Meta-patients: Using Mixed Reality Patients and an AI Framework for Simulating Life-Like Clinical Examinations

This chapter addresses an augmented learning experience created for the Griffith University School of Nursing and Midwifery in 2022. An interdisciplinary research team from Griffith University (Australia) deployed the first iteration of an application for students in response to the difficulties imposed through the previous two years. The impacts of the COVID pandemic bought challenges to the Bachelor of Nursing program, particularly in relation to student competency in the physical assessment of patients, through objective structured clinical examinations. This pilot study introduced life-like, simulated patients, designed and rendered within Unreal Engine to the students. The patients were accessible through cross platform applications, including mixed reality devices. Students were also able to interact with patient information communicated using the AI framework afforded by Microsoft PowerApps all packaged in a bespoke SharePoint site. Student participants were interviewed as part of the development process and approved of Augmented and Mixed Reality as successful platforms for the deployment of the simulated patient scenarios within Microsoft Teams and available through a mobile application and mixed reality device. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Streamlining the Fat: A Systematic Review of Active Closed Wash and Filtration in Autologous Fat Grafting After Breast Reconstruction.

While fat grafting in breast reconstruction continues to grow in popularity, the optimal technique remains elusive and outcomes are varied. This systematic review of available controlled studies utilizing active closed wash and filtration systems (ACWF) sought to examine differences in fat processing efficiency, aesthetic outcomes, and revision rates. A literature search was performed from inception to February 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in Ovid MEDLINE (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), Ovid Embase (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), and Cochrane Library (Wiley, Hoboken, NJ). Studies were screened by 2 independent reviewers for eligibility using Covidence screening software. Bibliographies and citing references from selected articles were screened from Scopus (Elsevier, Amsterdam, the Netherlands). The search identified 3476 citations, with 6 studies included. Three studies demonstrated a significantly higher volume of graftable fat harvested in a significantly lower mean grafting time with ACWF than with their respective controls. With respect to adverse events, three studies reported significantly lower incidences of nodule or cyst formation with ACWF with respect to control. Two studies reported a significantly lower incidence of fat necrosis with ACWF vs control, with this trend upheld in 2 additional studies. Three studies reported significantly lower revision rates with ACWF with respect to control. No study reported inferiority with ACWF for any outcome of interest. These data suggest that ACWF yields higher fat volumes in less time than other common techniques, with decreased rates of suboptimal outcomes and revisions, thereby supporting active filtration as a safe and efficacious means of fat processing that may reduce operative times. Further large-scale, randomized trials are needed to definitively demonstrate the above trends.

Progress in control and elimination of rubella and congenital rubella syndrome worldwide, 2012-2020

Progress towards rubella elimination has accelerated since 2012, and, in 2020, rubella elimination had been verified in approximately one half the countries of the world. Progress is reflected in increased numbers of countries introducing RCV into national childhood immunization schedules and the coverage achieved. Between 2012 and 2020, the number of countries that introduced RCV increased from 132 to 173, and global coverage increased from 40% to 70%. Although the availability of vaccine increased and more LICs and LMICs have introduced RCV, estimates of coverage continue to reflect barriers to access in lower-income countries. Nevertheless, coverage decreased by only 1 percentage point between 2019 and 2020 during the COVID-19 pandemic. Progress is also reflected in the decrease in the number of reported cases, including a 48% decrease during 2012- 2019 and a further decrease in 2020.

COVID-19 Impacts Highlight the Need for Holistic Evaluation of Research in the Hydrologic Sciences

As we reckon with the effect of COVID-19 on the research enterprise in hydrologic science, it is important to acknowledge that disruptions will be persistent and that institutional-level adjustments, while helpful, are not sufficient to mitigate all impacts on hydrologic scientists. Here, we describe the breadth of research contributions in the hydrologic sciences, consider how the pandemic has impacted this portfolio of contributions, document one impact that is already being realized in publication of research, and suggest guidance to the hydrologic science community, institutions, review panels, and funding organizations in considering these impacts at various stages of hiring and promotion in our community. Acknowledging the diversity of contributions to research is particularly valuable because it provides a more objective, transparent, and holistic basis for evaluating individuals within the context of norms of the hydrologic science community. With clearly established values, it is easier to identify impacts of life events, such as those related to the COVID-19 pandemic, as they are manifested in individuals under a diversity of circumstances.

Analysis of Benefits of an Expansion to UDOT’s Incident Management Program

In 2018 the Utah Department of Transportation (UDOT) funded a study in which data were collected to evaluate performance measures for UDOT’s Incident Management Team (IMT) program. Afterwards, UDOT received funding to expand the size of the program. Additionally, TransSuite, a data source used by the UDOT Traffic Operations Center to log incident-related data, was reconfigured to provide a higher quantity of performance measure data. This study made use of the new data source to collect performance measure data of the expanded program and measure the impacts of the IMT program expansion. Using a reanalyzed 2018 dataset and a new 2020 dataset, a comparison of performance measures was made. Performance measures were calculated for IMT responders at 320 incidents in 2018 and 289 incidents in 2020. Additionally, data regarding the affected volume, the excess travel time, and the excess user cost associated with incident congestion were gathered. In 2018 and 2020, 188 and 144 incidents were respectively analyzed for these user impacts. Statistical analyses were conducted to compare IMT performance between the two years and to determine relationships between performance measures and user impacts. The effects of the COVID-19 pandemic affected traffic volumes during this study, and statistical analyses were adjusted to account for volume differences between the two years. Results indicated that the expansion of the IMT program has allowed UDOT to respond faster to incidents, and respond to a larger quantity of incidents, even with extended coverage. Performance of the expanded IMT program has had significant effects in reducing incident-related congestion and its costs.

Can a virtual microbiology simulation be as effective as the traditional Wetlab for pharmacy student education?

BACKGROUND: Pharmacy practice education requires the development of proficiencies and an understanding of clinical microbiology. Learning in this area could be delivered using practical laboratory exercises, or potentially, simulation-based education. Simulation has previously successfully enhanced learning in health professional education. The current global climate due to COVID-19 has further highlighted the important role of technology-enhanced learning in delivering outcomes that meet the requisite learning objectives of a course. The aim of the present study was to compare the impact of a commercially available virtual microbiology simulation (VUMIE™) with a traditional wet laboratory (wetlab) on learner knowledge, skills and confidence in a second-year integrated pharmacotherapeutics course for Bachelor of Pharmacy students. METHODS: A randomised, crossover study was employed to determine whether the simulation intervention (VUMIE™) improves learning outcomes (knowledge, skills and confidence) of pharmacy students, when compared to a traditional wetlab intervention. Each student completed three 1-2 h length sessions, for both the wetlab and VUMIE™ interventions (6 sessions total). Data was collected using surveys deployed at baseline (pre-interventions), post-intervention 1 or 2 (VUMIE™ or wetlab) and endpoint (post-interventions 1 and 2). Statistical analysis was conducted using SPSS Statistics 25 and Instat™ software. RESULTS: Response rates were approximately 50% at initial survey and approximately 25% at endpoint survey. VUMIE™ produced higher post-intervention knowledge scores for the multiple-choice questions compared to the wetlab, however, the highest score was achieved at endpoint. Both interventions produced statistically significant differences for mean scores compared to baseline (pre-VUMIE™ and wetlab) across the domains of knowledge, skills and confidence. VUMIE™ produced higher post-intervention mean scores for knowledge, skills and confidence compared to post-intervention mean scores for the wetlab, however there was no statistical significance between the mean score for the two interventions, thus the VUMIE™ activity produced learning outcomes comparable to the wetlab activity. CONCLUSION: These findings suggest VUMIE™ provides similar effects on students' knowledge, skills, and confidence as a wetlab. The simulation's implementation was not cost-prohibitive, provided students with a physically and psychologically safe learning environment, and the benefit of being able to repeat activities, supporting deliberate practice.

Repurposing asynchronous video interview software for virtual pharmacy OSCEs during the COVID-19 pandemic

Background: The COVID-19 pandemic required pharmacy educators to seek creative and innovative ways of delivering learning outcomes in the virtual environment. Objective Structured Clinical Examinations (OSCEs) have been particularly challenging to deliver online. Objective: To explore the use of asynchronous video interview software as a platform for virtual OSCEs in pharmacy education, and for conducting brief structured research interviews. Method: Fourth year Bachelor of Pharmacy students at an Australian university, were interviewed via asynchronous video interview software (Big Interview) about their perceptions of using the platform for virtual OSCEs. Results: 37 students (92.5%) used Big Interview to complete at least one summative OSCE case during a team-based simulation. Seven research interviews were recorded by six students. Positive comments focussed on facilitation of self-reflection and self-correction in patient questioning and counselling. Negative views concerned the lack of authenticity, including the robotic and artificial nature of interactions. Conclusion: Asynchronous video interview software for pharmacy OSCEs may assist formative learning and self-reflection, offering an adjunct to, but not replacement of, in-person communication.

Thrombocytopaenia in pregnancy: the importance of differential diagnosis during the COVID-19 pandemic

Since the beginning of the COVID-19 pandemic, an optimal management of vulnerable patients, such as pregnant women, has been regarded as a challenge for healthcare professionals. Although thrombocytopaenia is considered a minor criterion for admission within an intensive care unit, a low platelet count has been observed in COVID-19 patients, including a pregnant woman, who developed severe pulmonary complications. Furthermore, thrombocytopaenia has been proposed as a potential biomarker in order to identify cases at high-risk complications. Nevertheless, thrombocytopaenia is a relatively frequent condition observed in pregnancy. In this context, a differential diagnosis is essential for the correct management of COVID-19 pregnant women.