions. Further, we learned that medical students are more than willing to open up regarding their emotional experiences in the clinic, if guided properly. Students felt empowered to share their emotions and to learn how to handle more difficult emotions, like frustration and helplessness. Following these successful first cohorts, we plan to make the resilience training mandatory for all students and to further validate the training with the Connor-Davidson Resilience Scale. O RCI D Jan Kiesewetterhttps://orcid.org/0000-0001-8165-402X R E FE R E N C E1. Howe A, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training. Med Educ.
Reflecting on the competition that can exist between interprofessional and intraprofessional goals, Lameez offers comment on Ganotice et al.'s exploration of motivation's role.
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