Uncertainty in surrogate decision-making about end-of-life care for people with dementia: An integrative review.

AIM: To describe uncertainty in surrogate decision-making regarding end-of-life care for people with dementia using Mishel's reconceptualized uncertainty in illness theory. DESIGN: Integrative literature review using Whittemore and Knafl's approach. DATA SOURCES: PubMed, CINAHL, EMBASE, Scopus and Web of Science were searched using terms such as uncertainty/unpredictability, decision-making/advance care planning/end-of-life care planning, surrogate/family/caregiver/proxy and dementia. The search was initially conducted on 28 September 2021 and updated on 31 July 2023. REVIEW METHODS: Through systematic screening, 20 research articles were included in the analysis. Content related to uncertainty in surrogate decision-making regarding end-of-life care was extracted and analysed, focusing on the reconceptualized uncertainty in illness theory. RESULTS: First, surrogate uncertainty exists in various areas of surrogate decision-making regarding end-of-life care. Second, antecedents of surrogate uncertainty include numerous intrinsic and extrinsic factors. Third, surrogates exhibited some negative psychological responses to uncertainty but continually processed and structured their uncertainty through certain approaches, leading them to grow as decision-makers. Finally, research-based evidence on surrogates' processing of uncertainty and shifts to new life perspectives remains limited. CONCLUSION: Surrogates' uncertainty in decision-making regarding end-of-life care for people with dementia is well characterized using the reconceptualized uncertainty in illness theory. Healthcare providers should help surrogates manage their uncertainty in surrogate decision-making more constructively throughout the dementia trajectory. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings highlight the importance of assessing how surrogates process uncertainty and gauging how to help them process uncertainty and transition to new life perspectives. IMPACT: This review contributes to healthcare professionals' understanding of surrogates' uncertainty in end-of-life care planning for people with dementia, especially what they are uncertain about, what influences their uncertainty and how they process it. REPORTING METHOD: This study adheres to the PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Development of Pollen Parent Cultivar-Specific SCAR Markers and a Multiplex SCAR-PCR System for Discrimination between Pollen Parent and Seed Parent in Citrus.

This study discusses the challenge of distinguishing between two high-quality mandarin cultivars, 'Asumi' and 'Asuki', which have been introduced and cultivated in Korea after being developed through crossbreeding in Japan. Owing to genetic similarities resulting from crossbreeding between the same parent cultivars, it is challenging to differentiate them morphologically at the seedling stage. This difficulty poses challenges for cultivation and harvesting on farms. To address this issue, we developed a method using sequence characteristic amplification region (SCAR) markers for rapid and accurate differentiation between the two cultivars. We selected specific primer sets from random amplified polymorphic DNA-SCAR combinations and sequence-related amplified polymorphism contrast markers. The multiplex PCR system using these molecular markers was able to identify 16 mandarin cultivars, including 'Asumi' and 'Asuki', among 30 cultivars. The use of these SCAR markers is expected to enhance citrus cultivation by accurately identifying mixed cultivars and facilitating proper harvest timing for citrus distribution. Additionally, the markers can help identify the genetic traits of hybrid varieties at the seedling stage.

Antiadipogenic Effect of Citrus Flavonoids: Evidence from RNA Sequencing Analysis and Activation of AMPK in 3T3-L1 Adipocytes.

Citrus fruits are rich in dietary flavonoids and have many health benefits, but their antiadipogenic mechanism of action and their impact on lipid metabolism remain unclear. In this study, we investigated the effect of citrus flavonoids, namely, hesperidin (HES), narirutin (NAR), nobiletin (NOB), sinensetin (SIN), and tangeretin (TAN), on preventing fat cell development by gene expression in 3T3-L1 adipocytes. Among the citrus flavonoids tested, HES and NAR significantly reduced fat storage and triglyceride levels and increased glucose uptake in 3T3-L1 adipocytes. Additionally, HES and NAR treatment increased the phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) while reducing the protein expression of 3-hydroxy-3-methylglutaryl CoA reductase (HMGCR). Furthermore, in silico docking revealed that flavonoids activate AMPK. RNA sequencing analysis demonstrated that citrus flavonoids normalized the expression of 40 genes, which were either upregulated by more than 2-fold or downregulated by less than 0.6-fold including Acadv1, Acly, Akr1d1, Awat1, Cyp27a1, Decr1, Dhrs4, Elovl3, Fasn, G6pc, Gba, Hmgcs1, Mogat2, Lrp5, Sptlc3, and Snca to levels comparable to the control group. Altogether, HES and NAR among five citrus flavonoids showed antiadipogenic effects by regulating the expression of specific lipid metabolism genes partially restored to control levels in 3T3-L1 cells.

Comparative Analysis of Physicochemical Properties and Storability of a New Citrus Variety, Yellowball, and Its Parent.

Although numerous citrus varieties have recently been developed to enhance their quality, information on their quality characteristics is limited. We assessed the quality characteristics of Yellowball, a novel citrus variety, by evaluating its appearance, storability, sensory properties, functionality, and metabolite profiles and then comparing these characteristics with those of its parent varieties, Haruka and Kiyomi. The metabolite profiles between the citrus varieties differed significantly, resulting in distinct physicochemical and functional qualities. The storability of Yellowball was significantly increased compared with that of its parent varieties owing to its strong antifungal activity and unique peel morphology, including the stoma and albedo layers. While we did not investigate the volatile compounds, overall functional activities, and detailed characteristics of each metabolite, our data provide valuable insights into the relationship between citrus metabolites, peel morphology, physicochemical properties, and storability, and demonstrate the potential of Yellowball as a promising variety in the citrus industry.

The Anatomical Differences and Physiological Responses of Sunburned Satsuma Mandarin (Citrus unshiu Marc.) Fruits.

Sunburn causes fruit browning and other physiological symptoms, reducing fruit production and quality. Therefore, we aimed to investigate the anatomical differences and abiotic stress responses in 'Nichinan 1 gou' satsuma mandarin (Citrus unshiu Marc.) according to the severity of sunburn damage (five grades: control, no sunburn; I to IV, increasing severity of sunburn). Additionally, the quality of sunburned and non-sunburned fruits was compared, and the sunburn-inducing temperature was estimated. Anatomical observations confirmed that with increased severity of symptoms, the damage to fruit rind surface and oil glands was increased. In the analysis of peel pigments, chlorophyll content in the rind gradually decreased compared with IV, whereas the carotenoid content gradually increased up to III. The flavonoid content in the peel and pulp was the highest in III. In the 1,1-diphenyl-2-picrylhydrazyl and 2,2'-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) radical analyses, the IC50 (the concentration of compound at which the percentage of inhibition is 50%) value was the lowest in grade III in peel or IV in pulp, indicating a high free radical scavenging ability. The fruit quality analysis between sunburned and non-sunburned fruits showed differences in total soluble solid content, total acidity, firmness, coloration, and free sugar and organic acid contents, indicating a significant effect on fruit quality. In the heat tolerance tests on fruit rind in the laboratory and field, the damage was confirmed at temperatures above 47 °C.

Metabolomic Profiling of Citrus unshiu during Different Stages of Fruit Development.

Citrus fruits undergo significant metabolic profile changes during their development process. However, limited information is available on the changes in the metabolites of Citrus unshiu during fruit development. Here, we analyzed the total phenolic content (TPC), total carotenoid content (TCC), antioxidant activity, and metabolite profiles in C. unshiu fruit flesh during different stages of fruit development and evaluated their correlations. The TPC and antioxidant activity significantly decreased during fruit development, whereas the TCC increased. The metabolite profiles, including sugars, acidic compounds, amino acids, flavonoids, limonoids, carotenoids, and volatile compounds (mono- and sesquiterpenes), in C. unshiu fruit flesh also changed significantly, and a citrus metabolomic pathway related to fruit development was proposed. Based on the data, C. unshiu fruit development was classified into three groups: Group 1 (Aug. 1), Group 2 (Aug. 31 and Sep. 14), and Group 3 (Oct. 15 and Nov. 16). Although citrus peel was not analyzed and the sensory and functional qualities during fruit development were not investigated, the results of this study will help in our understanding of the changes in chemical profile during citrus fruit development. This can provide vital information for various applications in the C. unshiu industry.

Effects of Social Networking Service (SNS) Addiction on Mental Health Status in Chinese University Students: Structural Equation Modeling Approach Using a Cross-sectional Online Survey.

BACKGROUND: Although social networking services (SNSs) have become popular among young people, problematic SNS use has also increased. However, little is known about SNS addiction and its association with SNS use patterns and mental health status. OBJECTIVE: This study aims to test the mediating role of SNS addiction between SNS use patterns and mental health status among Chinese university students in Hong Kong (HK). METHODS: An online cross-sectional survey was conducted using a convenience sampling method. In total, 533 university students (323 [66.9%] female, mean age [SD]=20.87 [2.68] years) were recruited from February to March 2019. Multiple linear regression was used to assess the association between SNS use and SNS addiction. Structural equation modeling (SEM) was performed to examine the pathways and associations among SNS use, SNS addiction, psychosocial status, and mental health status (including anxiety and depressive symptoms). RESULTS: A longer time spent on SNSs per day (>3 h), a longer time spent on each SNS access (≥31 min), a higher frequency of SNS access (≤every 30 min), a longer duration of SNS use before sleeping (≥61 min), and a shorter duration from waking to first SNS use (≤5 min) were significantly associated with a higher level of SNS addiction (adjusted beta [aß]=6.03, 95% CI 4.66-7.40; aß=4.99, 95% CI 3.14-6.83; aß=5.89, 95% CI 4.14-7.64; aß=5.92, 95% CI 4.19-7.65; and aß=3.27, 95% CI 1.73-4.82, respectively). SEM showed a significant mediating effect of SNS addiction in the relationship between SNS use and psychosocial status, and mental health status, including an indirect effect (ß=0.63, 95% CI 0.37-0.93) and the total effect (ß=0.44, 95% CI 0.19-0.72), while the direct effect was insignificant (ß=-0.19, 95% CI -0.49 to 0.08). CONCLUSIONS: SNS use patterns were associated with SNS addiction, and SNS addiction mediated the associations between SNS use, psychosocial status, and mental health status of Chinese university students in HK. The findings suggest that screening for and addressing excessive SNS use are needed to prevent SNS addiction and mental distress among young people.

Comparative Metabolomics Analysis of Citrus Varieties.

Many citrus varieties are hybridized to improve their quality and to overcome the effects of climate change. However, there is limited information on the effect of the chemical profiles of hybrid varieties on their quality. In this study, we analyzed 10 citrus varieties and evaluated the correlation with their general characteristics and antioxidant activities. Chemical profiles, including the contents of sugars, organic acid compounds, flavonoids, limonoids, and carotenoids, which are related to taste, color, and health benefits, were significantly different depending on the citrus varieties, leading to different antioxidant capacities and general quality parameters. Based on these data, the correlations were investigated, and 10 citrus varieties were clustered into four groups-Changshou kumquat and Jeramon (cluster I); Setoka (cluster II-1); Natsumi, Satsuma mandarin, and Navel orange (cluster II-2); Kanpei, Tamnaneunbong, Saybyeolbong, and Shiranui (cluster II-3). Moreover, a metabolomic pathway was proposed. Although citrus peels were not analyzed and the sensory and functional qualities of the citrus varieties were not investigated in this study, our results are useful to better understand the relationship between citrus quality and metabolite profiles, which can provide basic information for the development and improvement of new citrus varieties.

Operating Room Nurses Want Differentiated Education for Perioperative Competencies-Based on the Clinical Ladder.

Operating room (OR) nurses' perioperative competence is vital in operation and patient care. This cross-sectional descriptive study aimed to identify perioperative competencies and educational needs for improving competencies according to the clinical ladder. A total of 318 OR nurses in Korean tertiary hospitals were recruited. Data from the self-reported questionnaire of perioperative competencies, measured on a five-point Likert scale, were used. The average score of perioperative competence was 3.78 ± 0.54; among the sub-categories of competencies were collaboration (4.08 ± 0.55), foundational knowledge and skills (3.98 ± 0.56), proficiency (3.87 ± 0.64), empathy (3.77 ± 0.77), professional development (3.65 ± 0.64), and leadership (3.34 ± 0.89). There were significant differences in perioperative competencies according to the clinical ladder as follows: foundational knowledge and skills (p < 0.001), leadership (p < 0.001), collaboration (p = 0.017), proficiency (p < 0.001), and professional development (p < 0.001). The educational needs for foundational knowledge and skills (4.43 ± 0.60) were highest, and educational needs for proficiency (4.26 ± 0.70), collaboration (4.21 ± 0.77), leadership (4.08 ± 0.81), empathy (3.99 ± 0.91), and professional development (3.91 ± 0.76) were noted. The educational needs for improving perioperative competencies by clinical ladder showed a significant difference in leadership (p = 0.026), proficiency (p = 0.045), and professional development (p = 0.002). In order to develop an effective education program for OR nurses, differentiated education designs that reflect perioperative competencies and educational needs per clinical ladder are necessary.

In Vitro and In Vivo Effects of Nobiletin on DRG Neurite Elongation and Axon Growth after Sciatic Nerve Injury.

Sciatic nerve injury (SNI) leads to sensory and motor dysfunctions. Nobiletin is a major component of polymethoxylated flavonoid extracted from citrus fruits. The role of nobiletin on sciatic nerve regeneration is still unclear. Thus, the purpose of this study was to investigate whether nobiletin increases DRG neurite elongation and regeneration-related protein expression after SNI. Cytotoxicity of nobiletin was measured in a concentration-dependent manner using the MTT assay. For an in vitro primary cell culture, the sciatic nerve on the middle thigh was crushed by holding twice with forceps. Dorsal root ganglion (DRG) and Schwann cells were cultured 3 days after SNI and harvested 36 h later and 3 days later, respectively. In order to evaluate specific regeneration-related markers and axon growth in the injured sciatic nerve, we applied immunofluorescence staining and Western blot techniques. Nobiletin increased cell viability in human neuroblastoma cells and inhibited cytotoxicity induced by exposure to H2O2. Mean neurite length of DRG neurons was significantly increased in the nobiletin group at a dose of 50 and 100 µM compared to those at other concentrations. GAP-43, a specific marker for axonal regeneration, was enhanced in injury preconditioned Schwann cells with nobiletin treatment and nobiletin significantly upregulated it in injured sciatic nerve at only 3 days post crush (dpc). In addition, nobiletin dramatically facilitated axonal regrowth via activation of the BDNF-ERK1/2 and AKT pathways. These results should provide evidence to distinguish more accurately the biochemical mechanisms regarding nobiletin-activated sciatic nerve regeneration.

Influence of Excessively High Temperatures on the Fruit Growth and Physicochemical Properties of Shiranuhi Mandarin in Plastic-Film Greenhouse Cultivation.

Excessively high temperatures frequently occur between spring and late fall because of global warming. These problems have a negative effect on fruit production capacity and actual production. However, there is a lack of information on the effects of excessively high temperatures (exceeding the optimum range) on the growth of citrus fruits. Thus, the objective of this present study was to determine the effects of excessively high temperatures on Shiranuhi mandarin fruit growth, physiological characteristics, amino acid contents, and antioxidant activity. In this study, five different high-temperature treatments were applied: normal atmospheric temperature (Con), Con + 4 °C during the day (D4), Con + 8 °C during the day (D8), Con + 4 °C during the night (N4), and Con + 4 °C during the day and night (DN4). The total soluble sugar contents were lowest in D8, and the acid content under DN4 was significantly lower than that under Con. Rising temperature during the day or night affected the colouration of the rind, and the free sugar composition ratio under D8 was lower than those under the other treatments. The total amino acid content tended to increase with increasing temperature during the day. The total flavonoid and total phenolic contents in the peel were significantly higher under Con and N4 than the other treatments and in the pulp under Con.

Characteristics of Advance Care Planning Interventions Across Dementia Stages: A Systematic Review.

PURPOSE: Little is known regarding how advance care planning (ACP) interventions change with the progression of dementia. Thus, the primary purpose of this systematic review is to compare characteristics of ACP interventions across dementia stages. We also identify the role of nurses in implementing ACP interventions for persons with dementia and their surrogates. DESIGN: A systematic review of ACP intervention studies. METHODS: After searching PubMed, Web of Science, EMBASE, PsycArticles, the Cumulative Index to Nursing and Allied Health Literture (CINAHL), and Scopus, the final sample included 11 studies representing 10 interventions. We conducted a quality assessment and extracted data on dementia stage, intervention characteristics, and the role of nurses in the intervention. The extracted data were categorized according to stages of dementia, and analyzed to identify commonalities and differences between intervention characteristics. FINDINGS: Three ACP interventions focused on mild dementia and seven on advanced dementia. We observed four primary findings. First, we found a major difference in intervention recipients between the two dementia stages. Second, most ACP interventions included structured discussions regarding the person's life goals and values, goals of care, and preferences concerning future care via individual, face-to-face interactions. Third, ACP interventions designed to promote ongoing discussions and documentation were lacking. Finally, nurses played important roles in implementing ACP interventions. CONCLUSIONS: The findings suggest more nurse-led, dementia-related ACP interventions. In addition, ACP interventions should promote ongoing discussions and documentation and target persons with dementia and their surrogates in various countries. CLINICAL RELEVANCE: Many persons with dementia and their surrogates have limited knowledge about ACP; thus, more nurse-led ACP programs that reflect dementia stages may help them prepare for the situations in which persons with dementia lack decision-making capacity.

Pedagogical foundations of cybercivility in health professions education: a scoping review.

BACKGROUND: Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks (hereafter "tools") provide useful foundations for integrating new knowledge and skills into existing professional practice and education. We conducted this scoping review to identify tools used for teaching cybercivility in health professions education. METHODS: Using Arksey and O'Malley's scoping review framework, we searched six biomedical and educational databases and three grey literature databases for articles available in English published between January 1, 2000 and March 31, 2020. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we screened and extracted relevant data, and reported the results of the search. RESULTS: The search resulted in 2272 articles, with 8 articles included in this review after inclusion criteria were applied. Four articles (50%) were peer-reviewed journal papers while the other 4 (50%) were dissertations. Eleven unique tools were identified by this review: (1) Transpersonal Caring Theory, (2) Theory of Workplace Incivility, (3) Conceptualization of Incivility, (4) Media Ecology Theory, (5) Principlism, (6) Salmon's Five Stage Model of Online Learning, (7) Learner-Centered Educational Theory, (8) Gallant and Drinan's 4-Stage Model of Institutionalization of Academic Integrity, (9) Theory of Planned Behavior, (10) Communication Privacy Management Theory, and (11) Moral Development Theory. Based on the tools analyzed in our scoping review, we determined three features of cybercivility pedagogy to which the tools provided a guide: (1) behavioral manifestations, (2) academic integrity, and (3) digital professionalism. CONCLUSIONS: The reviewed tools provide a pedagogical foundation and guidance for teaching various properties of cybercivility. Future studies should be expanded to include a broader literature body and non-English literature to provide the global perspective and global skills needed by a diverse population of learners.

Cyberincivility Experience of Korean Clinical Nurses in the Workplace: A Qualitative Content Analysis.

Although clinical nurses use online platforms to acquire health-related information and communicate with other healthcare providers, there are increasing reports on their incivility exposure in cyberspace. However, an in-depth understanding of their cyberincivility experience is lacking. This study aimed to identify Korean clinical nurses' perception and experience of cyberincivility. A qualitative study was conducted. Twenty clinical nurses from seven private and public hospitals in the Seoul metropolitan area were recruited using purposive sampling. Individual semi-structured interviews were conducted with the nurses from June to September 2019. Conventional content analysis was applied for the interview data analysis. Clinical nurses perceived cyberincivility as disrespectful and condemning behavior as users hide under the shield of anonymity to persecute others without fear of retribution. Four themes regarding participants' cyberincivility experience emerged: unprofessional behavior, hierarchical communication, lack of respect and morality, and forming an inefficient work environment. The results of this study provide an understanding regarding clinical nurses' experience of cyberincivility that goes beyond that of previous studies, which mainly focused on students. These results could increase awareness of cyberincivility among clinical nurses, and provide key information for the design of cybercivility educational programs and guidelines to curb cyberincivility, nurture professional online communication, and consequently improve quality of care.

Effects of Infection Control Education for Nursing Students Using Standardized Patients vs. Peer Role-Play.

This study was conducted to identify and compare the effects of two education programs for infection control-a simulation using standardized patients and a peer role-play-on standard precaution knowledge, standard precaution awareness, infection-related anxiety, and infection control performance. This study used a nonequivalent control group pretest-posttest design. A total of 62 undergraduate nursing students in their 3rd year participated in the study, and were assigned to the experimental and control groups, accordingly. The infection control education program was developed based on the analysis, design, development, implementation, and evaluation model. The program for the experimental group included lectures, skills training, simulation using standardized patients, and debriefing, while the control group participated in the usual infection control education, consisting of lectures, skills training, and peer tutoring practices. Both groups exhibited statistically significant increases in knowledge, awareness of standard precaution, and infection control performance after the intervention. Infection-related anxiety and infection control performance were significantly higher in the simulation using a standardized patient group. Both education programs influenced compliance with the standard precaution for infection control. The results of this study contribute to the evidence regarding effective educational methods to improve infection control.

Educational Simulation Program Based on Korean Triage and Acuity Scale.

This study aimed to develop and implement an educational simulation program based on the Korean Triage and Acuity Scale (KTAS) for nurses in emergency medical centers who completed the KTAS training, and assess its effects. We examined the educational effects of the program by evaluating clinical decision-making ability, job satisfaction, and customer orientation among the participants, namely 27 nurses in the emergency center of a general hospital. Data were collected from 3 to 24 May 2017, and analyzed using SPSS 22.0. There was a significant difference in nurses' mean scores on clinical decision-making ability, job satisfaction, and customer orientation before and after the simulation-based education. In other words, after completing the KTAS-based simulation education program, the emergency nurses showed improved clinical decision-making ability, job satisfaction, and customer orientation. Based on the results of this study, it is expected that this educational program can be effectively used for KTAS education, and it was confirmed that simulation-based education is a useful learning method for triage nurses in emergency medical centers.

Exploration of Cybercivility in Nursing Education Using Cross-Country Comparisons.

Many nursing students have experienced negative social behaviors and incivility in cyberspace. We aimed to explore knowledge, experience, and acceptability of cyberincivility, as well as the perceived benefits of cybercivility education among nursing students in the United States of America (USA), Hong Kong (HK), and South Korea (K). We used a cross-sectional study design. The Academic Cyberincivility Assessment Questionnaire was administered to participants, and data were collected from 336 nursing students from a university in each country (USA (n = 90), HK (n = 115), and K (n = 131)). Cyberincivility was perceived as a problem by 76.8% of respondents. More than 50% of respondents had experienced cyberincivility, were knowledgeable about it, and found it unacceptable. Longer hours spent on social networking services and perception of cyberincivility were positively associated with the variables, but negatively associated with perceived benefits of learning. Cross-country differences in items and level of variables were identified (p < 0.01). The HK respondents demonstrated lower knowledge, compared to USA and K respondents. Frequency of cyberincivility experience and perceived learning benefit were lower for students in the USA than in HK and K. Acceptability of cyberincivility was significantly lower in respondents from K. Developing educational programs on general and sociocultural patterns of online communication could be useful in promoting cybercivility globally.

Effects of a Simulation With Team-Based Learning on Knowledge, Team Performance, and Teamwork for Nursing Students.

Simulation and team-based learning are reported as useful strategies in nursing education. However, empirical evidence on the effects of participating in an integrated course of team-based learning and simulation is limited. The aim of this study was to identify the effects of a nursing simulation program with team-based learning on knowledge, team performance, and teamwork among Korean nursing students. A one-group pretest-posttest design was used. Fourth-year students (N = 229) participated in a 32-hour nursing simulation program with team-based learning. Each of the three sessions of the program involved a 3-hour task training with video-assisted learning and skills performance assessment, 1-hour team-based learning, and 4-hour simulation session with a high-fidelity simulator. In addition to the knowledge test and performance assessment, participants completed a self-administered questionnaire on teamwork. Participants achieved higher scores in the Group Readiness Assurance Test than they did in the Individual Readiness Assurance Test. The posttest scores on team performance and teamwork were significantly higher than their pretest scores. The simulation with team-based learning induced favorable effects on participants' knowledge, performance, and teamwork. A curricular integration of simulation program with team-based learning is consistent with achieving outcomes-based learning in nursing education.

Microlearning in Health Professions Education: Scoping Review.

BACKGROUND: Microlearning, the acquisition of knowledge or skills in the form of small units, is endorsed by health professions educators as a means of facilitating student learning, training, and continuing education, but it is difficult to define in terms of its features and outcomes. OBJECTIVE: This review aimed to conduct a systematic search of the literature on microlearning in health professions education to identify key concepts, characterize microlearning as an educational strategy, and evaluate pedagogical outcomes experienced by health professions students. METHODS: A scoping review was performed using the bibliographic databases PubMed (MEDLINE), CINAHL, Education Resources Information Center, EMBASE, PsycINFO, Education Full Text (HW Wilson), and ProQuest Dissertations and Theses Global. A combination of keywords and subject headings related to microlearning, electronic learning, or just-in-time learning combined with health professions education was used. No date limits were placed on the search, but inclusion was limited to materials published in English. Pedagogical outcomes were evaluated according to the 4-level Kirkpatrick model. RESULTS: A total of 3096 references were retrieved, of which 17 articles were selected after applying the inclusion and exclusion criteria. Articles that met the criteria were published between 2011 and 2018, and their authors were from a range of countries, including the United States, China, India, Australia, Canada, Iran, Netherlands, Taiwan, and the United Kingdom. The 17 studies reviewed included various health-related disciplines, such as medicine, nursing, pharmacy, dentistry, and allied health. Although microlearning appeared in a variety of subject areas, different technologies, such as podcast, short messaging service, microblogging, and social networking service, were also used. On the basis of Buchem and Hamelmann's 10 microlearning concepts, each study satisfied at least 40% of the characteristics, whereas all studies featured concepts of maximum time spent less than 15 min as well as content aggregation. According to our assessment of each article using the Kirkpatrick model, 94% (16/17) assessed student reactions to the microlearning (level 1), 82% (14/17) evaluated knowledge or skill acquisition (level 2), 29% (5/17) measured the effect of the microlearning on student behavior (level 3), and no studies were found at the highest level. CONCLUSIONS: Microlearning as an educational strategy has demonstrated a positive effect on the knowledge and confidence of health professions students in performing procedures, retaining knowledge, studying, and engaging in collaborative learning. However, downsides to microlearning include pedagogical discomfort, technology inequalities, and privacy concerns. Future research should look at higher-level outcomes, including benefits to patients or practice changes. The findings of this scoping review will inform education researchers, faculty, and academic administrators on the application of microlearning, pinpoint gaps in the literature, and help identify opportunities for instructional designers and subject matter experts to improve course content in didactic and clinical settings.

Chitinophaga aurantiaca sp. nov., isolated from a soil sample from a tangerine field.

A Gram-stain-negative, facultatively anaerobic, non-motile and rod-shaped bacterial strain, designated THG-SD5.5T, was isolated from a soil sample collected in a tangerine field, Republic of Korea. According to the 16S rRNA gene sequence comparisons, the isolate was identified as a member of the genus Chitinophaga and to be closely related to Chitinophaga ginsengihumi KACC 17604T (97.9%) and Chitinophaga rupis KACC 14521T (97.5%). The 16S rRNA gene sequence similarities with other species of the genus Chitinophaga were in the range 92.8-95.5%. Catalase test was positive. Oxidase test was negative. The DNA G + C content was determined to be 46.1 mol%. DNA-DNA hybridization values between strain THG-SD5.5T and C. ginsengihumi KACC 17604T and C. rupis KACC 14521T were 45.1% and 15.6%, respectively. Strain THG-SD5.5T was also found to be able to grow at 24-33 °C, at 0-5% NaCl and at pH 5.5-9.0. The major fatty acids were identified as anteiso-C15:0, C16:0, anteiso-C17:0 and C18:0. The dominant respiratory quinone was identified as menaquinone-7 (MK-7). The polar lipids were found to be diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, an unidentified aminolipid, two unidentified phospholipids and three unidentified lipids. Based on these phenotypic, genotypic and phylogenetic characterisations, strain THG-SD5.5T (= KACC 19338T = CGMCC 1.16304T) is concluded to represent a novel species of the genus Chitinophaga, for which the name Chitinophaga aurantiaca sp. nov. is proposed.