•VR interventions are shown to be effective adjunct or alternative pain therapies for both children and adults.•VR analgesia can operate on different levels, to mediate simple distraction, focus ...shifting or self-regulation of pain.•The evidence for impact of VR analgesia on chronic pain is under-investigated, compared to impacts on acute pain.•More research is needed to support the long-term benefits of using VR for managing pain, particularly for chronic pain.•Future research should address the impact of interactivity and personalization on the efficacy of VR analgesia.
Virtual Reality (VR) is now consumer ready and nearing ubiquity. In terms of clinical applications, several studies suggest that VR can be effective as a complementary adjunct or alternative non-pharmacologic analgesic in a range of pain-inducing procedures and in management of chronic pain. The increasing affordability and quality of portable VR headsets and the ongoing utility of pain therapy signals an exciting future for the use of VR for analgesia. However, further research is needed to establish its long-term benefits if VR is to be adopted into mainstream protocols for analgesia management. This research requires a range of study designs with collection of patient self-report and clinical data together to develop bespoke interventions for different cohorts.
Upper limb tennis injuries are primarily chronic, resulting from repetitive overuse. We developed a wearable device which simultaneously measures risk factors (grip strength, forearm muscle activity, ...and vibrational data) associated with elbow tendinopathy development resulting from tennis players' technique. We tested the device on experienced (
= 18) and recreational (
= 22) tennis players hitting forehand cross-court at both flat and topspin spin levels under realistic playing conditions. Using statistical parametric mapping analysis, our results showed that all players showed a similar level of grip strength at impact, regardless of spin level, and the grip strength at impact did not influence the percentage of impact shock transfer to the wrist and elbow. Experienced players hitting with topspin exhibited the highest ball spin rotation, low-to-high swing path brushing action, and shock transfer to the wrist and elbow compared to the results obtained while hitting the ball flat, or when compared to the results obtained from recreational players. Recreational players exhibited significantly higher extensor activity during most of the follow through phase compared to the experienced players for both spin levels, potentially putting them at greater risk for developing lateral elbow tendinopathy. We successfully demonstrated that wearable technologies can be used to measure risk factors associated with elbow injury development in tennis players under realistic playing conditions.
Adipocytes secrete a number of bioactive adipokines that activate a variety of cell signaling pathways in central and peripheral tissues. Obesity is associated with the altered production of many ...adipokines and is linked to a number of pathologies. As an increase in body weight is directly associated with an increased risk for developing chronic kidney disease (CKD), there is significant interest in the link between obesity and renal dysfunction. Altered levels of the adipokines leptin, adiponectin, resistin, and visfatin can decrease the glomerular filtration rate and increase albuminuria, which are pathophysiological changes typical of CKD. Specifically, exposure of the glomerulus to altered adipokine levels can increase its permeability, fuse the podocytes, and cause mesangial cell hypertrophy, all of which alter the glomerular filtration rate. In addition, the adipokines leptin and adiponectin can act on tubular networks. Thus, adipokines can act on multiple cell types in the development of renal pathophysiology. Importantly, most studies have been performed using in vitro models, with future studies in vivo required to further elucidate the specific roles that adipokines play in the development and progression of CKD.
The structural organisation of pancreatic β-cells in the islets of Langerhans is relatively unknown. Here, using three-dimensional (3D) two-photon, 3D confocal and 3D block-face serial electron ...microscopy, we demonstrate a consistent in situ polarisation of β-cells and define three distinct cell surface domains. An apical domain located at the vascular apogee of β-cells, defined by the location of PAR-3 (also known as PARD3) and ZO-1 (also known as TJP1), delineates an extracellular space into which adjacent β-cells project their primary cilia. A separate lateral domain, is enriched in scribble and Dlg, and colocalises with E-cadherin and GLUT2 (also known as SLC2A2). Finally, a distinct basal domain, where the β-cells contact the islet vasculature, is enriched in synaptic scaffold proteins such as liprin. This 3D analysis of β-cells within intact islets, and the definition of distinct domains, provides new insights into understanding β-cell structure and function.
The COVID-19 pandemic required higher education institutions to rapidly transition to Emergency Remote Instruction (ERI) with little preparation. Discussions are now underway globally to learn the ...lessons of COVID-19 and to use this knowledge to shape the future of learning science in higher education. In this study, we examined the experiences of instructors and students to ERI in three universities across three continents-America, Europe, and Australia. We measured the instructional strategies used by instructors including assessment types, and interaction opportunities during and outside class schedules. We also measured the learning challenges experienced by students including planning, distractions, technology, learning resources, their views on educational quality and what characterized quality interactions during ERI. Our findings suggest that most instructional strategies used by instructors changed little during ERI, although the nature of instructor and student interactions during class relied more heavily on technology. Students reported significant learning challenges which included distractions from their physical and social media environments and access to technology. Both instructors and students reported that interactions with each other and their peers were concerningly low, albeit similar to pre COVID-19 pandemic levels. There were differences in the perceptions of instructors and students on whether instructor-student interactions were better or worse online. Common among all universities, there was a large proportion of students reporting mental health and work-related stress. Lessons to be learned from the COVID-19 pandemic include ensuring more support for instructors to implement effective and equitable pedagogies and an increased recognition of the importance of practicals, and the social, interactive and hands-on aspects of learning science in higher education. We predict that the incorporation of active learning pedagogies and strategies which increase student engagement and foster a sense of belonging will be ongoing global challenges for learning science in a post COVID-19 campus.
Background
Violence and aggression are significant workplace challenges faced by clinicians worldwide. Traditional methods of training consist of “on-the-job learning” and role-play simulations. ...Although both approaches can result in improved skill levels, they are not without limitation. Interactive simulations using virtual reality (VR) can complement traditional training processes as a cost-effective, engaging, easily accessible, and flexible training tool.
Objective
In this exploratory study, we aimed to determine the feasibility of and barriers to verbal engagement with a virtual agent in the context of the Code Black VR application. Code Black VR is a new interactive VR-based verbal de-escalation trainer that we developed based on the Clinical Training Through VR Design Framework.
Methods
In total, 28 participants with varying clinical expertise from 4 local hospitals enrolled in the Western Sydney Local Health District Clinical Initiative Nurse program and Transition to Emergency Nursing Programs and participated in 1 of 5 workshops. They completed multiple playthroughs of the Code Black VR verbal de-escalation trainer application and verbally interacted with a virtual agent. We documented observations and poststudy reflection notes. After the playthroughs, the users completed the System Usability Scale and provided written comments on their experience. A thematic analysis was conducted on the results. Data were also obtained through the application itself, which also recorded the total interactions and successfully completed interactions.
Results
The Code Black VR verbal de-escalation training application was well received. The findings reinforced the factors in the existing design framework and identified 3 new factors—motion sickness, perceived value, and privacy—to be considered for future application development.
Conclusions
Verbal interaction with a virtual agent is feasible for training staff in verbal de-escalation skills. It is an effective medium to supplement clinician training in verbal de-escalation skills. We provide broader design considerations to guide further developments in this area.
Air pollution is the 9th cause of the overall disease burden globally. The solid component in the polluted air, particulate matters (PMs) with a diameter of 2.5 μm or smaller (PM2.5) possess a ...significant health risk to several organ systems. PM2.5 has also been shown to cross the blood–placental barrier and circulate in foetal blood. Therefore, it is considered an intrauterine environmental toxin. Exposure to PM2.5 during the perinatal period, when the foetus is particularly susceptible to developmental defects, has been shown to reduce birth weight and cause preterm birth, with an increase in adult disease susceptibility in the offspring. However, few studies have thoroughly studied the health outcome of foetuses due to intrauterine exposure and the underlying mechanisms. This perspective summarises currently available evidence, which suggests that intrauterine exposure to PM2.5 promotes oxidative stress and inflammation in a similar manner as occurs in response to direct PM exposure. Oxidative stress and inflammation are likely to be the common mechanisms underlying the dysfunction of multiple systems, offering potential targets for preventative strategies in pregnant mothers for an optimal foetal outcome.
As technological innovation increases the availability of novel therapeutic options in general practice, healthcare professionals will need to equip themselves with a sound understanding of their ...professional legal duties in light of emerging medical technologies, including virtual reality (VR).
Using a case study of VR to augment analgesia in burn treatment, this article examines how medical negligence laws apply to the use of new technology in healthcare settings.
While there is currently no positive duty on healthcare professionals to use VR when treating patients, healthcare professionals may be held liable for harm arising from negligent advice or treatment using VR technology. The case study illustrates the flexible nature of negligence principles in adapting to harms arising from new risks such as simulation sickness. Specific warnings and standards of best practice will need to be developed if VR becomes a feature of general practice.
•Nedd4 expression is abundant in the hippocampus.•Nedd4 heterozygous mice show significant decrease in long-term spatial learning and memory.•A significant decrease in long-term potentiation (LTP) ...was observed in the Nedd4 heterozygous mice.
The consolidation of short-term memory into long-term memory involves changing protein level and activity for the synaptic plasticity required for long-term potentiation (LTP). AMPA receptor trafficking is a key determinant of LTP and recently ubiquitination by Nedd4 has been shown to play an important role via direct action on the GluA1 subunit, although the physiological relevance of these findings are yet to be determined. We therefore investigated learning and memory in Nedd4+/− mice that have a 50% reduction in levels of Nedd4. These mice showed decreased long-term spatial memory as evidenced by significant increases in the time taken to learn the location of and subsequently find a platform in the Morris water maze. In contrast, there were no significant differences between Nedd4+/+ and Nedd4+/− mice in terms of short-term spatial memory in a Y-maze test. Nedd4+/− mice also displayed a significant reduction in post-synaptic LTP measured in hippocampal brain slices. Immunofluorescence of Nedd4 in the hippocampus confirmed its expression in hippocampal neurons of the CA1 region. These findings indicate that reducing Nedd4 protein by 50% significantly impairs LTP and long-term memory thereby demonstrating an important role for Nedd4 in these processes.
Significant epidemiological and clinical trial evidence supports the association between increased urinary albumin excretion, cardiovascular events and renal failure. An increase in albumin excretion ...has traditionally been considered to reflect a 'glomerular' leak of protein; however, it is now recognized that significant tubular reabsorption of albumin occurs under physiological conditions that may be modified by genetic determinants, systemic disease and drug therapies.
The endocytosis of albumin by the proximal tubule is a highly regulated process depending on protein-protein interactions between several membrane proteins and scaffolding and regulatory molecules. The elucidation of these interactions is an ongoing research focus. There is also mounting evidence for a transcytotic pathway for retrieval of albumin from the tubular filtrate. The molecular basis for the role of albuminuria in both interstitial renal disease and cardiovascular pathology continues to be defined. The clinical implications of albuminuria due to a glomerular leak vs. reduced tubular reabsorption of albumin are, however, now under consideration. In particular, the prognostic implication of microalbuminuria induced by the more potent 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors is under study.
The currently defined mechanisms underpinning the tubular reabsorption of albumin, how these are modified by pathology and pharmacology, and the clinical implications are the subject of this review.
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