Simulation training and professional self-confidence: A large-scale study of third year nursing students.

BACKGROUND: While hands-on training is a prerequisite for successful education of nursing students, constraints on clinical training availability and quality have increased focus on effects of in-school simulation training. However, existing research has produced inconsistent conclusions and the literature lacks high-powered evidence from controlled trials. OBJECTIVES: To test effects of a simulation scheme on student professional self-confidence in technical and non-technical skills, as well as to investigate effects on knowledge acquisition and interaction with clinical training. DESIGN: Field experiment, treatment is a three + two day simulation training scheme while control is a standard three hour simulation session. Self-confidence in a list of technical and non-technical skills is measured in three survey-rounds. Enriched with data on type of clinical training site and grade attainment. SETTING: University College Copenhagen Department of Nursing, all third year students in 2019. PARTICIPANTS: 352 in cohort, out of which 316 participated and 311 answered first survey round (163 in treatment, 148 in control). METHODS: Field experiment analyzed utilizing multivariate OLS regression analysis. RESULTS: Students who receive increased simulation training report markedly higher levels of professional self-confidence immediately after training. This effect is double the size for confidence in technical skills, compared to non-technical skills. The effects on self-confidence in technical skills persist at the end of the following semester for those that receive low intensity clinical training. Students who receive the treatment see a small (and statistically uncertain) relative increase in grade attainment in the semester of treatment, but this difference dissipates over time. CONCLUSIONS: Simulation training has substantial positive short-term effects for the professional self-confidence of nursing students and appears to have small positive effects on knowledge acquisition. Most of these effects are crowded out by other factors (notably intensive clinical training) over time but might have long-term positive effects for those that do not receive other intensive hands-on experiences. This is interpreted as an indication that simulation training can be used to compensate for uncertainties in providing sufficient training experiences outside of academic training.

Exposure to Static Magnetic and Electric Fields Treats Type 2 Diabetes.

Aberrant redox signaling underlies the pathophysiology of many chronic metabolic diseases, including type 2 diabetes (T2D). Methodologies aimed at rebalancing systemic redox homeostasis have had limited success. A noninvasive, sustained approach would enable the long-term control of redox signaling for the treatment of T2D. We report that static magnetic and electric fields (sBE) noninvasively modulate the systemic GSH-to-GSSG redox couple to promote a healthier systemic redox environment that is reducing. Strikingly, when applied to mouse models of T2D, sBE rapidly ameliorates insulin resistance and glucose intolerance in as few as 3 days with no observed adverse effects. Scavenging paramagnetic byproducts of oxygen metabolism with SOD2 in hepatic mitochondria fully abolishes these insulin sensitizing effects, demonstrating that mitochondrial superoxide mediates induction of these therapeutic changes. Our findings introduce a remarkable redox-modulating phenomenon that exploits endogenous electromagneto-receptive mechanisms for the noninvasive treatment of T2D, and potentially other redox-related diseases.

Different strokes for different folks: Examining additive and complimentary effects of the advisory working alliance and research team cohesion on trainees' research outcomes.

A primary task of scientific and scientist-practitioner training programs is to assist graduate students in acquiring research skills and, ultimately, developing research and scientific acumen. Informed by Gelso's (1979) model of effective research training environments (RTEs), we assessed the effect of the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity. With a sample of 76 counseling psychology doctoral trainees nested within 34 advisors, we examined the association between the advisory working alliance and research team cohesion and trainees' research self-efficacy and research activity. Next, we used polynomial regression and response surface analysis to test the additive and complementary effects between the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity. Univariate analyses indicated that the advisory working alliance and research team cohesion were positively associated with trainees' research self-efficacy and research activity. Moreover, polynomial regression models and response surface analyses indicated an additive effect between the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity, such that trainees' research self-efficacy and research activity were highest when the advisory working alliance and research team cohesion were consistent and high. Lastly, we found a complementary effect between the advisory working alliance and research team cohesion for trainees' research self-efficacy, meaning research self-efficacy was highest when students perceived either (a) high advisory working alliance and low research team cohesion or (b) low advisory working alliance and high research team cohesion. Training implications and future directions are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Making gender diversity work for scientific discovery and innovation.

Gender diversity has the potential to drive scientific discovery and innovation. Here, we distinguish three approaches to gender diversity: diversity in research teams, diversity in research methods and diversity in research questions. While gender diversity is commonly understood to refer only to the gender composition of research teams, fully realizing the potential of diversity for science and innovation also requires attention to the methods employed and questions raised in scientific knowledge-making. We provide a framework for understanding the best ways to support the three approaches to gender diversity across four interdependent domains - from research teams to the broader disciplines in which they are embedded to research organizations and ultimately to the different societies that shape them through specific gender norms and policies. Our analysis demonstrates that realizing the benefits of diversity for science requires careful management of these four interdependent domains.

Hypotheses and fundamental study design characteristics for evaluating potential reduced-risk tobacco products. Part I: Heuristic.

The risk-reducing effect of a potential reduced-risk tobacco product (PRRP) can be investigated conceptually in a long-term, prospective study of disease risks among cigarette smokers who switch to a PRRP and in appropriate comparison groups. Our objective was to provide guidance for establishing the fundamental design characteristics of a study intended to (1) determine if switching to a PRRP reduces the risk of lung cancer (LC) compared with continued cigarette smoking, and (2) compare, using a non-inferiority approach, the reduction in LC risk among smokers who switched to a PRRP to the reduction in risk among smokers who quit smoking entirely. Using standard statistical methods applied to published data on LC incidence after smoking cessation, we show that the sample size and duration required for a study designed to evaluate the potential for LC risk reduction for an already marketed PRRP, compared with continued smoking, varies depending on the LC risk-reducing effectiveness of the PRRP, from a 5-year study with 8000-30,000 subjects to a 15-year study with <5000 to 10,000 subjects. To assess non-inferiority to quitting, the required sample size tends to be about 10 times greater, again depending on the effectiveness of the PRRP.

Testing for additivity at select mixture groups of interest based on statistical equivalence testing methods.

Several assumptions, defined and undefined, are used in the toxicity assessment of chemical mixtures. In scientific practice mixture components in the low-dose region, particularly subthreshold doses, are often assumed to behave additively (i.e., zero interaction) based on heuristic arguments. This assumption has important implications in the practice of risk assessment, but has not been experimentally tested. We have developed methodology to test for additivity in the sense of Berenbaum (Advances in Cancer Research, 1981), based on the statistical equivalence testing literature where the null hypothesis of interaction is rejected for the alternative hypothesis of additivity when data support the claim. The implication of this approach is that conclusions of additivity are made with a false positive rate controlled by the experimenter. The claim of additivity is based on prespecified additivity margins, which are chosen using expert biological judgment such that small deviations from additivity, which are not considered to be biologically important, are not statistically significant. This approach is in contrast to the usual hypothesis-testing framework that assumes additivity in the null hypothesis and rejects when there is significant evidence of interaction. In this scenario, failure to reject may be due to lack of statistical power making the claim of additivity problematic. The proposed method is illustrated in a mixture of five organophosphorus pesticides that were experimentally evaluated alone and at relevant mixing ratios. Motor activity was assessed in adult male rats following acute exposure. Four low-dose mixture groups were evaluated. Evidence of additivity is found in three of the four low-dose mixture groups. The proposed method tests for additivity of the whole mixture and does not take into account subset interactions (e.g., synergistic, antagonistic) that may have occurred and cancelled each other out.

Titrating and evaluating multi-drug regimens within subjects.

The dosing of combination therapies is commonly undertaken empirically by practising physicians, and a coherent algorithm to approach the problem of combination dosing is currently lacking. Current methods of evaluating multiple drug combinations in clinical trials fail to provide information regarding the location of more effective doses when the combination is not found to differ from the standard, even though the absence of a difference does not necessarily mean the new combination is ineffective. Moreover, in studies where the new combination is found more effective, often a large proportion of the study participants obtain no benefit from the trial. Even with early stopping rules, the time these subjects spend on inferior treatments can have lasting detrimental effects, leading to problems with patient enrolment and adherence to study protocol. This paper describes an evolutionary operation (EVOP) direct-search procedure to titrate combination doses within individual patients. The Nelder-Mead simplex direct-search algorithm is used to titrate combinations of drugs within individual subjects. Desirability functions are utilized to define the main response of interest and additional responses or constraints. Statistical methodology for determining whether the titrated treatment combination has resulted in an improvement in subject response and for evaluating for therapeutic synergism is developed. Inferences can then be made about the efficacy of the combination or about the individual drugs that comprise the combination. The advantages of this approach include affording every patient the potential to benefit from the combination under study and permitting the consideration of multiple endpoints simultaneously.

Bioaerosol Exposure Method for Package Integrity Testing †.

Test organism motility, concentration, aerosol exposure time, hole diameter and length were evaluated to determine their influence on microbial ingress into a flexible plastic pouch. Microtubes with 10- and 20-µm hole diameters and of 5- and 10-mm lengths were used as defects in 128 flexible pouches. A bioaerosol with a 2.68-µm mean particle size comprised of 102 or 106 CFU/ml source concentrations of motile or nonmotile Pseudomonas fragi TM 849 was introduced into a 119,911-cm3 chamber for exposures of 15 or 30 minutes. Six pouches showed test organism growth after a 72-h incubation period. Microbial ingress was significant (P < .05) for motile test organisms with source concentrations of 106 CFU/ml.

Contamination of Flexible Pouches Challenged by Immersion Biotesting †.

Immersion biotesting has long been used to challenge packages, particularly cans, for pinholes and channel leaks. Such testing for all types of plastic packaging may not be appropriate because some packages (e.g., aseptic, hot fill) are not exposed to water. As the food-packaging industry develops alternative environmental biotests there is a need to benchmark them against traditional immersion testing. The purpose of this research was to examine the threshold of critical-defect dimensions using artifically created channel leaks of 10 and 20 µm and 5- and 10-mm lengths sealed into plastic pouches which were subsequently tested by immersion at 102 and 106 CFU of motile and nonmotile Pseudomonas fragi TM849 per ml. Forty-four percent (44%) of the pouches tested became contaminated, indicating the threshold defect value is below 10 µm. Microbial ingress was significant (P < .05) for motile test organisms with a concentration of 106 CFU/ml. The interaction of concentration and time was also significant at 102 CFU/ml at 30 min exposure and 106 CFU/ml at 15 min. Channel length was not statistically significant. The markedly greater contamination rate using immersion testing versus that of aerosol testing highlights the importance of using test methods that reflect environmental exposure conditions of the packages.

Dietary fat manipulation (Omega-3 vs Omega-6 fatty acids) on inmune function and septic survival in a model of consecutive hemorrhage / Manejo dietético de grasas (Omega-3 vs Omega-6 de ácidos grasos) en la función inmune y supervivencia septica en un modelo de hemorragia consecutiva

Following hemorrhagic shock, severe deragements of hemodynamic and inmune responses occur wich may lead to increased mortality and infectious complications. We utilized a murine model of hemorrhagic shock, and tested the effects of pre-feeding animals for 7 days with 3 different diets. Two consecutive acute hemorrhages were induced by cutting the tail under light anesthesia 30 min apart, with each bleeding depleting the animal of approximately 20// of the blood volume. At 24 hrs after hemorrhage, a period of maximal immunosuppresionand susceptibility to srpsis, animals underwent septic challenge, using cecal ligation. Pre-feeding the animals with a defined diet which contains high protein, arginine, nucleic acids, and structured lipids including fish oil (ImpactTM) improved survival after subsequent abdominal sepsis, compared to animals receiving standard rodent chow does not contain supplemental arginine, nucleic acids or structured lipids (TraumacalTM). Although special diets may improve survival in the face of subsequent septic challenge, the mechanisms involved are not clear, and factors other than immune simulation may account for this effect