Using Telehealth to Improve the Accuracy of Delirium Screening by Bedside Critical Care Nurses

Background Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs. Objectives This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses. Methods The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability. Results Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the “unable to assess” designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P < .001). All 13 nurses strongly agreed that the training was beneficial and practice changing. Conclusions The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.

Fertility awareness and intentions among young adults in Greece

Background: Greece has a mean age of first motherhood at 31.5 years, higher than the European average age of 29.4. Delaying conception, however, may be an important non-reversible cause of infertility. The aim of this study was to identify possible knowledge deficits regarding fertility in young adults. Methods: This was an online survey of young adults, regarding information on intention to parenthood and knowledge on issues affecting fertility. This study was conducted from February to December 2020, aiming for a representative sample of Greek men and women aged 18 and 26 years. The questionnaire was designed by a multidisciplinary group based on the Cardiff Fertility Knowledge Scale, which contained 22 multiple-choice or Likert-scale questions. Results: We obtained responses from 1875 young adults, whose mean age was 22.1 years. About 91.8% of men and 94.0% of women declared an intention to have children, out of which 44.0% wanted to have two and 29.0% three children. About 52.0 and 50.8% men and women, respectively, aimed to start a family between 31 and 35 years. Residents of rural areas and those with a lower education level more likely aimed to have children before the age of 30. The most prevalent answers for age of ideal parenthood were between 26 and 30 years for a woman and 31–35 years for a man. Smoking, alcohol consumption and sexually transmitted infections were identified as factors affecting both female and male fertility. Half of men and women, respectively, overestimated general success rates of reproductive techniques. Conclusion: The knowledge of fertility, particularly with regards to assisted reproductive techniques’ success rates, may be overestimated as more young adults plan for having children after the age of 30.

ROLE OF SOFTWARE AND METHODOLOGICAL SUPPORT FOR TRAINING TRACK-AND-FIELD ATHLETES (RACEWALKERS) AT THE STAGE OF SPORTS SKILLS IMPROVEMENT

Statement of the problem. Specialists involved in the training of track and field athletes-walkers note the need to develop recommendations for optimizing and individualizing the training process. At the same time, experts see the problem in the need to improve the methodological framework. This article presents the role of not just a methodological complex for providing training for athletes, but a methodological complex taking into account their specialization. The purpose of the article is to identify ways for improving methodological tools when training track-and-field athletes at the stage of sports skills improvement. The research methodology consists of general scientific research methods. In particular, the method of generalization, analysis, and content analysis. The analysis resulted in conclusions that determine the role of software and methodological support. Research results. As a result of the analysis, generalization of the results of a number of authors, including practitioners, the necessity of using an interdisciplinary approach to the problem of methodological support for the training of athletes was revealed. It is proposed to use digital technologies in the development and implementation of methodological tools in the practice of coaching at the stage of improving sports mastery. Conclusion. The article proposes a new approach to the development of the methodological basis of the training process. To achieve the stage of sports skills improvement, athletes and a coach need effective teaching materials, since the period of improvement coincides with the process of preparing for a competition, and such training must take into account many factors, a coach must have a significant amount of theoretical knowledge and practical skills, and this does not always correspond to reality. At the stage of improvement, effective and tested in practice software and methodological complex can solve many problems, eliminate knowledge deficits, so its importance can hardly be overestimated. The article concludes that it is necessary to introduce programming elements, to use digital technologies in the development and use of training programs for athletes. The created program will allow a trainer to track athlete’s achievements, will allow predicting, analyzing, modeling the results achieved, and, most importantly, and to take into account the characteristics of the athlete. Such a methodological complex based on the programming language and modern digital technologies is based on interdisciplinary and integrated approaches to the problem of improving sports mastery.

Using Online Texts to Build Independent Readers in ESL Classrooms

Studies with proficient users of English suggest that readers demonstrate deeper comprehension of texts when reading non-linear hypertexts than when reading linear texts. This is attributed to the networked nature of texts that helps readers exercise cognitive flexibility. An aspect that remains largely unresearched is the potential of linear online texts to facilitate comprehension in readers who are non-proficient users of English. Keeping in mind the fact that a majority of readers reading online texts in English can be hindered by three types of comprehension deficits – low levels of language proficiency, non-availability of prior knowledge, or both – this study investigated the interactive effects of two salient features of online texts, viz., non-linearity in the presentation of text and the availability of additional sources of information, on the reading comprehension of ESL readers. Two groups of readers with high and low levels of English proficiency read twelve texts on familiar and unfamiliar topics in print, linear online, and non-linear online modes. A comparison of readers’ responses to comprehension questions and free recalls showed that those with low linguistic competence and/or topic familiarity were able to achieve better comprehension of linear online texts than print texts or non-linear online texts. The findings indicate that text linearity when combined with the presence of multiple information resources (both provided by the author within the text and freely available on the internet) might have the potential to scaffold linguistic and content knowledge deficits in ESL readers and promote deep levels of comprehension.

How registered nurses balance limited resources in order to maintain competence: a grounded theory study

Background Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse’s personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace.

Knowledge of stoma care among nurses working in acute settings: an integrated review

Background: Ostomy formation is life-changing surgery, and patient numbers are increasing globally. Knowledge of stoma care and management among nurses in acute settings is vital to provide holistic care, support patients' return to normal life and prevent complications. Aim: To estimate the knowledge of stoma care among nurses working in acute settings using an integrative review. Method: Five databases were searched between 2009 and 2020. A methodological approach for integrative reviews and a thematic analysis framework were used to identify themes from 10 papers. Reporting followed PRISMA guidelines, and quality appraisal was conducted. Findings: Nurses working in acute care settings have limited knowledge of stoma care, and confidence in care provision to patients with ostomies is affected by a lack of exposure. Confusion exists regarding the responsibilities of nurses when stoma care is required for an inpatient. Conclusion: Knowledge deficits regarding stoma care need to be addressed via exposure and support to deliver stoma care, access to evidence-based policies and protocols and clear referral pathways.

Toxic Sensorium

Pesticides and toxicity are constitutive features of modernization in Africa, despite ongoing portrayals of the continent as “too poor to pollute.” This article examines social science scholarship on agricultural pesticide expansion in Sub-Saharan Africa. We recount the rise of agrochemical usage in colonial projects that placed African smallholder farmers at the forefront of toxic vulnerability. We then outline prevalent literature on “knowledge deficits” and unsafe farmer practices as approaches that can downplay deeper structures. Missing in this literature, we argue, are the embodied and sensory experiences of African farmers as they become pesticide users, even amid an awareness of toxicity. Drawing on ethnographic research in Mozambique and Burkina Faso, we explore how the “toxic sensorium” of using agrochemicals intersects with farmers’ projects of modern aspiration. Th is approach can help elucidate why and how differently situated farmers live with pesticides, thereby expanding existing literature on structural violence and knowledge gaps.

Predictive language comprehension in Parkinson’s disease

Language impairment in Parkinson’s disease (PD) may be attributable to motor and action/event knowledge deficits. We predicted that cognitively intact PD participants would be impaired in anticipating objects in sentences from event-based thematic fit information. Twenty-four PD and 24 healthy age-matched participants completed comprehensive neuropsychological assessments. We recorded participants’ eye movements as they heard predictive (The fisherman rocks the boat) and non-predictive baseline sentences (Look at the bathtub). Predictive sentences contained target, agent-related, verb-related, and unrelated images. Baseline sentences used phonologically and semantically unrelated distractors. We tested effects of group (PD/control) on gaze using growth curve models. There were no significant differences between PD and control participants in either sentence type, suggesting that PD participants successfully and rapidly use combinatory thematic fit information to predict upcoming language. Additionally, we conducted an exploratory analysis contrasting PD and controls’ performance on low motion content versus high motion content verbs. This analysis revealed fewer predictive fixations in high-motion sentences only for healthy older adults, suggesting that people with Parkinson’s disease may adapt to their disease by relying on spared, non-action-simulation-based language prediction and processing mechanisms. Given that multiple studies have shown that individuals with PD have difficulty processing verbs, it is highly surprising that they match healthy adults in their ability to use verb meaning to predict upcoming nouns.

Ocean Outreach in Australia: How a National Research Facility is Engaging with Community to Improve Scientific Literacy

Marine systems across the globe are experiencing myriad pressures with consequences for their health, management and the industries and communities that depend on them. Critical to improved management of our oceans and coasts is effective education and communication that ultimately leads to improved societal value of the world’s oceans. In Australia, the national scientific research agency, CSIRO, operates critical national research infrastructure such as the Marine National Facility (MNF), which also plays an important role in marine education, training and communication. The MNF Outreach Program seeks to strategically engage the community in marine science, identifying audience segments and developing programs, activities and content to meet their specific information needs. The program is structured around three specific audience segments: Purpose Seekers, Nurturers and Lifelong Learners. With both at-sea and shore-based activities and programs including the Indigenous Time at Sea Scholarship, CAPSTAN sea-training, Educator on Board, Floating Classroom, live ship-to-shore crosses and media and social media programming, the MNF Outreach program delivers meaningful engagement through experiential learning opportunities, rather than simply addressing knowledge deficits. As marine issues are varied and complex, marine communication and education approaches must be equally multifaceted, and a successful outreach program will have a spectrum of activities of varying resource intensity (such as cost, time and appropriately skilled personnel) which are matched to clear target audience segments. With increasing recognition of the importance of science communication in informing science literacy and policy, publicly funded national research facilities have an essential role to play by shifting from traditional research-only roles to also provide for targeted education and outreach.

Advanced learners’ responses to Chinese greetings in study abroad

This study explored the pragmatic strategies that advanced L2 learners of Chinese produced in greeting responses (GRs). Data were collected through roleplays and retrospective verbal reports (RVRs) from 11 advanced learners of Chinese who were studying in China. To obtain comparison data, 20 Chinese students were recruited to complete the same roleplays. The GRs were coded into openings, head acts and closings, and classified into ten strategies: phatic phrases, address terms, corresponding answers, reciprocal compliments, disagreeing, seeking confirmation, thanking, reciprocity questions, introducing another topic and reasons. The findings revealed that compared with Chinese native speakers (NSs), advanced learners produced non-target-like GRs, although their GRs were acceptable based on two NSs’ evaluation. The RVR data indicated that the learners’ non-target-like GRs might result from their idiosyncratic perceptions of Chinese greetings, pragmatic knowledge deficits, effects of instruction and learner agency. Implications for future research and teaching Chinese pragmatics are also discussed.