Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

Objective: The clinical clerkship and practice stage plays a pivotal role in the transition of medical students from theoretical knowledge to practical application, bridging the gap between classroom learning and real-life clinical experience. In order to improve the teaching quality of interns and probationers, we try to let them practice the skills of laparoscopic surgery in the early stage, and summed up a set of evaluation methods that can be widely used in medical education. Methods: From September 2019 to December 2019, a total of 54 interns and 72 trainees were selected as research objects. They were assigned to training sessions and their proficiency was assessed before and after the training. The change in proficiency is compared to determine whether the training course is valuable. Results: Before the operation training, the interns scores were BP 17.3 3.1, CC 17.9 3.4, KT 16.4 3.4, LS 16.7 3.3. The results of probationers were BP 16.9 2.7, CC 16.8 2.8, KT 15.2 1.6, and LS 14.8 2.2. After completing the operations training, the results of interns were BP 21.1 1.9, CC 20.6 2.7, KT 19.6 3.0, and LS 20.9 1.4. The probationers scores were BP 19.3 3.2, CC 19.6 3.5, KT 19.6 2.6, and LS 20.0 2.4. After the operation training, the performance of the intern group was better than that before the training (P < 0.05). The same is true of the probationer group. The time-consuming intern examinations were BP 147.9 38.5 s, CC 123.2 28.7 s, KT 82.6 24.1 s and LS 162.5 31.1 s. The examination time of probationers were BP 179.9 46.4 s, CC 132.1 24.3 s, KT 109.3 27.5 s and LS 210.0 58.8 s. Conclusion: Simulation training for laparoscopic surgery can improve minimally invasive surgical techniques for interns and probationers.

Clinical competency:perceptions of nursing interns and clinical mentors

Objective:To assess the clinical competency of nursing interns and the perception of clinical nurse mentors toward student nurses'clinical competency.Methods:A study was carried out among 104 nursing interns and 26 clinical nurse mentors using the purposive sampling technique.A self-repor ted perception scale was used to collect the data.Results:In general,most nursing interns perceived themselves as clinically competent during the internship.The clinical nurse mentors too repor ted that the current internship is helping the nursing interns in becoming competent.Conclusions:Frequent clinical evaluation,buddy system,provision of stipends,good leadership,and coordination between the academic institute and hospital are repor ted as the critical motivating factors for improving the clinical competency of student interns.

Exploring the Role of Narrative Medicine in the Cultivation of Humanistic Spirit among Respiratory Medicine Interns

Objective:To explore the role of narrative medicine in cultivating the humanistic spirit of respiratory medicine interns.Methods:Thirty interns were selected,all of whom were received by the respiratory department of our hospital from September 2023 to June 2024 and underwent narrative medicine teaching.Scores on narrative medicine knowledge,empathy ability,humanistic care ability,and teaching recognition were compared before and after the internship.Results:Compared to before the internship,the interns’scores on narrative medicine knowledge were significantly higher after the internship,as were their empathy and humanistic care scores(P<0.05).Among the 30 interns,25 expressed interest in narrative medicine,and 29 were willing to continue with the narrative medicine teaching model.Conclusion:The application of narrative medicine in respiratory medicine internship teaching is highly effective.It cultivates the humanistic spirit of interns,improves their empathy and humanistic care abilities,and is worthy of wider implementation.

Progress in the Application of Reflective Education on Undergraduate Nursing Interns

Objective:To explore the implementation methods and effects of reflective education,and to provide references for the development of reflective education in Chinese nursing schools.Methods:Relevant literature was searched from China National Knowledge Infrastructure,Wanfang Database,Wipro Chinese Science and Technology Journal Database,and PubMed Database,and the included studies were analyzed descriptively.Results:The implementation of reflective education included work-site education,group discussion,video teaching,self-reflection,and expert lectures;the interventions mainly included study groups,role-playing,individual instruction,peer cooperation,demonstration and observation,field simulation,and video presentations.The implementation of reflective education can improve the sense of professional identity and professional competence of nursing interns,and reduce nursing errors and adverse events.Conclusion:Currently,nurses in China lack self-awareness and critical thinking skills,it is recommended that reflective education be incorporated into the teaching content of undergraduate nursing students during their internship in order to promote the development of professionalism and humanistic caring skills of nursing students.

Research and Application of Bedside Rhetorical Teaching Method in Teaching Nursing Interns

Objective:To observe and analyze the application of the bedside rhetorical teaching method in teaching nursing interns.Methods:A total of 64 nursing interns in the gastroenterology department of our hospital from July 2022 to May 2023 were randomly divided into two groups,32 cases in the control group and 32 cases in the intervention group.The control group was given conventional teaching methods,and the intervention group was given the bedside rhetorical teaching method on the basis of the conventional teaching.The differences in the methods of teaching between the two groups were compared after the end of the internship,and there was a statistically significant difference with P<0.05.Results:The scores of the interns in the intervention group were significantly better than those of the control group in theoretical knowledge,communication skills,and case analysis items(P<0.05).Conclusion:The bedside rhetorical teaching method transforms classroom education into bedside teaching,which enables the interns to apply the theoretical knowledge to clinical practice,and has a higher improvement in the three aspects of disease knowledge,communication skills,and case analysis,cultivates the interns’comprehensive clinical skills,and lays a good foundation for the future entry into the nursing field.

Effect of external and internal cues on core muscle activation during the Sahrmann five-level core stability test

BACKGROUND Pain in the back or pelvis or fear of back pain may affect the timing or cocontraction of the core muscles.In both static and dynamic movements,the Sahrmann core stability test provides an assessment of core muscle activation and a person's ability to stabilize the lumbopelvic complex.Preparatory cues and images can be used to increase the activation of these muscles.To attain optimal movement patterns,it will be necessary to determine what cueing will give the most effective results for core stability.AIM To investigate the effects of external and internal cues on core muscle activation during the Sahrmann five-level core stability test.METHODS Total 68 participants(21.83±3.47 years)were randomly allocated to an external(n=35)or internal cue group(n=33).Participants performed the Sahrmann fivelevel core stability test without a cue as baseline and the five-level stability exercises with an internal or external cue.External cue group received a pressure biofeedback unit(PBU),and the internal cue group received an audio cue.A Delsys Trigno^(TM)surface electromyography unit was used for muscle activation from the rectus abdominis,external oblique,and transverse abdominis/internal oblique muscles.RESULTS Linear mixed effects model analysis showed that cueing had a significant effect on core muscle activation(P=0.001);however,there was no significant difference between cue types(internal or external)(P=0.130).CONCLUSION Both external and internal cueing have significant effects on core muscle activation during the Sahrmann five-level core stability test and the PBU does not create higher muscle activation than internal cueing.

Knowledge,attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City,India

BACKGROUND: This cross-sectional study aimed to assess the knowledge, attitude and anxiety pertaining to basic life support(BLS) and medical emergencies among interns in dental colleges of Mangalore city, Karnataka, India.METHODS: The study subjects comprised of interns who volunteered from the four dental colleges. The knowledge and attitude of interns were assessed using a 30-item questionnaire prepared based on the Basic Life Support Manual from American Heart Association and the anxiety of interns pertaining to BLS and medical emergencies were assessed using a State-Trait Anxiety Inventory(STAI) Questionnaire. Chi-square test was performed on SPSS 21.0(IBM Statistics, 2012) to determine statistically signifi cant differences(P<0.05) between assessed knowledge and anxiety.RESULTS: Out of 183 interns, 39.89% had below average knowledge. A total of 123(67.21%) reported unavailability of professional training. The majority(180, 98.36%) felt the urgent need of training in basic life support procedures. Assessment of stress showed a total of 27.1% participants to be above highstress level. Comparison of assessed knowledge and stress was found to be insignifi cant(P=0.983).CONCLUSION: There was an evident lack of knowledge pertaining to the management of medical emergencies among the interns. As oral health care providers moving out to the society, a focus should be placed on the training of dental interns with respect to Basic Life Support procedures.

Professional identity, wellness, and future hope among nurse interns in Egypt

Objective:Since nursing is a performance-based profession,clinical learning environments play an important role in the acquisition of professional abilities and train nursing students to enter the nursing profession and become a registered nurse.The study aimed to investigate the relations among professional identity,wellness,and future hope in nurse interns.Methods:A cross-sectional,analytic,descriptive,correlational study design was used to test these relations in the study where 210 nurse interns’students were selected using a convenience sampling from Zagazig University hospitals and Suez Canal University hospitals in Egypt.The questionnaires consisted of 4 parts,namely demographic characteristics,Professional Identity Scale for Nursing Students(PISNS),Holistic Health and Wellness Survey,and Hope scale.Results:Less than half of the study sample had chosen nursing specialty by own will(43.8%),while slightly more than half of them had a"very good"graduation level,and had no nursing role model.The lowest mean professional identity score was for independence in career choice while the highest was for social modeling.The repor ted physical wellness mean-score was the least,while social wellness was the highest.Professional identity,wellness,and future hope scores differed significantly based on nurse interns’personal characteristics.There were statistically significant,positive,weak-to-moderate correlations among the scores of professional identity,wellness,and future hope;however,the"choice of nursing study by own will"was a statistically significant independent positive predictor of the scores of professional identity,wellness,and future hope.Conclusions:Nurse interns’professional identity,wellness,and future hope were positively inter-correlated.However,nurse interns’wellness was the lowest,and it should be fostered as it was the main predictor for future hope.The internship programs should be modulated to improve nurse interns’professional identity,par ticularly regarding independence,and should foster their well-being in the clinical environment.

Mechanism of internal thermal runaway propagation in blade batteries

Blade batteries are extensively used in electric vehicles,but unavoidable thermal runaway is an inherent threat to their safe use.This study experimentally investigated the mechanism underlying thermal runaway propagation within a blade battery by using a nail to trigger thermal runaway and thermocouples to track its propagation inside a cell.The results showed that the internal thermal runaway could propagate for up to 272 s,which is comparable to that of a traditional battery module.The velocity of the thermal runaway propagation fluctuated between 1 and 8 mm s^(-1),depending on both the electrolyte content and high-temperature gas diffusion.In the early stages of thermal runaway,the electrolyte participated in the reaction,which intensified the thermal runaway and accelerated its propagation.As the battery temperature increased,the electrolyte evaporated,which attenuated the acceleration effect.Gas diffusion affected thermal runaway propagation through both heat transfer and mass transfer.The experimental results indicated that gas diffusion accelerated the velocity of thermal runaway propagation by 36.84%.We used a 1D mathematical model and confirmed that convective heat transfer induced by gas diffusion increased the velocity of thermal runaway propagation by 5.46%-17.06%.Finally,the temperature rate curve was analyzed,and a three-stage mechanism for internal thermal runaway propagation was proposed.In Stage I,convective heat transfer from electrolyte evaporation locally increased the temperature to 100℃.In Stage II,solid heat transfer locally increases the temperature to trigger thermal runaway.In StageⅢ,thermal runaway sharply increases the local temperature.The proposed mechanism sheds light on the internal thermal runaway propagation of blade batteries and offers valuable insights into safety considerations for future design.

Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Practical Experience in Home Care of Nursing Interns: A Qualitative Research

Purpose: To explore practical experience in home care of nursing interns. Methods: The phenomenological method for qualitative research was to interview 15 nursing interns in a semi-structured way, and then the collected data were analyzed and summarized by using the Colaizzi analysis method. Results: Interviewing results showed that there were five recurring themes, including: 1) personalized care;2) health education;3) humanistic care;4) solid professional foundation and sense of responsibility;5) expanded vision. Conclusion: Through home care practice, nursing interns deepened their cognitions of nursing connotation, stimulated their love for nursing and motivation of continuous learning, and improved their sense of identity to nursing career. In general, the practice of home care had a positive impact on nursing interns.

Flow Regimes in Bubble Columns with and without Internals: A Review

Hydrodynamics characterization in terms offlow regime behavior is a crucial task to enhance the design of bubble column reactors and scaling up related methodologies.This review presents recent studies on the typicalflow regimes established in bubble columns.Some effort is also provided to introduce relevant definitions pertaining to thisfield,namely,that of“void fraction”and related(local,chordal,cross-sectional and volumetric)variants.Experimental studies involving different parameters that affect design and operating conditions are also discussed in detail.In the second part of the review,the attention is shifted to cases with internals of various types(perfo-rated plates,baffles,vibrating helical springs,mixers,and heat exchanger tubes)immersed in the bubble columns.It is shown that the presence of these elements has a limited influence on the global column hydrodynamics.However,they can make the homogeneousflow regime more stable in terms of transition gas velocity and transi-tion holdup value.The last section is used to highlight gaps which have not beenfilled yet and future directions of investigation.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

Suppressed Internal Intrinsic Stress Engineering in High-Performance Ni-Rich Cathode Via Multi layered In Situ Coating Structure

LiNi_(x)Co_(y)Al_(z)O_(2)(NCA)cathode materials are drawing widespread attention,but the huge gap between the ideal and present cyclic stability still hinders their further commercial application,especially for the Ni-rich LiNi_(x)Co_(y)Al_(z)O_(2)(x>0.8,x+y+z=1)cathode material,which is owing to the structural degradation and particles'intrinsic fracture.To tackle the problems,Li_(0.5)La_(2)Al_(0.5)O_(4)in situ coated and Mn compensating doped multilayer LiNi_(0.82)Co_(0.14)Al_(0.04)O_(2)was prepared.XRD refinement indicates that La-Mn co-modifying could realize appropriate Li/Ni disorder degree.Calculated results and in situ XRD patterns reveal that the LLAO coating layer could effectively restrain crack in secondary particles benefited from the suppressed internal strain.AFM further improves as NCA-LM2 has superior mechanical property.The SEM,TEM,XPS tests indicate that the cycled cathode with LLAO-Mn modification displays a more complete morphology and less side reaction with electrolyte.DEMS was used to further investigate cathode-electrolyte interface which was reflected by gas evolution.NCA-LM2 releases less CO_(2)than NCA-P indexing on a more stable surface.The modified material presents outstanding capacity retention of 96.2%after 100 cycles in the voltage range of 3.0-4.4 V at 1C,13%higher than that of the pristine and 80.8%at 1 C after 300 cycles.This excellent electrochemical performance could be attributed to the fact that the high chemically stable coating layer of Li_(0.5)La_(2)Al_(0.5)O_(4)(LLAO)could enhance the interface and the Mn doping layer could suppress the influence of the lattice mismatch and distortion.We believe that it can be a useful strategy for the modification of Ni-rich cathode material and other advanced functional material.

Application of the “Six-Step Teaching Method” in the Nursing Teaching of Obstetric Interns

Objective: The “six-step teaching method” is a teaching method, which is summarized based on practical experience. This study aimed to explore the effect of “six-step teaching method” in clinical teaching of obstetrics. Methods: A quasi-experimental study design was used, 30 nursing students who entered obstetrics practice from March 2022 to July 2022 were selected as the control group according to the order of time, and traditional teaching methods were adopted. From August to December 2022, 30 interns were selected as the experimental group, and the “six-step teaching method” was adopted. After 8 weeks of clinical practice, the assessment results and teaching effect satisfaction of the two groups were compared. Results: The scores of obstetrical specialty in the experimental group were higher than those in the control group, and the difference was statistically significant (P < 0.05);The evaluation of teaching methods, teaching quality, classroom atmosphere and individual observation ability, clinical thinking ability and nurse-patient communication ability of the experimental group were higher than those of the control group, and the differences were statistically significant (P Conclusion: “six-step teaching method” can effectively master the professional knowledge of obstetrics, stimulate the clinical thinking ability of interns, and improve the teaching effect and satisfaction. .

Research on the Stress Management Strategies of Hotel Interns:A Case Study of Hotel Z in Foshan

In this study,by the combination of quantitative and qualitative research,the number of valid questionnaires was 217.The results show that there was a positive correlation between stress sources and stress response,and the four stress sources of own ability and quality,interpersonal relationship and communication,role requirements,work environment and atmosphere had a significant predictive effect on work pressure response;different personality characteristics had significant differences in the effect of work stress.

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.

Hospitality and Tourism International Internships and Perceived Employability

This paper investigates the experiences of UK undergraduate students who have undertaken a one year paid internship abroad within the hotel sector by using a phenomenological approach.Semi-structured interviews were conducted with 25 final year undergraduate students.The findings shed light on the alignment of key elements of the constructs of positive psychological capital and cosmopolitan human capital,along with strong self-belief in employability as a consequence of the experience.A theoretical model of international experience and positive psych-social development is postulated and contributes to improved practice in internship and employability mentoring and policy decision-making with respect to current internationalisation and employability agendas in the UK’s higher education system.

Adaptive Optimal Discrete-Time Output-Feedback Using an Internal Model Principle and Adaptive Dynamic Programming

In order to address the output feedback issue for linear discrete-time systems, this work suggests a brand-new adaptive dynamic programming(ADP) technique based on the internal model principle(IMP). The proposed method, termed as IMP-ADP, does not require complete state feedback-merely the measurement of input and output data. More specifically, based on the IMP, the output control problem can first be converted into a stabilization problem. We then design an observer to reproduce the full state of the system by measuring the inputs and outputs. Moreover, this technique includes both a policy iteration algorithm and a value iteration algorithm to determine the optimal feedback gain without using a dynamic system model. It is important that with this concept one does not need to solve the regulator equation. Finally, this control method was tested on an inverter system of grid-connected LCLs to demonstrate that the proposed method provides the desired performance in terms of both tracking and disturbance rejection.