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.

Virtual, augmented, and mixed reality: potential clinical and training applications in pediatrics.

BACKGROUND: COVID-19 pandemic has significantly impacted the field of medical training, necessitating innovative approaches to education and practice. During this period, the use of novel technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) has become increasingly vital. These technologies offer the advantage of transcending the limitations of time and space, thus enabling medical professionals to access various personalized programs for both education and service delivery. This shift is particularly relevant in the realm of pediatric medicine, where traditional training and clinical methods face unique challenges. PURPOSE: The primary aim of this study is to explore the application of VR, AR, and MR technologies in pediatric medical settings, with a focus on both clinical applications and the training of pediatric medical professionals. We aim to comprehensively search and review studies that have utilized these technologies in the treatment of pediatric patients and the education of healthcare providers in this field. METHODS: Peer-reviewed articles published in PubMed, the Cochrane Library, ScienceDirect, Google Scholar, and Scopus from January 1, 2018, to March 1, 2023, were comprehensively searched. The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Among the 89 studies, 63 investigated the clinical applications of VR (n=60) or AR (n=3) in pediatric patients, and 25 investigated the applications of VR (n=19), AR (n=5), or MR (n=1) for training medical professionals. RESULTS: A total of 36 randomized controlled trials (RCTs) for clinical application (n=31) and medical training (n=5) were retrieved. Among the RCTs, 21 reported significant improvements in clinical applications (n=17) and medical training (n=4). CONCLUSION: Despite a few limitations in conducting research on innovative technology, such research has rapidly expanded, indicating that an increasing number of researchers are involved in pediatric research using these technologies.

Correction: Development and Application of a Metaverse-Based Social Skills Training Program for Children With Autism Spectrum Disorder to Improve Social Interaction: Protocol for a Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/35960.].

Intervention in the Timeliness of Two Electrocardiography Types for Patients in the Emergency Department With Chest Pain: Randomized Controlled Trial.

BACKGROUND: In the emergency department (ED), the result obtained using the 12-lead electrocardiography (ECG) is the basis for diagnosing and treating patients with chest pain. It was found that performing ECG at the appropriate time could improve treatment outcomes. Hence, a wearable ECG device with a timer can ensure that the findings are continuously recorded. OBJECTIVE: We aimed to compare the time accuracy of a single-patch 12-lead ECG (SP-ECG) with that of conventional ECG (C-ECG). We hypothesized that SP-ECG would result in better time accuracy. METHODS: Adult patients who visited the emergency room with chest pain but were not in shock were randomly assigned to one of the following 2 groups: the SP-ECG group or the C-ECG group. The final analysis included 33 (92%) of the 36 patients recruited. The primary outcome was the comparison of the time taken by the 2 groups to record the ECG. The average ages of the participants in the SP-ECG and C-ECG groups were 63.7 (SD 18.4) and 58.1 (SD 12.4) years, respectively. RESULTS: With a power of 0.95 and effect sizes of 0.05 and 1.36, the minimum number of samples was calculated. The minimum sample size for each SP-ECG and C-ECG group is 15.36 participants, assuming a 20% dropout rate. As a result, 36 patients with chest pain participated, and 33 of them were analyzed. The timeliness of SP-ECG and C-ECG for the first follow-up ECG was 87.5% and 47.0%, respectively (P=.74). It was 75.0% and 35.2% at the second follow-up, respectively (P=.71). CONCLUSIONS: Continuous ECG monitoring with minimal interference from other examinations is feasible and essential in complex ED situations. However, the precision of SP-ECG has not yet been proved. Nevertheless, the application of SP-ECG is expected to improve overcrowding and human resource shortages in EDs, though more research is needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT04114760; https://clinicaltrials.gov/ct2/show/NCT04114760.

Decision effect of a deep-learning model to assist a head computed tomography order for pediatric traumatic brain injury.

The study aims to measure the effectiveness of an AI-based traumatic intracranial hemorrhage prediction model in the decisions of emergency physicians regarding ordering head computed tomography (CT) scans. We developed a deep-learning model for predicting traumatic intracranial hemorrhages (DEEPTICH) using a national trauma registry with 1.8 million cases. For simulation, 24 cases were selected from previous emergency department cases. For each case, physicians made decisions on ordering a head CT twice: initially without the DEEPTICH assistance, and subsequently with the DEEPTICH assistance. Of the 528 responses from 22 participants, 201 initial decisions were different from the DEEPTICH recommendations. Of these 201 initial decisions, 94 were changed after DEEPTICH assistance (46.8%). For the cases in which CT was initially not ordered, 71.4% of the decisions were changed (p < 0.001), and for the cases in which CT was initially ordered, 37.2% (p < 0.001) of the decisions were changed after DEEPTICH assistance. When using DEEPTICH, 46 (11.6%) unnecessary CTs were avoided (p < 0.001) and 10 (11.4%) traumatic intracranial hemorrhages (ICHs) that would have been otherwise missed were found (p = 0.039). We found that emergency physicians were likely to accept AI based on how they perceived its safety.

Development and Application of a Metaverse-Based Social Skills Training Program for Children With Autism Spectrum Disorder to Improve Social Interaction: Protocol for a Randomized Controlled Trial.

BACKGROUND: Autism spectrum disorder (ASD) is characterized by abnormalities in social communication and limited and repetitive behavioral patterns. Children with ASD who lack social communication skills will eventually not interact with others and will lack peer relationships when compared to ordinary people. Thus, it is necessary to develop a program to improve social communication abilities using digital technology in people with ASD. OBJECTIVE: We intend to develop and apply a metaverse-based child social skills training program aimed at improving the social interaction abilities of children with ASD aged 7-12 years. We plan to compare and analyze the biometric information collected through wearable devices when applying the metaverse-based social skills training program to evaluate emotional changes in children with ASD in stressful situations. METHODS: This parallel randomized controlled study will be conducted on children aged 7-12 years diagnosed with ASD. A metaverse-based social skills training program using digital technology will be administered to children who voluntarily wish to participate in the research with consent from their legal guardians. The treatment group will participate in the metaverse-based social skills training program developed by this research team once a week for 60 minutes per session for 4 weeks. The control group will not intervene during the experiment. The treatment group will use wearable devices during the experiment to collect real-time biometric information. RESULTS: The study is expected to recruit and enroll participants in March 2022. After registering the participants, the study will be conducted from March 2022 to May 2022. This research will be jointly conducted by Yonsei University and Dobrain Co Ltd. Children participating in the program will use the internet-based platform. CONCLUSIONS: The metaverse-based Program for the Education and Enrichment of Relational Skills (PEERS) will be effective in improving the social skills of children with ASD, similar to the offline PEERS program. The metaverse-based PEERS program offers excellent accessibility and is inexpensive because it can be administered at home; thus, it is expected to be effective in many children with ASD. If a method can be applied to detect children's emotional changes early using biometric information collected through wearable devices, then emotional changes such as anxiety and anger can be alleviated in advance, thus reducing issues in children with ASD. TRIAL REGISTRATION: Clinical Research Information Service KCT0006859; https://tinyurl.com/4r3k7cmj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/35960.

Timeliness of Single-Patch 12-Lead Electrocardiography for Patients with Chest Pain at the Emergency Department.

A 12-lead ECG is used in emergency departments to diagnose and treat patients with chest discomfort. Performing ECGs at the proper time has been found to increase treatment outcomes. A timer on a wearable ECG ensures proper recording. We compared the timing accuracy of single-patch 12-lead ECG to conventional ECG, expecting the former to be more accurate. Adult patients with chest pain but not in shock were randomized into two groups: SP-ECG and C-ECG. The final analysis included 33 of the 36 recruited patients. The key result was the time taken to record the ECG in both groups. The two groups' average ages were 63.7 and 58.1 years. The SP-ECG group was 87.5 percent timely, while the C-ECG group was 47.0 percent (P.74). At the second follow-up, it was 75.0 percent and 35.2%. Continuous ECG without interfering with other exams is feasible in complex ER circumstances. But the accuracy of single-patch ECG has not been verified. The device also had some minor difficulties. The use of SP-ECG may help alleviate overcrowding or staffing issues in EDs, although more research is required.

Respiratory Safety Evaluation in Mice and Inhibition of Adenoviral Amplification in Human Bronchial Endothelial Cells Using a Novel Type of Chlorine Dioxide Gas Reactor.

Since the onset of the COVID-19 pandemic, there has been a growing demand for effective and safe disinfectants. A novel use of chlorine dioxide (ClO2) gas, which can satisfy such demand, has been reported. However, its efficacy and safety remain unclear. For the safe use of this gas, the stable release of specific concentrations is a must. A new type of ClO2 generator called Dr.CLOTM has recently been introduced. This study aimed to investigate: (1) the effects of Dr.CLOTM on inhibiting adenoviral amplification on human bronchial epithelial (HBE) cells; and (2) the acute inhalation safety of using Dr.CLOTM in animal models. After infecting HBE cells with a recombinant adenovirus, the inhibitory power of Dr.CLOTM on the virus was expressed as IFU/mL in comparison with the control group. The safety of ClO2 gas was indirectly predicted using mice by measuring single-dose inhalation toxicity in specially designed chambers. Dr.CLOTM was found to evaporate in a very constant concentration range at 0-0.011 ppm/m3 for 42 days. In addition, 36-100% of adenoviral amplification was suppressed by Dr.CLOTM, depending on the conditions. The LC50 of ClO2 gas to mice was approximately 68 ppm for males and 141 ppm for females. Histopathological evaluation showed that the lungs of female mice were more resistant to the toxicity from higher ClO2 gas concentrations than those of male mice. Taken together, these results indicate that Dr.CLOTM can be used to provide a safe indoor environment due to its technology that maintains the stable concentration and release of ClO2 gas, which could suppress viral amplification and may prevent viral infections.

Molecular Dynamics Simulation of Silicon Dioxide Etching by Hydrogen Fluoride Using the Reactive Force Field.

In this study, we develop a reactive force field (ReaxFF) for a Si/O/H/F system to perform etching simulations of SiO2 with an HF etchant. Quantum mechanical (QM) training sets from density functional theory calculations, which contain structures of reactant/product and energies with bond dissociation, valence angle distortions, and reactions between SiO2 clusters and SiO2 slab with HF gases, are used to optimize the ReaxFF parameters. Structures and energies calculated using the ReaxFF match well with the QM training sets. Using the optimized ReaxFF, we conduct molecular dynamics simulations of the etching process of SiO2 substrates with active HF molecules. The etching yield and number of reaction products with different incident energies of the HF etchant are investigated. These simulations show that the developed ReaxFF offers insights into the atomistic surface reaction of the SiO2 etching process.

Providing Personal Health Records Based on a Mobile Application for Emergencies.

We developed the service showing patient health record altogether which is managed by each hospital separately and recording the patient health information based on mobile application. We evaluated the effectiveness and satisfaction of the service. This study is aimed to reduce instances where patient's medical records are unknown to the medical staff in emergencies and allow patients to use and utilize their health information.

Characteristics of malodor pollutants and aromatic VOCs around an urban valley in Korea.

In this study, the environmental behavior of malodor pollutants (MPs) [including reduced sulfur compounds (RSCs)] and aromatic volatile organic compounds (AVOCs) were investigated around urban valley areas during several field campaigns (February through December 2006). The MPs measured in the study area include the RSCs (H(2)S, CH(3)SH, DMS, and DMDS), ammonia (NH(3)), and styrene (STY); the AVOCs include benzene (BEN), toluene (TOL), ethylbenzene (EB), m,p-xylene (MPX), and o-xylene (OX). The variation of most MP concentrations (except for DMDS) was found to be larger than that of AVOCs. It was found that STY (2,346 +/- 4,867 ppbv) was the most dominant MP followed by NH(3) (447 +/- 285), CH(3)SH (16 +/- 41), and the others (<8). The magnitude of AVOCs was found in the following descending order: TOL (1.4 +/- 2.2 ppbv), EB (1.0 +/- 2.1), MPX (0.9 +/- 2.0), and the others (<0.8). The concentration levels of most MPs on industrial (I) and downwind (D) sites were up to an order of magnitude higher than those at non-industrial (N) and upwind (U) sites. For most AVOCs, the former was ~3 times higher than the latter. For malodor intensity in RSCs, CH(3)SH was the dominant contributor. The concentration difference in target compounds between the sites/periods is likely to be caused by the combined effects such as emission sources, geographical features (e.g., semi-closed topography), and meteorological conditions (e.g., wind directions) in and outside the urban valley.