Simulation in Nursing Education: A Literature Review on Debriefing

The purpose of this literature review is to evaluate and compare debriefing models used during simulation experiences and to make recommendations for nurse educators and researchers about debriefing. Learning does not occur during a simulated experience alone, but occurs as a result of the experience and the purposeful reflection and analysis following the experience. This purposeful guided reflection and analysis is known as debriefing. The method used in this scholarly inquiry paper is a literature review. Five debriefing frameworks were reviewed and summarized in detail. The goal was to identify best practices for simulation debriefing to foster undergraduate nursing students’ improved critical thinking and clinical judgment. The frameworks were then compared to the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice. The INACSL Standards of Best Practice were used as a framework to systematically review each of the frameworks. Kolb’s Experiential Learning Theory aligns with all five debriefing models and could serve as the theoretical framework for debriefing. The literature reinforces that debriefing is of value in helping learners improve future practice. Unfortunately, there are few studies testing the validity of debriefing frameworks, and the level of evidence of the articles found is low. There is a need for high level research studies, evaluating each method of debriefing, to determine if each model is effective in improving critical thinking or clinical judgment of learners. There is minimal evidence to suggest the superiority of one debriefing model over the others, so high level research studies are needed to compare them. Additional research will contribute to the growing body of knowledge relating to debriefing in nursing education and perhaps improve clinical judgment of nurses entering practice

Confirmatory Factor Analysis of the Motor Unified Parkinson’s Disease Rating Scale

The motor examination section of the unified Parkinson's disease rating scale (UPDRS) is widely used in research but few studies have examined whether subscales exist that tap relatively distinct motor abnormalities. We analyzed data from 193 persons enrolled in a population-based study in Central California. Patients were examined after overnight PD medication washout (“OFF” state) and approximately one hour after taking medication (“ON” state). We performed confirmatory factor analysis of the UPDRS for OFF and ON state examinations; correlations, reliability, and relative validity of resulting subscales were evaluated. A model with five factors (gait/posture, tremor, rigidity, bradykinesia affecting the left extremities, bradykinesia affecting the right extremities) fit the data well, with similar results for OFF and ON states. Internal consistency reliability coefficients were 0.90 or higher for all subscales. The gait/posture subscale most strongly discriminated across levels of patient reported PD symptom severity and of how PD affects them on a daily basis. Compared to the right sided bradykinesia subscale, the left sided bradykinesia subscale had higher discrimination across levels of self-reported PD symptom severity and functional impairment. This supports motor UPDRS containing multiple subscales that can be analyzed separately and provide information distinct from the total score that may be useful in clinical studies

Extension and flexion in the upper cervical spine in neck pain patients

Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain

Predictors of invertebrate biomass and rate of advancement of invertebrate phenology across eight sites in the North American Arctic

Average annual temperatures in the Arctic increased by 2–3 °C during the second half of the twentieth century. Because shorebirds initiate northward migration to Arctic nesting sites based on cues at distant wintering grounds, climate-driven changes in the phenology of Arctic invertebrates may lead to a mismatch between the nutritional demands of shorebirds and the invertebrate prey essential for egg formation and subsequent chick survival. To explore the environmental drivers afecting invertebrate availability, we modeled the biomass of invertebrates captured in modifed Malaise-pitfall traps over three summers at eight Arctic Shorebird Demographics Network sites as a function of accumulated degree-days and other weather variables. To assess climate-driven changes in invertebrate phenology, we used data from the nearest long-term weather stations to hindcast invertebrate availability over 63 summers, 1950–2012. Our results confrmed the importance of both accumulated and daily temperatures as predictors of invertebrate availability while also showing that wind speed negatively afected invertebrate availability at the majority of sites. Additionally, our results suggest that seasonal prey avail ability for Arctic shorebirds is occurring earlier and that the potential for trophic mismatch is greatest at the northernmost sites, where hindcast invertebrate phenology advanced by approximately 1–2.5 days per decade. Phenological mismatch could have long-term population-level efects on shorebird species that are unable to adjust their breeding schedules to the increasingly earlier invertebrate phenologies.publishedVersio

Kinect-Based Correction of Overexposure Artifacts in Knee Imaging with C-Arm CT Systems

Objective. To demonstrate a novel approach of compensating overexposure artifacts in CT scans of the knees without attaching any supporting appliances to the patient. C-Arm CT systems offer the opportunity to perform weight-bearing knee scans on standing patients to diagnose diseases like osteoarthritis. However, one serious issue is overexposure of the detector in regions close to the patella, which can not be tackled with common techniques. Methods. A Kinect camera is used to algorithmically remove overexposure artifacts close to the knee surface. Overexposed near-surface knee regions are corrected by extrapolating the absorption values from more reliable projection data. To achieve this, we develop a cross-calibration procedure to transform surface points from the Kinect to CT voxel coordinates. Results. Artifacts at both knee phantoms are reduced significantly in the reconstructed data and a major part of the truncated regions is restored. Conclusion. The results emphasize the feasibility of the proposed approach. The accuracy of the cross-calibration procedure can be increased to further improve correction results. Significance. The correction method can be extended to a multi-Kinect setup for use in real-world scenarios. Using depth cameras does not require prior scans and offers the possibility of a temporally synchronized correction of overexposure artifacts. To achieve this, we develop a cross-calibration procedure to transform surface points from the Kinect to CT voxel coordinates

IODP Expedition 330: Drilling the Louisville Seamount Trail in the SW Pacific

Deep-Earth convection can be understood by studying hotspot volcanoes that form where mantle plumes rise up and intersect the lithosphere, the Earth's rigid outer layer. Hotspots characteristically leave age-progressive trails of volcanoes and seamounts on top of oceanic lithosphere, which in turn allow us to decipher the motion of these plates relative to "fixed" deep-mantle plumes, and their (isotope) geochemistry provides insights into the long-term evolution of mantle source regions. However, it is strongly suggested that the Hawaiian mantle plume moved ~15° south between 80 and 50 million years ago. This raises a fundamental question about other hotspot systems in the Pacific, whether or not their mantle plumes experienced a similar amount and direction of motion. Integrated Ocean Drilling Program (IODP) Expedition 330 to the Louisville Seamounts showed that the Louisville hotspot in the South Pacific behaved in a different manner, as its mantle plume remained more or less fixed around 48°S latitude during that same time period. Our findings demonstrate that the Pacific hotspots move independently and that their trajectories may be controlled by differences in subduction zone geometry. Additionally, shipboard geochemistry data shows that, in contrast to Hawaiian volcanoes, the construction of the Louisville Seamounts doesn’t involve a shield-building phase dominated by tholeiitic lavas, and trace elements confirm the rather homogenous nature of the Louisville mantle source. Both observations set Louisville apart from the Hawaiian-Emperor seamount trail, whereby the latter has been erupting abundant tholeiites (characteristically up to 95% in volume) and which exhibit a large variability in (isotope) geochemistry and their mantle source components

Unexpected diversity in socially synchronized rhythms of shorebirds

The behavioural rhythms of organisms are thought to be under strong selection, influenced by the rhythmicity of the environment. Such behavioural rhythms are well studied in isolated individuals under laboratory conditions, but free-living individuals have to temporally synchronize their activities with those of others, including potential mates, competitors, prey and predators. Individuals can temporally segregate their daily activities (for example, prey avoiding predators, subordinates avoiding dominants) or synchronize their activities (for example, group foraging, communal defence, pairs reproducing or caring for offspring). The behavioural rhythms that emerge from such social synchronization and the underlying evolutionary and ecological drivers that shape them remain poorly understood. Here we investigate these rhythms in the context of biparental care, a particularly sensitive phase of social synchronization where pair members potentially compromise their individual rhythms. Using data from 729 nests of 91 populations of 32 biparentally incubating shorebird species, where parents synchronize to achieve continuous coverage of developing eggs, we report remarkable within-and between-species diversity in incubation rhythms. Between species, the median length of one parent's incubation bout varied from 1-19 h, whereas period length-the time in which a parent's probability to incubate cycles once between its highest and lowest value-varied from 6-43 h. The length of incubation bouts was unrelated to variables reflecting energetic demands, but species relying on crypsis (the ability to avoid detection by other animals) had longer incubation bouts than those that are readily visible or who actively protect their nest against predators. Rhythms entrainable to the 24-h light-dark cycle were less prevalent at high latitudes and absent in 18 species. Our results indicate that even under similar environmental conditions and despite 24-h environmental cues, social synchronization can generate far more diverse behavioural rhythms than expected from studies of individuals in captivity. The risk of predation, not the risk of starvation, may be a key factor underlying the diversity in these rhythms.</p

The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

INTRODUCTION: The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms. METHODS: We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis. RESULTS: We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d(+) = -0.13 (95% CI: -0.26, -0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = -0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = -0.26, p = 0.01) and when cancer survivors were between 47-62 yr (β = 0.27, p = 0.01). CONCLUSION: Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47-62 yr, or when exercise sessions were supervised

Long-distance migratory shorebirds travel faster towards their breeding grounds, but fly faster post-breeding

Long-distance migrants are assumed to be more time-limited during the pre-breeding season compared to the post-breeding season. Although breeding-related time constraints may be absent post-breeding, additional factors such as predation risk could lead to time constraints that were previously underestimated. By using an automated radio telemetry system, we compared pre- and post-breeding movements of long-distance migrant shorebirds on a continent-wide scale. From 2014 to 2016, we deployed radio transmitters on 1,937 individuals of 4 shorebird species at 13 sites distributed across North America. Following theoretical predictions, all species migrated faster during the pre-breeding season, compared to the post-breeding season. These differences in migration speed between seasons were attributable primarily to longer stopover durations in the post-breeding season. In contrast, and counter to our expectations, all species had higher airspeeds during the post-breeding season, even after accounting for seasonal differences in wind. Arriving at the breeding grounds in good body condition is beneficial for survival and reproductive success and this energetic constraint might explain why airspeeds are not maximised in the pre-breeding season. We show that the higher airspeeds in the post-breeding season precede a wave of avian predators, which could suggest that migrant shorebirds show predation-minimizing behaviour during the post-breeding season. Our results reaffirm the important role of time constraints during northward migration and suggest that both energy and predation-risk constrain migratory behaviour during the post-breeding season

Unexpected diversity in socially synchronized rhythms of shorebirds

The behavioural rhythms of organisms are thought to be under strong selection, influenced by the rhythmicity of the environment1, 2, 3, 4. Such behavioural rhythms are well studied in isolated individuals under laboratory conditions1, 5, but free-living individuals have to temporally synchronize their activities with those of others, including potential mates, competitors, prey and predators6, 7, 8, 9, 10. Individuals can temporally segregate their daily activities (for example, prey avoiding predators, subordinates avoiding dominants) or synchronize their activities (for example, group foraging, communal defence, pairs reproducing or caring for offspring)6, 7, 8, 9, 11. The behavioural rhythms that emerge from such social synchronization and the underlying evolutionary and ecological drivers that shape them remain poorly understood5, 6, 7, 9. Here we investigate these rhythms in the context of biparental care, a particularly sensitive phase of social synchronization12 where pair members potentially compromise their individual rhythms. Using data from 729 nests of 91 populations of 32 biparentally incubating shorebird species, where parents synchronize to achieve continuous coverage of developing eggs, we report remarkable within- and between-species diversity in incubation rhythms. Between species, the median length of one parent’s incubation bout varied from 1–19 h, whereas period length—the time in which a parent’s probability to incubate cycles once between its highest and lowest value—varied from 6–43 h. The length of incubation bouts was unrelated to variables reflecting energetic demands, but species relying on crypsis (the ability to avoid detection by other animals) had longer incubation bouts than those that are readily visible or who actively protect their nest against predators. Rhythms entrainable to the 24-h light–dark cycle were less prevalent at high latitudes and absent in 18 species. Our results indicate that even under similar environmental conditions and despite 24-h environmental cues, social synchronization can generate far more diverse behavioural rhythms than expected from studies of individuals in captivity5, 6, 7, 9. The risk of predation, not the risk of starvation, may be a key factor underlying the diversity in these rhythms