Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study.

BACKGROUND: In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue. OBJECTIVE: The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning. METHODS: An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews. RESULTS: This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education. CONCLUSIONS: To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition. TRIAL REGISTRATION: ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663.

A Microlearning-Based Self-directed Learning Chatbot on Medication Administration for New Nurses: A Feasibility Study.

New nurses must acquire accurate knowledge of medication administration, as it directly affects patient safety. This study aimed to develop a microlearning-based self-directed learning chatbot on medication administration for novice nurses. Furthermore, the study had the objective of evaluating the chatbot feasibility. The chatbot covered two main topics: medication administration processes and drug-specific management, along with 21 subtopics. Fifty-eight newly hired nurses on standby were asked to use the chatbot over a 2-week period. Moreover, we evaluated the chatbot's feasibility through a survey that gauged changes in their confidence in medication administration knowledge, intrinsic learning motivation, satisfaction with the chatbot's learning content, and usability. After using the chatbot, participants' confidence in medication administration knowledge significantly improved in all topics (P < .001) except "Understanding a concept of 5Right" (P = .077). Their intrinsic learning motivation, satisfaction with the learning content, and usability scored above 5 out of 7 in all subdomains, except for pressure/tension (mean, 2.12; median, 1.90). They scored highest on ease of learning (mean, 6.69; median, 7.00). A microlearning-based chatbot can help new nurses improve their knowledge of medication administration through self-directed learning.

Nox4-SH3YL1 complex is involved in diabetic nephropathy.

Nox4-derived H2O2 generation plays an important role in the pathogenesis of chronic kidney diseases (CKDs) such as diabetic nephropathy (DN). Here, we showed that SH3 domain-containing Ysc84-like 1 (SH3YL1), a Nox4 cytosolic activator, regulated DN. Streptozotocin (STZ)-induced type Ⅰ diabetic models in SH3YL1 whole-body knockout (KO) mice and podocyte-specific SH3YL1 conditional KO (Nphs2-Cre/SH3YL1fl/fl) mice were established to investigate the function of SH3YL1 in DN. The expression of fibrosis markers and inflammatory cytokines, the generation of oxidative stress, and the loss of podocytes were suppressed in diabetic SH3YL1 KO and Nphs2-Cre/SH3YL1fl/fl mice, compared to diabetic control mice. To extrapolate the observations derived from diabetic mice to clinical implication, we measured the protein level of SH3YL1 in patients DN. In fact, the SH3YL1 level was increased in patients DN. Overall, the SH3YL1-Nox4 complex was identified to play an important role in renal inflammation and fibrosis, resulting in the development of DN.

Recovery of dopaminergic amacrine cells after strobe light stimulation in the developing rat retina.

Concerns regarding the impact of strobe light on human health and life have recently been raised. Sources of strobe light include visual display terminals, light-emitting diodes, and computer monitors. Strobe light exposure leads to visual discomfort, headaches, and poor visual performance and affects the number of dopaminergic amacrine cells (DACs) in the developing retina, as well as retinal dopamine levels in animals. DACs serve as the sole source of retinal dopamine, and dopamine release from the retina is activated by light exposure following a circadian rhythm. Using a Sprague-Dawley rat model, this study sought to determine whether changes in DACs caused by strobe light are recoverable after ceasing strobe light exposure during retinal development. From eye opening (postnatal 2 weeks), rats in the control group were reared under normal light (an unflickering 150 lux incandescent lamp with a 12 h light/dark cycle), whereas those in the experimental group (i.e., strobe-recovery group) were reared under strobe light (2 Hz for 12 h/day) exposure for 2 weeks. After postnatal week 4, normal light was provided to all animals to observe the reversibility of the effect of strobe light. Immunohistochemistry and immunoblot analysis for the rate limiting enzyme for dopamine synthesis, tyrosine hydroxylase (TH), as well as high-pressure liquid chromatography for measuring dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) were performed at postnatal weeks 4, 6, 8, and 10. The number of type I and type II TH-immunoreactive (TH-IR) cells across the entire retina was counted to evaluate whether changes in DACs induced by strobe light could recover after ceasing strobe light exposure. The number of type I TH-IR cells slightly decreased but remained at a constant level in the control group. In contrast, the number of type I TH-IR cells rapidly decreased up to postnatal week 6, but then increased after postnatal week 8 in the strobe-recovery group. Subsequently, the number of type I TH-IR cells eventually reached a number similar to that in the control group. In addition, the number of intermediate-sized TH-IR cells were increased at postnatal weeks 8 and 10 and the dopamine level was decreased at postnatal week 8 in the strobe-recovery group. However, the levels of DOPAC and TH proteins did not differ between the two groups. This suggests that changes in DACs caused by strobe light are reversible and that type II TH-IR cells may play a key role in this recovery.

Molecular interactions between Tbx3 and Bmp4 and a model for dorsoventral positioning of mammary gland development.

The formation of the dorsoventral (DV) boundary is central to establishing the body plan in embryonic development. Although there is some information about how limbs are positioned along the DV axis and how DV skin color pattern is determined, the way in which mammary glands are positioned is unknown. Here we focus on Bmp4 and Tbx3, a gene associated with ulnar-mammary syndrome, and compare their expression along the DV axis in relation to mammary gland initiation in mouse embryos. Tbx3 is expressed in the mammary gland-forming region with Tbx15, a gene involved in a DV coat color being expressed more dorsally and Bmp4 being expressed more ventrally. When Tbx3 was overexpressed, formation of mammary gland epithelium was extended along the DV axis. In contrast, overexpression of Bmp4 inhibited both Tbx3 and Tbx15 expression. In addition, when BMP signaling was inhibited by NOGGIN, Lef1 expression was lost. Thus, we propose that mutual interactions between Bmp4 and Tbx3 determine the presumptive DV boundary and formation of mammary glands in early mouse embryogenesis. 1,19-Dioctadecyl-3,3,39,39-tetramethyl indocarbocyanine perchloride labeling experiments showed that cells associated with mammary glands originate more dorsally and then move ventrally. This finding, together with previous findings, suggests that the same DV boundary may not only position limbs and determine coat color but also position mammary glands. Furthermore, Bmp signaling appears to be a fundamental feature of DV patterning.

Characteristic tissue interaction of the diastema region in mice.

Rodents have a toothless diastema between the incisor and the first molar, which may contain rudimentary tooth germs. In the lower diastema region of mice at E13, the rudimentary tooth germs, which developed into the bud stage before its removal by apoptosis, was found. The immunoreactivity to tenascin was observed in the condensed mesenchyme around the normal tooth bud and was detected in only the basement membrane in the diastema bud. This result shows that the relationship between mesenchymal condensation and tooth development. The similar patterns of Msx-1 and Msx-2 expression between the tooth bud and the diastema bud show that the diastema bud may have some other genetic mechanism in the developmental arrest of the rudimentary tooth germs rather than the Msx-1 and Msx-2 expression. Strikingly, the induction of the tooth formation was possible using tissue recombination between the oral epithelium of the diastema bud and the dental mesenchyme of the molar tooth bud, which indicates the potential capability of the diastema in the tooth formation. In conclusion, it is suggested that the condensed mesenchyme may be the key to tooth development.

Interactions between FGF and Wnt signals and Tbx3 gene expression in mammary gland initiation in mouse embryos.

Interactions between Wnts, Fgfs and Tbx genes are involved in limb initiation and the same gene families have been implicated in mammary gland development. Here we explore how these genes act together in mammary gland initiation. We compared expression of Tbx3, the gene associated with the human condition ulnar-mammary syndrome, expression of the gene encoding the dual-specificity MAPK phosphatase Pyst1/MKP3, which is an early response to FGFR1 signalling (as judged by sensitivity to the SU5402 inhibitor), and expression of Lef1, encoding a transcription factor mediating Wnt signalling and the earliest gene so far known to be expressed in mammary gland development. We found that Tbx3 is expressed earlier than Lef1 and that Pyst1 is also expressed early but only transiently. Patterns of expression of Tbx3, Pyst1 and Lef1 in different glands suggest that the order of mammary gland initiation is 3, 4, 1, 2 and 5. Consistent with expression of Pyst1 in the mammary gland, we detected expression of Fgfr1b, Fgf8 and Fgf9 in both surface ectoderm and mammary bud epithelium, and Fgf4 and Fgf17 in mammary bud epithelium. Beads soaked in FGF-8 applied to the flank of mouse embryos, at a stage just prior to mammary bud initiation, induce expression of Pyst1 and Lef1 and maintain Tbx3 expression in flank tissue surrounding the bead. Grafting beads soaked in the FGFR1 inhibitor, SU5402, abolishes Tbx3, Pyst1 and Lef1 expression, supporting the idea that FGFR1 signalling is required for early mammary gland initiation. We also showed that blocking Wnt signalling abolishes Tbx3 expression but not Pyst1 expression. These data, taken together with previous findings, suggest a model in which Tbx3 expression is induced and maintained in early gland initiation by both Wnt and Fgf signalling through FGFR1.

Lineage of non-cranial neural crest cell in the dental mesenchyme: using a lacZ reporter gene during early tooth development.

The tooth is one of the ectodermal organs controlled by reciprocal interactions between the epithelium and the mesenchyme. Mesenchymal cells in the developing tooth, so-called dental mesenchymal cells, are derived from two different origins: the cranial neural crest (CNC) and the non-CNC. These CNC-derived cells migrate, proliferate and differentiate into odontoblasts, cementoblasts, fibroblasts, osteoblasts and chondroblasts. Tooth germs of wild-type mice were transplanted into the kidney of adult lacZ-transgenic mice. After 1 week of transplantation, a few lacZ-expressing cells and many red blood cells were found near or inside the blood vessels in the pulp of wild-type tooth germs. This result shows that circulating cells of the adult host could invade the dental pulp during tooth development, through the blood vessels, and be a part of dental pulp tissue. Therefore, it can be suggested that these circulating progenitor cells could be the origin of non-CNC-derived cells in tooth germ and their migration pathways would be the blood vessels invading the dental pulp during tooth development. If variations of this experiment were suitably adjusted, such as the embryonic stage of the tooth germ, duration of transplantation, etc., this transplantation experiment using adult lacZ-transgenic mice could be a good system to reveal the origin and migration pathway of cells in developing organs as well as in dental mesenchymal cells.