Explore the vast range of titles available.

To examine the correlation between undergraduate nursing students’ personality and high-fidelity simulation learning effectiveness. Simulation is a fundamental approach in nursing education, with learning outcomes associated with various factors. Personality, reflecting on one’s way of learning, thinking and behaving, is a potential factor associated with simulation learning. A descriptive correlational study was conducted. 68 final year undergraduate nursing students completed an online survey following a high-fidelity nursing simulation. The five personality traits of neuroticism, extraversion, openness, conscientiousness and agreeableness were examined using the Neuroticism-Extraversion-Openness Five-Factor Inventory 3 (NEO-FFI-3). To investigate the relationship between personality and learning effectiveness, the revised English version of the Simulation Learning Effectiveness Inventory (SLEI) was also completed. No significant association was found between the five personality traits and students’ simulation learning effectiveness. However, the SLEI subscale of ‘resources’ was positively correlated with the trait of conscientiousness (r = 0.248, p = 0.04). In addition, students’ nursing work experience was associated with their learning effectiveness in high- fidelity simulation. Nursing students scored the highest in the personality trait of agreeableness (35.04 SD 5.28) and the lowest in that of neuroticism (26.53 SD 7.33). Understanding personality assists in the application of best practice simulation for undergraduate nursing students. The design and implementation of high-fidelity simulation needs to consider students’ previous nursing work experience. •In undergraduate nursing students, agreeableness is the predominant personality trait.•Experienced students reported a lower learning effectiveness in simulation than inexperienced students.•Students’ personalities are not related to their learning effectiveness in face-to-face simulation.•Neuroticism tendency for undergraduate nursing students was higher than general population and maybe linked to future burnout

To explore final year nursing student’s ability to transfer clinical judgement skills to the clinical practice setting following immersive simulation. Clinical judgement is considered a fundamental skill for nurses to ensure safe, quality care is delivered. In undergraduate nursing education where students have limited clinical experience, simulation-based education is an important educational strategy for introducing and developing these skills. Simulation allows for students to be exposed to repeated experiences and emotional responses to varying clinical situations. Despite this, there is a paucity of literature relating to students’ ability to transfer clinical judgement skills from the simulated environment into clinical practice. A naturalistic philosophical approach informed data collection in this qualitative phase of a larger study. Data were collected from students and nurse educators using semi-structured interviews as well as from facilitated simulation debriefs. Data were thematically analysed. Four themes were identified which related to student knowledge, self-awareness and the clinical context: Safely collecting the data; Understanding the data to safely make decisions; Emotional intelligence; and Role variation. Students and educators held similar views on many of these elements. Questioning was identified as a key component of nursing students’ clinical judgements. There were challenges in assessing students’ ability to link theory to practice in the clinical setting, despite evidence of this occurring in the simulated setting. Simulation prepares students for practice by exposing them to new experiences and stressors and therefore an effective educational technique for developing clinical judgement skills in this cohort.

ObjectivesThe skill of the debriefer is known to be the strongest independent predictor of the quality of simulation encounters yet educators feel underprepared for this role. The aim of this review was to identify frameworks used for debriefing team-based simulations and measures used to assess debriefing quality.MethodsWe systematically searched PubMed, CINAHL, MedLine and Embase databases for simulation studies that evaluated a debriefing framework. Two reviewers evaluated study quality and retrieved information regarding study methods, debriefing framework, outcome measures and debriefing quality.ResultsA total of 676 papers published between January 2003 and December 2017 were identified using the search protocol. Following screening of abstracts, 37 full-text articles were assessed for eligibility, 26 studies met inclusion criteria for quality appraisal and 18 achieved a sufficiently high-quality score for inclusion in the evidence synthesis. A debriefing framework was used in all studies, mostly tailored to the study. Impact of the debrief was measured using satisfaction surveys (n=11) and/or participant performance (n=18). Three themes emerged from the data synthesis: selection and training of facilitators, debrief model and debrief assessment. There was little commonality across studies in terms of participants, experience of faculty and measures used.ConclusionsA range of debriefing frameworks were used in these studies. Some key aspects of debrief for team-based simulation, such as facilitator training, the inclusion of a reaction phase and the impact of learner characteristics on debrief outcomes, have no or limited evidence and provide opportunities for future research particularly with interprofessional groups.

Healthcare simulations help learners develop teamwork and clinical skills in a risk-free setting, promoting reflection on real-world practices through structured debriefs. However, despite video's potential, it is hard to use, leaving a gap in providing concise, data-driven summaries for supporting effective debriefing. Addressing this, we present TeamVision, an AI-powered multimodal learning analytics (MMLA) system that captures voice presence, automated transcriptions, body rotation, and positioning data, offering educators a dashboard to guide debriefs immediately after simulations. We conducted an in-the-wild study with 56 teams (221 students) and recorded debriefs led by six teachers using TeamVision. Follow-up interviews with 15 students and five teachers explored perceptions of its usefulness, accuracy, and trustworthiness. This paper examines: i) how TeamVision was used in debriefing, ii) what educators found valuable and challenging, and iii) perceptions of its effectiveness. Results suggest TeamVision enables flexible debriefing and highlights the challenges and implications of using AI-powered systems in healthcare simulation.

Multimodal Learning Analytics (MMLA) innovations make use of rapidly evolving sensing and artificial intelligence algorithms to collect rich data about learning activities that unfold in physical learning spaces. The analysis of these data is opening exciting new avenues for both studying and supporting learning. Yet, practical and logistical challenges commonly appear while deploying MMLA innovations \"in-the-wild\". These can span from technical issues related to enhancing the learning space with sensing capabilities, to the increased complexity of teachers' tasks and informed consent. These practicalities have been rarely discussed. This paper addresses this gap by presenting a set of lessons learnt from a 2-year human-centred MMLA in-the-wild study conducted with 399 students and 17 educators. The lessons learnt were synthesised into topics related to i) technological/physical aspects of the deployment; ii) multimodal data and interfaces; iii) the design process; iv) participation, ethics and privacy; and v) the sustainability of the deployment.

The opioid/substance use disorder (SUD) epidemic in the United States has become a public health crisis. Stigma by health care workers towards patients with SUD has been identified as a barrier to treatment. Additionally, racial inequities in wait times and service provision have been found in Emergency Departments (EDs). The purpose of this study was to examine the racial/ethnic differences in severity of ED triage assignment among visits for SUD. This retrospective study utilized pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016-20. The dependent variable was the recorded triage level for patients with SUD. The independent variable was patient race/ethnicity. Analyses controlled for variables such as age, sex, and arrival by ambulance. Differences in triage level by race/ethnicity among visits by patients with SUD was assessed via multivariable logistic regression models. Of the reported 788 SUD-specific ED visits from patients with SUD, 56.0% were non-Hispanic White, 28.6% were non-Hispanic Black, 12.9% were Hispanic, and 2.5% were of another race. Visits by Black patients with SUD had 53% lower odds of being assigned to an immediate/emergent triage level compared to visits by White patients with SUD (OR=0.47, p = .025). We found that visits by Black patients with SUD were associated with lower odds of receiving an immediate/emergent triage assignment compared to visits by White patients with SUD, after adjusting for confounding variables. Our results suggest potential dual stigma in ED care of being Black and having a substance use disorder.

Shrubs are invading into grasslands around the world, but we don’t yet know how these shrubs will fare in a warmer future. In ecotonal coastal wetland ecosystems, woody mangroves are encroaching into herbaceous salt marshes owing to changes in temperature, precipitation, and sediment dynamics. Increasing mangrove biomass in wetlands often increases carbon storage, which is high in these productive ecosystems, but little is known about how mangrove growth will change in response to warming. To address this knowledge gap, we deployed warming experiments at three coastal wetland sites along a latitudinal gradient in northeast Florida where Avicennia germinans, black mangroves, are encroaching into salt marshes. We achieved air temperature warming (+1.6°C during the day) at all three sites and measured stem elongation, canopy height and area changes, and leaf and node number. After 2 yr of warming, we found that mangrove growth rate in height increased due to warming. Warming increased stem elongation by 130% over unwarmed control plots after 1 yr at the northern site. Mangrove growth in canopy area did not respond to warming. Site differences in growth rate were pronounced, and mangrove growth in both height and area were lowest at the northern site, despite greater impacts of warming at that site. We also found that area-based relative growth rate was five times higher across all treatments than height-based relative growth rate, indicating that mangroves are growing wider rather than taller in these ecotonal environments. Our findings indicate that the growth effect of experimental warming depends on site characteristics and growth parameter measured. We also propose that differential mangrove growth across the three sites may be driven by biotic factors such as the identity of the salt marsh species into which mangroves are encroaching. Our results suggest that, as seen in other ecosystems, wetland plants may respond most strongly to warming at their poleward range edge.

The existence of coastal ecosystems depends on their ability to gain sediment and keep pace with sea level rise. Similar to other coastal areas, Northeast Florida (United States) is experiencing rapid population growth, climate change, and shifting wetland communities. Rising seas and more severe storms, coupled with the intensification of human activities, can modify the biophysical environment, thereby increasing coastal exposure to storm-induced erosion and inundation. Using the Guana Tolomato Matanzas National Estuarine Research Reserve as a case study, we analyzed the distribution of coastal protection services–expressly, wave attenuation and sediment control–provided by estuarine habitats inside a dynamic Intracoastal waterway. We explored six coastal variables that contribute to coastal flooding and erosion–(a) relief, (b) geomorphology, (c) estuarine habitats, (d) wind exposure, (e) boat wake energy, and (f) storm surge potential–to assess physical exposure to coastal hazards. The highest levels of coastal exposure were found in the north and south sections of the Reserve (9% and 14%, respectively) compared to only 4% in the central, with exposure in the south driven by low wetland elevation, high surge potential, and shorelines composed of less stable sandy and muddy substrate. The most vulnerable areas of the central Reserve and main channel of the Intracoastal waterway were exposed to boat wakes from larger vessels frequently traveling at medium speeds (10–20 knots) and had shoreline segments oriented towards the prevailing winds (north-northeast). To guide management for the recently expanded Reserve into vulnerable areas near the City of Saint Augustine, we evaluated six sites of concern where the current distribution of estuarine habitats (mangroves, salt marshes, and oyster beds) likely play the greatest role in natural protection. Spatially explicit outputs also identified potential elevation maintenance strategies such as living shorelines, landform modification, and mangrove establishment for providing coastal risk-reduction and other ecosystem-service co-benefits. Salt marshes and mangroves in two sites of the central section (N-312 and S-312) were found to protect more than a one-quarter of their cross-shore length (27% and 73%, respectively) from transitioning to the highest exposure category. Proposed interventions for mangrove establishment and living shorelines could help maintain elevation in these sites of concern. This work sets the stage for additional research, education, and outreach about where mangroves, salt marshes, and oyster beds are most likely to reduce risk to wetland communities in the region.

Low temperature stress is the primary factor determining the latitudinal limits of tropical plants. As the climate warms, tropical species are migrating poleward, displacing native species and modifying ecosystem structure and function. Changes are particularly evident along latitudinal gradients with the highest velocity of change occurring in wetlands. In coastal wetlands, saltmarshes dominate at latitudes above 30°, whereas mangroves occur mostly in the tropics because most species are intolerant of freezing temperatures, but others, like Avicennia germinans (black mangrove), do tolerate freezing temperatures. In response to a warmer climate and fewer killing freezes, mangroves are currently expanding into saltmarshes. However, the speed of the transition from saltmarsh to mangrove can also be modified by extreme events and nutrient subsidies. In a fertilization experiment along the Atlantic coast of North America, we found that nitrogen addition altered plant traits in Avicennia, which increased their resistance to freezing temperatures. This trait shift resulted in negligible freeze effects during a January 2018 extreme freeze event compared to unfertilized plants, which lost more than 80% of the leaves and more than 40% of the wood in their canopies. The freeze-killed litter from unfertilized plants provided a nutrient pulse that influenced recovery, growth and mangrove cover for three years following the freeze. Nutrient enrichment and recovery from the freeze effects led to increased growth and structural complexity of the mangrove canopy, which further enhanced freeze tolerance, shrub growth form and the ability of Avicennia to displace the saltmarsh in the temperate–tropical ecotone.

Objectives An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. Methods A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. Results A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. Conclusions This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.