Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game

Background Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. Aims This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. Methods A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom’s taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. Results The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user–computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. Conclusions Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user–computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process

Wide-range Angle-sensitive Plasmonic Color Printing on Lossy-Resonator Substrates

We demonstrate a sustainable, lithography-free process for generating non fading plasmonic colors with a prototype device that produces a wide range of vivid colors in red, green, and blue (RGB) ([0-1], [0-1], [0-1]) color space from violet (0.7, 0.72, 1) to blue (0.31, 0.80, 1) and from green (0.84, 1, 0.58) to orange (1, 0.58, 0.46). The proposed color-printing device architecture integrates a semi-transparent random metal film (RMF) with a metal back mirror to create a lossy asymmetric Fabry-P\'erot resonator. This device geometry allows for advanced control of the observed color through the five-degree multiplexing (RGB color space, angle, and polarization sensitivity). An extended color palette is then obtained through photomodification process and localized heating of the RMF layer under various femtosecond laser illumination conditions at the wavelengths of 400 nm and 800 nm. Colorful design samples with total areas up to 10 mm2 and 100 {\mu}m resolution are printed on 300-nm-thick films to demonstrate macroscopic high-resolution color generation. The proposed printing approach can be extended to other applications including laser marking, anti-counterfeiting and chromo-encryption

Customer relationship management: digital transformation and sustainable business model innovation

[EN] The point of departure for this study is the understanding of customer relationship management (CRM) as a set of technological solutions key for efficient business management, the benefits of which, highlighted by previous works, are presented and defined here as crucial for entrepreneurial success. Of particular interest for this purpose are the existing studies on sustainability, which provide a viable research model to assess and validate the potential effect of each CRM component (sales, marketing, and services) on the three dimensions of sustainability (economic, environmental, and social). Upon confirmation of our hypotheses, the subsequent validation of such model should bring a better understanding of the way in which CRM-related benefits may increase the positive impact of its components on each dimension of sustainability. CRM can hence be considered a sort of Green IT, oriented toward digital transformation and sustainable business model innovation. 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Characterization of transcriptome dynamics during watermelon fruit development: sequencing, assembly, annotation and gene expression profiles

<p>Abstract</p> <p>Background</p> <p>Cultivated watermelon [<it>Citrullus lanatus </it>(Thunb.) Matsum. & Nakai var. <it>lanatus</it>] is an important agriculture crop world-wide. The fruit of watermelon undergoes distinct stages of development with dramatic changes in its size, color, sweetness, texture and aroma. In order to better understand the genetic and molecular basis of these changes and significantly expand the watermelon transcript catalog, we have selected four critical stages of watermelon fruit development and used Roche/454 next-generation sequencing technology to generate a large expressed sequence tag (EST) dataset and a comprehensive transcriptome profile for watermelon fruit flesh tissues.</p> <p>Results</p> <p>We performed half Roche/454 GS-FLX run for each of the four watermelon fruit developmental stages (immature white, white-pink flesh, red flesh and over-ripe) and obtained 577,023 high quality ESTs with an average length of 302.8 bp. <it>De novo </it>assembly of these ESTs together with 11,786 watermelon ESTs collected from GenBank produced 75,068 unigenes with a total length of approximately 31.8 Mb. Overall 54.9% of the unigenes showed significant similarities to known sequences in GenBank non-redundant (nr) protein database and around two-thirds of them matched proteins of cucumber, the most closely-related species with a sequenced genome. The unigenes were further assigned with gene ontology (GO) terms and mapped to biochemical pathways. More than 5,000 SSRs were identified from the EST collection. Furthermore we carried out digital gene expression analysis of these ESTs and identified 3,023 genes that were differentially expressed during watermelon fruit development and ripening, which provided novel insights into watermelon fruit biology and a comprehensive resource of candidate genes for future functional analysis. We then generated profiles of several interesting metabolites that are important to fruit quality including pigmentation and sweetness. Integrative analysis of metabolite and digital gene expression profiles helped elucidating molecular mechanisms governing these important quality-related traits during watermelon fruit development.</p> <p>Conclusion</p> <p>We have generated a large collection of watermelon ESTs, which represents a significant expansion of the current transcript catalog of watermelon and a valuable resource for future studies on the genomics of watermelon and other closely-related species. Digital expression analysis of this EST collection allowed us to identify a large set of genes that were differentially expressed during watermelon fruit development and ripening, which provide a rich source of candidates for future functional analysis and represent a valuable increase in our knowledge base of watermelon fruit biology.</p

The genetic overlap of Attention-Deficit/Hyperactivity Disorder and Autistic-like traits: an investigation of individual symptom scales and cognitive markers

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) frequently co-occur. However, due to previous exclusionary diagnostic criteria, little is known about the underlying causes of this covariation. Twin studies assessing ADHD symptoms and autistic-like traits (ALTs) suggest substantial genetic overlap, but have largely failed to take into account the genetic heterogeneity of symptom subscales. This study aimed to clarify the phenotypic and genetic relations between ADHD and ASD by distinguishing between symptom subscales that characterise the two disorders. Moreover, we aimed to investigate whether ADHD-related cognitive impairments show a relationship with ALT symptom subscales; and whether potential shared cognitive impairments underlie the genetic risk shared between the ADHD and ALT symptoms. Multivariate structural equation modelling was conducted on a population-based sample of 1312 twins aged 7–10. Social-communication ALTs correlated moderately with both ADHD symptom domains (phenotypic correlations around 0.30) and showed substantial genetic overlap with both inattention and hyperactivity-impulsivity (genetic correlation = 0.52 and 0.44, respectively). In addition to previously reported associations with ADHD traits, reaction time variability (RTV) showed significant phenotypic (0.18) and genetic (0.32) association with social-communication ALTs. RTV captured a significant proportion (24 %) of the genetic influences shared between inattention and social-communication ALTs. Our findings suggest that social-communication ALTs underlie the previously observed phenotypic and genetic covariation between ALTs and ADHD symptoms. RTV is not specific to ADHD symptoms, but is also associated with social-communication ALTs and can, in part, contribute to an explanation of the co-occurrence of ASD and ADHD

Educational attainment of same-sex and opposite-sex dizygotic twins : An individual-level pooled study of 19 twin cohorts

Comparing twins from same- and opposite-sex pairs can provide information on potential sex differences in a variety of outcomes, including socioeconomic-related outcomes such as educational attainment. It has been suggested that this design can be applied to examine the putative role of intrauterine exposure to testosterone for educational attainment, but the evidence is still disputed. Thus, we established an international database of twin data from 11 countries with 88,290 individual dizygotic twins born over 100 years and tested for differences between twins from same- and opposite-sex dizygotic pairs in educational attainment. Effect sizes with 95% confidence intervals (CI) were estimated by linear regression models after adjusting for birth year and twin study cohort. In contrast to the hypothesis, no difference was found in women (β = −0.05 educational years, 95% CI −0.11, 0.02). However, men with a same-sex co-twin were slightly more educated than men having an opposite-sex co-twin (β = 0.14 educational years, 95% CI 0.07, 0.21). No consistent differences in effect sizes were found between individual twin study cohorts representing Europe, the USA, and Australia or over the cohorts born during the 20th century, during which period the sex differences in education reversed favoring women in the latest birth cohorts. Further, no interaction was found with maternal or paternal education. Our results contradict the hypothesis that there would be differences in the intrauterine testosterone levels between same-sex and opposite-sex female twins affecting education. Our findings in men may point to social dynamics within same-sex twin pairs that may benefit men in their educational careers.Peer reviewe

Genetic and environmental variation in educational attainment : an individual-based analysis of 28 twin cohorts

We investigated the heritability of educational attainment and how it differed between birth cohorts and cultural-geographic regions. A classical twin design was applied to pooled data from 28 cohorts representing 16 countries and including 193,518 twins with information on educational attainment at 25 years of age or older. Genetic factors explained the major part of individual differences in educational attainment (heritability: a(2)=0.43; 0.41-0.44), but also environmental variation shared by co-twins was substantial (c(2)=0.31; 0.30-0.33). The proportions of educational variation explained by genetic and shared environmental factors did not differ between Europe, North America and Australia, and East Asia. When restricted to twins 30 years or older to confirm finalized education, the heritability was higher in the older cohorts born in 1900-1949 (a(2)=0.44; 0.41-0.46) than in the later cohorts born in 1950-1989 (a(2)=0.38; 0.36-0.40), with a corresponding lower influence of common environmental factors (c(2)=0.31; 0.29-0.33 and c(2)=0.34; 0.32-0.36, respectively). In conclusion, both genetic and environmental factors shared by co-twins have an important influence on individual differences in educational attainment. The effect of genetic factors on educational attainment has decreased from the cohorts born before to those born after the 1950s.Peer reviewe

Heritable Variations in Gray Matter Concentration as a Potential Endophenotype for Psychopathic Traits

CONTEXT: Genetic vulnerability to psychopathic traits is likely to also manifest at the neural level. We have recently reported increased gray matter concentration in several brain areas in boys with psychopathic traits. OBJECTIVE: To explore whether these gray matter concentration differences can be regarded as endophenotypes for psychopathic traits by (1) assessing their heritability and (2) examining the etiology of the co-occurrence of psychopathic traits and increased gray matter concentration. DESIGN: Community twin sample. SETTING: On-campus neuroimaging facility. Patients or Other PARTICIPANTS: One hundred twenty-three male twins (56 monozygotic and 67 dizygotic individuals; mean age 11.55 years; range, 10-13 years). MAIN OUTCOME MEASURES: We analyzed structural magnetic resonance imaging scans. Voxel-based morphometry analyses were used to obtain gray matter concentration values that were analyzed in a biometrical genetic twin model. RESULTS: Left posterior cingulate and right dorsal anterior cingulate gray matter concentrations were found to be the strongest endophenotype markers, with heritability estimates of 46% and 37%, respectively, and common genes explaining the phenotypic relationship between these regions and psychopathic traits. No significant heritabilities were found for several regions, including the right orbitofrontal cortex and insula. CONCLUSIONS: These findings suggest that structural endophenotypes, in the form of variations in gray matter concentration, reflect genetic vulnerability for psychopathic traits. Specifically, gray matter concentration in the left posterior cingulate and right dorsal anterior cingulate, brain areas implicated in empathy, moral processing, and introspection, are potential candidate endophenotypes for psychopathic traits