High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education.

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

The effect of different patient-based learning models on student perceptions of empathy, engagement, knowledge, and learning experience.

BACKGROUND: Problem-based learning is used widely in pharmacy and medical programmes, incorporating realistic patient scenarios into regular teaching as a way of linking theory to practice. Routine case-based learning lessons ranges from real patient involvement, scripted patient scenarios, digital simulations (avatars) as well as through media such as Zoom. The existing literature has explored the extensive benefits of using patients in clinical education, but fewer studies have directly compared the efficacy of each model as learning tools. AIM: To compare student perceptions of patient-based learning models to elicit student empathy, increase engagement, improve knowledge, and enrich learning experience. METHODS: A questionnaire was distributed to second-year pharmacy students in Swansea University to gather their perceptions on the nine different patient-based learning models in their routine teaching (SUMS RESC 2023-0011). Students were asked to rank their experience of the models explicitly against each other, based on the four pillars of (1) eliciting student empathy, (2) increasing engagement, (3) improving knowledge and (4) enriching the learning experience. Students were also asked to rate the significance of realism (i.e. knowing the patient demographics/having a visual representation of the patient) to their experience. RESULTS: Altogether, 31 student rankings of the nine learning models were weighted (9 = highest rank; 1 = lowest ranked). The data showed clear preferences for real-patient involvement over fictional cases, especially for eliciting empathy. Interestingly, scripted scenarios were rated highly for both engagement and learning experience only when avatars were involved, which suggests a role of animated visual representation of the patient in facilitating these outcomes. CONCLUSION: Whilst it is useful to have multiple patient-based learning models, this study serves as a guide for educators in preparing case-based learning sessions for achieving the desired outcomes of any of the four pillars above.

Disagreement Gets Mistaken for Bad Listening.

It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.

Are realistic details important for learning with visualizations or can depth cues provide sufficient guidance?

The optimal choice of the level of realism in instructional visualizations is a difficult task. Previous studies suggest that realism can overwhelm learners, but a growing body of research demonstrates that realistic details can enhance learning. In the first experiment (n = 107), it was assessed whether learning using realistic visualizations can be distracting and therefore particularly benefits from pre-training. Participants learned the anatomy of the parotid gland using labeled visualizations. While pre-training did not have an effect, a more realistic visualization enhanced learning compared to a schematic visualization. In the second experiment (n = 132), a schematic diagram was compared to a more realistic style featuring basic depth cues, and a highly realistic visualization containing a detailed surface. Regarding retention performance, no significant differences were found. However, an interesting pattern regarding subjective cognitive load ratings emerged: the schematic version received the highest cognitive load ratings, while the version featuring simplified shading was rated as least demanding. The version containing simplified depth cues also elicited lower cognitive load ratings than the detailed visualization. The two experiments demonstrate that fears concerning a detrimental effect of realistic details should not be over-generalized. While schematic visualizations may be easier to visually process in some cases, extracting depth information from contour drawings adds cognitive demands to a learning task. Thus, it is advisable that computer-generated visualizations contain at least simplified forms of shading, while the addition of details does not appear to have a strong positive effect.

Increasing the realism of on-screen embodied instructors creates more looking but less learning.

BACKGROUND: Although adding embodied instructors on the screen is considered an effective way to improve online multimedia learning, its effectiveness is still controversial. The level of realism of embodied on-screen instructors may be an influencing factor, but it is unclear how it affects multimedia learning. AIMS: We explored whether and how embodied on-screen instructors rendered with different levels of realism in multimedia lessons affect learning process and learning outcomes. SAMPLES: We recruited 125 college students as participants. METHODS: Students learned about neural transmission in an online multimedia lesson that included a real human, cartoon human, cartoon animal or no instructor. RESULTS: Students learning with cartoon human or cartoon animal instructors tended to fixate more on the relevant portions of the screen and performed better on retention and transfer tests than no instructor group. The real human group fixated more on the instructor, fixated less on the relevant portion of the screen and performed worse on a retention test in comparison to the cartoon human group. Fixation time on the instructor fully mediated the relationship between instructor realism and retention score. CONCLUSIONS: The addition of embodied on-screen instructors can promote multimedia learning, but the promotion effect would be better if the embodied instructor was a cartoon animal or cartoon human rather than a real human. This suggests an important boundary condition in which less realism of on-screen embodied instructors produces better learning processes and outcomes.

Psychopathology and Metaphysics: Can One Be a Realist About Mental Disorder?

Metaphysical realism about mental disorder is the thesis that mental disorder exists mind-independently. There are two ways to challenge metaphysical realism about mental disorder. The first is by denying that mental disorder exists. The second is by denying that mental disorder exists mind-independently. Or, differently put, by arguing that mental disorder is mind-dependent. The aim of this paper is three-fold: (a) to examine three ways in which mental disorder can be said to be mind-dependent (namely, by being causally dependent on the human mind, by being weakly dependent on human attitudes, and by being strongly dependent on human attitudes), (b) to clarify their differences, and (c) to discuss their implications regarding metaphysical realism about mental disorder. I argue that mental disorder being mind-dependent in the first two senses is compatible with metaphysical realism about mental disorder, whereas mental disorder being mind-dependent in the third sense is not.

Keeping social distance in a classroom while interacting via a telepresence robot: a pilot study.

Introduction: The use of various telecommunication tools has grown significantly. However, many of these tools (e.g., computer-based teleconferencing) are problematic in relaying non-verbal human communication. Telepresence robots (TPRs) are seen as telecommunication tools that can support non-verbal communication. Methods: In this paper, we examine the usability of TPRs, and communication distance related behavioral realism in communication situations between physically present persons and a TPR-mediated person. Twenty-four participants, who played out 36 communication situations with TPRs, were observed and interviewed. Results: The results indicate that TPR-mediated people, especially women, choose shorter than normal communication distances. The type of the robot did not influence the choice of communication distance. The participants perceived the use of TPRs positively as a feasible telecommunication method. Discussion: When introducing TPRs, situations with greater intrapersonal distances require more practice compared to scenarios where a physically present person communicates with a telepresent individual in the audience. In the latter situation, the robot-mediated person could be perceived as "behaviorally realistic" much faster than in vice versa communication situations.

Lightness constancy in reality, in virtual reality, and on flat-panel displays.

Virtual reality (VR) displays are being used in an increasingly wide range of applications. However, previous work shows that viewers often perceive scene properties very differently in real and virtual environments and so realistic perception of virtual stimuli should always be a carefully tested conclusion, not an assumption. One important property for realistic scene perception is surface color. To evaluate how well virtual platforms support realistic perception of achromatic surface color, we assessed lightness constancy in a physical apparatus with real lights and surfaces, in a commercial VR headset, and on a traditional flat-panel display. We found that lightness constancy was good in all three environments, though significantly better in the real environment than on the flat-panel display. We also found that variability across observers was significantly greater in VR and on the flat-panel display than in the physical environment. We conclude that these discrepancies should be taken into account in applications where realistic perception is critical but also that in many cases VR can be used as a flexible alternative to flat-panel displays and a reasonable proxy for real environments.

Influence of materiality in professional geriatric care: Conceptual, methodological and empirical insights.

Most people become more reliant on care and support as they age. The constitution of ageing people in the context of nursing support thus represents a material aspect in the daily life of these people and must be taken into account in the science of gerontology. However, theories of (geriatric) care have previously been predominantly human-centric. In light of the material turn, the goal of this paper is to highlight the potential to be found in using agential realism to critically examine geriatric care. It will begin by detailing previous perspectives on geriatric care and any use of material aspects to be found in it. It will then present a conceptual-methodical approach that allows for an examination of the act of caring, taking material aspects into account. The application of this approach to empirical material drawn from an example of acute care in Germany will, in conclusion, illustrate significant elements that, in light of agential realism, must also be taken into account when investigating what it means to provide good geriatric care.

Simcrafting: A comprehensive framework for scenario development for simulation.

Simulation can be an excellent teaching and learning method if the scenarios are created appropriately. It starts with assessing the learner's needs and is followed by laying down objectives embracing the SMART principles. While creating a scenario, it is essential to consider the different aspects of realism, such as physical, contextual and psychological aspects. Using moulages and props helps in creating physical realism. The simulation expert should also be aware of the learner's experience and decide the SimZones for their learners based on their level of clinical expertise. The scenario progression needs to be laid down in stages. The role of the embedded participant needs to be decided a priori, and the embedded participant should be well-versed in their role. Pilot testing is a crucial step in simulation development as it keeps the simulation expert aware of the loopholes in the simulation scenario before running.

Commentary on Antosz et al. (2023): The role of macro-micro-macro frameworks and critical realism in agent-based modelling.

Antosz and colleagues' review of the role of theory in agent-based modelling (ABM) makes important recommendations for modelling practitioners. However, macro-micro-macro frameworks are not necessarily as reliant on existing theory as the review suggests. Adopting a critical realist perspective to ABM design would help to deliver the recommendations, within which macro-micro-macro frameworks can play an important enabling role.

THUBreast: an open-source breast phantom generation software for x-ray imaging and dosimetry.

Objective. Establishing realistic phantoms of human anatomy is a continuing concern within virtual clinical trials of breast x-ray imaging. However, little attention has been paid to glandular distribution within these phantoms. The principal objective of this study was to develop breast phantoms considering the clinical glandular distribution.Approach. This research introduces an innovative method for integrating glandular distribution information into breast phantoms. We have developed an open-source software, THUBreast44http://github.com/true02Hydrogen/THUBreast/, which generates breast phantoms that accurately replicate both the structural texture and glandular distribution, two crucial elements in breast x-ray imaging and dosimetry. To validate the efficacy of THUBreast, we assembled three groups of breast phantoms (THUBreast, patient-based, homogeneous) for irradiation simulation and calculated the power-law exponents (ß) and mean glandular dose (Dg), indicators of texture realism and radiation risk, respectively, utilizing MC-GPU.Main results. Upon the computation of theDgfor the THUBreast phantoms, it was found to be in agreement with that absorbed by the phantoms based on patients, with an average deviation of 4%. The estimates of averageDgthus obtained were on average 23% less than those computed for the homogeneous phantoms. It was observed that the homogeneous phantoms did overestimate the averageDgby 30% when compared to the phantoms based on patients. The mean value ofßfor the images of THUBreast phantoms was found to be 2.92 ± 0.08, which shows a commendable agreement with the findings of prior investigations.Significance. It is evidently clear from the results that THUBreast phantoms have a preliminary good performance in both imaging and dosimetry in terms of indicators of texture realism and glandular dose. THUBreast represents a further step towards developing a powerful toolkit for comprehensive evaluation of image quality and radiation risk.

Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings.

Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.

On compatibility between realism and fictionalism: A response to Suárez' proposal.

In a series of articles, Mauricio Suárez defends the neutrality of fictionalism with respect to the scientific realism-anti-realism debate. Suárez understands fictionalism from a strictly methodological point of view, linked to the practice of model building in the context of the philosophy of science. He moves away from the type of fictionalism analysed in other areas of philosophy such as metaphysics, the philosophy of language, aesthetics or the philosophy of mathematics. Following Vaihinger's position, he emphasizes the inferential role of fiction in scientific modelling and argues that scientific fictionalism is not incompatible with scientific realism, as is often believed. We argue against Suárez's position and reject the ubiquitous character assigned to fictions in scientific discourse, as well as the deflationary view of scientific realism defended by Suárez. We conclude that when the semantic, epistemic, and metaphysical aspects at stake in the realism-antirealism debate are taken into account, the alleged compatibility between scientific realism and fictionalism starts to generate some tension.

[In situ simulation training of medical-surgical teams in the management of severe trauma patients]. / La formation par simulation in situ des équipes médico-chirurgicales à la prise en charge des traumatisés sévères.

In the management of severe trauma, the aim is to assess the patient's clinical stability as quickly as possible, enabling referral to imaging (whole-body CT scan, embolization if necessary) or the operating room, or even the decision to perform in situ surgery (resuscitation thoracotomy). To cope with these critical situations, team training is essential, with the aim of ensuring the reproducibility of the difficulties encountered. High-fidelity in situ simulation is the ideal tool for meeting this training challenge.

Moving toward reality: Electrocortical reactivity to naturalistic multimodal emotional videos.

While previous research has investigated the effects of emotional videos on peripheral physiological measures and conscious experience, this study extends the research to include electrocortical measures, specifically the steady-state visual-evoked potential (ssVEP). A carefully curated set of 45 videos, designed to represent a wide range of emotional and neutral content, were presented with a flickering border. The videos featured a continuous single-shot perspective, natural soundtrack, and excluded elements associated with professional films, to enhance realism. The results demonstrate a consistent reduction in ssVEP amplitude during emotional videos which strongly correlates with the rated emotional intensity of the clips. This suggests that narrative audiovisual stimuli have the potential to track dynamic emotional processing in the cortex, providing new avenues for research in affective neuroscience. The findings highlight the potential of using realistic video stimuli to investigate how the human brain processes emotional events in a paradigm that increases ecological validity. Future studies can further develop this paradigm by expanding the video set, targeting specific cortical networks, and manipulating narrative predictability. Overall, this study establishes a foundation for investigating emotional perception using realistic video stimuli and has the potential to expand our understanding of real-world emotional processing in the human brain.

Synthetic surprise as the foundation of the psychedelic experience.

Psychedelic agents, such as LSD and psilocybin, induce marked alterations in consciousness via activation of the 5-HT2A receptor (5-HT2ARs). We hypothesize that psychedelics enforce a state of synthetic surprise through the biased activation of the 5-HTRs system. This idea is informed by recent insights into the role of 5-HT in signaling surprise. The effects on consciousness, explained by the cognitive penetrability of perception, can be described within the predictive coding framework where surprise corresponds to prediction error, the mismatch between predictions and actual sensory input. Crucially, the precision afforded to the prediction error determines its effect on priors, enabling a dynamic interaction between top-down expectations and incoming sensory data. By integrating recent findings on predictive coding circuitry and 5-HT2ARs transcriptomic data, we propose a biological implementation with emphasis on the role of inhibitory interneurons. Implications arise for the clinical use of psychedelics, which may rely primarily on their inherent capacity to induce surprise in order to disrupt maladaptive patterns.

Potentiality realism: a realistic and indeterministic physics based on propensities.

We propose an interpretation of physics named potentiality realism. This view, which can be applied to classical as well as to quantum physics, regards potentialities (i.e. intrinsic, objective propensities for individual events to obtain) as elements of reality, thereby complementing the actual properties taken by physical variables. This allows one to naturally reconcile realism and fundamental indeterminism in any theoretical framework. We discuss our specific interpretation of propensities, that require them to depart from being probabilities at the formal level, though allowing for statistics and the law of large numbers. This view helps reconcile classical and quantum physics by showing that most of the conceptual problems that are customarily taken to be unique issues of the latter -- such as the measurement problem -- are actually in common to all indeterministic physical theories.

The usage of data in NHS primary care commissioning: a realist evaluation.

BACKGROUND: To improve health outcomes and address mounting costs pressures, policy-makers have encouraged primary care commissioners in the British National Health Service (NHS) to increase the usage of data in decision-making. However, there exists limited research on this topic. In this study, we aimed to understand how and why primary care commissioners use data (i.e. quantitative, statistical information) to inform commissioning, and what outcomes this leads to. METHODS: A realist evaluation was completed to create context-mechanism-outcome configurations (CMOs) relating to the contexts influencing the usage of data in primary care commissioning. Using a realist logic of analysis and drawing on substantive theories, we analysed qualitative content from 30 interviews and 51 meetings (51 recordings and 19 accompanying meeting minutes) to develop CMOs. Purposive sampling was used to recruit interviewees from diverse backgrounds. RESULTS: Thirty-five CMOs were formed, resulting in an overarching realist programme theory. Thirteen CMOs were identical and 3 were truncated versions of those formed in an existing realist synthesis on the same topic. Seven entirely new CMOs, and 12 refined and enhanced CMOs vis-à-vis the synthesis were created. The findings included CMOs containing contexts which facilitated the usage of data, including the presence of a data champion and commissioners' perceptions that external providers offered new skillsets and types of data. Other CMOs included contexts presenting barriers to using data, such as data not being presented in an interoperable way with consistent definitions, or financial pressures inhibiting commissioners' abilities to make evidence-based decisions. CONCLUSIONS: Commissioners are enthusiastic about using data as a source of information, a tool to stimulate improvements, and a warrant for decision-making. However, they also face considerable challenges when using them. There are replicable contexts available to facilitate commissioners' usage of data, which we used to inform policy recommendations. The findings of this study and our recommendations are pertinent in light of governments' increasing commitment to data-driven commissioning and health policy-making.

¿Un “nuevo” Perspectivismo? Delirio y verdad desde el punto de vista del Nuevo Realismo / A “New” Perspectivism? Delusion and Truth from the Point of View of the New Realism

El concepto de delirio ha sido tematizado ampliamente por la psiquiatría feno-menológica a lo largo del siglo XX. Por el contrario, su relación con la verdad aparece en su desarrollo filosófico un tanto volátil. Ya Jaspers advirtió de la futilidad de esta a la hora de definir el delirio. En la práctica, en cambio, sí que adquiere cierta significación y efectividad a la hora de un diagnóstico. En el presente ensayo se trata de emprender una exploración de la relación entre el delirio y la verdad a la luz de los principios filosóficos del Nuevo Realismo representado por Markus Gabriel y del perspectivismo orteguiano. Se intentará concluir que la relación entre ambos conceptos se decidirá en su valor para la vida. (AU)

The concept of delusion was widely discussed in the Psychiatry and Pheno-menology of the 20th century. In contrast, its relation to truth in its philosophical deve-lopment appears to be quite elusive. Jaspers warned about its futility in the definition of delusion. Nevertheless, from a practical perspective seems to play a meaningful, efficient role as a diagnostic indication. We pursue an investigation about delusion and truth in the light of Markus Gabriel’s New Realism and Ortega y Gasset’s Perspecti-vism. Finally, their relation will be decided in its value for life. (AU)