The impact of a three-phase video-assisted debriefing on nursing students' debriefing experiences, perceived stress and facilitators' practices: A mixed methods study.

BACKGROUND: As an integral part of simulation, debriefing helps learners to construct knowledge through reflecting, internalizing, and relating. Video-assisted debriefing (VAD) adds audio-visual captures and reviews to support traditional verbal debriefing (VD), but evidence evaluating its educational effects has been mixed, with limited attention focusing on its structure development. AIMS: This study aimed to 1) investigate the effects of a three-phase VAD in enhancing nursing students' debriefing experiences and perceived stress compared to VD and 2) to explore its impact on facilitators' debriefing practices. METHODS: A mixed-methods design was adopted. The quantitative phase involved a prospective controlled trial on 145 nursing students from a university in Singapore who were randomized into the intervention cluster (n = 72) and the control cluster (n = 73). The debriefing experience scale (DES), the stress visual analogue scale (Stress VAS), and the debriefing assessment for simulation in healthcare (DASH© student version) were used as outcome measures. For the qualitative component, a purposive sample of eight facilitators evaluated their own debriefing practices using the DASH© instructor version and each completed an open-ended question survey. Qualitative data were analyzed using content analysis. RESULTS: Students from the intervention cluster significantly improved their debriefing experiences (p = 0.01), experienced comparable stress, and had better impressions of VAD facilitators' practices (p < 0.001) compared to those in the control cluster. Repeated VAD significantly reduced students' stress (p < 0.001). Students viewed the VAD facilitators as more effective than the VD facilitators. Three categories were derived from the qualitative comments: the act of debriefing, the crux of VAD, and debriefing for success. CONCLUSION: The three-phase VAD significantly improved nursing students' debriefing experiences without adding extra stress. It also helped to improve facilitators' practices. Future research will benefit from exploring how experts facilitate the three-phase VAD "on the ground" and its effect on learning transfer and cost-effectiveness.

Detection and distribution of anti-leptospiral antibody among dogs and their handlers.

The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >=1:100 (dog) and >=1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100-1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50-1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

Detection and distribution of anti-leptospiral antibody among dogs and their handlers

@# The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >1:100 (dog) and >1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100–1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50–1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

Prelicensure nursing students' perspectives on video-assisted debriefing following high fidelity simulation: A qualitative study.

BACKGROUND: Video-assisted debriefing has not attracted sufficient attention on exploring learners' perceptions. A full understanding of learners' attitudes and perceptions towards video-assisted debriefing sets the foundation for effective learning, which should be considered when integrating video-assisted debriefing to the nursing curricula. However, limited evidence on learners' perspectives makes it difficult to fully understand this phenomenon. OBJECTIVES: To explore prelicensure nursing students' experiences and perspectives on video-assisted debriefing following a high-fidelity simulation. DESIGN: An exploratory qualitative approach using focus groups. SETTING: This study was conducted at a local university in Singapore. PARTICIPANTS: A purposive sample of 27 prelicensure nursing students in Singapore were recruited. METHODS: Six focus group interviews were conducted. Thematic analysis was used to analyze the transcribed data. RESULTS: Three themes and eight subthemes were derived from the data analysis. The themes included journey from traditional verbal debriefing to video-assisted debriefing, praise and criticism of video-assisted debriefing, and the road to successful video-assisted debriefing. CONCLUSIONS: Nursing students revealed that video-assisted debriefing not only complemented the drawback of verbal debriefing by offering objective evidence but also improved their attitudes and behaviors through the unique experience of an emotional roller coaster. Learners should be desensitized to the fear of video and their discriminating capabilities should be developed prior to video-assisted debriefing. The findings can serve as a reference when designing and integrating video-assisted debriefing interventions into simulation-based education.

Sub-100 nm patterning of TiO2 film for the regulation of endothelial and smooth muscle cell functions.

Previous studies have shown that fundamental cell functions such as adhesion, proliferation, and morphology are regulated by the interaction of cells with basement membrane nano- and micron- scale surface topography. By taking the basement membrane as a guiding principle, the surface can be designed with biophysical cues in the form of surface topographies to modulate the cellular functions of vascular endothelial and smooth muscle cells, which are crucial for vascular diseases. Titanium-based materials whose surfaces are covered by a thin layer of titanium dioxide (TiO2) are utilized in several regenerative medicine applications such as vascular prosthetics. The utilization of TiO2-covered materials makes it essential to understand the interaction of cells with the TiO2 layer to control the cell response. While it has been shown by means of patterned micro- and nano-topography that it is important to regulate cell functions on non-metallic materials, it would be of interest in the field of regenerative medicine to study the cell response on patterned TiO2 surface layers. Previous studies have mostly focused on studying the cell response on random micro- and nano-roughened metallic and metal oxide surfaces as it is challenging to fabricate patterned TiO2 surface layers. Here, the biocompatibility of a method that is capable of the rational patterning of a continuous TiO2 surface layer of sub-100 nm resolution scale using thermally curable resin-based nanoimprinting was studied. The responses of human umbilical vein endothelial cell (HUVEC), such as proliferation, morphology and focal adhesions, and smooth muscle cell (SMC) proliferation and morphology to the nano-patterned TiO2 layer were investigated. Overall, the TiO2 layer with surface nano-gratings showed enhanced proliferation of HUVECs, while it significantly lowered the proliferation of SMCs as compared to the unpatterned control. The HUVECs and SMCs were shown by topography to be sensitive to the 70 nm gratings as evident by the regulation of proliferation and cell shape. A significantly lower focal adhesion density was found of HUVECs on TiO2 nano-gratings, while a significantly higher average focal adhesion size of HUVECs was seen on TiO2 nano-wells and nano-gratings, compared to the unpatterned controls.

Effectiveness of frequency mapping on 28 nm device broken scan chain failures.

Frequency mapping methodology is an effective diagnostic tool for detection of manufacturing defects in scan chains. It analyses reflected laser modulations from toggling scan cells to localize defective scan path or scan cell. In this paper, we demonstrate experimentally that the use of solid immersion lens technology to enhance signal and spatial resolution is not a prerequisite for this technique up till 28 nm technology node. We present case studies to show the effectiveness of frequency mapping for detecting systematic and random broken scan chain failures on a 28 nm technology node test chip. We achieved 81% success rate in this methodology.

eIF3m expression influences the regulation of tumorigenesis-related genes in human colon cancer.

Abnormal regulation of gene expression is essential for tumorigenesis. Recent studies indicate that regulation of oncogene expression and neoplastic transformation are controlled by subunits of eukaryotic translation initiation factors (eIFs). Here we focused on eIF3 performing a pivotal role in protein synthesis and the differential expression of its subunits in cancer. The most uncharacterized non-core subunit eIF3m was confirmed to be highly expressed in human cancer cell lines and colon cancer patient tissues. By expression silencing with eIF3m-specific small interfering RNA (siRNA), we confirmed that eIF3m influences cell proliferation, cell cycle progression and cell death in human colon cancer cell line HCT-116. Using a ribonomics approach, we identified a subset of elF3m-influenced genes and showed that the expression of two highly represented tumorigenesis-related genes, MIF and MT2, were affected by eIF3m at the mRNA level. We also confirmed eIF3m-dependent regulation of MT2A downstream molecule CDC25A, which is necessary for cell cycle progression in HCT-116 cells. These results suggest that eIF3m mediates regulation of tumorigenesis-related genes in human colon cancer. Further investigations on tumorigenesis-related genes and their regulation by eIFs will provide clues for designing targeted therapy for cancer.

Design considerations for refractive solid immersion lens: application to subsurface integrated circuit fault localization using laser induced techniques.

With fast scaling and advancement of integrated circuit (IC) technology, circuitries have become smaller and denser. New materials and more sophisticated designs have evolved. These changes reduced the effectiveness of conventional laser induced fault localization techniques. Since IC fault localization is the most critical step in failure analysis, there are strong motivations to improve both spatial resolution and sensitivity of such systems to meet the new challenges from advanced technology. Refractive solid immersion lens (RSIL) is well known to enhance the laser spot size which directly affects resolution and sensitivity in back side fault localizations. In practice, it is difficult to operate RSIL at the ideal configurations to obtain the smallest spot resolution. It is necessary to understand the resolution performance at the other design focal planes. Besides resolution, there are also other factors that affect sensitivity in a RSIL enhanced system. This paper identifies and characterizes key RSIL design parameters to optimize RSIL performance on laser induced techniques. We report that the most efficient conditions are achieved close to aplanatic RSIL design to within 20-25 microm (for a 1 mm diameter lens), and the backing objective should be the minimum numerical aperture required for optimum resolution performance. The size of the mechanical clear aperture opening should be large enough (>80%) to exploit the advantage of aplanatic RSIL. RSIL is developed on a laser scanning optical microscope in this work, and a resolution of 0.3 microm (for a wavelength of 1340 nm) was achieved over a range of operating conditions. A quantitative resolution of 0.25 microm is achieved and a pitch structure of 0.4 microm is easily resolvable. Close to 15 times enhancement in laser induced signal is obtained.

Bomb blast mass casualty incidents: initial triage and management of injuries.

Bomb blast injuries are no longer confined to battlefields. With the ever present threat of terrorism, we should always be prepared for bomb blasts. Bomb blast injuries tend to affect air-containing organs more, as the blast wave tends to exert a shearing force on air-tissue interfaces. Commonly-injured organs include the tympanic membranes, the sinuses, the lungs and the bowel. Of these, blast lung injury is the most challenging to treat. The clinical picture is a mix of acute respiratory distress syndrome and air embolism, and the institution of positive pressure ventilation in the presence of low venous pressures could cause systemic arterial air embolism. The presence of a tympanic membrane perforation is not a reliable indicator of the presence of a blast injury in the other air-containing organs elsewhere. Radiological imaging of the head, chest and abdomen help with the early identification of blast lung injury, head injury, abdominal injury, eye and sinus injuries, as well as any penetration by foreign bodies. In addition, it must be borne in mind that bomb blasts could also be used to disperse radiological and chemical agents.

Molecular ecology of a facultative swine waste lagoon.

AIMS: To investigate the microbial ecology of three facultative swine waste lagoons. METHODS AND RESULTS: Phylogenetic analysis of sequences in a 16S rRNA gene clone library and fluorescence in situ hybridization (FISH) analyses were used to assess bacterial diversity in a swine waste lagoon. FISH analysis and Gram-staining were used to compare the microbial communities of all three swine waste lagoons. Six operational taxonomic units were in high relative abundance and corresponded to the following phylotypes; Thiolamprovum, Verrucomicrobia, Acholeplasma, Turicibacter, Clostridium and Bacteroides. PCR was employed to detect the genes apsA and dsrAB which encode for enzymes specifically associated with dissimilatory sulfate-reduction within sulfate-reducing bacteria (SRB). Amplification of these genes confirmed their presence within the lagoons. CONCLUSIONS: All lagoons were dominated by purple sulfur bacteria, affiliated to Thiolamprovum pedioforme. The molecular identification of fermentative bacteria and SRB indicate the following metabolic processes within such facultative ponds: sulfur-cycling, fermentation, inter-species hydrogen transfer and carbon cycling. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides the first molecular evidence for the existence of a sulfur cycle which is linked to phototrophic sulfide oxidation by purple bacteria and organotrophic sulfate-reduction by SRB.

Muscarinic receptor binding activity of polyoxygenated flavones from Melicope subunifoliolata.

The bark extract of Melicope subunifoliolata (Stapf) T.G. Hartley showed competitive muscarinic receptor binding activity. Six polymethoxyflavones [melibentin (1); melisimplexin (3); 3,3',4',5,7-pentamethoxyflavone (4); meliternatin (5); 3,5,8-trimethoxy-3',4',6,7-bismethylenedioxyflavone (6); and isokanugin (7)] and one furanocoumarin [5-methoxy-8-geranyloxypsoralen (2)] were isolated from the bark extract. Compounds 2 and 6 were isolated for the first time from M. subunifoliolata. The methoxyflavones (compounds 1, 3, 4, 5, 6, and 7) show moderate inhibition in a muscarinic receptor binding assay, while the furanocoumarin (compound 2) is inactive. The potency of the methoxyflavones to inhibit [(3)H]NMS-muscarinic receptor binding is influenced by the position and number of methoxy substitution. The results suggest these compounds are probably muscarinic modulators, agonists or partial agonists/antagonists.

When the stork arrives unannounced - seven years of emergency deliveries in a non-obstetric general hospital.

INTRODUCTION: Emergency department deliveries are uncommon in the Singapore setting, but when they do occur, the emergency physician has to be able to deliver the child safely, perform neonatal resuscitation if needed, and try to prevent any birth trauma to the child or complications of delivery in the mother. We present our experience of emergency room deliveries spanning 7 years in a community hospital without obstetric or neonatal backup. MATERIALS AND METHODS: This is a retrospective case series. A search was made through our electronic medical records system for patients presenting in labour or with deliveries from March 1997 to October 2004. They were studied for demographic and social factors, gravidity and parity, as well as any complications (during birth and in the immediate post-delivery period) in both parent and child. RESULTS: Twenty-three patients presented to our emergency department with labour contractions, and 14 progressed to vaginal deliveries. Twelve were single mothers who had hidden their pregnancies, while another 2 married patients had unsuspected pregnancies. No neonate needed resuscitation or airway support, but there were 4 patients without episiotomy who sustained perineal tears, and another 2 patients in whom the placenta could not be delivered. A child (born to a single mother without antenatal care) had a low Apgar score, but improved with oxygen and suctioning. CONCLUSIONS: An emergency department in a non-obstetric hospital should have in place adequate preparations to cater for the occasional unexpected emergency delivery and the associated need for neonatal resuscitation. In our series, there was a high proportion of concealed (hidden) and "unaware" pregnancies presenting in labour. Prompt referral to a maternity hospital with neonatal care should be made for any complications.

Electrocardiographical case. Young man with generalised myalgia.

A 24-year-old man presented with generalised malaise and myalgia for three days. He presented to the Emergency Department after a fall at his workplace due to weakness. 12-lead electrocardiogram (ECG) showed normal sinus rhythm with ST depression in the leads V4 to V6, with a U wave. The tallest U wave appeared in V3. These ECG features are characteristic of hypokalaemia. ECG changes in hypokalaemia and differential diagnosis are discussed. A second case of thyrotoxic periodic paralysis with similar ECG changes of hypokalaemia is also presented.

Self perceived work related stress and the relation with salivary IgA and lysozyme among emergency department nurses.

AIMS: To assess and compare the self perceived work related stress among emergency department (ED) and general ward (GW) nurses, and to investigate its relation with salivary IgA and lysozyme. METHODS: One hundred and thirty two of 208 (63.5%) registered female ED and GW nurses participated in the study. A modified mental health professional stress scale (PSS) was used to measure self perceived stress. ELISA methods were used to determine the salivary IgA and lysozyme levels. RESULTS: On PSS, ED nurses had higher scores (mean 1.51) than GW nurses (1.30). The scores of PSS subscales such as organisational structure and processes (OS), lack of resources (RES), and conflict with other professionals (COF) were higher in ED than in GW nurses. ED nurses had lower secretion rates of IgA (geometric mean (GM) 49.1 micro g/min) and lysozyme (GM 20.0 micro g/min) than GW nurses (68.2 micro g/min, 30.5 micro g/min). Significant correlations were observed between PSS and log IgA and lysozyme secretion rates. OS, RES, and COF were correlated with log IgA and lysozyme levels. CONCLUSION: ED nurses, who reported a higher level of professional stress, showed significantly lower secretion rates of salivary IgA and lysozyme compared to GW nurses. Salivary IgA and lysozyme were inversely correlated with self perceived work related stress. As these salivary biomarkers are reflective of the mucosal immunity, results support the inverse relation between stress and mucosal immunity.

The acute presentation of pulmonary thromboembolism: a retrospective viewpoint.

INTRODUCTION: Acute pulmonary thromboembolism (PE) has been considered rare among Asians. We aim to describe the frequency and clinical features of this condition in a hospital in Singapore. Among patients admitted by the Emergency Department (ED), comparisons were made between those primarily diagnosed in the ED and those who were not. MATERIALS AND METHODS: Retrospective review of all cases of radiologically proven acute PE over a 20-month period. RESULTS: Sixty-two patients were identified. The mean age was 61.5 +/- 18.0 years with a female to male ratio of 1.8:1. There were more Malays compared to other races. There were also more Caucasians, given the proximity of the hospital to the airport and the inclusion of tourists. The commonest symptoms were dyspnoea and chest pain, while the commonest signs were tachycardia and tachypnoea. Prolonged immobilisation was the commonest risk factor. Electrocardiographic S1Q3T3 pattern was seen in more patients compared to Western studies. Cardiomegaly was the commonest chest X-ray finding. Thirty-two patients were identified to have a source of embolisation. Overall mortality rate was 21%. The ED diagnosed 36% of the cases. Alternative admitting diagnoses were predominantly ischaemic heart disease and pneumonia. The group diagnosed in the ED were notably female (P = 0.044), Caucasian (P = 0.002) and had prolonged immobilisation (P = 0.025) prior to the onset of PE. CONCLUSION: Acute PE is not as rare here as previously thought. Clinical features reveal more similarities than differences compared to other studies in the literature. We advocate a high index of suspicion for earlier diagnosis in the ED.

Palm oil: a healthful and cost-effective dietary component.

Palm oil is an excellent choice for food manufacturers because of its nutritional benefits and versatility. The oil is highly structured to contain predominantly oleic acid at the sn2-position in the major triacylglycerols to account for the beneficial effects described in numerous nutritional studies. Oil quality and nutritional benefits have been assured for the variety of foods that can be manufactured from the oil directly or from blends with other oils while remaining trans-free. The oxidative stability coupled with the cost-effectiveness is unparalleled among cholesterol-free oils, and these values can be extended to blends of polyunsaturated oils to provide long shelf-life. Presently the supply of genetic-modification-free palm oil is assured at economic prices, since the oil palm is a perennial crop with unparalleled productivity. Numerous studies have confirmed the nutritional value of palm oil as a result of the high monounsaturation at the crucial 2-position of the oil's triacylglycerols, making the oil as healthful as olive oil. It is now recognized that the contribution of dietary fats to blood lipids and cholesterol modulation is a consequence of the digestion, absorption, and metabolism of the fats. Lipolytic hydrolysis of palm oil glycerides containing predominantly oleic acid at the 2 position and palmitic and stearic acids at the 1 and 3 positions allows for the ready absorption of the 2-monoacrylglycerols while the saturated free fatty acids remain poorly absorbed. Dietary palm oil in balanced diets generally reduced blood cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides while raising the high-density lipoprotein (HDL) cholesterol. Improved lipoprotein(a) and apo-A1 levels were also demonstrated from palm oil diets; an important benefits also comes from the lowering of blood triglycerides (or reduced fat storage) as compared with those from polyunsaturated fat diets. Virgin palm oil also provides carotenes apart from tocotrienols and tocopherols that have been shown to be powerful antioxidants and potential mediators of cellular functions. These compounds can be antithrombotic, cause an increase of the prostacyclin/thromboxane ratio, reduce restenosis, and inhibit HMG-CoA-reductase (thus reducing) cholesterol biosynthesis). Red palm oil is a rich source of beta-carotene as well as of alpha-tocopherol and tocotrienols.

Use of percussion as a screening tool in the diagnosis of occult hip fractures.

Traumatic hip pain is a common clinical problem in the emergency department. There is significant morbidity in discharging a patient with an undiagnosed undisplaced hip fracture. The auscultatory percussion technique is a useful method to risk stratify patients who present with traumatic hip pain and with normal radiographs. We sought to study the sensitivity and specificity of the auscultatory percussion technique in a prospective study.