Nursing students' readiness towards the 'new normal' in clinical practice: a distributed cognition qualitative perspective.

BACKGROUND: Clinical practicums are a core component of baccalaureate nursing education. Following the coronavirus pandemic, there have been extensive changes in the workforce environment that may potentially affect nursing students' experience and readiness for clinical practicums. METHODS: A qualitative study was conducted to explore final-year nursing students' experiences and readiness for their final clinical practicum before becoming a registered nurse. A purposive sample of 24 final-year baccalaureate nursing students was included in this study. Individual semi-structured interviews were conducted face-to-face via Zoom. The data was analysed using an inductive thematic analysis approach. RESULTS: Three themes depicting students' experiences and clinical readiness were elucidated. The themes included: (1) Experiencing multiple concerns, (2) requiring a network of support, and (3) easing the transition to professional practice. Students considered the final clinical practicum as challenging and demanding which evoked numerous concerns. CONCLUSIONS: Considering the stress that final-year nursing students experience, it will be important to devise strategies ranging from personal, relational, and environmental protective factors to enable their successful transition and completion of clinical practice.

Assessment of the microbial electrochemical sensor (SENTRY™) as a potential wastewater quality monitoring tool for common pollutants found in Malaysia.

Bioelectrochemical sensors for environment monitoring have the potential to provide facility operators with real-time data, allowing for better and more timely decision-making regarding water and wastewater treatment. To assess the robustness and sensitivity of the Sentry™ biosensor in local conditions, it was tested in Malaysia using domestically available wastewater. The study objectives included (1) enrich the biosensor locally, (2) operate and test the biosensor with local domestic wastewater, and (3) determine the biosensor's responsiveness to model pollutants through pollutant spike and immersion test as well as response to absence of wastewater. Lab-scale operation shows the biosensor was successfully enriched with (1) local University Kebangsaan Malaysia's, microbial community strain collection and (2) local municipal wastewater microflora, operated for more than 50 days with a stable yet responsive carbon consumption rate (CCR) signal. Meanwhile, two independent biosensors were also enriched and operated in Indah Water Research Centre's crude sewage holding tank, showing a stable response to the wastewater. Next, a pilot scale setup was constructed to test the enriched biosensors for the spiked-pollutant test. The biosensors showed a proportional CCR response (pollutant presence detected) towards several organic compounds in the sewage, including ethanol, chicken blood, and dilution of tested sewage but less to curry powder, methanol, and isopropanol. Conversely, there was no significant response (pollutant presence not detected) towards hexane, Congo red, engine oil, and paint, which may be due to their non-biodegradability and/or insoluble nature. Additionally, the biosensors were exposed to air for 6 h to assess their robustness towards aerobic shock with a positive result. Overall, the study suggested that the biosensor could be a powerful monitoring tool, given its responsiveness towards organic compounds in sewage under normal conditions.

Singapore's Total Diet Study (2021-2023): Study Design, Methodology, and Relevance to Ensuring Food Safety.

A total diet study is often used to evaluate a population's baseline dietary exposure to chemical hazards from across the diet. In 2021-2023, Singapore carried out a TDS, and this article presents an overview of the study design and methodological selections in Singapore's TDS, as well as its relevance to ensuring food safety. A food consumption survey was conducted on Singapore citizens and permanent residents, where food consumption patterns of the Singapore population were identified. The selection of chemical hazards and foods for inclusion in Singapore's TDS, as well as principal considerations on sampling, food preparation, and analytical testing are discussed. Commonly consumed foods by the Singapore population in food categories such as grain and grain-based products, meat and meat products, fish and seafood, vegetables, fruits, milk and dairy products were included in this study, and mean concentrations of chemicals tested in each food category were reported, with food categories possessing higher levels identified. Future work will include dietary exposure assessments for the population and analysis of the contributions by food and cooking method.

Trait emotional intelligence as a predictor of resilience among undergraduate nursing students: A structural equation modelling approach.

BACKGROUND: There is a growing interest in understanding the role of trait emotional intelligence and resilience. However, few studies have examined the relationships between the various factors of trait emotional intelligence and resilience. OBJECTIVE: To examine the factors of trait emotional intelligence and resilience using a structure equation modelling approach. DESIGN: A quantitative exploratory design using structural equation modelling approach. SETTING: One university in Singapore. PARTICIPANTS: A total of 300 undergraduate nursing students were included in this study. METHOD: A quantitative exploratory study using the structural equation modelling technique was conducted. The Trait Emotional Intelligence Questionnaire and Brief Resilience Scale were used to examine the relationships between trait emotional intelligence and resilience. The data analyses were conducted using SPSS and AMOS software. RESULTS: The structural equation model found relationships between the various factors of trait emotional intelligence. There were associations between self-control, sociability, and emotionality scores with well-being scores. In addition, there is a relationship between emotionality and well-being scores on resilience scores. CONCLUSIONS: The findings from this study illustrate the complex relationships between the various factors of trait emotional intelligence, and specifically how these factors are related to each other and resilience. The findings of this study propose that emotional intelligence are associated with one's resilience. For this reason, these findings will be important in the development of future resilience programs.

Evaluating the online Resilience Skills Enhancement programme among undergraduate students: A double-blind parallel randomized controlled trial.

Resilience training has beneficial effects on the ability of undergraduate students to withstand adversity and stress. However, there are inconsistencies in the content and delivery approaches for resilience training. Given the increasing shifts towards computer-assisted instruction, there is a need to develop and evaluate innovative approaches for resilience training. This study aimed to examine the efficacy of two versions of the Resilience Skills Enhancement (RISE) programme. A randomized controlled trial was used to evaluate the effects of blended learning (BL) and a self-guided RISE programme on the resilience, social support, and learning outcomes of undergraduate students. One hundred and fourteen students were recruited and randomly allocated to receive either BL or the self-guided RISE programme. The within-group analyses indicated significant improvements in resilience scores for the BL (F = 37.74, p < 0.001) and self-guided groups (F = 10.16, p < 0.001) with moderate (d = 0.62, 95% CI: 0.25, 1.00) to large effect sizes (d = 1.11, 95% CI: 0.71, 1.50) respectively. There were also significant differences across the three time points for social support scores for the BL (F = 4.50, p < 0.05) and self-guided groups (F = 4.59, p < 0.05). Students in the BL group had considerable improvements in self-efficacy of learning and performance (F = 5.42, p < 0.01) and meta-cognitive self-regulation scores (F = 5.91, p < 0.01). In the between-group analyses, both BL and self-guided RISE were comparable for resilience, social support, and learning scores (p > 0.05). The study provided preliminary evidence that both modes, BL and self-guided RISE programme lead to positive effects on the resilience, social support, and learning scores of students.

Unpacking the Experiences of Health Care Professionals About the Web-Based Building Resilience At Work Program During the COVID-19 Pandemic: Framework Analysis.

BACKGROUND: The COVID-19 pandemic has resulted in a greater workload in the health care system. Therefore, health care professionals (HCPs) continue to experience high levels of stress, resulting in mental health disorders. From a preventive perspective, building resilience has been associated with reduced stress and mental health disorders and promotes HCPs' intent to stay. Despite the benefits of resilience training, few studies provided an in-depth understanding of the contextual factors, implementation, and mechanisms of impact that influences the sustainability of resilience programs. Therefore, examining target users' experiences of the resilience program is important. This will provide meaningful information to refine and improve future resilience programs. OBJECTIVE: This qualitative study aims to explore HCPs' experiences of participating in the web-based Building Resilience At Work (BRAW) program. In particular, this study aims to explore the contextual and implementational factors that would influence participants' interaction and outcome from the program. METHODS: A descriptive qualitative approach using individual semistructured Zoom interviews was conducted with participants of the web-based resilience program. A framework analysis was conducted, and it is guided by the process evaluation framework. RESULTS: A total of 33 HCPs participated in this qualitative study. Three themes depicting participants' experiences, interactions, and impacts from the BRAW program were elucidated from the framework analysis: learning from web-based tools, interacting with the BRAW program, and promoting participants' workforce readiness. CONCLUSIONS: Findings show that a web-based asynchronous and self-paced resilience program is an acceptable and feasible approach for HCPs. The program also led to encouraging findings on participants' resilience, intent to stay, and employability. However, continued refinements in the components of the web-based resilience program should be carried out to ensure the sustainability of this intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05130879; https://clinicaltrials.gov/ct2/show/NCT05130879.

Real-time Tracking of Handheld Object from Color or Depth Images.

Object tracking during rehabilitation could help a therapist to evaluate a patient's movement and progress. Hence, we present an image-based method for real-time tracking of handheld objects due to its ease of use and availability of color or depth cameras. We use an efficient projective point correspondence method and generalize the use of precomputed spare viewpoint information to allow real-time tracking of a rigid object. The method runs at more than 30 fps on a CPU while achieving submillimeter accuracy on synthetic datasets and robust tracking on a semi-synthetic dataset.Clinical relevance Real-time, accurate, and robust tracking of an object using an image-based method is a promising tool for rehabilitation applications as it is practical for clinical settings.

Wireless Pressure Sensor Array Module for Sensorized Object.

To complement rehabilitation assessments that involve hand-object interaction with additional information on the grasping parameters, we sensorized an object with a pressure sensor array module that can generate a pressure distribution map. The module can be customized for cylindrical and cuboid objects with up to 1024 sensing elements and it supports the efficient transfer of data wirelessly at more than 30 Hz. Although the module uses inexpensive materials, it is sensitive to changes in pressure distribution. It can also depict the shape of various objects with reasonable details as shown in the small errors for object pose estimation and high accuracy scores for hand grasp classification. The module's modular design and wireless functionality help to simplify integration with existing objects to create a smart sensing surface.Clinical relevance The resulting pressure distribution map allows the therapist to analyze grasping parameters that cannot be determined from visual observations alone.

Unveiling the potential role of natriuretic peptide receptor a isoforms in fine-tuning the cGMP production and tissue-specific function.

Atrial natriuretic peptide (ANP) is a peptide hormone that regulates blood pressure and volume. ANP interacts with natriuretic peptide receptor-A (NPR-A) to lower the blood pressure through vasodilation, diuresis and natriuresis. Previously, we designed two human ANP analogues, one with exclusively diuretic function (DGD-ANP) and the other with exclusively vasodilatory function (DRD-ANP). Although both ANP analogues interact with NPR-A, their ability to produce cGMP was different. Three alternatively spliced isoforms of NPR-A were previously identified in rodents. Here, we evaluated the putative human isoforms for their cGMP production independently and in combination with WT NPR-A in various percentages. All three NPR-A isoforms failed to produce cGMP in the presence of ANP, DGD-ANP, or DRD-ANP. Co-expression of isoforms with WT NPR-A were found to significantly impair cGMP production. Considering the differential tissue expression levels of all three spliced isoforms in rodents have previously been demonstrated, the existence of these non-functional receptor isoforms may act as negative regulator for ANP/NPR-A activation and fine-tune cGMP production by WT NPR-A to different degree in different tissues. Thus, NPR-A isoforms potentially contribute to tissue-specific functions of ANP.

Creation and Evaluation of Human Models with Varied Walking Ability from Motion Capture for Assistive Device Development.

As the world ages, rehabilitation and assistive devices will play a key role in improving mobility. However, designing controllers for these devices presents several challenges, from varying degrees of impairment to unique adaptation strategies of users. To use computer simulation to address these challenges, simulating human motions is required. Recently, deep reinforcement learning (DRL) has been successfully applied to generate walking motions whose goal is to produce a stable human walking policy. However, from a rehabilitation perspective, it is more important to match the walking policy's ability to that of an impaired person with reduced ability. In this paper, we present the first attempt to investigate the correlation between DRL training parameters with the ability of the generated human walking policy to recover from perturbation. We show that the control policies can produce gait patterns resembling those of humans without perturbation and that varying perturbation parameters during training can create variation in the recovery ability of the human model. We also demonstrate that the control policy can produce similar behaviours when subjected to forces that users may experience while using a balance assistive device.

Adaptive Gravity Compensation Framework Based on Human Upper Limb Model for Assistive Robotic Arm Extender.

The Assistive Robotic Arm Extender (ARAE) is an upper limb assistive and rehabilitation robot that belongs to the end-effector type, enabling it to assist patients with upper limb movement disorders in three-dimensional space. However, the problem of gravity compensation for the human upper limb with this type of robot is crucial, which directly affects the deployment of the robot in the assistive or rehabilitation field. This paper presents an adaptive gravity compensation framework that calculates the compensated force based on the estimated human posture in 3D space. First, we estimated the human arm joint angles in real-time without any wearable sensors, such as inertial measurement unit (IMU) or magnetic sensors, only through the kinematic data of the robot and established human model. The performance of the estimation method was evaluated through a motion capture system, which validated the accuracy of joint angle estimation. Second, the estimated human joint angles were input to the rigid link model to demonstrate the support force profile generated by the robot. The force profile showed that the support force provided by the developed ARAE robot could adaptively change with human arm postures in 3D space. The adaptive gravity compensation framework can improve the usability and feasibility of the 3D end-effector rehabilitation or assistive robot.

Effectiveness of resilience interventions among cancer patients - A systematic review, meta-analysis, and meta-regression of randomised controlled trials.

PURPOSE: This systematic review, meta-analysis and meta-regression aimed to (1) evaluate the effects of resilience interventions on cancer patients' resilience and posttraumatic growth and (2) identify essential contents and features of resilience interventions. METHODS: A systematic review, meta-analysis, and meta-regression analyses were conducted. Published and unpublished randomised controlled trials evaluating the effects of resilience interventions among cancer patients were retrieved from nine databases, trial registries, and grey literature. The mean and standard deviation scores were used to compute the effect sizes. RESULTS: 23 randomised controlled trials comprising 3287 cancer patients were included. The random effects model found that resilience interventions had beneficial impacts on patients' resilience, posttraumatic growth, quality of life, anxiety, and depressive symptoms with moderate to large effects. The subgroup analyses concluded that theoretically guided interventions that adopted synchronous communication delivered physically had greater effect sizes. Interventions comprising skills that promote patients' cognitive flexibility, self-efficacy, self-esteem, self-regulation, and coping had greater effect in comparison with interventions lacking these components. The meta-regression analyses revealed that sample size has a significant effect on posttraumatic growth scores. More well-designed trials are needed to confirm the effects of resilience interventions. CONCLUSIONS: There is merit in utilizing resilience interventions to improve cancer patients' resilience and psychological well-being. Resilience interventions should be incorporated into the routine care for cancer patients and survivors.

A hybrid systematic narrative review of instruments measuring home-based care nurses' competency.

AIM: The aim of the study was to identify and synthesize the contents and the psychometric properties of the existing instruments measuring home-based care (HBC) nurses' competencies. DESIGN: A hybrid systematic narrative review was performed. REVIEW METHODS: The eligible studies were reviewed to identify the competencies measured by the instruments for HBC nurses. The psychometric properties of instruments in development and psychometric testing design studies were also examined. The methodological quality of the studies was evaluated using the Medical Education Research Study Quality Instrument and COSMIN checklist accordingly. DATA SOURCES: Relevant studies were searched on CINAHL, MEDLINE (via PubMed), EMBASE, PsychINFO and Scopus from 2000 to 2022. The search was limited to full-text items in the English language. RESULTS: A total of 23 studies reporting 24 instruments were included. 12 instruments were adopted or modified by the studies while the other 12 were developed and psychometrically tested by the studies. None of the instruments encompassed all of the 10 home-based nursing care competencies identified in an earlier study. The two most frequently measured competencies were the management of health conditions, and critical thinking and problem-solving skills, while the two least measured competencies were quality and safety, and technological literacy. The content and structural validity of most instruments were inadequate since the adopted instruments were not initially designed or tested among HBC nurses. CONCLUSION: This review provides a consolidation of existing instruments that were used to assess HBC nurses' competencies. The instruments were generally not comprehensive, and the content and structural validity were limited. Nonetheless, the domains, items and approaches to instrument development could be adopted to develop and test a comprehensive competency instrument for home-based nursing care practice in the future. IMPACT: This review consolidated instruments used to measure home-based care nurses' competency. The instruments were often designed for ward-based care nurses hence a comprehensive and validated home-based nursing care competency instrument is needed. Nurses, researchers and nursing leaders could consider the competency instruments identified in this review to measure nurses' competencies, while a home-based nursing care competency scale is being developed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was required in this review.

Rapid Surface Modification of Stainless Steel 304L Electrodes for Microbial Electrochemical Sensor Application.

Electrogenic microorganisms serve as important biocatalysts for microbial electrochemical sensors (MESes). The electrical signal produced is based on the rate of electron transfer between the microbes and electrodes, which represents the biotoxicity of water. However, existing MESes require complex and sophisticated fabrication methods. Here, several low-cost and rapid surface modification strategies (carbon powder-coated, flame-oxidized, and acid-bleached) have been demonstrated and studied for biosensing purposes. Surface-modified MESe bioanodes were successfully applied to detect multiple model pollutants including sodium acetate, ethanol, thinner, and palm oil mill effluent under three different testing sequences, namely, pollutant incremental, pollutant dumping, and water dilution tests. The carbon powder-coated bioanode showed the most responsive signal profile for all the three tests, which is in line with the average roughness values (Ra) when tested with atomic force microscopy. The carbon powder-coated electrode possessed a Ra value of 0.844, while flame-oxidized, acid-bleached, and control samples recorded 0.323, 0.336, and 0.264, respectively. The higher roughness was caused by the carbon coating and provided adhesive sites for microbial attachment and growth. The accuracy of MESe was also verified by correlating with chemical oxygen demand (COD) results. Similar to the sensitivity test, the carbon powder-coated bioanode obtained the highest R2 value of 0.9754 when correlated with COD results, indicating a high potential of replacing conventional water quality analysis methods. The reported work is of great significance to showcase facile surface modification techniques for MESes, which are cost-effective and sustainable while retaining the biocompatibility toward the microbial community with carbon-based coatings.

Safety-Based Speed Control of a Wheelchair Using Robust Adaptive Model Predictive Control.

Electric-powered wheelchairs play a vital role in ensuring accessibility for individuals with mobility impairments. The design of controllers for tracking tasks must prioritize the safety of wheelchair operation across various scenarios and for a diverse range of users. In this study, we propose a safety-oriented speed tracking control algorithm for wheelchair systems that accounts for external disturbances and uncertain parameters at the dynamic level. We employ a set-membership approach to estimate uncertain parameters online in deterministic sets. Additionally, we present a model predictive control scheme with real-time adaptation of the system model and controller parameters to ensure safety-related constraint satisfaction during the tracking process. This proposed controller effectively guides the wheelchair speed toward the desired reference while maintaining safety constraints. In cases where the reference is inadmissible and violates constraints, the controller can navigate the system to the vicinity of the nearest admissible reference. The efficiency of the proposed control scheme is demonstrated through high-fidelity speed tracking results from two tasks involving both admissible and inadmissible references.

Occurrence and Dietary Exposure to Acrylamide from Foods Consumed within and outside Main Meals in Singapore.

This study investigated the influence of 'snackification' in Singaporean diets, leading to increased dietary acrylamide exposure. Acrylamide concentrations in commonly consumed foods within and outside the main meals were measured using liquid chromatography with tandem mass spectrometry (LC-MS/MS). High acrylamide concentrations were detected in vegetables cooked at high temperatures (ranging from 0.5 to 478.4 µg/kg) and potato-based crackers and chips (ranging from 81.8 to 2095.8 µg/kg). The estimated total dietary exposure for the Singapore population was 0.165 µg/kg bw/day for general consumers and 0.392 µg/kg bw/day for high consumers (95th percentile). The acrylamide exposure from outside main meals was nearly equivalent to that from within the main meals. The calculated margins of exposure (MOE) were below 10,000, indicating potential human health concern. These findings highlight the need for industry practices and consumer advisories to reduce acrylamide exposure from foods consumed both within and outside main meals.

A Keystone Gut Bacterium Christensenella minuta-A Potential Biotherapeutic Agent for Obesity and Associated Metabolic Diseases.

A new next-generation probiotic, Christensenella minuta was first discovered in 2012 from healthy human stool and described under the phylum Firmicutes. C. minuta is a subdominant commensal bacterium with highly heritable properties that exhibits mutual interactions with other heritable microbiomes, and its relative abundance is positively correlated with the lean host phenotype associated with a low BMI index. It has been the subject of numerous studies, owing to its potential health benefits. This article reviews the evidence from various studies of C. minuta interventions using animal models for managing metabolic diseases, such as obesity, inflammatory bowel disease, and type 2 diabetes, characterized by gut microbiota dysbiosis and disruption of host metabolism. Notably, more studies have presented the complex interaction between C. minuta and host metabolism when it comes to metabolic health. Therefore, C. minuta could be a potential candidate for innovative microbiome-based biotherapy via fecal microbiota transplantation or oral administration. However, the detailed underlying mechanism of action requires further investigation.

Effects of Plant-Based Diets on Anthropometric and Cardiometabolic Markers in Adults: An Umbrella Review.

We conducted an umbrella review to consolidate the evidence of adopting plant-based diets on anthropometric and cardiometabolic outcomes. Six electronic databases (CINAHL, EMBASE, PubMed, Scopus, the Cochrane Library, and Web of Science) were searched for systematic reviews with meta-analysis (SRMAs) published from each journal's inception until 1 October 2022. Effect sizes from SRMAs and primary studies were pooled separately using random effects models. Overlapping primary studies were removed for primary studies' analyses. Seven SRMAs representing 51 primary studies were included, suggesting significant benefits of plant-based diets on weight (-2.09 kg, 95% CI: -3.56, -0.62 kg, p = 0.01, I2 = 95.6%), body mass index (-0.95 kg/m2, 95% CI: -1.26, -0.63 kg/m2, p = 0.002; I2 = 45.1%), waist circumference (-2.20 cm, 95% CI: -0.08, 0.00 cm, p = 0.04; I2 = 88.4%), fasting blood glucose (-0.11 mmol/L, 95% CI: -0.13, -0.09 mmol/L, p < 0.001, I2 = 18.2%), and low-density lipoprotein cholesterol (-0.31 mmol/L, 95% CI: -0.41, -0.20 mmol/L, p < 0.001, I2 = 65.6%). Changes in high-density lipoprotein cholesterol, triglycerides, and blood pressure were not statistically significant. Generally, plant-based diets were recommended to improve anthropometry, lipid profile, and glucose metabolism. However, findings should be interpreted with caution, because most of the reviews were rated to be of low credibility of evidence and were largely based on Western eating habits and traditions, which may limit the generalizability of findings.

Inequalities in Consumption Expenditure on Pharmaceuticals: Evidence from Malaysia.

Pharmaceuticals play an important role in health improvements. This study is the first of its kind to examine the influences of household heads' sociodemographic characteristics and household profiles on pharmaceuticals expenditure among households of different income levels. The country of interest is a fast-growing developing country. Data from the Malaysian Household Expenditure Surveys 2014 and 2016 were used in the pooled cross-sectional analyses. Double-hurdle models were used to analyze consumption and amount decisions of pharmaceuticals. Analyses stratified by income were conducted. Results showed that households headed by younger adults (<60 years), males, less educated individuals, Bumiputera, and divorced/widowed adults were less likely to consume and spent less on pharmaceuticals compared with households headed by older adults (≥60 years), females, more educated individuals, non-Bumiputera, and single adults. These differentials varied across income groups. In conclusion, household heads' age, gender, educational levels, ethnicity, marital status, and household profiles are important determining factors of expenditure on pharmaceuticals among low-, middle- and high-income households.