Pilot study looking at the benefits of Virtual Reality (VR) simulation for Physician Associates (PA)

Background and aim: Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation. Methods: As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software. Results: Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus. Conclusion: VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation. Ethics statement: Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable. References 1. Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. Quality & Safety in Health Care. 2010;19(Suppl 2). 2. Tabatabai S. COVID-19 impact and virtual medical education. Journal of Advances in Medical Education & Professionalism [Internet]. 2020;8(3):140–143. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32802908 3. Barteit S, Lanfermann L, Bärnighausen T, Neuhann F, Beiersmann C. Augmented, mixed, and virtual reality-based head-mounted devices for medical education: systematic review. Vol. 9, JMIR Serious Games. JMIR Publications Inc. 2021

Diagnostic Accuracy of Prion Disease Biomarkers in Iatrogenic Creutzfeldt-Jakob Disease

Human prion diseases are classified into sporadic, genetic, and acquired forms. Within this last group, iatrogenic Creutzfeldt-Jakob disease (iCJD) is caused by human-to-human transmission through surgical and medical procedures. After reaching an incidence peak in the 1990s, it is believed that the iCJD historical period is probably coming to an end, thanks to lessons learnt from past infection sources that promoted new prion prevention and decontamination protocols. At this point, we sought to characterise the biomarker profile of iCJD and compare it to that of sporadic CJD (sCJD) for determining the value of available diagnostic tools in promptly recognising iCJD cases. To that end, we collected 23 iCJD samples from seven national CJD surveillance centres and analysed the electroencephalogram and neuroimaging data together with a panel of seven CSF biomarkers: 14-3-3, total tau, phosphorylated/total tau ratio, alpha-synuclein, neurofilament light, YKL-40, and real-time quaking induced conversion of prion protein. Using the cut-off values established for sCJD, we found the sensitivities of these biomarkers for iCJD to be similar to those described for sCJD. Given the limited relevant information on this issue to date, the present study validates the use of current sCJD biomarkers for the diagnosis of future iCJD cases.This research was funded by the Instituto Carlos III (grants CP/00041 and PI19/00144) and by the Fundació La Marató de TV3 (201821‐30‐31‐32) to FL and by the Robert Koch Institute through funds from the Federal Ministry of Health (grant No, 1369‐341) to IZ. This project was also funded at 65% by the Fondo Europeo de Desarrollo Regional (FEDER) through the Interreg V‐A España‐Francia‐Andorra (POCTEFA 2014‐2020) programme. SJC is funded in part by a NHMRC Practitioner Fellowship (identification #APP1105784).S

Fusion Learning Conference 2023 - proceedings

Welcome to the 3rd annual Fusion Learning Conference at BU. The event provides a hub for the exchange of knowledge, pedagogical innovations, and cutting-edge research that shape the landscape of our learning and teaching. This year we are hosting the largest number of submissions to the conference and look forward to an exciting line up of guest speaker from IBM presenting on the influence of Artificial Intelligence on higher education; a BU panel of experts sharing their insight about some of the emerging themes in our learning and teaching and preparing our students for future of work; staff presentations and discussions including, student engagement, digital transformation, academic integrity, inclusive and sustainability in the curriculum design. I hope that you find this selection of posters and abstracts to be enlightening

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The impact of Artificial Intelligence on the marketing practices of Professional Services Firms

Artificial intelligence (AI) is rapidly evolving, influencing service industries and Professional Services Firms (PSFs) embracing AI to improve margins. In this paper, we reveal how AI impacts the characteristics and marketing practices of PSFs. AI has the potential to provide considerable efficiency and organizational benefits, yet simultaneously changes service attributes, threatens the competitive advantage of deep client relationships, and directly influences the marketing practices of PSFs, including pricing strategy. Based on an extensive literature review, we present a conceptual model illustrating the changes impacting the business model, marketing practices, and client relationships of PSFs

Farmers' attitudes toward cooperatives

Cover title

Urban Soil Carbon and Nitrogen Converge at a Continental Scale

In urban areas, anthropogenic drivers of ecosystem structure and function are thought to predominate over larger‐scale biophysical drivers. Residential yards are influenced by individual homeowner preferences and actions, and these factors are hypothesized to converge yard structure across broad scales. We examined soil total C and total δ13C, organic C and organic δ13C, total N, and δ15N in residential yards and corresponding reference ecosystems in six cities across the United States that span major climates and ecological biomes (Baltimore, Maryland; Boston, Massachusetts; Los Angeles, California; Miami, Florida; Minneapolis‐St. Paul, Minnesota; and Phoenix, Arizona). Across the cities, we found soil C and N concentrations and soil δ15N were less variable in residential yards compared to reference sites supporting the hypothesis that soil C, N, and δ15N converge across these cities. Increases in organic soil C, soil N, and soil δ15N across urban, suburban, and rural residential yards in several cities supported the hypothesis that soils responded similarly to altered resource inputs across cities, contributing to convergence of soil C and N in yards compared to natural systems. Soil C and N dynamics in residential yards showed evidence of increasing C and N inputs to urban soils or dampened decomposition rates over time that are influenced by climate and/or housing age across the cities. In the warmest cities (Los Angeles, Miami, Phoenix), greater organic soil C and higher soil δ13C in yards compared to reference sites reflected the greater proportion of C4 plants in these yards. In the two warm arid cities (Los Angeles, Phoenix), total soil δ13C increased and organic soil δ13C decreased with increasing home age indicating greater inorganic C in the yards around newer homes. In general, soil organic C and δ13C, soil N, and soil δ15N increased with increasing home age suggesting increased soil C and N cycling rates and associated 12C and 14N losses over time control yard soil C and N dynamics. This study provides evidence that conversion of native reference ecosystems to residential areas results in convergence of soil C and N at a continental scale. The mechanisms underlying these effects are complex and vary spatially and temporally

Electrochemical Anion Sensing in Conductive Porous Manifolds

Anion sensing technology is motivated by the widespread and critical roles played by anions in biological systems and the environment. Electrochemical approaches comprise a major portion of this field, but so far have relied on redox-active molecules appended to electrodes that often lack the ability to produce distinct signatures for different anions. Here, we demonstrate the ability to differentiate anions based on size using metal-organic framework (MOF) nanocrystal thin films with sub-nanometer pores. The reversible oxidation of Cr(1,2,3-triazolate)2 couples to the intercalation of charge-balancing anions such that larger anions (ClO4–, PF6–, and OTf–) give rise to redox potentials shifted anodically by hundreds of mV due to the additional work of solvent reorganization and anion desolvation, whereas smaller anions (BF4–) may enter partially solvated. As a proof-of-concept, we leverage this “nanoconfinement” approach to report an electrochemical ClO4– sensor in aqueous media that is recyclable, reusable, and sensitive to sub-100-nM concentrations. Taken together, these results highlight the unusual combination of distinct external versus internal surface chemistry in MOF nanocrystals and the interfacial chemistry they enable as a novel supramolecular approach for redox voltammetric anion sensing