A review of clinical reasoning in nursing education:based on high-fidelity simulation teaching method

Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.

Evaluation of undergraduate students’nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient

Objective:To evaluate nursing students’assessment and communication skills through an objective structured clinical examination(OSCE)within a high-fidelity simulation using a student-simulated patient(SSP)and analyze the validity,reliability,degree of difficulty,and discriminability of the OSCE.Methods:A descriptive study was conducted at one nursing school in Macao.All scenarios were designed using a high-fidelity simulator combined with SSPs.A convenience sample of 54 baccalaureate nursing students completed the OSCE.The nursing assessment OSCE checklist(NAOC)and the communication evaluation rubric(CER)were used as observational measurements with three-point Likert scales(2=Achieved,1=Partly achieved,0=Not completed/Incorrect).Results:Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills.The discrimination index of the majority items of the NAOC(86.4%)was>0.20,showing a better to good discriminability.The items of the CER had satisfactory indexes of item discrimination(from 0.38 to 0.84).Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment.Students presented good communication skills in eye contacting and listening,but culture assessment needs to be improved.The students with experiences in simulation or simulated patient(SP)interactions had better assessment and communication skills than students without those experiences.There was a positive relationship between nursing assessment and communication skills(r=0.67,P=0.000).Conclusions:SSPs were involved in enhancing the realism of interactions in simulated scenarios.Nursing students can conduct nursing assessments specific to patient conditions,explain the conditions to the patient,and ensure that the patient remains informed at all times of the precautions to be taken.However,students’cultural awareness and some communication skills need further training.With moderate difficulty and high discrimination index,OSCE showed satisfactory reliability and validity.

Nursing student perspectives of high-fidelity simulation in Macao

Objective The purpose of this study was to explore student perspectives of high-fidelity simulation.Methods A descriptive study with semi-structured focus group interviews was conducted in Macao.Twenty-one focus group interviews were held with 113 baccalaureate nursing students who had experienced 36-hour of simulation.Results Students perceived that simulation created a nonrisk learning environment,and was helpful in knowledge and skill enhancement and nurse role understanding.However,lack of realistic interactions in psychosocial responses made it difficult for students to relate simulation experience to real-working situations,and poor group contributions affected their learning.ConclusionInteracting with a human patient simulator does not replicate the experience of working with a live patient.Tutors need to come up with ideas about how to make scenarios more real and give more forthright responses to improve the realism of psychosocial responses during simulation.Students experienced uncertainty with clinical decision making and commented on the minimal contributions of some group members.Tutors should be prepared to provide students with substantial supports in developing their understanding of simulation and engaging in the learning process.

基于Plant Simulation的化纤自动落丝系统仿真实验分析

基于Plant Simulation软件,构建一种化纤自动落丝系统的3D数字化模型,对系统效率关键输入因子进行参数化设置,将系统各工位三维数字模型导入软件中建立层次化运动机构图形结构,并运用Simltalk语言实现三维动作仿真,通过基础物理参数设置,保证了仿真数字化模型与现实系统更具一致性。通过多级实验设计分析了系统影响因子对于系统效率的影响特性曲线,并进一步通过动态参数化实验方法,计算出双输入因子对系统效能影响的敏感度。该实验结果可为化纤自动落丝系统的建设成本控制与可行性分析提供指导,具有较好的工程应用价值。

基于Simulation X的多轴转向系统功能安全仿真分析

基于ISO 26262《道路车辆功能安全》的标准要求,对特种车的多轴电液转向系统进行分析,以提高系统的安全性和可靠性。运用Simulation X软件建立详细的多轴特种车仿真模型,通过模拟故障模式注入进行仿真试验。对仿真结果和数据进行分析,评估得到故障的严重性、暴露度和可控性,从而确定相应的汽车安全完整性等级。基于故障注入仿真的汽车功能安全分析方法,在系统早期设计阶段可以作为评估架构安全性的重要手段。

基于Plant Simulation的压气机叶片型线加工产线分析与优化

运用专业仿真软件Plant Simulation,根据压气机叶片型线机械加工工艺特点和物料运行流程建立生产线仿真模型,从产能、设备利用率及产线瓶颈等多方面进行仿真分析与优化。结果表明:Plant Simulation仿真平台的仿真可以找出规划设计方案中存在的问题并验证方案的合理性。该仿真结果为型线机械加工产线的优化设计提供了可靠依据,达到了节约投资成本和缩短设计周期的目的。

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Global hybrid simulations of soft X-ray emissions in the Earth’s magnetosheath

Earth’s magnetopause is a thin boundary separating the shocked solar wind plasma from the magnetospheric plasmas,and it is also the boundary of the solar wind energy transport to the magnetosphere.Soft X-ray imaging allows investigation of the large-scale magnetopause by providing a two-dimensional(2-D)global view from a satellite.By performing 3-D global hybrid-particle-in-cell(hybrid-PIC)simulations,we obtain soft X-ray images of Earth’s magnetopause under different solar wind conditions,such as different plasma densities and directions of the southward interplanetary magnetic field.In all cases,magnetic reconnection occurs at low latitude magnetopause.The soft X-ray images observed by a hypothetical satellite are shown,with all of the following identified:the boundary of the magnetopause,the cusps,and the magnetosheath.Local X-ray emissivity in the magnetosheath is characterized by large amplitude fluctuations(up to 160%);however,the maximum line-of-sight-integrated X-ray intensity matches the tangent directions of the magnetopause well,indicating that these fluctuations have limited impact on identifying the magnetopause boundary in the X-ray images.Moreover,the magnetopause boundary can be identified using multiple viewing geometries.We also find that solar wind conditions have little effect on the magnetopause identification.The Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)mission will provide X-ray images of the magnetopause for the first time,and our global hybrid-PIC simulation results can help better understand the 2-D X-ray images of the magnetopause from a 3-D perspective,with particle kinetic effects considered.

The Probability Density Function Related to Shallow Cumulus Entrainment Rate and Its Influencing Factors in a Large-Eddy Simulation

The process of entrainment-mixing between cumulus clouds and the ambient air is important for the development of cumulus clouds.Accurately obtaining the entrainment rate(λ)is particularly important for its parameterization within the overall cumulus parameterization scheme.In this study,an improved bulk-plume method is proposed by solving the equations of two conserved variables simultaneously to calculateλof cumulus clouds in a large-eddy simulation.The results demonstrate that the improved bulk-plume method is more reliable than the traditional bulk-plume method,becauseλ,as calculated from the improved method,falls within the range ofλvalues obtained from the traditional method using different conserved variables.The probability density functions ofλfor all data,different times,and different heights can be well-fitted by a log-normal distribution,which supports the assumed stochastic entrainment process in previous studies.Further analysis demonstrate that the relationship betweenλand the vertical velocity is better than other thermodynamic/dynamical properties;thus,the vertical velocity is recommended as the primary influencing factor for the parameterization ofλin the future.The results of this study enhance the theoretical understanding ofλand its influencing factors and shed new light on the development ofλparameterization.

基于Simulation的薄壁桶搬运过程的形变研究

桶料的搬运方式主要有托底式、夹取式和挂取(吊取)式,文中针对薄壁桶的搬运方式进行模拟分析,通过模拟分析的具体数值来进行合理的选择。主要对挂取(吊取)和夹取2种薄壁桶的搬运方式进行模拟分析,基于Soildworks中的Simulation进行计算,并得出具体数值,选取合理的薄壁桶搬运方式。模拟分析表明:在同等桶壁厚的情况下,夹取式桶料搬运形式薄壁桶的变形程度较大,主要体现在薄壁桶的夹持部位,如特定场景需夹持薄壁桶的桶身进行搬运时,还需适当加厚薄壁桶的桶壁来抵抗夹持板的夹持力,使薄壁桶不会产生较大的形变量。

Magnetopause properties at the dusk magnetospheric flank from global magnetohydrodynamic simulations,the kinetic Vlasov equilibrium,and in situ observations--Potential implications for SMILE

We derived the properties of the terrestrial magnetopause(MP)from two modeling approaches,one global–fluid,the other local–kinetic,and compared the results with data collected in situ by the Magnetospheric Multiscale 2(MMS2)spacecraft.We used global magnetohydrodynamic(MHD)simulations of the Earth’s magnetosphere(publicly available from the NASA-CCMC[National Aeronautics and Space Administration–Community Coordinated Modeling Center])and local Vlasov equilibrium models(based on kinetic models for tangential discontinuities)to extract spatial profiles of the plasma and field variables at the Earth’s MP.The global MHD simulations used initial solar wind conditions extracted from the OMNI database at the time epoch when the MMS2 observes the MP.The kinetic Vlasov model used asymptotic boundary conditions derived from the same in situ MMS measurements upstream or downstream of the MP.The global MHD simulations provide a three-dimensional image of the magnetosphere at the time when the MMS2 crosses the MP.The Vlasov model provides a one-dimensional local view of the MP derived from first principles of kinetic theory.The MMS2 experimental data also serve as a reference for comparing and validating the numerical simulations and modeling.We found that the MP transition layer formed in global MHD simulations was generally localized closer to the Earth(roughly by one Earth radius)from the position of the real MP observed by the MMS.We also found that the global MHD simulations overestimated the thickness of the MP transition by one order of magnitude for three analyzed variables:magnetic field,density,and tangential speed.The MP thickness derived from the local Vlasov equilibrium was consistent with observations for all three of these variables.The overestimation of density in the Vlasov equilibrium was reduced compared with the global MHD solutions.We discuss our results in the context of future SMILE(Solar wind Magnetosphere Ionosphere Link Explorer)campaigns for observing the Earth’s MP.

Hybrid-Vlasov simulation of soft X-ray emissions at the Earth’s dayside magnetospheric boundaries

Solar wind charge exchange produces emissions in the soft X-ray energy range which can enable the study of near-Earth space regions such as the magnetopause,the magnetosheath and the polar cusps by remote sensing techniques.The Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)and Lunar Environment heliospheric X-ray Imager(LEXI)missions aim to obtain soft Xray images of near-Earth space thanks to their Soft X-ray Imager(SXI)instruments.While earlier modeling works have already simulated soft X-ray images as might be obtained by SMILE SXI during its mission,the numerical models used so far are all based on the magnetohydrodynamics description of the space plasma.To investigate the possible signatures of ion-kinetic-scale processes in soft Xray images,we use for the first time a global hybrid-Vlasov simulation of the geospace from the Vlasiator model.The simulation is driven by fast and tenuous solar wind conditions and purely southward interplanetary magnetic field.We first produce global X-ray images of the dayside near-Earth space by placing a virtual imaging satellite at two different locations,providing meridional and equatorial views.We then analyze regional features present in the images and show that they correspond to signatures in soft X-ray emissions of mirrormode wave structures in the magnetosheath and flux transfer events(FTEs)at the magnetopause.Our results suggest that,although the time scales associated with the motion of those transient phenomena will likely be significantly smaller than the integration time of the SMILE and LEXI imagers,mirror-mode structures and FTEs can cumulatively produce detectable signatures in the soft X-ray images.For instance,a local increase by 30%in the proton density at the dayside magnetopause resulting from the transit of multiple FTEs leads to a 12%enhancement in the line-of-sight-and time-integrated soft X-ray emissivity originating from this region.Likewise,a proton density increase by 14%in the magnetosheath associated with mirror-mode structures can result in an enhancement in the soft X-ray signal by 4%.These are likely conservative estimates,given that the solar wind conditions used in the Vlasiator run can be expected to generate weaker soft X-ray emissions than the more common denser solar wind.These results will contribute to the preparatory work for the SMILE and LEXI missions by providing the community with quantitative estimates of the effects of small-scale,transient phenomena occurring on the dayside.

Relative Impacts of Sea Ice Loss and Atmospheric Internal Variability on the Winter Arctic to East Asian Surface Air Temperature Based on Large-Ensemble Simulations with NorESM2

To quantify the relative contributions of Arctic sea ice and unforced atmospheric internal variability to the “warm Arctic, cold East Asia”(WACE) teleconnection, this study analyses three sets of large-ensemble simulations carried out by the Norwegian Earth System Model with a coupled atmosphere–land surface model, forced by seasonal sea ice conditions from preindustrial, present-day, and future periods. Each ensemble member within the same set uses the same forcing but with small perturbations to the atmospheric initial state. Hence, the difference between the present-day(or future) ensemble mean and the preindustrial ensemble mean provides the ice-loss-induced response, while the difference of the individual members within the present-day(or future) set is the effect of atmospheric internal variability. Results indicate that both present-day and future sea ice loss can force a negative phase of the Arctic Oscillation with a WACE pattern in winter. The magnitude of ice-induced Arctic warming is over four(ten) times larger than the ice-induced East Asian cooling in the present-day(future) experiment;the latter having a magnitude that is about 30% of the observed cooling. Sea ice loss contributes about 60%(80%) to the Arctic winter warming in the present-day(future) experiment. Atmospheric internal variability can also induce a WACE pattern with comparable magnitudes between the Arctic and East Asia. Ice-lossinduced East Asian cooling can easily be masked by atmospheric internal variability effects because random atmospheric internal variability may induce a larger magnitude warming. The observed WACE pattern occurs as a result of both Arctic sea ice loss and atmospheric internal variability, with the former dominating Arctic warming and the latter dominating East Asian cooling.

Multiple Perspective of Multipredictor Mechanism and Multihistogram Modification for High-Fidelity Reversible Data Hiding

Reversible data hiding is a confidential communication technique that takes advantage of image file characteristics,which allows us to hide sensitive data in image files.In this paper,we propose a novel high-fidelity reversible data hiding scheme.Based on the advantage of the multipredictor mechanism,we combine two effective prediction schemes to improve prediction accuracy.In addition,the multihistogram technique is utilized to further improve the image quality of the stego image.Moreover,a model of the grouped knapsack problem is used to speed up the search for the suitable embedding bin in each sub-histogram.Experimental results show that the quality of the stego image of our scheme outperforms state-of-the-art schemes in most cases.

Machine learning-enhanced Monte Carlo and subset simulations for advanced risk assessment in transportation infrastructure

The maintenance of safety and dependability in rail and road embankments is of utmost importance in order to facilitate the smooth operation of transportation networks.This study introduces a comprehensive methodology for soil slope stability evaluation,employing Monte Carlo Simulation(MCS)and Subset Simulation(SS)with the"UPSS 3.0 Add-in"in MS-Excel.Focused on an 11.693-meter embankment with a soil slope(inclination ratio of 2H:1V),the investigation considers earthquake coefficients(kh)and pore water pressure ratios(ru)following Indian zoning requirements.The chance of slope failure showed a considerable increase as the Coefficient of Variation(COV),seismic coefficients(kh),and pore water pressure ratios(ru)experienced an escalation.The SS approach showed exceptional efficacy in calculating odds of failure that are notably low.Within computational modeling,the study optimized the worst-case scenario using ANFIS-GA,ANFIS-GWO,ANFIS-PSO,and ANFIS-BBO models.The ANFIS-PSO model exhibits exceptional accuracy(training R2=0.9011,RMSE=0.0549;testing R2=0.8968,RMSE=0.0615),emerging as the most promising.This study highlights the significance of conducting thorough risk assessments and offers practical insights into evaluating and improving the stability of soil slopes in transportation infrastructure.These findings contribute to the enhancement of safety and reliability in real-world situations.

Two Monte Carlo-based simulators for imaging-system modeling and projection simulation of flat-panel X-ray source

The advantages of a flat-panel X-ray source(FPXS)make it a promising candidate for imaging applications.Accurate imaging-system modeling and projection simulation are critical for analyzing imaging performance and resolving overlapping projection issues in FPXS.The conventional analytical ray-tracing approach is limited by the number of patterns and is not applicable to FPXS-projection calculations.However,the computation time of Monte Carlo(MC)simulation is independent of the size of the patterned arrays in FPXS.This study proposes two high-efficiency MC projection simulators for FPXS:a graphics processing unit(GPU)-based phase-space sampling MC(gPSMC)simulator and GPU-based fluence sampling MC(gFSMC)simulator.The two simulators comprise three components:imaging-system modeling,photon initialization,and physical-interaction simulations in the phantom.Imaging-system modeling was performed by modeling the FPXS,imaging geometry,and detector.The gPSMC simulator samples the initial photons from the phase space,whereas the gFSMC simulator performs photon initialization from the calculated energy spectrum and fluence map.The entire process of photon interaction with the geometry and arrival at the detector was simulated in parallel using multiple GPU kernels,and projections based on the two simulators were calculated.The accuracies of the two simulators were evaluated by comparing them with the conventional analytical ray-tracing approach and acquired projections,and the efficiencies were evaluated by comparing the computation time.The results of simulated and realistic experiments illustrate the accuracy and efficiency of the proposed gPSMC and gFSMC simulators in the projection calculation of various phantoms.

Simulation Analysis of Deformation Control for Magnetic Soft Medical Robots

Dear Editor,This letter presents a biocompatible cross-shaped magnetic soft robot and investigates its deformation mode control strategy through COMSOL modeling and simulation.Magnetic soft robots offer novel avenues for precise treatment within intricate regions of the human body.

Mathematical modeling and simulations of stress mitigation by coating polycrystalline particles in lithium-ion batteries

A chemo-mechanical model is developed to investigate the effects on the stress development of the coating of polycrystalline Ni-rich LiNixMnyCo_(z)O_(2)(x≥0.8)(NMC)particles with poly(3,4-ethylenedioxythiophene)(PEDOT).The simulation results show that the coating of primary NMC particles significantly reduces the stress generation by efficiently accommodating the volume change associated with the lithium diffusion,and the coating layer plays roles both as a cushion against the volume change and a channel for the lithium transport,promoting the lithium distribution across the secondary particles more homogeneously.Besides,the lower stiffness,higher ionic conductivity,and larger thickness of the coating layer improve the stress mitigation.This paper provides a mathematical framework for calculating the chemo-mechanical responses of anisotropic electrode materials and fundamental insights into how the coating of NMC active particles mitigates stress levels.

Application of Patient Simulators Combined with Internet plus Scenario Simulation Teaching Models on Intravenous Infusion Nursing Education in China

Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.

Frontogenesis and Frontolysis of a Cold Filament Driven by the Cross-Filament Wind and Wave Fields Simulated by a Large Eddy Simulation

The variations of the frontogenetic trend of a cold filament induced by the cross-filament wind and wave fields are studied by a non-hydrostatic large eddy simulation. Five cases with different strengths of wind and wave fields are studied.The results show that the intense wind and wave fields further break the symmetries of submesoscale flow fields and suppress the levels of filament frontogenesis. The changes of secondary circulation directions—that is, the conversion between the convergence and divergence of the surface cross-filament currents with the downwelling and upwelling jets in the filament center—are associated with the inertial oscillation. The filament frontogenesis and frontolysis caused by the changes of secondary circulation directions may periodically sharpen and smooth the gradient of submesoscale flow fields.The lifecycle of the cold filament may include multiple stages of filament frontogenesis and frontolysis.