Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review.

BACKGROUND: The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored. OBJECTIVE: To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education. DESIGN: Systematic review. REVIEW METHODS: A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT). RESULTS: A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified. CONCLUSIONS: While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

The affordances of clinical simulation immersive technology within healthcare education: a scoping review.

Whilst clinical simulation is established as an effective education tool within the healthcare community, the inability to offer authentic educational learning environments remains problematic. Advances in technology such as immersive virtual reality offer new opportunities to enhance traditional practice to an extent that may transform learning. However, with traditional clinical simulation stress and anxiety can both hinder performance and learning, yet it is unknown what nuances are applicable within a clinical virtual simulation environment. Determining potential benefits, drawbacks (including related stress and anxiety) and affordances of immersive technology clinical simulation designs may help provide an understanding of its usefulness. The aim of this scoping review is to investigate the range and nature of evidence associated with immersive virtual reality clinical simulation and education design. In addition, the review will describe authentic immersive technology clinical simulation use and reported stress response measurements. A search of seven electronic database and grey literature was performed in accordance with the Joanna Briggs Institute methodology. A key term search strategy was employed with five themes identified and investigated: (1) Healthcare professionals, (2) Clinical simulation, (3) Immersive virtual reality, (4) Stress/anxiety and (5) Authentic learning design. Application of the search strategy resulted in a hit total of 212 articles. Twelve articles met inclusion criteria. With most literature focusing on procedural performance and non-transferable education needs, there was a paucity of research that specifically investigated immersive virtual reality clinical simulation education and related stress. Therefore, this scoping review contributes new understandings by providing valuable insight and potential research gaps into current immersive virtual reality clinical simulation, its relationship to stress and the education design models currently being utilised to develop these concepts.

Influences of zinc loads in urban catchment runoff: Roof type, land use type, climate and management strategies.

The contribution of ecotoxic dissolved metals from metallic roofs into urban waterways is a global issue. Identifying the specific origin of dissolved metals is critical to enabling appropriate stormwater management approaches that can provide the intended outcome of cleaner urban waterways. An event load pollutant model, Modelled Estimates of Discharges for Urban Stormwater Assessments (MEDUSA2.0), was used to predict the zinc load contributed from individual roof surfaces, under a wide range of rainfall conditions. Zinc was chosen as the pollutant of most concern given the extensive area of zinc-based roof surfaces, and the prevalence and mobility of zinc within urban waterways. The model categorized each roof by surface material and condition, and was run for individual rain events across multiple years to illustrate the influences on zinc loads from both surface type and rainfall conditions. Scenarios of future management were also assessed through the model to compare their benefits in terms of load reductions against the current baseline loadings. To understand how the load prediction and scenario modelling can provide valuable guidance for stormwater management decision-makers, the model was applied to a large urban catchment in Christchurch, New Zealand. Seven representative subcatchments of the varying proportions of industrial, commercial and residential land use type were also modelled to compare zinc loads generated. Results showed that an individual catchment's composition of roof types was the main driver of zinc load generation rather than the catchment's land use type. The modelled management scenarios demonstrated that reductions of 30% zinc could be achieved by changing only 4-13% of a subcatchment's unpainted zinc-based roof surfaces.

Using educational design research to develop authentic learning for graduate entry nursing students in New Zealand.

This paper describes using an educational design-based methodology to evaluate authentic learning environments for Graduate Entry Nursing (GEN) students. While developing this new GEN programme in New Zealand, two specific challenges arose: how to design and deliver a condensed and intensive programme that met healthcare sector requirements, while ensuring the content met the needs of the typical GEN student. To meet these challenges the authors used educational design research (EDR) as a reflective and iterative approach to develop and adapt the teaching and learning strategies, content, and delivery. EDR involves four phases: exploration and analysis of the issues, design of a prototype intervention, reflection and evaluation, followed by iterative redesign and re-evaluation; this paper reports on Phase 1 and Phase 2. It is envisaged this paper will provide timely insights for those in the process of developing or refining graduate entry programmes in Australasia.

The influence of urban surface type and characteristics on runoff water quality.

Untreated runoff was collected over multiple rain events from 19 impermeable urban surfaces, including nine roofs, six roads and four carparks, to quantify the differences in water quality due to surface type, age, condition and location. All 19 sites were exposed to the same climatic conditions. Samples were analysed for key urban pollutants of concern, namely total suspended solids and total and dissolved copper and zinc. Results showed uncoated zinc-based roofs produced zinc concentrations (up to 55 mg/L) several orders of magnitude higher than receiving environment water quality guidelines in New Zealand, of which the vast majority was in dissolved form. Even non-metallic roofs with zinc-based guttering produced zinc concentrations over ten times higher than the same roof material without zinc-based guttering. Older zinc-based roofs had approximately five times higher zinc concentrations, demonstrating a substantial age effect on the untreated runoff quality. Similarly, copper roofs produced more than an order of magnitude higher copper concentrations (up to 7.8 mg/L) above the next highest copper-producing surfaces: higher trafficked roads and carparks. Regardless of traffic volume or function, all roads and carparks produced high TSS concentrations. Dissolved metal concentrations were high across the dataset confirming that metal partitioning is an important consideration for effective pollutant control as different removal processes need to be used for dissolved versus particulate metals. This dataset provides an important benchmark of untreated runoff quality across different impermeable surface types within the same geographical area and clearly shows the influence of surface characteristics on water quality runoff regardless of the local differences in land use. These findings provide valuable guidance to stormwater managers in identifying priority surfaces and selection of appropriate treatment strategies for effective stormwater management for total suspended solids, zinc and copper.

Long-term safety and tolerability of bimagrumab (BYM338) in sporadic inclusion body myositis.

OBJECTIVE: To assess the long-term safety and tolerability and to monitor benefits of extended use of bimagrumab in individuals with sporadic inclusion body myositis (sIBM) who completed a single-dose core study. METHODS: In this multicenter, open-label extension study, 10 adults received bimagrumab 10 mg/kg IV every 4 weeks up to 2 years (104 weeks). Safety (primary endpoint) was assessed by recording adverse events (AEs). Clinical benefits were assessed by changes from baseline in thigh muscle volume (TMV), lean body mass (LBM), 6-minute walk distance (6MWD), handgrip, and quadriceps strength. RESULTS: Participants had a mean age of 70.1 (SD 10.4) years. All participants (n = 10) discontinued the treatment due to early termination of the study (n = 7) or AEs (n = 3; myocardial infarction, esophageal carcinoma, and dementia, none of which were treatment related). The most common AEs were muscle spasms and falls (both 9 of 10, 90%), followed by diarrhea (6 of 10, 60%) and acne and skin eruption (both 5 of 10, 50%). At weeks 8 and 16, mean TMV increased from baseline by 4.1% (SD 4.3%) and 4.5% (SD 6.3%). Mean LBM increased from baseline and was sustained at 6.9% (SD 3.9%) at week 76. Means of 6MWD showed a progressive decline from baseline to week 76, during which there was a modest numerical increase in handgrip strength and no significant changes in quadriceps strength. CONCLUSIONS: Long-term treatment up to 2 years with bimagrumab had a good safety profile and was well tolerated in individuals with sIBM. An increase in muscle mass was noted on a group level; however, there was no evidence of clinical improvement. CLINICALTRIALSGOV IDENTIFIER: NCT02250443. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with sIBM, long-term bimagrumab treatment was safe and well tolerated and did not lead to functional improvement.

Comparison of three types of laser optical disdrometers under natural rainfall conditions.

Optical disdrometers can be used to estimate rainfall erosivity; however, the relative accuracy of different disdrometers is unclear. This study compared three types of optical laser-based disdrometers to quantify differences in measured rainfall characteristics and to develop correction factors for kinetic energy (KE). Two identical PWS100 (Campbell Scientific), one Laser Precipitation Monitor (Thies Clima) and a first-generation Parsivel (OTT) were collocated with a weighing rain gauge (OTT Pluvio2) at a site in Austria. All disdrometers underestimated total rainfall compared to the rain gauge with relative biases from 2% to 29%. Differences in drop size distribution and velocity resulted in different KE estimates. By applying a linear regression to the KE-intensity relationship of each disdrometer, a correction factor for KE between the disdrometers was developed. This factor ranged from 1.15 to 1.36 and allowed comparison of KE between different disdrometer types despite differences in measured drop size and velocity.

Associations of built environment and proximity of food outlets with weight status: Analysis from 14 cities in 10 countries.

The study aimed to examine associations of neighborhood built environments and proximity of food outlets (BE measures) with body weight status using pooled data from an international study (IPEN Adult). Objective BE measures were calculated using geographic information systems for 10,008 participants (4463 male, 45%) aged 16-66 years in 14 cities. Participants self-reported proximity to three types of food outlets. Outcomes were body mass index (BMI) and overweight/obesity status. Male and female weight status associations with BE measures were estimated by generalized additive mixed models. Proportion (95% CI) of overweight (BMI 25 to <30) ranged from 16.6% (13.1, 19.8) to 41.1% (37.3, 44.7), and obesity (BMI ≥ 30) from 2.9% (1.3, 4.4) to 31.3% (27.7, 34.7), with Hong Kong being the lowest and Cuernavaca, Mexico highest for both proportions. Results differed by sex. Greater street intersection density, public transport density and perceived proximity to restaurants (males) were associated with lower odds of overweight/obesity (BMI ≥ 25). Proximity to public transport stops (females) was associated with higher odds of overweight/obesity. Composite BE measures were more strongly related to BMI and overweight/obesity status than single variables among men but not women. One standard deviation improvement in the composite measures of BE was associated with small reductions of 0.1-0.5% in BMI but meaningful reductions of 2.5-5.3% in the odds of overweight/obesity. Effects were linear and generalizable across cities. Neighborhoods designed to support public transport, with food outlets within walking distance, may contribute to global obesity control.

Changing sediment budget of the Mekong: Cumulative threats and management strategies for a large river basin.

Two decades after the construction of the first major dam, the Mekong basin and its six riparian countries have seen rapid economic growth and development of the river system. Hydropower dams, aggregate mines, flood-control dykes, and groundwater-irrigated agriculture have all provided short-term economic benefits throughout the basin. However, it is becoming evident that anthropic changes are significantly affecting the natural functioning of the river and its floodplains. We now ask if these changes are risking major adverse impacts for the 70 million people living in the Mekong Basin. Many livelihoods in the basin depend on ecosystem services that will be strongly impacted by alterations of the sediment transport processes that drive river and delta morpho-dynamics, which underpin a sustainable future for the Mekong basin and Delta. Drawing upon ongoing and recently published research, we provide an overview of key drivers of change (hydropower development, sand mining, dyking and water infrastructures, climate change, and accelerated subsidence from pumping) for the Mekong's sediment budget, and their likely individual and cumulative impacts on the river system. Our results quantify the degree to which the Mekong delta, which receives the impacts from the entire connected river basin, is increasingly vulnerable in the face of declining sediment loads, rising seas and subsiding land. Without concerted action, it is likely that nearly half of the Delta's land surface will be below sea level by 2100, with the remaining areas impacted by salinization and frequent flooding. The threat to the Delta can be understood only in the context of processes in the entire river basin. The Mekong River case can serve to raise awareness of how the connected functions of river systems in general depend on undisturbed sediment transport, thereby informing planning for other large river basins currently embarking on rapid economic development.

Ethical Issues in the Neurology of Pregnancy.

Decision making for pregnant women and fetuses who suffer brain injuries is emotionally difficult and conceptually challenging. Occasionally, both the pregnant woman and the fetus have suffered an injury that confers a poor neurological prognosis, and decisions about one of them will have implications for the other-making the process of decision making even more problematic. In this article, decision-making standards and principles are reviewed for both pregnant women and fetuses, using a real case from the author's institution. Practical suggestions are made regarding deliberative processes and consultative models that can help with these difficult cases.

Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.

BACKGROUND: There are numerous studies that show an increased incidence of cardiovascular disease with increasing levels of socio-economic disadvantage. Exposures that might influence the relationship include elements of the built environment and social systems that shape lifestyle risk behaviors. In Canberra (the Australian capital city) there has been a particular housing policy to create 'mixed-tenure' neighborhoods so that small pockets of disadvantage are surrounded by more affluent residences (known as a 'salt-and-pepper' pattern). This may contribute to a scatter of higher incidence rates in very small areas in this population that may be obscured if aggregated data are used. This study explored the effect of changing the scale of the spatial units used in small area disease modelling, aiming to understand the impact of this issue and the implications for local public health surveillance. METHODS: The residence location of hospitalized individuals were aggregated to two differently scaled area units. First, the Australian Bureau of Statistics Statistical Area 2 (SA2) which is normally used as the basis for deidentification and release of health data. Second, these data were aggregated to a smaller level: the Statistical Area 1 (SA1). Generalized Additive Models with penalized regression splines were used to assess the association of age-sex-standardized rates for cardiovascular disease hospital admissions with disadvantage. RESULTS: The relationships observed were different between the two types of spatial units. The SA1 level exposure-response curve for rates against the disadvantage index extended in a linear fashion above the midrange level, while that found at SA2-level suggested a curvilinear form with no evidence that rates increased with higher disadvantage beyond the midrange. CONCLUSION: Our result supports findings of other work that has found disadvantage increases risk of cardiovascular disease. The shape of the curves suggest a difference in associations of cardiovascular disease rates with disadvantage scores between SA1 versus SA2. From these results it can be concluded that scale of analysis does influence the understanding of geographical patterns of socio-economic disadvantage and cardiovascular disease morbidity. Health surveillance and interventions in Canberra should take into account the impact of the scale of aggregation on the association between disadvantage and cardiovascular disease observed.

Mixed-Methods Evaluation of a Healthy Exercise, Eating, and Lifestyle Program for Primary Schools.

BACKGROUND: Reversing decline in physical fitness and increase in excess body weight in school children are considered major public health challenges. We evaluated a proposed model to integrate a screening and healthy exercise, eating, and lifestyle program (HEELP) into primary schools in Canberra, Australia. Objectives were: (1) to establish body status and physical competencies of 5- to 10-year-old children; (2) to evaluate the service's impact on body status and physical fitness; and (3) to gauge parent/guardian and school perspectives on the service. METHODS: A mixed-methods approach was used over 4 school years, 2010-2013. Primary evaluation used direct quantitative measurement. Confirmatory qualitative methods were implemented in the last 2 years. RESULTS: The service was delivered on 71 occasions involving 25 schools; 7750 children were screened and 709 completed all aspects of the HEELP evaluation. Over 60% of children screened had 2 or more measures that would benefit from remedial intervention. CONCLUSIONS: All body status and physical fitness measures showed small beneficial changes on a population basis immediately after the HEELP. Further benefit did not accrue at 6 months after the program. Semistructured interviews with schools and parent/guardian surveys confirmed some beneficial effects observed by direct quantitative measurement.

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

BACKGROUND: The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. METHODS: Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. RESULTS: Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. CONCLUSIONS: The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Anthropometric standards for Australian primary school children: Towards a system for monitoring and supporting children's development.

OBJECTIVES: To provide two foundation elements of a proposed new system to support children's physical and body status development throughout primary school: (a) age and gender appropriate achievement (anthropometric) standards and (b) a system of monitoring, feedback and support. DESIGN: Repeated cross-sectional sampling involving 91 schools across 5 Australian States and Territories between 2000 and 2011. METHODS: Anthropometric data from 29,928 (14,643 girls, 15,285 boys) Australian children aged between 5 and 12.5 years were used to develop progression standards (norm centiles) covering the primary school years. Measures used were: height, weight, body mass index, per cent body fat, grip strength, standing long jump, cardiorespiratory fitness, sit-ups and sit-and-reach. These norms were then used to develop a Physical Activity and Lifestyle Management (PALM) system that could form the basis for progression, monitoring and reporting of anthropometric achievement standards for children. RESULTS: Tables and representative centile curves (3rd, 15th, 50th, 85th and 97th) for each gender and half-year age group were produced. An illustrative example of the PALM system in operation was also provided. CONCLUSIONS: Our research provides gender and half-year age specific anthropometric standards for Australian primary school children. Furthermore, we have developed a monitoring and progression system that could be embedded in school communities to help address the prevalence of underweight, overweight and obesity and decline in physical fitness standards. The proposed system is designed on behalf of children and families and would be administered through school settings. Change, where needed, would be delivered by the supporting school community.

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state.

OBJECTIVES: To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. DESIGN: A cross-sectional analysis of public hospital episode data (2007-2013). SETTING: Hospitalisations from the ACT, Australia at very small geographic areas. PARTICIPANTS: Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. MAIN EXPOSURE MEASURES: Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. MAIN OUTCOME MEASURES: Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. RESULTS: Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers. CONCLUSIONS: Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.

The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems.

Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability. We advocate the development of a comprehensive ethical and legal framework to address the challenges of emerging closed-loop neurotechnologies like BCIs and stress the centrality of informed consent and refusal as a means to foster accountability. We propose the creation of an international neuroethics task force with members from medical neuroscience, neuroengineering, computer science, medical law, and medical ethics, as well as representatives of patient advocacy groups and the public.

Ethics of Preclinical Dopamine Transporter Imaging.

While dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging is sensitive and specific when performed in patients with signs or symptoms of parkinsonism, its predictive value is uncertain in healthy subjects, even with patients who have first-degree relatives affected by Parkinson disease. In deciding whether to honor a patient's request for a DAT-SPECT, neurologists must balance a patient's autonomy rights with beneficence and nonmaleficence and also consider the distributive justice implications of ordering the test. Generally speaking, the benefits of a DAT-SPECT will be too small to justify its use in an asymptomatic patient concerned about developing Parkinson disease.

Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study.

BACKGROUND: The objective of this study was to investigate the effect of a 4-year specialist-taught Physical Education (PE) program on physical activity (PA) among primary school children. METHODS: A 4-year cluster randomised controlled trial was conducted in children (initially aged 8 years) from 29 primary schools (13 Intervention, 16 Control). Intervention students (N = 457) received 2 × 45 min PE lessons per week from specialist-trained PE teachers (68 lessons per year, 272 lessons over 4 years). Control group students (N = 396) received usual practice PE from generalist classroom teachers. PA during PE lessons was examined using the System for Observing Fitness Instruction Time (SOFIT). Pedometers (steps/day) were worn for 7 days each year, and accelerometers were worn concurrently in the final two years to assess moderate to vigorous (MVPA) and sedentary activity. Linear and generalized mixed models were used to determine differences in Intervention and Control student PA and the proportion of students meeting PA guidelines. RESULTS: The intervention increased SOFIT-observed student MVPA during PE lessons by 6.5 mins (16.7 v 10.2, p < 0.001). Within intervention schools, participants increased their whole-day step counts (boys = 449 [CI,140 to 756]; girls = 424 [CI,222 to 626]) and minutes of MVPA (boys = 8.0 [CI,6.8 to 9.2]; girls = 3.5 [CI,1.7 to 5.4]) on PE days. However, compared to the Control group the Intervention did not: increase habitual steps/day or MVPA when averaged over 7 days; elicit greater improvements in these measures over time; or increase the odds of meeting step/day or MVPA recommendations. At age 11 years Intervention group boys were 20 mins less sedentary per day (380 [CI,369 to 391] vs 360 [CI,350 to 369]) and this effect was sustained at age 12 years. CONCLUSIONS: Well-designed specialist-taught PE can improve student PA during PE lessons. However for PE to be a significant contributor to improving habitual PA in pre-adolescent children, daily classes are likely to be required, and even this would need to be supplemented with a wider multicomponent strategy. Our finding of a reduction in sedentary time among Intervention boys warrants further investigation into the potential role PE could play in influencing sedentary behaviour.