Fabrication, Testing, and 3D Comprehensive Analysis of Swept-Tip Tiltrotor Blades

This paper covers the design, fabrication, testing, and modeling of a family of Froude-scale tiltrotor blades. They are designed with the objective of gaining a fundamental understanding of the impact of a swept tip on tiltrotor whirl flutter. The goal of this paper is to describe the development of the blades needed for this purpose. The rotor is three bladed with a diameter of 4.75 ft. The blades have a VR-7 profile, chord of 3.15 inches, and linear twist of −37◦ per span. The swept-tip blades have a sweep of 20◦ starting at 80%R. The blade properties are loosely based on the XV-15 design. A CATIA and Cubit-based high-fidelity three-dimensional (3D) finite element model is developed. It accurately represents the fabricated blade and is analyzed with X3D. Experiments in a vacuum chamber were carried out to demonstrate the structural integrity of the blades. Measured frequencies and strains were validated with X3D predictions proving the fidelity of the 3D model. Thus, even though the wind tunnel facilities were closed due to COVID-19, hover and forward flight calculations for the blade stress could be performed using the high-fidelity 3D structural model. The results prove the blades have sufficient structural integrity and stress margins to allow for wind tunnel testing. © 2023 Vertical Flight Society.

Innovative high-fidelity simulation for vaccination training of pharmacist including emergency cases - a randomised controlled study

IntroductionRecently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. To adapt pharmacy curriculum for clinical practice, an innovative, high level vaccination training course comprising clinical skills, techniques required for level of competence was developed with participants interacting either with a high-fidelity simulator or low-fidelity injection pad. Clinical scenarios to manage adverse events were also implemented.MethodsA randomized controlled trial using a pre-post-design with pharmacy undergraduates alongside with a theoretical part was performed. The intervention group interacted with a high-fidelity simulator, while the control group was trained with low-fidelity injection pads. Before and after the respective training each participant went through an objective structured clinical examination (OSCE) and each participant completed a self-assessment questionnaire and knowledge quiz.ResultsOSCE Score were raised through an analytical checklist examining skills in anamnesis, patient information, vaccination process, and handling emergency case. Both training methods showed a significant (p<0,01) increase of skills but a significant (p<0,01) greater increase in the intervention group compared to the control group, particularly in vaccination process (p=0,007). Both Groups showed a similar increase of self-assessment score raised through a 6-point-Likert scale, and no significant differences were observed in the quizzes.ConclusionsHigh fidelity simulation proves to be an appropriate tool to train pharmacy students for vaccine administration, as a new pharmaceutical service and enable the students to recognize and manage adverse events.

Using a Palliative Extubation Simulation-Based Learning Model to Teach Key Palliative Medicine Topics and Skills Across Graduate and Undergraduate Medical Education (Sch472)

Outcomes: 1. Self-report the ability to use a palliative extubation simulation curriculum to teach key palliative care topics to learners across various levels. 2. Self-report the ability to mitigate communication and procedural errors associated with suboptimal palliative extubations to provide maximum comfort for patients and families at end of life. Background(s): The COVID-19 pandemic revealed gaps in the provision of end-of-life (EOL) care. In particular, the high number of mechanically ventilated patients at the EOL highlighted the need to standardize evidence-based palliative extubation (PE) amidst significant practice variation. Suboptimal PE practices can worsen symptoms, inappropriately hasten death, and add undue stress on patients, families, and healthcare staff. Effective training models are needed to standardize evidence-based PE. Simulation-based learning (SBL) has been shown to effectively improve medical knowledge, procedural proficiency, and interprofessional communication, all of which are necessary to successfully perform a PE. Unfortunately, the use of SBL in palliative care (PC) education is sparse. Method(s): An innovative educational activity using high-fidelity simulation and SBL models was created to teach key PC topics and skills within the context of a simulated PE procedure. The curriculum consists of a 1-hour didactic followed by 2 hours of simulation, divided into 4 sections. The simulation is designed to teach complex symptom management, communication strategies, and leadership skills. Each section concludes with a debrief to provide feedback and teaching points. This curriculum was piloted over multiple years among palliative medicine fellows. It will expand to include medical students this academic year with the plan to be further incorporated into medical resident education in the future. The following validated questionnaires will be used to study the efficacy of this SBL model: Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire. Participants will complete the questionnaires following the simulation. Conclusion(s): Multiple specialties have adopted SBL as an effective modality to enhance training. The use of SBL in palliative medicine education is relatively sparse. An innovative PE-simulation educational activity may provide an optimal way to teach key PC concepts across graduate and undergraduate medical education.Copyright © 2023

High-fidelity simulation and nurse clinical competence-An integrative review.

AIM: The aim of this review was to synthesise current knowledge of high-fidelity simulation practices and its impact on nurse clinical competence in the acute care setting. BACKGROUND: There is no consensus or standardisation surrounding best practices for the delivery of high-fidelity simulation in the acute care setting. This is an understudied area. DESIGN: An integrative review using Johns Hopkins Nursing Evidence-Based Practice Model. METHODS: Medical subject heading terms 'Clinical Competence', AND 'High Fidelity Simulation Training', AND 'Clinical Deterioration' were systematically searched in PubMed, CINAHL and Embase databases for peer-reviewed literature published through September 2020. The current study was evaluated using PRISMA checklist. RESULTS: Seven studies met the inclusion criteria. Three main concepts were identified: modes of delivery, approach to learner participation and outcome measurement. CONCLUSIONS: This review substantiated the use of high-fidelity simulation to improve acute care nurses' early identification and management of clinical deterioration. Global variations in course design and implementation highlight the need for future approaches to be standardised at the regional level (i.e., country-centric approach) where differing scopes of practice and sociocultural complexities are best contextualised. RELEVANCE TO CLINICAL PRACTICE: These findings add to the growing body of evidence of simulation science. Important considerations in course planning and design for nursing clinical educators were uncovered. This is especially relevant given the current COVID-19 pandemic and urgent need to train redeployed nurses safely and effectively from other units and specialties to acute care.

Teaching of Physics Courses in Epochs of Pandemic: Tablet versus Blackboard

Because the pandemic of Covid-19, lectures and classes have demanded to employ the latest technologies to present an educational session as an online session. For example, universities courses have required that instructors have kept the quality of teaching by employing electronic tools that to some extent can replace the classical blackboard with a high fidelity. In this manner, mostly educators have used electronic tablets as e-blackboard, particularly when mathematical and physics are passing through the chapters where equations and specific demonstrations of equations are needed to convince students some laws of nature. This paper discusses in a quantitatively manner the usage of tactile technologies to teach Physics in pandemic epochs. © 2022 ACM.

Engaging with program adaptations in evaluation: A range of existing options and a new opportunity

Premised on the idea that evaluators should be familiar with a range of approaches to program modifications, I review several existing approaches and then describe another, less well-recognized option. In this newer option, evaluators work with others to identify potentially needed adaptations for select program aspects in advance. In describing this approach, I note the general steps involved and present alternative techniques for identifying, a priori, adaptations that may come to be needed. In the final section, I discuss implications of the a priori adaptation planning approach for the fidelity-adaptation trade-off, past criticism of logic models as overly fixed and linear, potential research and evaluation questions, the development of more detailed views of programs in evaluation theory and training, and possible resistance to adaptation planning. Discussion also considers the potential future of program adaptations in the wake of the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A virtual reality platform for training in the management of acute respiratory diseases

Introduction: During the COVID-19 pandemic, alternatives to face-to-face teaching were on the urge. What's more, in the context of the respiratory support of COVID patients, the training and capacitation of personnel capable of taking care of these patients was critical. Aims and objectives: Develop a Virtual Reality (VR) app for remote training of medical staff in the management of different acute respiratory diseases, including COVID-19. Method(s): Pulmonologists and software developers designed an app based on a virtual hospital using VR glasses. The teacher programs different clinical scenarios, where the student can converse with the patient and explore him, observing the respiratory mechanics and the skin coloration, auscultating different noises in various cardiac and pulmonary foci, edema in the lower extremities, etc. The student can request different tests (blood analysis, radiography, etc.) and prescribe treatment, including oxygen therapy and respiratory support. The clinical situation of the patient can change during the simulation. Result(s): Different acute respiratory diseases were successfully simulated, with a correct interaction between the student and the teacher. Conclusion(s): VR can be used as a tool for the remote training of medical staff, and provide high fidelity simulations for training in a wide variety of clinical situations.

Classification of Simulation Methods Using in Nursing Education

Difficulties encountered in nursing clinical education, limited clinical practice time, and the COVID-19 outbreak negatively affect the clinical practice and duration of students with real patients. For this reason, it is aimed to develop nursing students' competencies such as critical thinking skills, learning and self-confidence through various teaching approaches. Educational strategies such as simulation-based education offer students the opportunity to clinical practice in a safe environment by providing realistic clinical situations. The concept of fidelity plays an important role in the selection of the simulation method. Selection of simulation method and fidelity level, depend on factors such as the goals and results of the education, student level and facilitator. In the literature, there are different classifications related to simulation methods and the concept of fidelity. Although the classifications made are similar to each other, there are also differences between them. In this review, different classifications and definitions of fidelity regarding simulation-based education features found in the literature are examined. © 2022, Dokuz Eylul University. All rights reserved.

Arousing Real or Real Threat? How Realism in Avatars Affects the Perception of Virtual Reality Pornography and Relationships for Heterosexual Women

New immersive technologies and COVID lockdowns increase the attention for Virtual Reality Pornography (VRP). In this study, heterosexual women were interviewed about the effect of realism in VRP, using a new VRP Role-framework based on six dimensions. Results showed that VRP evokes strong negative and positive emotions. Different types of realism evoked confusion around fidelity and pornography and triggered different relationship boundaries, roles, and rules. Feelings of betrayal and fidelity seemed less when the partner experiences 360° recorded VRP (VR-type-dimension) alone (companion-dimension). Acceptance and confusion appear high around shared computer-generated experiences with control over avatars (interactive-dimension) that look like the self (resemblance-dimension). Feelings of doubt and betrayal seem high when the partner experiences VRP with strangers using realistic-looking avatars (realism-dimension) that resemble (well)known persons or the partner. This study helps companies explore ways to improve VRP content while considering ethical questions society raises concerning VRP's impact on relationships. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

ALPINE: Improving Remote Heart Rate Estimation using Contrastive Learning

Heart rate (HR) is a crucial physiological indicator of human health and can be used to detect cardiovascular disorders. The traditional HR estimation methods, such as electrocardiograms (ECG) and photoplethysmographs, require skin contact. Due to the increased risk of viral in- fection from skin contact, these approaches are avoided in the ongoing COVID-19 pandemic. Alternatively, one can use the non-contact HR estimation technique, remote photo- plethysmography (rPPG), wherein HR is estimated from the facial videos of a person. Unfortunately, the existing rPPG methods perform poorly in the presence of facial deformations. Recently, there has been a proliferation of deep learning networks for rPPG. However, these networks require large-scale labelled data for better generalization. To alleviate these shortcomings, we propose a method ALPINE, that is, A noveL rPPG technique for Improving the remote heart rate estimatioN using contrastive lEarning. ALPINE utilizes the contrastive learning framework during training to address the issue of limited labelled data and introduces diversity in the data samples for better network generalization. Additionally, we introduce a novel hybrid loss comprising contrastive loss, signal-to-noise ratio (SNR) loss and data fidelity loss. Our novel contrastive loss maximizes the similarity between the rPPG information from different facial regions, thereby minimizing the effect of local noise. The SNR loss improves the quality of temporal signals, and the data fidelity loss ensures that the correct rPPG signal is extracted. Our extensive experiments on publicly available datasets demonstrate that the proposed method, ALPINE outperforms the previous well-known rPPG methods. © 2023 IEEE.

Low Treatment Fidelity as an Indication to Switch Interventions: Pivoting From Child-Parent Psychotherapy to Parent-Child Interaction Therapy for Early Childhood Trauma

Young children who experience trauma and adverse experiences are at an increased risk of developing an insecure attachment style as well as negative physical and mental health problems. These can include internalizing and externalizing behavioral problems, developmental delay, emotional dysregulation, and aggression. Several evidence-based interventions exist to treat young children with symptoms related to trauma, each with different foundational theories. This article presents the case of a 4-year-old boy with posttraumatic stress disorder who was in the middle of a legal fight between caregivers and transitioning between caregivers' homes. Initially, therapy began with Child-Parent Psychotherapy to address caregivers' first concerns. Later, the therapeutical approach was switched to Parent-Child Interaction Therapy due to difficulty with treatment fidelity related to caregivers' symptoms and conflict. This case demonstrates great improvement in treatment fidelity and subsequently problem behaviors after switching to an intervention that allowed to address behavior management shortcomings in a family with ongoing conflict.Copyright © The Author(s) 2022.

Dissecting nucleotide selectivity in viral RNA polymerases.

Designing antiviral therapeutics is of great concern per current pandemics caused by novel coronavirus or SARS-CoV-2. The core polymerase enzyme in the viral replication/transcription machinery is generally conserved and serves well for drug target. In this work we briefly review structural biology and computational clues on representative single-subunit viral polymerases that are more or less connected with SARS-CoV-2 RNA dependent RNA polymerase (RdRp), in particular, to elucidate how nucleotide substrates and potential drug analogs are selected in the viral genome synthesis. To do that, we first survey two well studied RdRps from Polio virus and hepatitis C virus in regard to structural motifs and key residues that have been identified for the nucleotide selectivity. Then we focus on related structural and biochemical characteristics discovered for the SARS-CoV-2 RdRp. To further compare, we summarize what we have learned computationally from phage T7 RNA polymerase (RNAP) on its stepwise nucleotide selectivity, and extend discussion to a structurally similar human mitochondria RNAP, which deserves special attention as it cannot be adversely affected by antiviral treatments. We also include viral phi29 DNA polymerase for comparison, which has both helicase and proofreading activities on top of nucleotide selectivity for replication fidelity control. The helicase and proofreading functions are achieved by protein components in addition to RdRp in the coronavirus replication-transcription machine, with the proofreading strategy important for the fidelity control in synthesizing a comparatively large viral genome.

Application of Hydrogels as Three-Dimensional Bioprinting Ink for Tissue Engineering.

The use of three-dimensional bioprinting technology combined with the principle of tissue engineering is important for the construction of tissue or organ regeneration microenvironments. As a three-dimensional bioprinting ink, hydrogels need to be highly printable and provide a stiff and cell-friendly microenvironment. At present, hydrogels are used as bioprinting inks in tissue engineering. However, there is still a lack of summary of the latest 3D printing technology and the properties of hydrogel materials. In this paper, the materials commonly used as hydrogel bioinks; the advanced technologies including inkjet bioprinting, extrusion bioprinting, laser-assisted bioprinting, stereolithography bioprinting, suspension bioprinting, and digital 3D bioprinting technologies; printing characterization including printability and fidelity; biological properties, and the application fields of bioprinting hydrogels in bone tissue engineering, skin tissue engineering, cardiovascular tissue engineering are reviewed, and the current problems and future directions are prospected.

Characterizing modifications to a comparative effectiveness research study: the OPTIMIZE trial-using the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME).

BACKGROUND: The OPTIMIZE trial is a multi-site, comparative effectiveness research (CER) study that uses a Sequential Multiple Assessment Randomized Trial (SMART) designed to examine the effectiveness of complex health interventions (cognitive behavioral therapy, physical therapy, and mindfulness) for adults with chronic low back pain. Modifications are anticipated when implementing complex interventions in CER. Disruptions due to COVID have created unanticipated challenges also requiring modifications. Recent methodologic standards for CER studies emphasize that fully characterizing modifications made is necessary to interpret and implement trial results. The purpose of this paper is to outline the modifications made to the OPTIMIZE trial using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME) to characterize modifications to the OPTIMIZE trial in response to the COVID pandemic and other challenges encountered. METHODS: The FRAME outlines a strategy to identify and report modifications to evidence-based interventions or implementation strategies, whether planned or unplanned. We use the FRAME to characterize the process used to modify the aspects of the OPTIMIZE trial. Modifications were made to improve lower-than-anticipated rates of treatment initiation and COVID-related restrictions. Contextual modifications were made to permit telehealth delivery of treatments originally designed for in-person delivery. Training modifications were made with study personnel to provide more detailed information to potential participants, use motivational interviewing communication techniques to clarify potential participants' motivation and possible barriers to initiating treatment, and provide greater assistance with scheduling of assigned treatments. RESULTS: Modifications were developed with input from the trial's patient and stakeholder advisory panels. The goals of the modifications were to improve trial feasibility without compromising the interventions' core functions. Modifications were approved by the study funder and the trial steering committee. CONCLUSIONS: Full and transparent reporting of modifications to clinical trials, whether planned or unplanned, is critical for interpreting the trial's eventual results and considering future implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT03859713. Registered on March 1, 2019.

Simulation training for medical emergencies of dental patients: A review of the dental literature.

In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study.

AIM: To evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students' generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants' satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module. BACKGROUND: Following the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated. DESIGN: A mixed methods study incorporating quasi-experimental and qualitative components. METHODS: We recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants' post-intervention satisfaction, experiences and opinions. RESULTS: Post-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings. CONCLUSIONS: This study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students' learning outcomes. Further studies should include a control group, evaluate students' knowledge and skills, and retention of knowledge to confirm the true impact of such training.

Fidelity of implementing a competency-based nursing programme during the COVID-19 pandemic: A case study.

AIM: The study describes the fidelity of implementing a competency-based nursing education (CBNE) programme during the COVID-19 pandemic in a low-resource setting. DESIGN: A descriptive case study research design integrating mixed methods underpinned by the fidelity of implementation framework was applied to assess teaching, learning and assessment during the COVID-19 pandemic. METHODS: A survey, focus group and document analysis were applied to collect data from 16 educators, 128 students and eight administrators of a nursing education institution and accessing institutional documents. Data were analysed through descriptive statistics and deductive content analysis and packaging the outcome of the study according to the five elements related to the fidelity of implementation framework. RESULTS: The fidelity of implementing the CBNE programme was satisfactorily maintained as described in the fidelity of implementation framework. However, sequenced progression and programmatic assessments were not aligned with a CBNE programme within the context of the COVID-19 pandemic. PATIENT OR PUBLIC CONTRIBUTION: This paper proposes strategies to enhance the fidelity of implementing competency-based education during educational disruptions.

Parent resolution of diagnosis and intervention fidelity in a parent-delivered intervention for pre-school children with autism: A mixed methods study

Background: There is growing interest in parent-delivered interventions (PDI) for children with autism. Treatment fidelity has been associated with child outcomes in PDI but little is known about what impacts fidelity. One factor not previously examined is parents' resolution to the autism diagnosis which involves adjusting expectations about the child and sensitively responding to their cues, strengths and needs. Relatively little is known about resolution in the context of autism but there is evidence of an association between resolution and parent wellbeing. Method: The study adopted a mixed methods approach to examine whether there is an association between PDI fidelity and parent resolution to diagnosis, and whether resolution is associated with parent wellbeing. Parents of 31 preschool children diagnosed with autism who attended up to 12 Parent-delivered Early Start Denver Model (P-ESDM) coaching sessions participated in the study. A thematic analysis of parent interviews was also undertaken to identify themes raised by resolved and unresolved parents in interviews. Results: There was no difference in overall mean fidelity scores between resolved and unresolved parents. Those classified as resolved had lower depression scores and parenting stress scores than parents classified as unresolved. The qualitative analysis revealed that parents' perceptions of their child's progress and their hopes for the future appeared to distinguish resolved and unresolved parents. Conclusions: Findings suggest that parent wellbeing and child progress may predict resolution which was not related to parent treatment fidelity in this study. Parent wellbeing and resolution status should be assessed at entry to PDI.

Innovative use of a flipped-classroom approach to teach fundamental nursing skills.

Prelicensure nursing students are required to master fundamental nursing skills. The COVID-19 pandemic created challenges in maintaining excellence while teaching skill acquisition. The purpose of this study was to evaluate skill validation scores and student satisfaction and self-confidence using a flipped classroom approach and a low-fidelity simulation model to innovatively teach skill acquisition. Researchers used a quasi-experimental method to compare skill validation scores of a control group and intervention group using independent samples t-test. Researchers also evaluated whether prelicensure nursing students had satisfaction and self-confidence with this teaching strategy. Findings suggested that skills validations scores were no different using a flipped-classroom approach than in-person instruction. Prelicensure nursing students were satisfied and self-confident following the implementation of this teaching strategy. This teaching strategy has the potential to decrease in-person clinical practice time, provide alternative opportunities for clinical make-up and remediation, and decrease cost.

Development and Assessment of Innovative High-Fidelity Simulation Vaccination Course Integrating Emergency Cases for Pharmacy Undergraduates-A Randomized Controlled Study.

Recently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. In order to adapt the pharmacy curriculum for clinical practice, an innovative, vaccination training course using a high-fidelity simulator (HFS) was developed, implementing clinical scenarios to manage adverse events. In a randomized controlled trial using a pre and post design with pharmacy undergraduates, the intervention group interacted with an HFS, while the control group was trained with low-fidelity injection pads. Before and after the respective training, each participant went through an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire and knowledge quiz. Both training methods showed a significant increase in skills, but there was also a significant greater increase in the intervention group when compared to the control group, particularly with respect to the vaccination process. Furthermore, every individual in the intervention group improved from the pre- to post-training OSCEs. Therefore, HFS has been proven to be an appropriate tool to train pharmacy students for the purposes of vaccine administration and to prepare for future challenges. Particularly, recognizing and managing adverse reactions can be addressed in a very effective way.