Age-Related Performance in Using a Fully Immersive and Automated Virtual Reality System to Assess Cognitive Function.

Introduction: Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language). Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment (MoCA) has limitations and is influenced by age. Virtual reality (VR) is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system (Cognitive Assessment using Virtual Reality, CAVIRE) has been developed to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system. Aims: This is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system. Methods: Conducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: (1) 35-44; (2) 45-54; (3) 55-64, and (4) 65-74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test (p < 0.05). Results: One participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains (all p < 0.05). Conclusion: The CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices.

A good day in nursing: views of recent Singaporean graduates.

This paper arises from the analysis of data from a large Singapore-based survey and a complementary qualitative series of 17 individual interviews. Some results from both arms of the research have been previously analysed and are reported elsewhere. Answers to a series of questions within the questionnaire and the structured interviews have been drawn together under the umbrella of investigating of recent Singaporean graduates' views about the characteristics of a good nurse, a good day at work, and how they uphold ethical standards. Overall five themes emerged, these are: caring for others; respectful interpersonal interaction; rational clinical decision-making; the harsh reality of the workplace; and personal qualities (not easily influenced by formal education). Interviewees believed that potential nursing students should be made aware of the harsh realities they will face on graduation, which may seem counter-intuitive. However, graduates recalled their own struggles and perseverance and toughness to simply survive the early months as a key component of transition shock, indicating that an earlier awareness may be beneficial.

Recent graduate nurse views of nursing, work and leadership.

AIMS AND OBJECTIVES: To assess recent nurse graduates of a large university and seeks their views of university preparation, requisite nursing skills and qualities, workplace transition, supports received, nurse leadership and role models, and career development and retention. BACKGROUND: Concern about attracting and retaining registered nurses is a continuing workforce issue in parts of Asia and throughout the world. DESIGN: Qualitative interviews with recent nursing graduates. METHODS: Seventeen face-to-face interviews took place using a structured schedule of 23 questions. Data were coded and analysed by hand to determine clusters of interest and develop themes. RESULTS: Four broad topics emerged: (1) skills and qualities graduates consider central to nursing; (2) the support they received during the transition from graduate to novice practitioner and that which continues; (3) elements they value in nursing role models and leaders; and (4) the ward characteristics that will encourage them to remain in nursing and develop a career. Interviewees expressed concerns about retention-related issues, making suggestions for improvements. Unique findings focus on the blaming culture that many respondents consider they are working in, and the system whereby they are not free to access postgraduate studies until a specific time frame has elapsed, and when they do pursue further studies, they are bonded to the auspicing hospital/health service. CONCLUSIONS: Responses unique to this research are the explicit concerns about a blaming culture, and complaints about rigid rules (bonding system) that virtually prevent an individual from accessing postgraduate studies independent of the hospital system. Interviewees strongly resent the bonding system that indentures them to that place of work. RELEVANCE TO CLINICAL PRACTICE: Quality health care is dependent on a well-educated, sustainable and skilled nursing workforce. Recognition of the concerns of newly graduated nurses in relation to nursing skill acquisition, workplace support issues and career concerns can assist in ensuring these issues are adequately addressed and in turn contribute to a stronger, more stable and competent nursing workforce.

Career development: graduate nurse views.

AIMS AND OBJECTIVES: To explore recent Singapore nursing graduates' experience of and views about their career development and progress. BACKGROUND: The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities. DESIGN: Survey of recent nursing graduates. METHODS: Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved. RESULTS: Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education. CONCLUSIONS: Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education. RELEVANCE TO CLINICAL PRACTICE: Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career.

Endogenous hydrogen sulfide insufficiency as a predictor of sexual dysfunction in aging rats.

OBJECTIVE: Our earlier studies showed that endogenous hydrogen sulfide (H(2)S) pathway contributed significantly to erectile function. In this study, we tested the hypothesis that age-dependent changes in the bioavailability of H(2)S increased the risk of erectile dysfunction (ED). METHODS: Young, adult (3-month) and older (18-month) male Sprague-Dawley rats (n = 6-8/group) were treated daily with sodium hydrosulfide hydrate (NaHS), DL-propargylglycine, sildenafil or l-NAME for 10 weeks. Subsequent to cavernous nerve electrical stimulation, intracavernosal pressure (ICP) responses were determined, and the samples were collected and processed for hormonal (plasma) and gaseous parameters (plasma and erectile corpus cavernosum [CC]) using standard assay protocols. RESULTS: Aging significantly reduced the ICP response (35.9 ± 2.0 mmHg vs. 45.2 ± 1.9 mmHg in young controls), which was countered by NaHS (53.5 ± 6.0) or sildenafil (52.8 ± 9.8) treatment. In these rats, marked increments to testosterone (T) or estradiol resulted from NaHS supplementation. Similar to age-dependent decline in NO, the plasma and CC level of H(2)S was significantly lower in senescent rats when compared with young animals (p < 0.05). CONCLUSION: Our results confirm that ED with aging may be linked to a derangement in the H(2)S pathway accompanied by low T levels. It is likely that a pharmacologic intervention delivering H(2)S will provide additional benefits to sexual function from an improved T milieu.