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• Individuals with type 2 diabetes have an increased risk of progressive cognitive decline. • Combined exercises improve cognition in middle-aged and older adults with diabetes. • The recommended duration of exercise is at least 135 minutes per week. To evaluate the effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life (HRQoL) in middle-aged and older adults with type 2 diabetes mellitus (T2DM). Systematic search of CINAHL, Cochrane, EMBASE, Scopus, PubMed, ProQuest Dissertation and Thesis, PsycINFO, Web of Science databases, and gray literature from Google Scholar. Pertinent randomized controlled trials (RCTs) were selected. The Protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023387336). The risk of bias was evaluated using the Cochrane Risk of Bias tool by 2 reviewers independently. Outcome data were extracted in a fixed-effect model if heterogeneity test were not significant and I2≤50%; otherwise, the random-effects model was used. Sixteen studies with 2426 participants were included in this review. Combined aerobic and resistance exercise had significant positive effects on cognition (SMD=0.34, 95% CI: 0.13 to 0.55), metabolic health on HbA1c (SMD=-0.35, 95% CI: -0.48 to -0.22) and lipid profile (total cholesterol SMD=-0.20, 95% CI: -0.34 to -0.07; low-density lipoprotein SMD=-0.19, 95% CI: -0.33 to -0.05; high-density lipoprotein SMD=0.25, 95% CI: 0.12 to 0.39; and triglycerides SMD=-0.18, 95% CI: -0.31 to -0.04), physical function on aerobic oxygen uptake (SMD=0.58, 95% CI: 0.21 to 0.95) and body mass index (MD=-1.33, 95% CI: -1.84 to -0.82), and physical HRQoL (MD=4.17, 95% CI: 0.86 to 7.48). Our results showed that clinically important effects on cognition may occur in combining the low-moderate intensity of aerobic exercise and progressive intensity of resistance training, the total duration of the exercise needs to be at least 135 minutes per week, among which, resistance training should be at least 60 minutes. Combined aerobic and resistance exercise effectively improves cognition, ameliorates metabolic health, enhances physical function, and increases physical HRQoL in middle-aged and older adults with T2DM. More RCTs and longitudinal follow-ups are required to provide future evidence of structured combined aerobic and resistance exercise on other domains of cognition. [ABSTRACT FROM AUTHOR]

Background: Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training.Objective: This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students' communication skill performances and teamwork attitudes.Methods: In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions.Results: The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points.Conclusions: Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education.Trial Registration: ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924. [ABSTRACT FROM AUTHOR]

Highlights • Both ESI and PACS demonstrated moderate reliability for actual patients. • Both ESI and PACS showed construct validity for hospital admissions and number of resources used. • ESI is better at discriminating minor emergency patients using resources, compared to PACS. Abstract Objectives To compare the reliability, validity and resource utilization of the Emergency Severity Index (ESI) and Patient Acuity Category Scale (PACS) triage scales. Methods A descriptive, correlational, and cross-sectional design was used. Twenty-seven triage nurses were recruited to test interrater reliability for 20 patient case scenarios. Subsequently, interrater reliability was tested on 300 actual patients. Construct validity was analyzed using patients' hospital dispositions and resources utilized. Results For patient case scenarios, interrater reliability for both were very good, at 0.87 (95% CI: 0.86–0.88) for ESI and 0.88 (95% CI: 0.87–0.89) for PACS. For actual patients, interrater reliability for both were moderate, at 0.59 (95% CI: 0.50–0.68) for ESI and 0.49 (95% CI: 0.40–0.60) for PACS. Both ESI and PACS demonstrated construct validity with moderate correlations for hospital admissions and the number of resources used. PACS was unable to discriminate between patients that required more or less resources, whereas the ESI can. Patients that required two or more resources had higher rates of admission. Conclusions Both triage systems demonstrated moderate interrater reliability and construct validity in triaging actual patients. The ESI has better resource discrimination ability than the PACS and can improve resource management in the ED. [ABSTRACT FROM AUTHOR]

Air pollution is a leading public health concern around the world. Assessing the public's knowledge about air quality is critical to calibrate public health interventions. However, previous efforts to measure knowledge about air quality (AQIQ) have not relied on consistent and validated measures, thus precluding cross-country comparisons. We aimed to develop a robust scale to assess AQIQ and tested it in multiple countries. To evaluate the psychometric properties and select the best performing items out of 10 AQIQ questions, we used methods from classical test theory and item response theory. We evaluated the scales using several scalability measures, including the Kuder-Richardson Formula 20 (KR-20), Loevinger's H, as well as trace lines. Volunteers from the United States (US, n = 400), India (n = 403), and China (n = 443) were recruited to validate the scale. Multiple linear regression was used to estimate the association between demographic factors and AQIQ. We found that participants from India had the highest AQIQ. In addition, not all questions performed well in each country. The scale was pruned and shorter subscales were validated. In the US, we obtained a 4-item scale (KR20 = 0.53, Loevinger's H = 0.34). In India, we obtained a 6-item scale (KR20 = 0.56; Loevinger's H = 0.48 for just 2 items). In China, we obtained a 5-item scale (KR20 = 0.39; Loevinger's H = 0.41 for just 2 items). Compared to the 10-item scale, the pruned scales showed stronger associations between measures of socioeconomic status and AQIQ. The results were robust to the scale used. Overall, general knowledge questions measured AQIQ more effectively in the US and India whereas knowledge of the air quality index better measured AQIQ in China. The findings suggest that careful measurement and validation are essential to develop knowledge scales for use in public health and environmental research. [Display omitted] • First study to validate an air quality knowledge (AQIQ) scale and compare results across countries. • We developed and validated our scale using classical test theory (CTT) and item response theory (IRT). • We recruited a total of 1,246 participants in the United States, India, and China. • We identified separate subscales that performed well in each country. • Participants from India had the highest AQIQ, followed by those from the US and China. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene is an important element of infection control. We conducted 2 surveys on hand hygiene practices and use of personal protective equipment among medical students during and after the outbreak of severe acute respiratory syndrome (SARS) to study its impact on their personal hygiene practice when they contacted patients. Methods: Two cross-sectional surveys were conducted among medical students in their clinical training years (years 3-5) in a teaching hospital (at which the first and major SARS outbreak occurred) in March 2003 and August 2004, respectively. Results: Prior to the recognition of the SARS outbreak in March 2003, 35.2% of the students washed their hands before and 72.5% after they physically examined patients in the wards. None of the students wore masks during history taking and physical examination. In the 2004 survey, the corresponding proportions were 60.3% and 100%, respectively, and 86.1% and 93.8% of students wore masks during history taking and physical examination, respectively. Attitudes to handwashing and perception of infection risk were not significantly associated with handwashing practice, whereas peer behavior might be a significant influencing factor. Conclusion: A significant improvement in compliance with hand hygiene practice was found after the SARS outbreak. [Copyright &y& Elsevier]