Real World Research Articles

Twelve tips for integrating Virtual Reality Simulation into Health Professions Curricula

Virtual reality simulation (VRS) has the potential to disrupt and transform current understandings and practices in simulation-based education in health professions curricula. Recent technological developments, including AI applications, give the learner high levels of immersion into a virtual environment that even more closely mimic the real world than heretofore. At the same time, there are significant obstacles facing educators who strive to integrate VRS into their simulation curricula. We have written a VRS handbook for nurse educators, developed VR scenarios and delivered VRS workshops to undergraduate nursing students. Our twelve tips are aimed at undergraduate curriculum developers and simulation leaders, guiding them on how to support educators in integrating VRS into their curricula. The tips describe key considerations to be addressed in the development and integration of VRS into curricula. The tips are timely, as health professions education is on the cusp of entering technology-enhanced simulation, of which VRS will be a key player.

Real-World Clinical Outcomes of Treatment With Olaparib for BRCA1/2 Mutation-Positive Metastatic Breast Cancer in Japanese Patients.

Background Olaparib is effective in the treatment of metastatic breast cancer (MBC) patients, mainly confirmed by deleterious germline BRCA mutations. However, real-world data are scarce. Methodology A total of 10 cases from our institute and 17 cases from the relevant Japanese literature were reviewed. All 27 patients had MBC with confirmed deleterious germline BRCA mutations. Tumor reduction, response duration, disease-free interval (DFI), overall survival (OS), and safety were assessed. Additionally, exploratory research was conducted on the characteristics of a subgroup of patients who had a long-term response to olaparib. Results In the 10 cases from two Juntendo hospitals who received olaparib from July 2018 to December 2021, the median age was 48 years (range = 37-63 years). The same numbers of BRCA1 and BRCA2 mutations and the same ratios of luminal and triple negative (TN) breast cancer cases were observed. The metastatic sites, mainly visceral, included the lungs (n = 4), liver (n = 5), and bone (n = 6). The median duration of drug use was four months (range = 1-36 months). The median number of treatment regimens from metastasis to olaparib administration was 2.0 (range = 1-9 regimens). The median DFI was 21 months (range = 0-106 months). The median OS was not reached (range = 16-191 months). In the subgroup analysis of six cases in which olaparib was effective for four months or more, there was a case where DFI was longer than 100 months. Treatment-related toxicities (TRTs) included neutropenia (n = 5; 50%), anemia (n = 4; 40%), thrombocytopenia (n = 2; 20%), nausea (n = 1; 10%), and fatigue (n = 1; 10%). CTCAE (version 5.0) grade ≥3 TRTs included anemia (n = 1; 10%) and neutropenia (n = 5; 50%). On the other hand, neutropenia was previously said to be as low as 27.3%, lower than anemia (40.0%), in a population including various races. We additionally examined another 17 cases from the Japanese literature. Conclusions To our knowledge, this study reports the first real-world data of Japanese patients with MBC and confirmed deleterious germline BRCA mutations. Our data showed that olaparib is effective in the real world. The incidence of neutropenia seemed higher in Japanese patients.

Subdural Electroencephalogram Monitoring for Early Seizure Detection in Patients With Subdural Hematoma: Considering It in the Real World.

Subdural Electroencephalogram Monitoring for Early Seizure Detection in Patients With Subdural Hematoma: Considering It in the Real World.

Extropy and statistical features of dual generalized order statistics’ concomitants arising from the Sarmanov family

Abstract In this study, we disclose several statistical properties of concomitants of dual generalized order statistics (DGOSs) under a generic setting from the Sarmanov family of bivariate distributions. For this family, cross-moments and joint distributions of concomitants of DGOSs are explored. These results' implications for order statistics and record values are examined. Extropy and cumulative residual extropy (CRE), two well-known information measures, are also investigated. This study offers a few beautiful symmetrical relationships that these inaccuracy measurements satisfy. In addition, based on the concomitants of DGOSs, the issue of estimating the negative cumulative residual extropy (NCRE), empirical NCRE and NCE are investigated using the empirical technique. Lastly, a set of bivariate data from the real world is examined.

Steiner 3-Wiener Index of Zigzag Polyhex Nanotubes.

Let G be a connected graph and S be a k element subset of the vertex set V(G) of G. Steiner distance is a natural generalization of the usual graph distance. The Steiner-k distance dG(S) between the vertices of S is the minimum size among all connected subgraphs whose vertex set contains S. The generalized indices based on Steiner distances have several applications in the real world. It is a well-known fact that "Steiner Problem" is NP-complete and hence any parameter based on Steiner distance is also an NP problem. The objective of this work is to determine the Steiner 3-Wiener index for an important chemical structure called the zigzag polyhex nanotube. In this paper, we present an algorithm for computing the Steiner 3-Wiener index (SW3) for zigzag polyhex nanotubes. The developed algorithm addresses the complexities associated with exponential increments in the number of vertices as the nanotube's circumference or length expands. The obtained SW3 values for zigzag polyhex nanotubes can be used for Quantitative Structure-Activity Relationship (QSAR) and Quantitative Structure-Property Relationship (QSPR) analyses. We have presented an algorithm and listed the numerical values of SW3 for various parameters of circumference and length of a zigzag polyhex nanotube to facilitate their utilization in QSAR/ QSPR analyses. We have obtained the time complexity for the algorithm, which shows that the SW3 values are computationally intensive. To explain this complex nature, we have used multiple linear regression to fit log SW3 values corresponding to log p and log q, the radius and length of a nanotube. The algorithm addresses the complexities associated with the exponential increase in vertices as the nanotube's circumference or length expands. Furthermore, we provide SW3 values for various parameter combinations up to circumference or length 17, and a general relation to determine the value of SW3, facilitating its utilization in real-world applications. These values serve as crucial descriptors for understanding the structural nuances of zigzag polyhex nanotubes, that find applications in material science, drug design, drug discovery, etc.

The process of developing an augmented reality (AR) tool for knowledge translation on climate change-related experiences among youth in Kenya

This report details a qualitative methodological approach of developing an Augmented Reality (AR) tool which integrates digital storytelling for context-specific, accessible, scalable participatory research knowledge translation on climate-related sexual health experiences among youth (aged 16-25 years) in Kenya. AR, which engages audiences through virtual images overlayed on the real world in real-time, enhances learning and knowledge retention. This suggests the potential for using this increasingly accessible technology in knowledge translation, despite such use being understudied. Our AR tool meaningfully incorporates seven digital storytelling videos made by youth in Kenya through a study in 2023, to amplify youth voices while illustrating complex pathways between four climate-related factors (drought, floods, extreme heat, and excess winds) and three HIV vulnerabilities (gender-based violence, early marriage, and transactional sex). The aim of this paper is to describe the design of an AR tool for knowledge translation, youth empowerment, and health promotion, and to outline how it can be harnessed for sexual health and climate change education to inform future knowledge translation approaches with youth climate-affected issues.

Advanced Therapy Medicinal Products: Availability, Access and Expenditure in Italy.

Advanced therapy medicinal products (ATMPs) are an innovative output of biomedical research, characterized by a high level of uncertainty on long-term efficacy and safety, elevated price tags and often complex administration. All these elements compounded make their European authorization, national price negotiation for reimbursement and subsequent dispensation and administration to the patient less straightforward and often less successful than for less innovative drugs. To assess if these hurdles have affected patient access and how are ATMPs used in Italy, we have analysed availability, access and expenditure of ATMPs in the period spanning from 2016 to 2023. We have analysed real world data on the duration of ATMP regulatory evaluations for authorisation and reimbursement, time to first patient access and expenditure for ATMPs through the Italian National Health System (INHS) expenditure data flow, as well as information on patient mobility and availability of health facilities specialized in administering ATMPs. Of the 18 ATMPs currently authorized in Europe, 9 are reimbursed by the INHS, but only 6 were actually used, generating a cumulative expenditure of roughly 300 Mln€ from 2016 to 2023, largely owing to CAR-T therapies. Time to patient access reaches an average of 340.6 days from the day publication in the official Gazette of the reimbursement decision to first patient treatment in one of the 107 health facilities authorized for ATMP administration, after an even longer evaluation time by regulatory agencies. Since the first reimbursement decision for an ATMP in Italy, back in 2016, these innovative drugs became progressively more and more available, both in terms of numbers and in terms of coverage across the country. Almost all Italian regions have at least one centre for ATMP administration and has performed a treatment in 2023. Notwithstanding their high per-treatment prices, ATMPs currently have a rather contained expenditure, however it is bound to keep growing in the next few years.

Analysis of thermal performance and irreversibility of double-diffusive buoyancy-driven nano-suspension subject to local thermal non-equilibrium model

In fact, local thermal equilibrium (LTE) would be unsuitable when it comes to nuclear reactors, electronic equipment, space devices, geothermal engineering, and high-conductivity foams, due to prominent temperature discrepancy between the two constituents (solid and nanofluid) in porous material. Local thermal non-equilibrium (LTNE) situation may be considered in above real world applications. In view of above relevance, the effects of LTNE model on double-diffusive natural convection (DDNC) within a fluid-saturated porous container loaded with the TiO2-H2O nanofluid and emplacing four cooling and hot channels in Forchheimer-Brinkman-extended Darcy medium have been investigated in the present study. The momentum, heat and mass equations are solved by finite element method. Irreversibility in the two constituents (nanofluid and solid) of the porous structure has been analyzed. The significant outcomes are that fluid circulations enhance due to rise in porosity of the medium. Fluid friction entropy EnFF,T ameliorates significantly by 1514.16 % and 872.97 % with increase in Rayleigh number and porosity of the medium. It is clear that Nuloc,nf,Nuave,nf, Nuloc,s&Nuave,s enhance significantly with rise of buoyancy and thermal conductivity ratio, interstitial solid/fluid heat transfer coefficient.

Linguistic Modelling of Possible Worlds in English Netspeak Discussions

The authors of the article use the semantics of possible worlds as a theoretical basis for the research into English-speaking linguistic creative activity of Netspeak participants, who develop and verbalize mutually stipulated and interdependent mental constructs. The teaser-trailers of The Little Mermaid, Snow White, Peter Pan and Wendy trigger spectators’ discussion and creativity. Having watched the videos Internet users write comments in which they use linguistic and extra linguistic means to express their opinion. Thus, they embody two types of axiologically opposed possible worlds (PW) that fit in the general assessment dichotomy “good – bad”. A PW gets the positive assessment if it meets the addressee’s expectations and the pre-established genre canon. A PW gets the negative assessment if it differs in some aspects from what the spectator hoped to see. The article deals exclusively with the linguistic aspect of the comments. The results of the research show that the above-mentioned PWs are embodied either by universal assessment utterances whose pattern suits both PWs or special assessment utterances whose pattern suits only one of the PWs. Participants of the discussion use both explicit and implicit linguistic means to express their opinion. However, they use more varied expressive means to embody the negatively assessed mental construct. The utterances with the content that contradicts “the encyclopedia of the real world” (counter fact utterances) are of special interest because their authors resort to a strict structural and semantic pattern to express the disagreement with the political correctness and censorship.

Designing sustainable diet plans by solving triobjective integer programs

AbstractWe present an algorithm for triobjective nonlinear integer programs that combines the $$\varepsilon $$ ε -constrained method with available oracles for biobjective integer programs. We prove that our method is able to detect the nondominated set within a finite number of iterations. Specific strategies to avoid the detection of weakly nondominated points are devised. The method is then used to determine the nondominated solutions of triobjective 0–1 models, built to design nutritionally adequate and healthy diet plans, minimizing their environmental impact. The diet plans refer to menus for school cafeterias and we consider the carbon, water and nitrogen footprints as conflicting objectives to be minimized. Energy and nutrient contents are constrained in suitable ranges suggested by the dietary recommendation of health authorities. Results obtained on two models and on real world data are reported and discussed.

THE USE OF ARTIFICIAL INTELLIGENCE, VIRTUAL AND AUGMENTED REALITY IN TEACHING GEOGRAPHY IN SECONDARY SCHOOL

In today's innovative education, artificial intelligence (AI), virtual reality (VR) and augmented reality (AR) technologies are increasingly emerging as powerful tools to enhance the learning experience, especially in the teaching of geography in primary schools. This research explores how these technologies are being used to improve geography teaching and stimulate students' interest. AI brings personalised learning where content is adapted to individual learners' needs. Easier access to information, better visualisation of content, and help with analysis and interpretation make learning more accessible for students. At the same time, the ease of recreating content and the help in tracking individual learners' progress allows teachers to adapt learning strategies better and provide additional resources according to individual needs. VR and AR technologies help to create more interactive and realistic learning environments. Virtual reality allows learners to experience geographical phenomena more directly, while augmented reality complements the real world with digital information that can enrich the understanding of geographical concepts. These technologies focus on creating interactive content, virtual field trips, simulations of natural phenomena, and encouraging student participation and interest. The study also discusses challenges and solutions related to introducing AI in school geography, such as access to technology, teacher training and professional development, curriculum adaptation and ethical dilemmas. AI, VR and AR technology enable a new, at least in Slovenia, technologically sophisticated approach to teaching geography in primary schools. It encourages students to explore, interact and better understand complex geographic content. Keywords: geography education, artificial intelligence, virtual reality, augmented reality, interactive content

Regional distribution of anaplastic thyroid cancer in the United States

Abstract Introduction/Objective Anaplastic thyroid cancer (ATC) is an aggressive rare malignancy found in less than 2% of thyroid cancer patients. Its low occurrence rate presents challenges for collecting sufficiently large cohorts at a single institution, making statistical analysis about the disease’s spread, geographical distribution, and prevalence difficult. Nationwide data lakes such as Oracle EHR Real-World Data (ORWD, formerly Cerner Real World Data) offer a boost in cohort sizes and an opportunity to study ATC’s geographical distribution and assess regional differences. Methods/Case Report We searched ATC distribution across US regions defined by ZIP codes recorded in ORWD using multiple coding parameters, including ICD9, ICD10, and SNOMED as well as direct text searches for “anaplastic thyroid carcinoma”. We analyzed the geographical associations defined by ORWD (region) with sex, race, and age of ATC onset using the Fisher’s exact test. We combined 10 regions into 4 representative groups because of the small sample size. The groups are West Coast including the Rockies, Midwest from North Dakota to Texas, East Coast, and New England. Results (if a Case Study enter NA) Search for ATC condition codes in ORWD produced only 200 region-coded patient records across the US using multiple methods to try and identify cases. The mid-section of the US and coastal regions shows the highest numbers of ATC patients while New England and South regions show the lowest. While more women have ATC overall, the East Coast group has significantly more males (p value = 0.04). ATC is a predominantly white disease (79.8% overall) with black population increasing in East Coast group and other races (Asian/Undeclared) in West Coast (p-value < 0.001). There appears to be no significant association between age of ATC onset and the geographical groups. Conclusion The data shows geographic differences in distribution of ATC although this preliminary analysis neither explains the nature of these differences nor allows for a clearer view. The rarity of the disease complicates data analysis. This study was also limited by number of cases retrievable from the database itself and lack of granularity in coding available for ATC to find cases of interest, highlighting the difficulty of accurate tumor classifications in large data lakes. Further research into geographical distribution and environmental factors (radioactivity, pollution) of thyroid cancer using more advanced tools, such as GeoSpark, are planned.

Validating risk behavior in driving simulation using naturalistic driving data

The absence of physical accident risk in driving simulation, which allows for safely studying critical driving situations, also reduces the driver's risk perception, which may result in unrealistic driver behavior. Validation studies in this context are rare for ethical reasons, making it difficult to assess the extent of this issue at present. The present study addresses this gap by utilizing naturalistic driving data. Four critical cut-in situations on German highways were extracted from naturalistic data and replicated in a driving simulator study with N = 58 participants. Both in-situ self-ratings on subjective criticality and post-hoc video-based ratings (from the driver and objective observers), as well as presence ratings, were collected to supplement driver behavior. Although driver reactions in the simulator and the field were not equivalent in absolute terms, drivers in both the simulation and the real world exhibited accident-avoidance behavior through braking reactions, indicating relative validity. No clear mediating role of the sense of presence towards a more careful driver behavior was found. This work shows that drivers exhibit accident-avoiding behavior in the simulator and tend to react to hazards in the simulator similarly as they would in a real situation, while absolute numerical values should only be interpreted with caution.

Investigating constraint programming and hybrid methods for real world industrial test laboratory scheduling

AbstractIn this paper we deal with a complex real world scheduling problem closely related to the well-known Resource-Constrained Project Scheduling Problem (RCPSP). The problem concerns industrial test laboratories in which a large number of tests are performed by qualified personnel using specialised equipment, while respecting deadlines and other constraints. We present different constraint programming models and search strategies for this problem. Furthermore, we propose a Very Large Neighborhood Search approach based on our CP methods. Our models are evaluated using CP solvers and a MIP solver both on real-world test laboratory data and on a set of generated instances of different sizes based on the real-world data. Further, we compare the exact approaches with VLNS and a Simulated Annealing heuristic. We could find feasible solutions for all instances and several optimal solutions and we show that using VLNS we can improve upon the results of the other approaches.

A Study on a Spatiotemporal Entity-Based Event Data Model

An event is an important medium for recording, expressing, and understanding the real world. Additionally, a data model can provide a digital and structured description method for the real world. Therefore, studying event data models is highly important for describing the real world. By analyzing the representational categories of the existing event data models, the representation of existing event models was found to have different emphases and not be sufficiently balanced, and the universality and comprehensiveness need to be improved. Therefore, based on the advantages of the ontological event model in expressing semantic information and the advantages of the object-event-based spatiotemporal data model in expressing entity multidimensional characteristics and dynamic processes, a spatiotemporal entity-based event data model and the modeling method were designed to provide model support for event organization and processing. Additionally, the Long March and its important battles were selected as case studies to validate the proposed model. The validation shows that the proposed model performs well in terms of event dynamics, hierarchical structure, and complex interrelationships.

Exploring racial and ethnic disparities in the hidradenitis suppurativa patient disease journey: Results from a real-world study in Europe and the USA.

Hidradenitis suppurativa (HS) is an inflammatory skin disease associated with high morbidity and disability that has limited treatment options. People from racial and ethnic minority groups may experience greater disease severity and delay to diagnosis. This study assessed the impact of race/ethnicity on HS diagnosis and management in real-world clinical settings. Data were derived from the Adelphi Real World Hidradenitis Suppurativa Disease Specific Programme, a survey of dermatologists and their consulting HS patients in five European countries and the USA in 2020/2021. Dermatologists returned demographic and clinical data, and treatment goals and satisfaction for their next five to seven consulting patients. Patients completed a questionnaire on disease history and diagnosis, disease burden, and treatment satisfaction. Groups were compared with bivariate tests. In total, 312 physicians returned data on 1787 patients; 57.6% were female and 77.7% White. People from racial and ethnic minority groups were younger than White patients (32.9 ± 11.6 vs. 34.9 ± 12.4, mean ± standard deviation) and reported symptoms at a younger age (23.3 ± 10.8 vs. 26.2 ± 11.1), but their time to first consultation was longer than for White patients (2.6 ± 5.7 vs. 1.2 ± 2.5 years). People from racial and ethnic minority groups took longer to receive a correct diagnosis following first consultation (2.7 ± 5.3 vs. 1.5 ± 4.1 years) and were more likely to be misdiagnosed with boils (73.5% vs. 40.4%). People from racial and ethnic minority groups had a greater disease awareness at diagnosis and reported wanting greater support. People from racial and ethnic minority groups reported a greater impact on life, more severe pain, and a greater level of activity impairment in the Work Productivity and Activity Impairment: General Health (27.0 ± 25.2 vs. 20.0 ± 20.6). All P values were ≤0.05. These data show evidence of delayed diagnosis and higher HS symptom burden amongst people from racial and ethnic minority groups, highlighting health disparities in HS.

Is “Application” Everything about Studying for a University Degree? The Multiple Influences Shaping Undergraduates in Chinese Higher Education in Contemporary Times

Abstract Based on the self-reflection of 22 undergraduate students at a renowned Chinese university regarding their journey towards obtaining a bachelor’s degree, this study reveals the discrepancy between the idealistic functions and missions of higher education as perceived by students and their actual implementations in the real world. It further explores the multifaceted logics exerted by the higher education environment on students during their educational journey. Data analysis shows that contemporary global neoliberalism, alongside traditional Chinese cultural ideologies such as Confucianism and Daoism, significantly impacts the educational philosophies of university students to varying extents. These diverse ideologies drive students to demonstrate varied learning states and behaviors, showcasing the complex interplay of global and local forces in shaping student experiences in higher education.

Overview of Finnish national patient data repository for research on medical risk assessment

The Kanta Patient Data Repository (PDR) contains healthcare data from the population of Finland for more than a decade. The repository is a continuously expanding real world dataset produced by many information systems and healthcare service providers. Kanta data has been available for secondary uses such as scientific research since 2019. The data can be requested from the Finnish authority Findata. However, before a request has been accepted, it is difficult to assess if the accumulated data allows answering a specific research question. Publicly available descriptions of data structures in the Kanta PDR do not tell how much they are used in practice. This publication enables future data use cases by providing a view on the overall availability of types of structured health data in the Kanta PDR based on a sample of 96 200 medical histories of over 18-year-old patients. We conclude that the Kanta PDR is a promising source of real world data for development and evaluation of medical risk calculators within the Finnish population. The wide coverage of the Finnish population and timeliness of the data are its strengths as a source of research data also outside of Finnish context. However, the limitations on data availability in variable level need to be considered on a case-by-case basis. Main challenges in the use of data in the Kanta PDR are multiple code systems for laboratory results, short durations of recorded data for specific data types, and missing or very rarely used structured format e.g., in cases of tobacco and alcohol use.

Real collapse responses of an RC flat plate structure under extreme overloading condition: Reversing load redistribution

Progressive collapse research of concrete flat plate structures, typically investigated through the alternate path (AP) method with a focus on column failure (removal), has often neglected the facts of real-life collapse events which are caused by slab overloading, leading to initial punching shear failure at slab-column joints. Progressive collapse of the structural systems triggered by slab-column joint failures exhibits distinct failure modes and resistance mechanisms from those triggered by column failures. Building upon our initial tests on the overloaded slab specimen under quasi-static loading regimes, this paper presents an innovative experimental study that closely mirrors the load-resistant mechanisms of the most common collapse incidents in flat plate structure systems in the real world. By successively stacking up gravity loads without additional interventions, the test accurately simulates the spontaneous failure conditions typical of flat plate structures. A key discovery of this research is the identification of a unique reversing load redistribution mechanism, a phenomenon not previously observed in our slab overloading tests or in studies focused on column removal scenarios. This discovery highlights the necessity of enhancing the post-punching capacity at the slab-column joints as a critical factor in preventing collapses due to slab overloading. In addition, this study provides an in-depth examination of the dynamic effects inherent in the progressive collapse of flat plate structures. Evaluating the dynamic increase factor and load amplification factor offers supplementary data pertinent to real-world collapses, providing essential insights for improving the resilience of flat plate structures against initial joint failure due to slab overloading.

Assessing disease control in inflammatory bowel disease: a real world cross-sectional study in the UK (PODCAST-IBD)

Objective Proportion Of suboptimal Disease Control And Strategy of Treatment in IBD (PODCAST-IBD) was an international real-world study which aimed to quantify disease control in IBD using STRIDE-II recommendations. Design/Method Cross-sectional assessment of IBD patients attending routine clinic appointments in four UK centers October 2022 to January 2023. Clinician-reported outcomes, patient-reported outcomes and retrospective data from medical chart review were used to assess IBD control against red flags aligned to STRIDE-II. Results Data were available from 198 UK patients. IBD was suboptimally controlled in 52.4% (54/103) of patients with Crohn’s disease (CD) and 45.3% (43/95) with ulcerative colitis (UC). Impaired quality of life (QOL), defined as Short inflammatory bowel disease questionnaire (SIBDQ) score <50, was the main contributor to suboptimal disease control. Suboptimal disease control has a detrimental impact on fatigue and disability with significantly lower mean Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) score in suboptimally controlled disease (CD: 81.5 vs 125, UC: 87.4 vs 122.8) and IBD Disk. Suboptimal disease control results in higher health care resource use (HCRU) (CD: £4,746 vs £1,924; UC: £2,428 vs £1,121) and higher rates of work productivity loss (CD: 41.7% vs 11.9%, UC: 38.0% vs 22.6%). Conclusion IBD was suboptimally controlled in around one-half of patients. Impaired QOL was the most common contributor (64%, 62/97) to suboptimal control. Suboptimal control had a considerable economic impact; HCRU more than doubled and productivity fell. Physicians could consider regular QOL assessments to prompt timely disease monitoring to enable identification of early active disease and appropriate treatment.